| QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
| TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
| (State or other jurisdiction of incorporation or organization) |
(I.R.S. Employer Identification No.) | |
| |
||
| (Address of principal executive offices) |
(Zip Code) | |
| Title of each class |
Trading Symbol(s) |
Name of each exchange on which registered | ||
| |
|
|
|
|
Voting |
| |
☒ |
Accelerated filer |
☐ | |||
| Non-accelerated filer |
☐ |
Smaller reporting company |
||||
Emerging growth company |
| Class of Common Stock |
Outstanding at October 26, 2020 | |
| |
|
|
Voting common stock, $.01 par value |
Page of Form 10-Q |
||||||
| Part I. |
Financial Information |
|||||
| |
|
|
|
|
|
|
| Item 1. |
Financial Statements (Unaudited): |
|||||
2 |
||||||
3 |
||||||
4 |
||||||
5 |
||||||
6 |
||||||
7 |
||||||
| Item 2. |
20 |
|||||
| Item 3. |
40 |
|||||
| Item 4. |
40 |
|||||
| Part II. |
Other Information |
|||||
| Item 1. |
40 |
|||||
| Item 1A. |
41 |
|||||
| Item 2. |
44 |
|||||
| Item 6. |
45 |
|||||
46 |
||||||
Quarter |
Nine Months |
|||||||||||||||
2020 |
2019 |
2020 |
2019 |
|||||||||||||
| Revenues |
$ |
$ |
$ |
$ |
||||||||||||
| Salaries and benefits |
||||||||||||||||
| Supplies |
||||||||||||||||
| Other operating expenses |
||||||||||||||||
| Government stimulus income reversal |
— |
— |
||||||||||||||
| Equity in earnings of affiliates |
( |
) |
( |
) |
( |
) |
( |
) | ||||||||
| Depreciation and amortization |
||||||||||||||||
| Interest expense |
||||||||||||||||
| Losses (gains) on sales of facilities |
( |
) |
( |
) | ||||||||||||
| Losses on retirement of debt |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Income before income taxes |
||||||||||||||||
| Provision for income taxes |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Net income |
||||||||||||||||
| Net income attributable to noncontrolling interests |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Net income attributable to HCA Healthcare, Inc. |
$ |
$ |
$ |
$ |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Per share data: |
||||||||||||||||
| Basic earnings |
$ |
$ |
$ |
$ |
||||||||||||
| Diluted earnings |
$ |
$ |
$ |
$ |
||||||||||||
| Shares used in earnings per share calculations (in millions): |
||||||||||||||||
| Basic |
||||||||||||||||
| Diluted |
||||||||||||||||
Quarter |
Nine Months |
|||||||||||||||
2020 |
2019 |
2020 |
2019 |
|||||||||||||
| Net income |
$ |
$ |
$ |
$ |
||||||||||||
| Other comprehensive income (loss) before taxes: |
||||||||||||||||
| Foreign currency translation |
( |
) |
( |
) |
( |
) | ||||||||||
| Unrealized gains on available-for-sale |
||||||||||||||||
| Defined benefit plans |
||||||||||||||||
| Pension costs included in salaries and benefits |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Change in fair value of derivative financial instruments |
( |
) |
( |
) |
( |
) | ||||||||||
| Interest expense (benefits) included in interest expense |
( |
) |
( |
) | ||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
( |
) |
( |
) |
( |
) | |||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Other comprehensive income (loss) before taxes |
( |
) |
( |
) |
( |
) | ||||||||||
| Income taxes (benefits) related to other comprehensive income items |
( |
) |
( |
) |
( |
) | ||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Other comprehensive income (loss) |
( |
) |
( |
) |
( |
) | ||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Comprehensive income |
||||||||||||||||
