Amid sweeping federal policy changes and ongoing challenges from reimbursement, labor costs and insurance denials, health systems reported differing financial outcomes in fiscal 2025.
Tenet Healthcare led the pack with a 16.5% operating margin, while HCA Healthcare posted a 13% margin on a $75.6 billion revenue. On the other end, Ascension recorded a $490.9 million operating loss, and Providence, CommonSpirit and Allina Health all finished in negative territory.
Below is a ranking of 40 health systems based on their operating margins for 2025.
Editor’s note: This is not an exhaustive list. The following financial results are for the 12 months ending Dec. 31, 2025, unless otherwise stated.
1. Tenet Healthcare (Dallas)
Revenue: $21.3 billion
Expenses: $17.8 billion
Operating income: $3.5 billion
Operating margin: 16.5%
2. HCA Healthcare (Nashville, Tenn.)
Revenue: $75.6 billion
Expenses: $65.8 billion
Operating income: $9.8 billion
Operating margin: 13%
3. BayCare Health System (Clearwater, Fla.)
Revenue: $7 billion
Expenses: $6.1 billion
Operating income: $821.4 million
Operating margin: 11.8%
4. AdventHealth (Altamonte Springs, Fla.)
Revenue: $23 billion
Expenses: $20.3 billion
Operating income: $2.7 billion
Operating margin: 11.6%
5. Universal Health Services (King of Prussia, Pa.)
Revenue: $17.4 billion
Expenses: $15.3 billion
Operating income: $2 billion
Operating margin: 11.5%
6. Baylor Scott & White (Dallas)
Editor’s note: For the six months ended Dec. 31
Revenue: $9.3 billion
Expenses: $8.4 billion
Operating income: $998 million
Operating margin: 10.7%
7. ProMedica (Toledo, Ohio)
Revenue: $3.1 billion
Expenses: $2.7 billion
Operating income: $249.4 million
Operating margin: 8.1%
8. Inova Health System (Falls Church, Va.)
Revenue: $7.3 billion
Expenses: $6.7 billion
Operating income: $582.7 million
Operating margin: 8%
9. WVU Health System (Morgantown, W.Va.)
Revenue: $8.6 billion
Expenses: $7.9 billion
Operating income: $641.9 million
Operating margin: 7.5%
10. Mayo Clinic (Rochester, Minn.)
Revenue: $21.5 billion
Expenses: $20.1 billion
Operating income: $1.5 billion
Operating margin: 6.8%
11. RWJBarnabas Health (West Orange, N.J.)
Revenue: $11 billion
Expenses: $10.3 billion
Operating income: $708.9 million
Operating margin: 6.4%
12. Cleveland Clinic
Revenue: $18.3 billion
Expenses: $16.5 billion
Operating income: $913 million
Operating margin: 5%
13. Novant Health (Winston-Salem, N.C.)
Revenue: $11.9 billion
Expenses: $11.3 billion
Operating income: $576.6 million
Operating margin: 4.8%
14. Ardent Health (Brentwood, Tenn.)
Revenue: $6.3 billion
Expenses: $6 billion
Operating income: $286.4 million
Operating margin: 4.5%
15. Advocate Health (Charlotte, N.C.)
Revenue: $38.9 billion
Expenses: $37.4 billion
Operating income: $1.5 billion
Operating margin: 4%
16. BJC Health (St. Louis)
Revenue: $12.1 billion
Expenses: $11.6 billion
Operating income: $454.5 million
Operating margin: 3.8%
Revenue: $9.9 billion
Expenses: $9.6 billion
Operating income: $345.7 million
Operating margin: 3.5%
18. Banner Health (Phoenix)
Revenue: $16 billion
Expenses: $15.5 billion
Operating income: $444 million
Operating margin: 2.8%
19. Intermountain Health (Salt Lake City)
