When Eugene (Gene) Woods became the CEO of Carolinas HealthCare System (CHS) in 2016, the institution was a respected non-profit network of hospitals primarily located in North Carolina. CHS recorded an annual revenue of $8 billion USD, supported by 60,000 employees. As an executive leader with a track record of success, Gene inherited a strong organization with a good margin, AA- balance sheet, exceptional clinical talent depth, and prominent long-term team leadership. On the other hand, all of this is a continuing success story, but a storm cloud is looming ahead.