| Comprehensive income attributable to noncontrolling interests |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Comprehensive income attributable to HCA Healthcare, Inc. |
$ |
$ |
$ |
$ |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
September 30, 2020 |
December 31, 2019 |
|||||||
ASSETS |
||||||||
| Current assets: |
||||||||
| Cash and cash equivalents |
$ |
$ |
||||||
| Accounts receivable |
||||||||
| Inventories |
||||||||
| Other |
||||||||
| |
|
|
|
|||||
| |
|
|
|
|
|
|
|
|
| Property and equipment, at cost |
||||||||
| Accumulated depreciation |
( |
) |
( |
) | ||||
| |
|
|
|
|||||
| |
|
|
|
|
|
|
| |
| Investments of insurance subsidiaries |
||||||||
| Investments in and advances to affiliates |
||||||||
| Goodwill and other intangible assets |
||||||||
| Right-of-use |
||||||||
| Other |
||||||||
| |
|
|
|
|||||
$ |
$ |
|||||||
| |
|
|
|
|||||
LIABILITIES AND STOCKHOLDERS’ EQUITY (DEFICIT) |
||||||||
| Current liabilities: |
||||||||
| Accounts payable |
$ |
$ |
||||||
| Accrued salaries |
||||||||
| Other accrued expenses |
||||||||
| Government stimulus refund liability |
— |
|||||||
| Long-term debt due within one year |
||||||||
| |
|
|
|
|||||
| Long-term debt, less debt issuance costs and discounts of $ |
||||||||
| Professional liability risks |
||||||||
| Right-of-use |
||||||||
| Income taxes and other liabilities |
||||||||
| Stockholders’ equity (deficit): |
||||||||
| Common stock $ |
||||||||
| Capital in excess of par value |
— |
|||||||
| Accumulated other comprehensive loss |
( |
) |
( |
) | ||||
| Retained deficit |
( |
) |
( |
) | ||||
| |
|
|
|
|||||
| Stockholders’ deficit attributable to HCA Healthcare, Inc. |
( |
) |
( |
) | ||||
| Noncontrolling interests |
||||||||
| |
|
|
|
|||||
( |
) | |||||||
| |
|
|
|
|||||
$ |
$ |
|||||||
| |
|
|
|
|||||
Equity (Deficit) Attributable to HCA Healthcare, Inc. |
Equity Attributable to Noncontrolling Interests |
Total |
||||||||||||||||||||||||||
Common Stock |
Capital in Excess of Par Value |
Accumulated Other Comprehensive Loss |
Retained Deficit |
|||||||||||||||||||||||||
Shares (in millions) |
Par Value |
|||||||||||||||||||||||||||
| Balances, December 31, 2018 |
$ |
$ |
— |
$ |
( |
) |
$ |
( |
) |
$ |
$ |
( |
) | |||||||||||||||
| Comprehensive income |
||||||||||||||||||||||||||||
| Repurchase of common stock |
( |
) |
( |
) |
( |
) | ||||||||||||||||||||||
| Share-based benefit plans |
( |
) |
( |
) | ||||||||||||||||||||||||
| Cash dividends declared ($ |
( |
) |
( |
) | ||||||||||||||||||||||||
| Distributions |
( |
) |
( |
) | ||||||||||||||||||||||||
| Other |
( |
) |
||||||||||||||||||||||||||
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
| Balances, March 31, 2019 |
— |
( |
) |
( |
) |
( |
) | |||||||||||||||||||||
| Comprehensive income |
( |
) |
||||||||||||||||||||||||||
| Repurchase of common stock |
( |
) |
( |
) |
( |
) |
( |
) | ||||||||||||||||||||
| Share-based benefit plans |
||||||||||||||||||||||||||||
| Cash dividends declared ($ |
( |
) |
( |
) | ||||||||||||||||||||||||
| Distributions |
( |
) |
( |
) | ||||||||||||||||||||||||
| Other |
( |
) |
( |
) | ||||||||||||||||||||||||
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
| Balances, June 30, 2019 |
— |
( |
) |
( |
) |
( |
) | |||||||||||||||||||||
| Comprehensive income |
( |
) |
||||||||||||||||||||||||||
| Repurchase of common stock |
( |
) |
( |
) |
( |
) |
( |
) | ||||||||||||||||||||
| Share-based benefit plans |
||||||||||||||||||||||||||||
| Cash dividends declared ($ |
( |
) |
( |
) | ||||||||||||||||||||||||
| Distributions |
( |
) |
( |
