Operator:

Good morning, and welcome to Tenet Healthcare's Fourth Quarter 2025 Earnings Conference Call. [Operator Instructions] I'll now turn the call over to your host, Mr. Will McDowell, Vice President of Investor Relations. Mr. McDowell, you may begin. William McDowell: Good morning, everyone, and thank you for joining today's call. I am Will McDowell, Vice President of Investor Relations. We're pleased to have you join us for a discussion of Tenet's fourth quarter 2025 results as well as a discussion of our financial outlook. Tenet's senior management participating in today's call will be Dr. Saum Sutaria, Chairman and Chief Executive Officer; and Sun Park, Executive Vice President and Chief Financial Officer. Our webcast this morning includes a slide presentation, which has been posted to the Investor Relations section of our website, tenethealth.com. Listeners to this call are advised that certain statements made during our discussion today are forward-looking and represent management's expectations based on currently available information. Actual results and plans could differ materially. Tenet is under no obligation to update any forward-looking statements based on subsequent information. Investors should take note of the cautionary statement slide included in today's presentation as well as the risk factors discussed in our most recent Form 10-K and other filings with the Securities and Exchange Commission. With that, I'll turn the call over to Saum. Saumya Sutaria: Thank you, Will, and good morning, everyone. We reported 2025 net operating revenues of $21.3 billion and consolidated adjusted EBITDA of $4.57 billion, which represents 14% growth over 2024. Full year adjusted EBITDA margin of 21.4% improved over 200 basis points from the prior year. Our fourth quarter results were, again, above our expectations, driven by strong same-store revenue growth, high acuity and disciplined cost control. I would note that our full year adjusted EBITDA ended the year nearly $500 million higher than the midpoint of our initial expectations. USPI continues to deliver attractive results. Volumes were strong and mix was good. Adjusted EBITDA grew 12% in 2025 to $2.026 billion. Same-facility revenues grew 7.5%, highlighted by double-digit same-store volume growth in total joint replacements in the ASCs over prior year. This performance was once again well above our long-term goal of 3% to 6% organic top line growth. We had an active year in the M&A and de novo activity lines as well, investing nearly $350 million in 2025 and adding 35 facilities to the portfolio, and the pipeline for both M&A and de novo development remains strong as we look into 2026. We remain the preferred acquirer and developer of assets in this space. Turning to our Hospital segment. Adjusted EBITDA grew 16% to $2.54 billion in 2025. Same-store revenues per adjusted admission was up 5.3% over the prior year as payer mix and acuity remains strong. We've continued to reinvest back in our business to further our capabilities, stepping up our growth capital in 2025. And finally, over the past 3 years, we have been active repurchasers of our shares, retiring approximately 22% of our outstanding shares for around $2.5 billion since our share repurchase program began in the fourth quarter of '22. We expect to continue to deploy capital for share repurchase, particularly at our current valuation multiples. Our portfolio of businesses is now more predictable with consistently strong performance in both the Hospital segment and USPI. Our results represent a continuation of a multiyear track record of strong same-store revenue growth, improved margins and disciplined execution by our management team. We remain focused on driving further organic growth supplemented by accretive M&A at USPI. Turning to 2026 guidance. We are projecting full year 2026 adjusted EBITDA of $4.485 billion to $4.785 billion, driven by ongoing strength in demand and acuity, physician recruitment and service line expansion as well as additional sites of care joining the portfolio. We are also tackling expense management more structurally in anticipation of the next few years. We anticipate full year adjusted EBITDA for USPI of $2.13 billion to $2.23 billion. The continued mix shift of services towards lower-cost sites of care will be furthered by the beginning of the phaseout of the inpatient-only list in 2026. We see this as a gradual tailwind for USPI that will play out over several years. In this first year, we see opportunities in areas such as high acuity spine and urology procedures. We have detailed tactical plans to capitalize on the opportunity and are actively operationalizing our capabilities to serve patients in 2026. USPI continues to be a high-growth, capital-efficient business that delivers high returns on capital expenditures. Turning to our Hospital segment. We are expecting adjusted EBITDA in the range of $2.355 billion to $2.555 billion in 2026. Our plans reflect the headwind associated with the expiration of the enhanced premium tax credits on the exchange marketplace. We continue to closely monitor enrollment levels as well as the potential off-ramps for individuals to obtain coverage