In the fourth quarter of 2020, overall Chapter 11 distress continued to rise both quarter-over-quarter and year-over-year, further narrowing the gap with historical benchmark levels. Real estate distress declined modestly from the prior quarter and remained only slightly higher than a year earlier, while continuing to track well below long-term benchmarks. Health care services distress declined for a second consecutive quarter but remained significantly elevated relative to historical norms, extending a prolonged period of outsized distress compared to other sectors.