) | ||||||||||||||||||||||||
| Other |
( |
) |
( |
) | ||||||||||||||||||||||||
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
| Balances, September 30, 2019 |
— |
( |
) |
( |
) |
( |
) | |||||||||||||||||||||
| Comprehensive income |
||||||||||||||||||||||||||||
| Repurchase of common stock |
( |
) |
( |
) |
( |
) |
( |
) | ||||||||||||||||||||
| Share-based benefit plans |
||||||||||||||||||||||||||||
| Cash dividends declared ($ |
( |
) |
( |
) | ||||||||||||||||||||||||
| Distributions |
( |
) |
( |
) | ||||||||||||||||||||||||
| Other |
( |
) |
||||||||||||||||||||||||||
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
| Balances, December 31, 2019 |
— |
( |
) |
( |
) |
( |
) | |||||||||||||||||||||
| Comprehensive income |
( |
) |
||||||||||||||||||||||||||
| Repurchase of common stock |
( |
) |
( |
) |
( |
) | ||||||||||||||||||||||
| Share-based benefit plans |
( |
) |
( |
) | ||||||||||||||||||||||||
| Cash dividends declared ($ |
( |
) |
( |
) | ||||||||||||||||||||||||
| Distributions |
( |
) |
( |
) | ||||||||||||||||||||||||
| Other |
( |
) |
||||||||||||||||||||||||||
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
| Balances, March 31, 2020 |
— |
( |
) |
( |
) |
( |
) | |||||||||||||||||||||
| Comprehensive income |
||||||||||||||||||||||||||||
| Share-based benefit plans |
||||||||||||||||||||||||||||
| Distributions |
( |
) |
( |
) | ||||||||||||||||||||||||
| Other |
( |
) |
( |
) | ||||||||||||||||||||||||
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
| Balances, June 30, 2020 |
( |
) |
( |
) |
||||||||||||||||||||||||
| Comprehensive income |
||||||||||||||||||||||||||||
| Share-based benefit plans |
||||||||||||||||||||||||||||
| Distributions |
( |
) |
( |
) | ||||||||||||||||||||||||
| Other |
||||||||||||||||||||||||||||
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
| Balances, September 30, 2020 |
$ |
$ |
$ |
( |
) |
$ |
( |
) |
$ |
$ |
||||||||||||||||||
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
2020 |
2019 |
|||||||
| Cash flows from operating activities: |
||||||||
| Net income |
$ |
$ |
||||||
| Adjustments to reconcile net income to net cash provided by operating activities: |
||||||||
| Increase (decrease) in cash from operating assets and liabilities: |
||||||||
| Accounts receivable |
( |
) | ||||||
| Inventories and other assets |
( |
) |
( |
) | ||||
| Accounts payable and accrued expenses |
( |
) | ||||||
| Government stimulus refund liability |
— |
|||||||
| Depreciation and amortization |
||||||||
| Income taxes |
( |
) |
||||||
| Losses (gains) on sales of facilities |
( |
) | ||||||
| Losses on retirement of debt |
||||||||
| Amortization of debt issuance costs and discounts |
||||||||
| Share-based compensation |
||||||||
| Other |
||||||||
| |
|
|
|
|||||
| Net cash provided by operating activities |
||||||||
| |
|
|
|
|||||
| Cash flows from investing activities: |
||||||||
| Purchase of property and equipment |
( |
) |
( |
) | ||||
| Acquisition of hospitals and health care entities |
( |
) |
( |
) | ||||
| Sales of hospitals and health care entities |
||||||||
| Change in investments |
( |
) |
||||||
| Other |
( |
) |
||||||
| |
|
|
|
|||||
| Net cash used in investing activities |
( |
) |
( |
) | ||||
| |
|
|
|
|||||
| Cash flows from financing activities: |
||||||||
| Issuances of long-term debt |
||||||||
| Net change in revolving bank credit facilities |
( |
) |
( |
) | ||||
| Repayment of long-term debt |
( |
) |
( |
) | ||||
| Distributions to noncontrolling interests |
( |
) |
( |
) | ||||