Revenue: $18.5 billion
Expenses: $17.2 billion
Operating income: $515 million
Operating margin: 2.8%
20. Sutter Health (Sacramento, Calif.)
Revenue: $19.8 billion
Expenses: $19.3 billion
Operating income: $509 million
Operating margin: 2.6%
21. University Hospitals (Cleveland)
Revenue: $7.3 billion
Expenses: $7.1 billion
Operating income: $191.8 million
Operating margin: 2.6%
22. Bon Secours Mercy Health (Cincinnati)
Revenue: $14 billion
Expenses: $13.7 billion
Operating income: $305.6 million
Operating margin: 2.2%
23. Sanford Health (Sioux Falls, S.D.)
Revenue: $11.7 billion
Expenses: $11.4 billion
Operating income: $210.9 million
Operating margin: 1.8%
24. Corewell Health (Southfield, Mich.)
Revenue: $17.6 billion
Expenses: $17.4 billion
Operating income: $276 million
Operating margin: 1.6%
25. Northwell Health (New Hyde Park, N.Y.)
Revenue: $20 billion
Expenses: $18.3 billion
Operating income: $248 million
Operating margin: 1.2%
26. SSM Health (St. Louis)
Revenue: $12.7 billion
Expenses: $12.5 billion
Operating income: $148.5 million
Operating margin: 1.2%
27. Kaiser Permanente (Oakland, Calif.)
Revenue: $127.7 billion
Expenses: $126.3 billion
Operating income: $1.4 billion
Operating margin: 1.1%
28. Henry Ford Health (Detroit)
Revenue: $13.1 billion
Expenses: $12.9 billion
Operating income: $133.8 million
Operating margin: 1%
29. UPMC (Pittsburgh)
Revenue: $33.6 billion
Expenses: $33.2 billion
Operating income: $286 million
Operating margin: 0.9%
30. Indiana University Health (Indianapolis)
Revenue: $9.5 billion
Expenses: $9.4 billion
Operating income: $50 million
Operating margin: 0.5%
31. Mass General Brigham (Sommerville, Mass.)
Revenue: $22.8 billion
Expenses: $22.7 billion
Operating income: $59 million
Operating margin: 0.3%
32. Mount Sinai Health System (New York City)
Revenue: $12.8 billion
Expenses: $12.7 billion
Operating income: $36.6 billion
Operating margin: 0.3%
33. Mercy Health (Chesterfield, Mo.)
Editor’s note: For the year ended June 30, 2025
Revenue: $10.2 billion
Expenses: $10.2 billion
Operating income: $21.4 million
Operating margin: 0.2%
34. Trinity Health (Livonia, Mich.)
Editor’s note: For the year ended June 30, 2025
Revenue: $25.4 billion
Expenses: $25.2 billion
Operating loss: $12.2 million
Operating margin: 0%
35. HonorHealth (Scottsdale, Ariz.)
Revenue: $4.1 billion
Expenses: $4.1 billion
Operating loss: $9.2 million
Operating margin: -0.2%
36. CommonSpirit Health (Chicago)
Editor’s note: For the year ended June 30, 2025
Revenue: $40.1 billion
Expenses: $40.3 billion
Operating loss: $225 million
Operating margin: -0.6%
37. Allina Health (Minneapolis)
Revenue: $6 billion
Expenses: $6.1 billion
Operating loss: $95.4 million
Operating margin: -1.6%
38. Ascension (St. Louis)
Editor’s note: For the year ended June 30, 2025
Revenue: $25.3 billion
Expenses: $25.8 billion
Operating loss: $490.9 million
Operating margin: -1.6%
39. Providence (Renton, Wash.)
Revenue: $29.5 billion
Expenses: $29.6 billion
Operating loss: $486 million
Operating margin: -1.6%
40. Adventist Health (Roseville, Calif.)
Revenue: $7.4 billion
Expenses: $7.5 billion
Operating loss: $159 million
Operating margin: -2.2%
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