through a lower metal tier commercial plans or other options. We are assuming a 20% reduction in overall enrollment as we have more significant exposure in states such as Arizona, Michigan and California. We recognize the uncertainty regarding effectuation rates as individuals make determinations if they can afford their premiums and the resultant expected increase in uninsured rates and have conservatively taken these matters into our initial guidance. Additionally, we are implementing cost savings plans to help mitigate this pressure and we'll continue to engage with our patients to ensure that they have good access to care. We are confident in our ability to achieve the strong core earnings growth we forecast for 2026. The significant margin improvements that we have made over the past few years provides us a strong foundation from which to grow our transformed portfolio of businesses. We carry momentum into this new year, and have many opportunities to expand our services and deliver value for patients, physician partners and in turn, our shareholders. And with that, Sun will provide us a more detailed review of our financial results. Sun? Sun Park: Thank you, Saum, and good morning, everyone. We are very pleased with the performance in 2025, which again demonstrated robust same-store revenue growth in both the hospitals and USPI segments and adjusted EBITDA that exceeded our expectations each quarter, driven by continued high patient acuity favorable payer mix and effective expense management. In the fourth quarter, we generated total net operating revenues of $5.5 billion and consolidated adjusted EBITDA of $1.183 billion, a 13% increase over last year. Our adjusted EBITDA margin in the quarter was 21.4%, a continuation of our improved margin performance over multiple quarters. For full year 2025, net operating revenues were $21.3 billion and consolidated adjusted EBITDA was $4.566 billion, a 14% increase over '24. Adjusted EBITDA margins in '25 was 21.4%, up 210 basis points from the prior year. I would now like to highlight some key items for both of our segments, beginning with USPI. In the fourth quarter, USPI's adjusted EBITDA grew 9% over last year, with adjusted EBITDA margins at 40.5%. USPI delivered a 7.2% increase in same-facility system-wide revenues, with net revenue per case up 5.5% and same-facility case volumes up 1.6%. Turning to our Hospital segment. Fourth quarter adjusted EBITDA was $603 million, a 16% increase over fourth quarter of '24. Same-hospital inpatient adjusted admissions were flat and revenue per adjusted admissions grew 7.5% year-over-year. Our consolidated salary, wages and benefits was 40.2% of net revenues in the quarter, a 110 basis point improvement from the prior year. And our contract labor expense was 2.1% of consolidated SW&B expenses. Next, we will discuss our cash flow, balance sheet and capital structure. We generated $367 million of free cash flow in the fourth quarter and $2.53 billion of free cash flow for full year '25. As of December 31, 2025, we had $2.88 billion of cash on hand with no borrowings outstanding under our line of credit facility. Additionally, we have no significant debt maturities until late 2027. And finally, during the fourth quarter, we repurchased 943,000 shares of our stock for $198 million. We repurchased 8.8 million shares for $1.386 billion in 2025. Our leverage ratio as of December 31 was 2.25x EBITDA or 2.85x EBITDA less NCI, driven by our strong operational performance and financial discipline. We remain committed to a deleveraged balance sheet, and believe that we have significant financial flexibility to support our capital deployment priorities and drive shareholder value. Let me now turn to our outlook for 2026. Our 2026 outlook assumes continued growth in same-store volumes and effective pricing as well as strong operational efficiencies and disciplined cost controls. Additionally, we anticipate further contributions from M&A and de novo center openings at USPI. In addition, we're also assuming same hospital admission growth of 1% to 2%, adjusted admissions growth of 1% to 2% and same-facility USPI revenue growth of 3% to 6% for 2026. Importantly, our outlook does not assume any contributions from potential increases in supplemental Medicaid programs that have not yet been approved. Also, we believe that the expiration of the enhanced exchange tax credits will result in lower volume growth and a less favorable payer mix. We estimate that this represents a $250 million impact to our 2026 adjusted EBITDA, primarily in the Hospital segment. Clearly, there are a wide range of potential outcomes here, and we will continue to monitor enrollment levels and effectuation rates. We will also leverage Conifer's capabilities to assist our patients with their insurance coverage. Based on all those items, we expect consolidated net operating revenues for 2026 in the range of $21.5 billion to $22.3 billion and consolidated adjusted EBITDA for 2026 in the range of $4.485 billion to $4.785 billion. There are 2 normalizing items that I would like to call out when comparing 2026 adjusted EBITDA to the prior year. First, we reported $148 million of prior year