| Payment of debt issuance costs |
( |
) |
( |
) | ||||
| Payment of dividends |
( |
) |
( |
) | ||||
| Repurchases of common stock |
( |
) |
( |
) | ||||
| Other |
( |
) |
( |
) | ||||
| |
|
|
|
|||||
| Net cash used in financing activities |
( |
) |
( |
) | ||||
| |
|
|
|
|||||
| Effect of exchange rate changes on cash and cash equivalents |
( |
) |
( |
) | ||||
| |
|
|
|
|||||
| Change in cash and cash equivalents |
||||||||
| Cash and cash equivalents at beginning of period |
||||||||
| |
|
|
|
|||||
| Cash and cash equivalents at end of period |
$ |
$ |
||||||
| |
|
|
|
|||||
| Interest payments |
$ |
$ |
||||||
| Income tax payments, net |
$ |
$ |
||||||
Quarter |
||||||||||||||||
2020 |
Ratio |
2019 |
Ratio |
|||||||||||||
| Medicare |
$ |
% |
$ |
% | ||||||||||||
| Managed Medicare |
||||||||||||||||
| Medicaid |
||||||||||||||||
| Managed Medicaid |
||||||||||||||||
| Managed care and insurers |
||||||||||||||||
| International (managed care and insurers) |
||||||||||||||||
| Other |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Revenues |
$ |
% |
$ |
% | ||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
Nine Months |
||||||||||||||||
2020 |
Ratio |
2019 |
Ratio |
|||||||||||||
| Medicare |
$ |
% |
$ |
% | ||||||||||||
| Managed Medicare |
||||||||||||||||
| Medicaid |
||||||||||||||||
| Managed Medicaid |
||||||||||||||||
| Managed care and insurers |
||||||||||||||||
| International (managed care and insurers) |
||||||||||||||||
| Other |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Revenues |
$ |
% |
$ |
% | ||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
Quarter |
Nine Months |
|||||||||||||||
2020 |
2019 |
2020 |
2019 |
|||||||||||||
| Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) |
$ |
$ |
$ |
$ |
||||||||||||
| Cost-to-charges |
% |
% |
% |
% | ||||||||||||
| Total uncompensated care |
$ |
$ |
$ |
$ |
||||||||||||
| Multiply by the cost-to-charges |
% |
% |
% |
% | ||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Estimated cost of total uncompensated care |
$ |
$ |
$ |
$ |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
Quarter |
Nine Months |
|||||||||||||||
2020 |
2019 |
2020 |
2019 |
|||||||||||||
| Net income attributable to HCA Healthcare, Inc. |
$ |
$ |
$ |
$ |
||||||||||||
| Weighted average common shares outstanding |
||||||||||||||||
| Effect of dilutive incremental shares |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Shares used for diluted earnings per share |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Earnings per share: |
||||||||||||||||
| Basic earnings |
$ |
$ |
$ |
$ |
||||||||||||
| Diluted earnings |
$ |
$ |
$ |
$ |
||||||||||||
September 30, 2020 |
||||||||||||||||
Amortized Cost |
Unrealized Amounts |
Fair Value |
||||||||||||||
Gains |
Losses |
|||||||||||||||
| Debt securities |
$ |
$ |
$ |
— |
$ |
|||||||||||
| Money market funds and other |
— |
— |
||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
$ |
$ |
$ |
— |
|||||||||||||
| |
|
|
|
|
|
|||||||||||
| Amounts classified as current assets |
( |
) | ||||||||||||||
| |
|
|||||||||||||||
| Investment carrying value |
$ |
|||||||||||||||
| |
|
|||||||||||||||
December 31, 2019 |
||||||||||||||||
Amortized Cost |
Unrealized Amounts |
Fair Value |
||||||||||||||
Gains |
Losses |
|||||||||||||||
| Debt securities |
$ |
$ |
$ |
— |
$ |
|||||||||||
| Money market funds and other |
— |
— |
||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
$ |
$ |
$ |
— |
|||||||||||||
| |
|
|
|
|
|
|||||||||||
| Amounts classified as current assets |
