Income Taxes

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

INCOME TAXES

5. INCOME TAXES

The provision for income taxes consists of the following (in millions):

	Year Ended December 31,
	2023			2022			2021
Current:
Federal	$	149		$	—		$	(46	)
State		7			5			6
		156			5			(40	)
Deferred:
Federal		(5	)		166			161
State		40			(1	)		10
		35			165			171
Total provision for income taxes for income	$	191		$	170		$	131

The following table reconciles the differences between the statutory federal income tax rate and the effective tax rate (dollars in millions):

	Year Ended December 31,
	2023						2022						2021
	Amount			%			Amount			%			Amount			%
Provision for income taxes at statutory   federal rate	$	44			21.0	%	$	73			21.0	%	$	105			21.0	%
State income taxes, net of federal income tax benefit		37			17.9			3			0.8			44			8.7
Net income attributable to noncontrolling interests		(31	)		(14.9	)		(28	)		(8.0	)		(29	)		(5.8	)
Change in valuation allowance		88			42.5			122			34.9			33			6.8
Change in uncertain tax position		10			4.9			—			—			—			—
Nondeductible goodwill		29			14.1			—			—			—			—
Amended return adjustments		9			4.3			—			—			(22	)		(4.4	)
Other		5			2.5			—			—			—			—
Provision for income taxes and   effective tax rate for income	$	191			92.3	%	$	170			48.7	%	$	131			26.3	%

The Company’s effective tax rates were 92.3%, 48.7% and 26.3% for the years ended December 31, 2023, 2022 and 2021, respectively. The increase in the Company’s effective tax rate for the year ended December 31, 2023, when compared to the year ended December 31, 2022, was primarily due to non-deductible goodwill related to hospitals divested in 2023 and a decrease in income before taxes. The increase in the Company’s effective tax rate for the year ended December 31, 2022, when compared to the year ended December 31, 2021, was primarily due to an increase in non-deductible interest for 2022 compared to 2021, compounded by an adverse change in the IRC Section 163(j) limit for deductible interest expense beginning in 2022.

Deferred income taxes are based on the estimated future tax effects of differences between the financial statement and tax bases of assets and liabilities under the provisions of the enacted tax laws. Deferred income taxes as of December 31, 2023 and 2022 consist of (in millions):

	December 31,
	2023					2022
	Assets			Liabilities		Assets			Liabilities
Net operating loss and credit carryforwards	$	533		$	—	$	553		$	—
Property and equipment		—			326		—			323
Self-insurance liabilities		16			—		30			—
Prepaid expenses		—			30		—			31
Intangibles		—			163		—			148
Investments in unconsolidated affiliates		—			72		—			58
Other liabilities		—			7		—			9
Long-term debt and interest		32			—		41			—
Accounts receivable		16			—		16			—
IRC Section 163(j) interest limitation		582			—		448			—
Accrued vacation		19			—		19			—
Accrued bonus		27			—		19			—
Other comprehensive income		4			—		6			—
Right-of-use assets		—			165		—			148
Right-of-use liability		173			—		156			—
Stock-based compensation		4			—		5			—
Deferred compensation		38			—		51			—
IRC Section 481(a) adjustments		—			57		—			122
Other		19			—		19			—
Total		1,463			820		1,363			839
Valuation allowance		(983	)		—		(829	)		—
Total deferred income taxes	$	480		$	820	$	534		$	839

The Company believes that the net deferred tax assets will ultimately be realized, except as noted below. Its conclusion is based on its estimate of future taxable income and the expected timing of temporary difference reversals. The Company has gross state net operating loss carryforwards of approximately $9.9 billion, which expire from 2024 through 2043. The Company’s tax affected federal and state net operating loss and credit carryforwards are approximately less than $1 million and $533 million, respectively. A valuation allowance of approximately $983 million has been recognized for state net operating loss carryforwards, state credit carryforwards and federal and state deferred tax assets that the Company does not expect to be able to realize. With respect to the deferred tax liability pertaining to intangibles, as included above, goodwill purchased in connection with certain of the Company’s business acquisitions is amortizable for income tax reporting purposes. However, for financial reporting purposes, there is no corresponding amortization allowed with respect to such purchased goodwill.

The valuation allowance for federal and state jurisdictions where the Company concluded that the associated deferred tax assets would not be realized increased by $88 million and $66 million, respectively, for the year ended December 31, 2023, and increased by $122 million and decreased by $108 million, respectively, for the year ended December 31, 2022.

The total amount of unrecognized benefit that would affect the effective tax rate, if recognized, was $45 million as of December 31, 2023. A total of $2 million of interest and penalties is included in the amount of the liability for uncertain tax positions at December 31, 2023. It is the Company’s policy to recognize interest and penalties related to unrecognized benefits in its consolidated statements of (loss) income as income tax expense.

It is possible the amount of unrecognized tax benefit could change in the next 12 months as a result of a lapse of the statute of limitations and settlements with taxing authorities; however, the Company does not anticipate the change will have a material impact on the Company’s consolidated results of operations or consolidated financial position.

The following is a tabular reconciliation of the total amount of unrecognized tax benefit for the years ended December 31, 2023, 2022 and 2021 (in millions):

	Year Ended December 31,
	2023			2022		2021
Unrecognized tax benefit, beginning of year	$	50		$	42	$	45
Gross increases — tax positions in current period		9			8		5
Reductions — tax positions in prior period		(1	)		—		(8	)
Unrecognized tax benefit, end of year	$	58		$	50	$	42

The Company’s income tax return for the 2018 tax year remains under examination by the Internal Revenue Service. The Company believes the result of this examination will not be material to its consolidated results of operations or consolidated financial position. The Company has extended the federal statute of limitations through June 30, 2025 for Community Health Systems, Inc. for the tax period ended December 31, 2018.

Cash paid for income taxes, net of refunds received, was $91 million, $6 million and $4 million during the years ended December 31, 2023, 2022 and 2021, respectively.