In the fourth quarter of 2024, overall Chapter 11 distress declined modestly from the prior quarter but remained elevated on a year-over-year basis and near historical benchmark levels. Real estate distress was largely flat quarter-over-quarter and significantly higher than a year earlier, though it continued to track below long-term norms. Health care services distress surged to yet another record high, extending an unprecedented multi-quarter escalation in sector-specific distress alongside a sharply rising share of health care filings.