( |
) | ||||||||||||||
| |
|
|||||||||||||||
| Investment carrying value |
$ |
|||||||||||||||
| |
|
|||||||||||||||
Amortized Cost |
Fair Value |
|||||||
| Due in one year or less |
$ |
$ |
||||||
| Due after one year through five years |
||||||||
| Due after five years through ten years |
||||||||
| Due after ten years |
||||||||
| |
|
|
|
|||||
$ |
$ |
|||||||
| |
|
|
|
|||||
Notional Amount |
Maturity Date |
Fair Value |
||||||||||
| Pay-fixed interest rate swaps |
$ |
$ |
( |
) | ||||||||
| Pay-fixed interest rate swaps |
( |
) | ||||||||||
| Derivatives in Cash Flow Hedging Relationships |
Amount of Loss Recognized in OCI on Derivatives, Net of |
Location of Loss Reclassified from Accumulated OCI into Operations |
Amount of Loss Reclassified from Accumulated OCI into Operations |
|||||||||
| Interest rate swaps |
$ |
Interest expense |
$ |
|||||||||
September 30, 2020 |
||||||||||||||||
Fair Value Measurements Using |
||||||||||||||||
Fair Value |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) |
Significant Other Observable Inputs (Level 2) |
Significant Unobservable Inputs (Level 3) |
|||||||||||||
| Assets: |
||||||||||||||||
| Investments of insurance subsidiaries: |
||||||||||||||||
| Debt securities |
$ |
$ |
— |
$ |
$ |
— |
||||||||||
| Money market funds and other |
— |
— |
||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Investments of insurance subsidiaries |
— |
|||||||||||||||
| Less amounts classified as current assets |
( |
) |
( |
) |
( |
) |
— |
|||||||||
| |
|
|
|
|
|
|
|
|||||||||
$ |
$ |
$ |
$ |
— |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Liabilities: |
||||||||||||||||
| Interest rate swaps (Income taxes and other liabilities) |
$ |
$ |
— |
$ |
$ |
— |
||||||||||
December 31, 2019 |
||||||||||||||||
Fair Value Measurements Using |
||||||||||||||||
Fair Value |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) |
Significant Other Observable Inputs (Level 2) |
Significant Unobservable Inputs (Level 3) |
|||||||||||||
| Assets: |
||||||||||||||||
| Investments of insurance subsidiaries: |
||||||||||||||||
| Debt securities |
$ |
$ |
— |
$ |
$ |
— |
||||||||||
| Money market funds and other |
— |
— |
||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Investments of insurance subsidiaries |
— |
|||||||||||||||
| Less amounts classified as current assets |
( |
) |
( |
) |
( |
) |
— |
|||||||||
| |
|
|
|
|
|
|
|
|||||||||
$ |
$ |
$ |
$ |
— |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Interest rate swaps (Other) |
$ |
$ |
— |
$ |
$ |
— |
||||||||||
| Liabilities: |
||||||||||||||||
| Interest rate swaps (Income taxes and other liabilities) |
$ |
$ |
— |
$ |
$ |
— |
||||||||||
September 30, 2020 |
December 31, 2019 |
|||||||
| Senior secured asset-based revolving credit facility |
$ |
$ |
||||||
| Senior secured revolving credit facility |
||||||||
| Senior secured 364-day term loan facility |
||||||||
| Senior secured term loan facilities (effective interest rate of |
||||||||
| Senior secured notes (effective interest rate of |
||||||||
| Other senior secured debt (effective interest rate of |
||||||||
| |
|
|
|
|||||
| Senior secured debt |
||||||||
| Senior unsecured notes (effective interest rate of |
||||||||
| Debt issuance costs and discounts |
( |
) |
( |
) | ||||
| |
|
|
|
|||||
| Total debt (average life of |
||||||||
| Less amounts due within one year |
||||||||
| |
|
|
|
|||||
$ |
$ |
|||||||
| |
|
|
|
|||||
Unrealized Gains on Available- for-Sale Securities |
Foreign Currency Translation Adjustments |
Defined Benefit Plans |
Change in Fair Value of Derivative Instruments |
Total |
||||||||||||||||
| Balances at December 31, 2019 |
$ |
$ |
( |
) |
$ |
( |
) |
$ |
( |
) |
$ |
( |
) | |||||||
| Unrealized gains on available-for-sale |
||||||||||||||||||||
| Foreign currency translation adjustments, net of $ |
( |
) |
( |
) | ||||||||||||||||
| Change in fair value of derivative instruments, net of $ |
( |
) |
( |
) | ||||||||||||||||
| Expense reclassified into operations from other comprehensive income, net of $ |
||||||||||||||||||||
| |
|
|
|
|
|
|
|
|
|
|||||||||||
| Balances at September 30, 2020 |
$ |
$ |
( |
) |
$ |
( |
) |
$ |
( |
) |
$ |
( |
) | |||||||
| |
|
|
|
|
|
|
|
|
|
|||||||||||
Quarter |
Nine Months |
|||||||||||||||
2020 |
2019 |
2020 |
2019 |
|||||||||||||
| Revenues: |
||||||||||||||||
| National Group |
$ |
$ |
$ |
$ |
||||||||||||
| American Group |
||||||||||||||||
| Corporate and other |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
$ |
$ |
$ |
$ |
|||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Equity in earnings of affiliates: |
||||||||||||||||
| National Group |
$ |
( |
) |
$ |
$ |
( |
) |
$ |
( |
) | ||||||
| American Group |
( |
) |
( |
) |
( |
) |
( |
) | ||||||||
| Corporate and other |
( |
) |
||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
$ |
( |
) |
$ |
( |
) |
$ |
( |
) |
$ |
( |
) | |||||
| |
|
|
|
|
|
|
|
|||||||||
| Adjusted segment EBITDA: |
||||||||||||||||
| National Group |
$ |
$ |
$ |
$ |
||||||||||||
| American Group |
||||||||||||||||
| Corporate and other |
( |
) |
( |
) |
( |
) |
( |
) | ||||||||
| |
|
|
|
|
|
|
|
|||||||||
$ |
$ |
$ |
$ |
|||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Depreciation and amortization: |
||||||||||||||||
| National Group |
$ |
$ |
$ |
$ |
||||||||||||
| American Group |
||||||||||||||||
| Corporate and other |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
$ |
$ |
$ |
$ |
|||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Adjusted segment EBITDA |
$ |
$ |
$ |
$ |
||||||||||||
| Depreciation and amortization |
||||||||||||||||
| Interest expense |
||||||||||||||||
| Losses (gains) on sales of facilities |
( |
) |
( |
) | ||||||||||||
| Losses on retirement of debt |
||||||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Income before income taxes |
$ |
$ |
$ |
$ |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
Quarter |
||||||||||||||||
2020 |
Ratio |
2019 |
Ratio |
|||||||||||||
| Medicare |
$ |
2,603 |
19.6 |
% |
$ |
2,592 |
20.4 |
% | ||||||||
| Managed Medicare |
1,760 |
13.2 |
1,615 |
12.7 |
||||||||||||
| Medicaid |
445 |
3.3 |
361 |
2.8 |
||||||||||||
| Managed Medicaid |
707 |
5.3 |
641 |
5.0 |
||||||||||||
| Managed care and insurers |
6,752 |
50.7 |
6,554 |
51.7 |
||||||||||||
| International (managed care and insurers) |
307 |
2.3 |
282 |
2.2 |
||||||||||||
| Other |
737 |
5.6 |
649 |
5.2 |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Revenues |
$ |
13,311 |
100.0 |
% |
$ |
12,694 |
100.0 |
% | ||||||||
| |
|
|
|
|
|
|
|
|||||||||
Nine Months |
||||||||||||||||
2020 |
Ratio |
2019 |
Ratio |
|||||||||||||
| Medicare |
$ |
7,618 |
20.5 |
% |
$ |
7,997 |
21.2 |
% | ||||||||
| Managed Medicare |
5,074 |
13.6 |
4,799 |
12.7 |
||||||||||||
| Medicaid |
1,423 |
3.8 |
1,124 |
3.0 |
||||||||||||
| Managed Medicaid |
1,904 |
5.1 |
1,808 |
4.8 |
||||||||||||
| Managed care and insurers |
19,028 |
51.0 |
19,405 |
51.1 |
||||||||||||
| International (managed care and insurers) |
838 |
2.3 |
863 |
2.3 |
||||||||||||
| Other |
1,355 |
3.7 |
1,817 |
4.9 |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Revenues |
$ |
37,240 |
100.0 |
% |
$ |
37,813 |
100.0 |
% | ||||||||
| |
|
|
|
|
|
|
|
|||||||||
Quarter |
Nine Months |
|||||||||||||||
2020 |
2019 |
2020 |
2019 |
|||||||||||||
| Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) |
$ |
11,170 |
$ |
11,060 |
$ |
32,428 |
$ |
32,619 |
||||||||
| Cost-to-charges |
12.0 |
% |
12.3 |
% |
12.1 |
% |
12.1 |
% | ||||||||
| Total uncompensated care |
$ |
7,023 |
$ |
7,923 |
$ |
21,625 |
$ |
22,703 |
||||||||
| Multiply by the cost-to-charges |
12.0 |
% |
12.3 |
% |
12.1 |
% |
12.1 |
% | ||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Estimated cost of total uncompensated care |
$ |
843 |
$ |
975 |
$ |
2,617 |
$ |
2,747 |
||||||||
| |
|
|
|
|
|
|
|
|||||||||
Quarter |
Nine Months |
|||||||||||||||
2020 |
2019 |
2020 |
2019 |
|||||||||||||
| Medicare |
25 |
% |
28 |
% |
26 |
% |
29 |
% | ||||||||
| Managed Medicare |
19 |
18 |
19 |
19 |
||||||||||||
| Medicaid |
5 |
5 |
6 |
5 |
||||||||||||
| Managed Medicaid |
13 |
12 |
12 |
12 |
||||||||||||
| Managed care and insurers |
30 |
28 |
29 |
27 |
||||||||||||
| Uninsured |
8 |
9 |
8 |
8 |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
100 |
% |
100 |
% |
100 |
% |
100 |
% | |||||||||
| |
|
|
|
|
|
|
|
|||||||||
Quarter |
Nine Months |
|||||||||||||||
2020 |
2019 |
2020 |
2019 |
|||||||||||||
| Medicare |
25 |
% |
28 |
% |
27 |
% |
28 |
% | ||||||||
| Managed Medicare |
15 |
14 |
15 |
15 |
||||||||||||
| Medicaid |
5 |
4 |
5 |
4 |
||||||||||||
| Managed Medicaid |
6 |
6 |
6 |
5 |
||||||||||||
| Managed care and insurers |
49 |
47 |
47 |
47 |
||||||||||||
| Uninsured |
— |
1 |
— |
1 |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
100 |
% |
100 |
% |
100 |
% |
100 |
% | |||||||||
| |
|
|
|
|
|
|
|
|||||||||
Quarter |
||||||||||||||||
2020 |
2019 |
|||||||||||||||
Amount |
Ratio |
Amount |
Ratio |
|||||||||||||
| Revenues |
$ |
13,311 |
100.0 |
$ |
12,694 |
100.0 |
||||||||||
| Salaries and benefits |
6,097 |
45.8 |
5,971 |
47.0 |
||||||||||||
| Supplies |
2,128 |
16.0 |
2,090 |
16.5 |
||||||||||||
| Other operating expenses |
2,251 |
16.9 |
2,352 |
18.5 |
||||||||||||
| Government stimulus income reversal |
822 |
6.2 |
— |
— |
||||||||||||
| Equity in earnings of affiliates |
(40 |
) |
(0.3 |
) |
(4 |
) |
— |
|||||||||
| Depreciation and amortization |
694 |
5.2 |
647 |
5.1 |
||||||||||||
| Interest expense |
385 |
2.9 |
448 |
3.5 |
||||||||||||
| Gains on sales of facilities |
(14 |
) |
( 0.1 |
) |
— |
— |
||||||||||
| Losses on retirement of debt |
— |
— |
211 |
1.7 |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
12,323 |
92.6 |
11,715 |
92.3 |
|||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Income before income taxes |
988 |
7.4 |
979 |
7.7 |
||||||||||||
| Provision for income taxes |
209 |
1.5 |
215 |
1.7 |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Net income |
779 |
5.9 |
764 |
6.0 |
||||||||||||
| Net income attributable to noncontrolling interests |
111 |
0.9 |
152 |
1.2 |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Net income attributable to HCA Healthcare, Inc. |
$ |
668 |
5.0 |
$ |
612 |
4.8 |
||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| % changes from prior year: |
||||||||||||||||
| Revenues |
4.9 |
% |
10.9 |
% |
||||||||||||
| Income before income taxes |
0.9 |
(8.4 |
) |
|||||||||||||
| Net income attributable to HCA Healthcare, Inc. |
9.0 |
(19.3 |
) |
|||||||||||||
| Admissions(a) |
(3.9 |
) |
5.9 |
|||||||||||||
| Equivalent admissions(b) |
(9.1 |
) |
7.5 |
|||||||||||||
| