With fiscal year 2026 results now in for many U.S. health systems, three of four large nonprofit organizations improved their operating performance this year.
Trinity Health swung to a $281 million operating gain from a $12.2 million loss in fiscal 2025, while both Ascension and CommonSpirit narrowed operating losses. Baylor Scott & White saw the most gain among the systems, with an 8.3% operating margin. However, its operating income slipped from $1.7 billion to $1.5 billion.
Strategic moves also shaped system results.
CommonSpirit’s operating loss reached $3.2 billion after $2.8 billion in special charges, mostly tied to its exit from Conifer Health Solutions. Ascension’s operating loss included interest on bonds issued ahead of its Amsurg acquisition. And Baylor Scott & White’s health plan has exited the Texas Medicaid managed care market and plans to leave the individual market in December.
Here’s how Baylor Scott & White, Trinity Health, Ascension and CommonSpirit performed in fiscal 2026:
Dallas-based Baylor Scott & White saw an operating income of $1.5 billion (8.3% margin) in the fiscal year ended June 30, 2026, down from a $1.7 billion operating gain (10% margin) during fiscal year 2025.
Baylor Scott & White’s revenue increased 6.6% year over year to $18.5 billion for the year ended June 30, up from $17.3 billion during the previous fiscal year. Net patient care revenue increased 6.8% to $14.4 billion and premium revenue increased 1.5% to $2.9 billion.
The health system’s operating income was $1.5 billion, down from $1.7 billion a year earlier. Operating expenses increased 8.6% to $16.9 billion. Salaries, wages and employee benefits increased 9.4% to $7.7 billion, while supply costs rose to $3.1 billion.
Baylor Scott & White’s health plan exited the Texas Medicaid managed care market and plans to exit its individual line of business in December. As of June 30, the two businesses represented around 227,077 members and accounted for about 68% of the health plan’s premium revenue and claims costs in fiscal 2026.
Livonia, Mich.-based Trinity Health reported $281 million operating income (1.1% margin) in the fiscal year ended June 30, 2026, up from a $12.2 million operating loss (0% margin) posted in the last fiscal year.
Trinity’s total revenue grew $1.3 billion (5.2%) year over year to $26.8 billion. The system’s net patient service revenue rose $580.5 million (2.7%) to $22.2 billion.
The system’s operating expenses were $26.3 billion in fiscal 2026, up from $25.2 billion the previous year. Its supply costs increased to $5.1 billion, purchased services and medical claims grew to $3.7 billion, salaries and wages grew to $11.4 billion, and employee benefits increased to $2.2 billion.
Trinity sold assets related to Sioux City, Iowa-based MercyOne Siouxland Medical Center’s operations on Sept. 1, 2025, to UnityPoint Health System. Trinity also signed an agreement in April to transfer Springfield, Mass.-based Mercy Medical Center to Baystate Health, also based in Springfield, with the deal expected to close in fiscal 2027.
St. Louis-based Ascension saw a $120 million loss from operations (-0.2% margin) for the fiscal year ended June 30, 2026, compared with a $491 million loss (-1.6% margin) in fiscal 2025. The health system narrowed its reported operating loss by $371 million in fiscal 2026, while its core operations saw positive operating income as stronger revenue, higher patient volumes and operational improvements strengthened performance.
Ascension’s revenues for fiscal 2026 were $24.5 billion, down from $25.3 billion in fiscal 2025. The health system’s expenses were $24.7 billion, down from $25.8 billion. Its net income rose to $1.5 billion from $918 million.
The system’s reported loss included interest expense connected to bonds issued ahead of the health system’s June acquisition of Amsurg. Investment income generated by those bond proceeds was recorded as nonoperating income rather than operating income, according to the health system. With the Amsurg-related bond interest and transaction costs excluded, Ascension reported its core operations generated $109 million in positive operating income for 2026.
Ascension ended its fiscal year with $15.1 billion in unrestricted cash and investments and 233 days cash on hand.
Chicago-based CommonSpirit saw an operating loss of $430 million (-1.0% operating margin) in fiscal 2026, excluding special charges, compared to an operating loss of $687 million (-1.8% margin) in fiscal 2025.
CommonSpirit saw an operating loss of $3.2 billion (-7.5% margin), including $2.8 billion in special charges. Of the charges, $2.3 billion is tied to CommonSpirit’s exit from Conifer Health Solutions. The system divested its ownership stake in the revenue cycle company and is terminating its services agreement effective Dec. 31, with plans to bring revenue cycle operations in-house by January 2027. Other special charges include a $245 million tradename impairment tied to the system’s brand unification efforts and $108 million in restructuring-related consulting and severance costs.
The system saw operating revenue of $42.4 billion for the 12 months ended June 30, up 8.5% from $39.1 billion the year prior. Its net patient and premium revenue was $39.5 billion, up 9.4% from $36.1 billion.
CommonSpirit saw operating expenses of $42.9 billion in fiscal 2026, up 7.7% from $39.8 billion the year prior. Salaries and benefits totaled $21.1 billion, up 5.2% from $20.1 billion. Supply expenses totaled $6.7 billion, up 5.6% from $6.3 billion. Purchased services and other expenses totaled $12.7 billion, up 12.6% from $11.3 billion.