supplemental Medicaid payments in 2025. Second, in the first quarter of 2026, we will recognize a onetime $40 million favorable revenue adjustment as a result of the completed Conifer transaction. After normalizing for these items and excluding the headwind from the expiration of the enhanced premium tax credits, our 2026 adjusted EBITDA is expected to grow 10% at the midpoint of our range. Finally, we would expect first quarter 2026 consolidated adjusted EBITDA to be 24% of our full year consolidated adjusted EBITDA at the midpoint. We anticipate that USPI's EBITDA in the first quarter will be 22% of our full year 2026 USPI EBITDA at the midpoint. Turning to our cash flows. For 2026, we expect adjusted cash flow from operations in the range of $3.2 billion to $3.6 billion. Capital expenditures in the range of $700 million to $800 million, resulting in adjusted free cash flows in the range of $2.5 billion to $2.8 billion. And adjusted free cash flow after NCI in the range of $1.6 billion to $1.83 billion. This range includes about $150 million in tax payments for the Conifer transaction. Excluding these tax payments, this would represent $1.865 billion of adjusted free cash flow less NCI at the midpoint of our 2026 outlook. We remain focused on strong free cash flow conversion from our EBITDA performance, including the continued outstanding cash collection performance at Conifer while continuing to invest in high priority areas of our businesses. Turning to our capital deployment priorities. We are well positioned to create value for shareholders through the effective deployment of free cash flow, and our priorities have not changed. First, we will continue to prioritize capital investments to grow USPI through M&A. And as Saum noted, we see a strong pipeline to support our $250 million annual target for USPI M&A in 2026. Second, we expect to continue investing in key hospital growth opportunities to fuel organic growth, including our focus on higher acuity service offerings. Third, we'll continue to have a balanced approach to share repurchases and depending on market conditions and other investment opportunities. And finally, we will continue to evaluate opportunities to retire and/or refinance debt. In conclusion, we had another outstanding year in 2025 with strong revenue growth, disciplined operations and very attractive free cash flow generation. We are confident in our ability to deliver on our outlook for 2026 and can continue to drive value for patients, physician partners and shareholders. And with that, we're ready to begin the Q&A. Operator? Operator: [Operator Instructions] Our first question comes from Ben Hendrix with RBC Capital. Ben, are you there? We'll go to the next one. Our next question comes from Stephen Baxter with Wells Fargo. Stephen Baxter: I was hoping that perhaps you could expand a little bit on the same-store hospital volume performance in the quarter and any moving parts there? It looked like it was a little bit weaker than the trend. And then just as you're thinking about hospital volumes in 2026, it looks like at the midpoint, you might be looking for that to potentially improve a little bit versus the 2025 performance. So just, I guess, help us think about the moving pieces there with the exchanges and the core performance. Saumya Sutaria: Yes. I mean, obviously, our acuity was good, which is what we're really focused on in the fourth quarter. Flu. I mean, I would just say from our standpoint, the respiratory season was probably a little weaker than otherwise might have expected. And that's probably the basic explanation. In 2026, understanding all the moving pieces, as I indicated in my comments, we had invested significantly in growth capital during the year, and we expect to see returns from some of those investments into 2026, and thus the improvement that you pick up on. Operator: Our next question comes from Whit Mayo with Leerink Partners. Benjamin Mayo: When you say, Saum, that you're tackling expense management more structurally, what do you mean by that? And can you elaborate on what's incremental about the cost efficiencies that you expect to see this year? Saumya Sutaria: Yes. Structurally, what really refers to the notion that we are looking as opposed to what I would describe as more traditional annual expense management. We're looking, as we've talked about over the past year, more thoroughly at the deployment of technology, basically that allows us more expense reduction opportunities, and that includes application of those technologies in our global business center. That's a little bit of a different pathway than before, more sustainable, more what I would describe as modernization of the business given some of the new tools and technologies available to us. It's not just AI, which has, I think, become kind of the central buzzword for this, but there's a lot more that can be done in automation. And then the other thing is just as we look at our clinical throughput, application of those technologies ramping up in our clinical throughput, we believe, is another area to take things to the next level. So whether that's areas like length of stay management or throughput in some of the more high-value portions of the hospitals, real estate, et cetera, ORs, ERs, et cetera. Those kinds of things become more structural in nature. That's what I meant by that. Operator: Our next question comes from Ben Hendrix with RBC Capital Markets. Benjamin Hendrix: Apologies for getting cut off earlier. I just wanted to get a little more color on the hospital admission growth guide, the 1% to 2%. Just wanted to talk a little bit about the slowdown from last year, the degree to which if we can parse out that slowdown between exchange expiry, between kind of investments toward higher acuity and higher margin capabilities in the hospital setting and then also just a general slowdown of admissions that we've been seeing across the acute sector to begin with. So just any commentary you can offer there. Sun Park: Ben, it's Sun. Saum already commented on kind of the Q4 mission, including sort of the flu respiratory season being sort of not material for us. And then as we get into 2026, a lot of it has to do with this CapEx and technology investment that we've made in '25, creating some volume momentum coming into '26. On your question about the exchange, as we said in our comments, there's a pretty wide range of potential outcomes here. As Saum mentioned, we're assuming about 20% decrease in enrollment. But we'd have to then -- there's lots of areas where -- what happens to those volumes, right? Do they -- those people find -- do those patients find alternate coverage and other plans, alternative plans. Certainly, a big majority of them could become uninsured. But that volume will still show up at our hospitals, obviously, and in USPI. It's just the question then becomes, can we optimize our cost and efficiency. So our range anticipates some impact of lost volumes, but I think our EBITDA range, and as we discussed, our lost EBITDA range is quantifying the exchange a little bit more. Operator: Our next question comes from Matthew Gillmor with KeyBanc Capital Markets. Matthew Gillmor: Maybe following up on the cost efficiencies. Are you able to quantify what you're able to pull through this year. I was also curious about the timing, building throughout the year such that you'll get a year-over-year benefit in future periods? Or do they take place earlier in the year, so they're all captured in '26? Saumya Sutaria: Yes. No, we're not providing specific guidance between that. I mean, if you think about our guidance core growth of EBITDA standpoint. I would just expect that embedded in there is both the value of the initiatives that we have invested in through capital and growth strategies for this year and expense management strategies that would be more -- as I said, more structural over and above what we might have done in a typical year. And as I indicated, the thought process behind those isn't just about 2026, it's about being prepared for the years ahead. Operator: Our next question comes from Kevin Fischbeck with Bank of America. Kevin Fischbeck: Yes. I just want to follow up on that point. I guess, when we think about that type of growth, I mean, is this the type of growth that you think is sustainable in out years as we think about offsets because 10% is a pretty big number to be thinking about. And so I just want to understand, is this new focus on expense management replicatable? Or are you -- is it kind of -- this is what we're doing in year 1, and that's it? Or is this is what we're doing in year 1, and we should be thinking about similar types of opportunity in the out years because it is a little hard to bridge what would normally be viewed as a hospital business that might grow 3% to 5%. Now you're saying it's 10%, like, is that sustainable? Saumya Sutaria: Well, Kevin, I mean, I think 2 things. One is we've built up a track record of acuity growth and net revenue per case growth ahead of generally what the market does. Our margin expansion over the past, not just 2 years, as I indicated, but even beyond that in the Hospital segment itself has been significant above and beyond the asset sales that we did, which obviously helped some of that margin improvement. We said all along that we kept the markets where we felt like we had the best opportunities for growth and leadership. And as we look ahead to the environment that may be coming in '28, '29, et cetera, with OBBB and other things, now is the time to take on the challenge of really being well prepared for that. And so look, we understand what the core growth guidance is. We think it's very attractive guidance. We think there's a lot of work that's going to be required to get there and creativity. But on the other hand, that's exactly the work we should be doing given the platform that we've built. And so that's what we're going after. Operator: Our next question is from Josh Raskin with Nephron Research. Joshua Raskin: I want to stay on the same topic and Saum, appreciate what you just said. I sort of looked at it, margins are up 680 basis points since 2019 and the Hospital segment is up 660 basis points. So it's not really mix. It seems as though we've heard a lot about process improvement and optimization at Tenet for a couple of years, and now we're hearing about this