The crisis created by the COVID-19 pandemic came at a time when NYC Health + Hospitals (H+H) had been working toward stabilizing its financial situation. Since 2015, it has been introducing initiatives to increase revenue collections through improving billing procedures, negotiating higher insurance rates, attracting and keeping patients, and lowering personnel costs. This report reviews H+H’s position before the pandemic, assesses the financial and operational impacts of its COVID-19 response, and weighs the long-term effects of the pandemic on the system.