new focus on expense management. I'd just be curious to get your view on just the broader technology agenda, specifically, including AI and overall business, including revenue cycle management. And just do you think there's additional step function improvements in margins. I guess that's the main question. Do you think we're going to see continued margin improvement like we've seen in the past? Saumya Sutaria: Yes. I mean I don't -- obviously, we're giving guidance in a year where there happens to be a headwind that we've done our best to quantify with respect to the exchange premium tax credits. Stated a different way, if those headwinds weren't there, we've been saying all along that we continue to believe there's margin expansion opportunity in the Hospital segment. The urgency with respect to much of what we're talking about doing is enhanced because of the -- what's happened on the exchange marketplace or what hasn't happened on the exchange marketplace as the case may be. The other thing I'm mindful of is that there are -- what happens with respect to many of these reimbursement items might change over the next couple of years, right? So we're not really planning out to that level of specificity for '27, '28, et cetera. There are elections that happened between now and then that could alter, modify or just transform policy from where it is today. But I think this gets back to the first part of your question, which is, as we look around the environment, we've done a lot in this organization to improve reliability, accountability, the types of efficiencies we've taken as we've scaled the company down in the Hospital segment, reliably moving our overhead structure in line with that. All the things you would expect from an organization that is attempting to be best-in-class in what it does. And now with the advent of many of these technologies in AI and automation, the ability to actually begin to deploy those and see if we can drive the next level of improvement, we're better set up for that now because we have more standard processes. We have more standard workflows. We have labor standards and supply standards that have been uniformly disseminated across the company. It's much harder to do those things when every market is doing something very different versus having established those standards. And we've done that. And we've consistently demonstrated that establishing those standards have improved our business. So now it's about taking that to the next level, and that's really what we're talking about. Operator: Our next question comes from Justin Lake with Wolfe Research. Justin Lake: Wanted to follow up on some of the guidance stuff. I appreciate all the details. You mentioned -- obviously, the DPP, you gave us the onetime benefit there last year that comes out. I'm just curious if you could specify, is DPP other than that flat year-over-year? Or any change within that core guidance? Maybe you could also give us the run rate of DPP. And then I thought your estimate of the impact of the subsidy expirations was towards the higher end of my expectations at least. And I'm curious how you treated at least your thoughts on the potential shift of some of these enrollees back to employer commercial. What you've assumed there versus, let's say, I think UHS or one of your peers is assuming none and one of your peers is assuming 15% to 20%. Sun Park: Justin, it's Sun. Thanks for your question. On your question about the Medicaid supplemental payments. Yes, as you pointed out, so a couple of numbers here. We finished 2025 with $1.34 billion in total supplemental payments. And obviously, we pointed out about $148 million of that is out-of-period payments. So let's call it $1.2 billion effective run rate for 2025. In '26, our guidance assumes effectively a pretty consistent number with our '25 normalized baseline. So hopefully, that helps. And then on your question about exchange, yes. I mean, like we said, we assume about 20% overall reduction of enrollment. I would say on your question about our assumptions for people finding alternative plans, including commercial, we're about 10% to 15% as our internal assumption. Now all of that, again, depends on what we've seen in Q1 and what run rates we see, but that's our assumption embedded in our guidance. Operator: Our next question comes from Peter Chickering with Deutsche Bank. Pito Chickering: Can I ask about sort of the first quarter guidance, normally, you guys are getting more than 24% of EBITDA in the first quarter. I think in the script, you said that 21% come for the ASCs, which is normal. So it means that the change is actually in the Hospital segment. So is this something fundamental like the flu or lower surgical demand? Or is this just the $40 million of prior period DPP from last year or something else? And then just a quick clarification. Can you quantify the DPP that you received in the fourth quarter of '25? Sun Park: Peter, it's Sun. Just to be clear, our USPI Q1 guidance is 22% of our full year guidance in Q1 for USPI. And then for our Hospital, you're right. I think the $40 million onetime benefit in Q1 kind of skews the total rates. Other than that, we see pretty standard annual Q1 percentages as a percent of full year. And then for your question on DPP Q4, we had $315 million. Operator: Our next question is from Andrew Mok with Barclays Bank. Thomas Walsh: This is Thomas Walsh on for Andrew. With Conifer services to CommonSpirit concluding at the end of this year, could you frame the current plan to redeploy existing resources to growth opportunities and otherwise reduce expenses to rightsize the cost structure? Saumya Sutaria: Well, I mean, we have a full year of service that we have to execute with respect to Conifer and our client this year. So we're not expecting to take cost reductions this year from that perspective. If anything, we may both increase revenue and cost if we end up doing more from a transition service standpoint, and that may come with a margin. After that, we've talked about the fact that we have other growth opportunities that are already locked in starting in and around 2027 that will allow us to redeploy talent in that direction. So we can see that we'll be rebasing a bit the business at Conifer and preparing it for future growth. I mean, I don't know, I would kind of just go back to the core of what actually happened here in what we did. I mean if I were to be very simple about this, we had an expiring contract for which the cash flow that we would have taken in between 2026 and 2032 was basically breakeven at best because at the end of that period, we would have significant obligations to the client in terms of payments that would need to be made and equity that we'd have to buy back. I mean one thing that may not have been so clear, we haven't made cash distributions from that joint venture in the last decade, and that resulted in a pretty significant buildup of redeemable noncontrolling interest and other liabilities. So what we did was we retired $885 million of those obligations on the balance sheet and got back 23.8% of the equity that was in the joint venture for $540 million. And then if you look at the remaining 6 years of the transaction of the contract that got dealt with in the transaction, we received $1.9 billion in accelerated cash flow over 3 years that would have come over 6 years in the contract and the present value of those 2 things was roughly double what we would have got by running off the contract. So I mean, we've gone back for what it's worth and done the math. If you just look at this on an NPV basis after tax, the incremental value from actually running out the contract that we've created, again, post-tax present value was north of $1 billion. We calculate $1.1 billion. I mean this was absolutely the right path to go down in addition to getting complete control of the strategic future of Conifer. How we deal with that in 2027 and beyond, including growth opportunities, investments that we can now control in reducing the cost to collect and positioning Conifer to be more competitive, is the work of 2026 that we have in this asset. But maybe that kind of bottom line calculation now that we've had a chance to look at what the earnings will look like in the out years based on what we know today is helpful in framing what we did in this transaction. Again, after-tax NPV of about $1 billion to $1.1 billion is what we calculate. We're pleased with the outcome. Operator: Our next question is from Scott Fidel with Goldman Sachs. Scott Fidel: I was hoping maybe you could elaborate a bit on -- for the ASC business, how you're thinking about and planning for investments that could be either around the new facilities in terms of organic or de novo expansion. From a case mix and procedure perspective, just interested in where you see underlying demand is strongest, where you see the best opportunities to continue to drive the trend that you've had of favorable case mix and profitable sort of acuity procedure growth in some of these specialty areas in the ASC business? Saumya Sutaria: Yes. No, thanks for the question. I guess I would make 3 comments. One is that I alluded earlier to the inpatient-only list and additional opportunities there. I think that will be a slow tailwind going forward as there are more things that qualify in that area. I think USPI is well known to be kind of at the leading edge of the innovation in higher acuity procedures in that area. We continue to build on our urology platform, looking forward to doing more spine work there. A lot of the robotics capabilities that we have brought into the ASCs continue to allow us to find new avenues of expansion. And obviously, the large ongoing opportunity that we continue to see double-digit growth in our joint programs across the network. All those areas are, I think, attractive looking forward. We had a big M&A year, and a lot of the value that USPI brings after we acquired the assets and get into those settings is the planning for service line diversification and whatnot. So we have a big cohort this year. Usually, it takes about a year to start to work on new physician entry and restructuring of the operating schedules where possible to bring some of that higher acuity in. Sometimes, as we've talked about in the past, it removes lower acuity procedures in the context of doing that. When you get new centers, usually takes a year or so to kind of get that done. So we have a lot of work to do in that regard. And then the last point I would make is that Q4 as we expected about a year ago, we said that we saw a ramp going forward. Q4 had a nice pickup in GI case recovery as well. And that was an important driver of that performance. So I think it's the same this year. We expect the year to build over the year stronger and stronger. The first quarter last year was an incredibly strong quarter for us because of a lot of the synergies that dropped on the Covenant transaction, the CPP transaction in Q1 of '25. But as we kind of overcome that this first quarter, we expect to see growing momentum in the business looking ahead. Operator: Our next question is from Ryan Langston with TD Cowen. Ryan Langston: Can you tell us where exchange volumes and revenues tracked in the fourth quarter? And I know you don't assume any pickup from the supplemental programs that aren't approved. But do you have any insight into where we're at in the approval process for the pending programs like Florida, Arizona, California? Sun Park: Ryan, on Q4 for exchanges, we were about almost 7 -- I'm sorry, 7.5% of total admissions for HICS. And then a little over 6%, 6.5%, somewhere in there of our total consolidated revenues was from exchange. On your question about Medicaid supplement payments, yes, we are obviously tracking all these sort of the pending submissions and approvals in some of the states that you mentioned. We don't -- I don't know that we have any specific updates to provide at this time. We'll obviously continue to monitor. Saumya Sutaria: Yes. I mean I think it's just worth reemphasizing we haven't put anything in our guidance about programs that haven't yet received approval for '26. Anything incremental, sorry, I should be clear. Anything incremental in our guidance. Operator: Our next question comes from A.J. Rice with UBS. Albert Rice: Maybe just some comments on what you're seeing with managed care contracting. Obviously, that sector continues to be under pressure with some of the government programs, et cetera. And I wondered, is there any change in discussion in terms of the pace of new contract or contract renegotiations or terms or just general update in rates? Sun Park: Yes. A.J., it's Sun. No real change in our commentary. Look, I think we have very positive and successful conversations with payers in general based on Tenet's overall service lines and what we bring to the table, including USPI as part of the overall package as well. Our commentary on rates is pretty consistent. We see 3% to 5% range from payers. And overall, from a contracting standpoint, we're virtually contracted in 2026, I would say, high 90s. And then even for '27, we're about 80% contracted. So I think we're in a very good spot. Thanks for your question. Operator: Our next question is from Sarah James with Cantor Fitzgerald. Sarah James: Can you elaborate a little bit more about what you saw in payer mix in 4Q for USPI and then unpack what you're assuming for Hospital and USPI as far as the scale of change in '26 between 1Q '26 and 4Q '26? Saumya Sutaria: I'll take the second half of it. I don't think we're anticipating any different -- if you're asking the question about are we anticipating any sort of a different mix quarter-to-quarter than we saw in the amount of EBITDA that we generate in the Hospital segment or USPI proportionally, I don't think we're saying that at all. I mean this is always the case where you could have movement of a percentage point or something like that up or down depending on -- we deal with winter weather, we deal with hurricanes, we deal with -- but we rebook those things and attempt to deal with them. Sometimes that's intra-quarter, sometimes it's out of quarter. So I'd personally focus on the overall guide and our message in terms of the percentages for Q1 aren't meant to imply that we're changing our proportions for Q2, 3 and 4. Yes... Sarah James: Got it. I guess I was thinking more in terms of as effectuation takes place, if you would expect the payer mix to change at the end of the year and to what degree compared to your assumptions [ on 1Q ]? Saumya Sutaria: Yes, I would say that -- I mean, there's a reason why the guidance range is wider than it normally is. I mean we don't know, right? I mean we're tracking it. We have a unique vantage point with Conifer because we do enrollment work as well. So we get a bit of a view into what that enrollment work is yielding in terms of where are people going, what reaction are they having to their premiums as they get exposure to them. So I think we'll have some leading-edge insights there. But let's be honest, it's not perfect at this stage. It's very early in the year. And I think the guidance is appropriately broad in the Hospital segment because we really don't know exactly how that's going to translate. We've been transparent with our assumptions with you all so that you can see where that's going to run relative to what actually happens. Sun Park: And Sarah, this is Sun. On your question about payer mix on USPI. I would say it's been very consistent. As Saum mentioned, we have some GI that came back. So that will tweak the overall mix a little bit from a payer standpoint, but nothing substantive. So we're very pleased with our payer mix. In Q4, we reported at USPI net revenue per case growth of 5.5%, total EBITDA margins above 40%. So I think all those metrics show very strong revenue acuity. Operator: Our next question is from Benjamin Rossi with JPMorgan. Benjamin Rossi: Just as a follow-up for the ambulatory side. For the $30 million EBITDA headwind across ambulatory from the EAPTCs expiring, how much of your payer mix for the ambulatory segment came from the ACA exchanges in 2024 and 2025? And then did you see any pull forward across that cohort here during the fourth quarter, given your typical seasonal dynamics for ambulatory? Saumya Sutaria: Yes, Ben, we don't disclose that information in terms of the segment. But we've been pretty clear all along that the HICS exposure at USPI is significantly less than the hospital segment. And no, we did not see any significant pull forward. We looked for it. Remember, we talked about this a quarter ago as well. We looked for it, but we did not see any significant pull forward. Operator: Next question comes from John Ransom with Raymond James. John, are you there? Are you muted, John? John Ransom: Sorry, can you hear me now? Saumya Sutaria: We can. John Ransom: Sorry. There's a big narrative over the past few months that providers are getting on top of payers with coding advances assisted by AI, particularly claims resubmissions are easier. Is that exaggerated? What inning are we in? And just given that you're positioned owning Conifer and being a provider, what's your position on that debate? Saumya Sutaria: Yes. I mean, John, I can only comment for Tenet and I guess, to some extent, for how we operate at Conifer. Our coding has always been appropriate, compliant. It's -- we audit carefully. We haven't changed our coding practices over the last few years, either for ourselves or necessarily for our clients. We aim for very high degrees of accuracy and we have not made changes in those areas. We have obviously been successful in increasing our acuity, which has supported our net revenue per case in terms of our pathway there. And finally, just to unpack a little bit the question earlier related to this with Sun's comments about our managed care contracting environment. We also don't have extremely heavy HOPD market drive from what we're doing. So we do a lot on the basis of freestanding outpatient in what we do, and that ends up being a value to the plans. We have not found ourselves in conflict over coding practices. We find ourselves in conflict over the nature of the amount of time and energy we put into disputes, denials, underpayments and things of that nature. That have a process back and forth that you got to work through. But increasingly, we've been setting up systems with the health plans to have adjudication mechanisms to work with them on in order to resolve these things in a less resource-intensive way. Some payers have been better than others about doing that with us, but that's the path we're moving down. Operator: Our final question is from Craig Hettenbach with Morgan Stanley. Craig Hettenbach: And I appreciate all the details given the fluid backdrop in terms of puts and takes on this year. Saum, just keying off of your comment of taking an active approach to buybacks, especially at the current valuation multiple given the significantly stronger balance sheet, free cash flow generation and CommonSpirit kind of proceeds, how are you and the Board just thinking about kind of the right cadence here of buybacks? Saumya Sutaria: Well, yes, I mean I purposely indicated I purposely noted and indicated that -- I mean, all these things link together, right? I mean it's not just that we have significant cash on the balance sheet. We just described maybe in more detail today, the kind of value we just generated from the Conifer transaction. Effectively, a portion of that transaction was like debt retirement, right? I mean it was an obligation on the balance sheet that was real coming up in the next few years. And so then the other proceeds from that go back into investing in the business, investing in USPI, and it gives us the opportunity for more share buybacks. And I would link this to our guidance for 2026 in terms of -- I know we've talked a little bit about our growth rates and core growth rates. I mean we attempt to operate and behave like a company that trades at a higher multiple. We will deploy our balance sheet like an organization that recognizes that the multiple has a valuation that's attractive to buy back shares. And I think we've done that over the last year. I mean that's our mindset, right? We expect to perform at that level. We also expect to deploy our balance sheet in a way that demonstrates we have confidence in our ability to operate. That might be the easiest way to describe how we think about the 2. They're interlinked for us. Operator: We have reached the end of the question-and-answer session, and this concludes today's conference. You may disconnect your lines at this time, and we thank you for your participation.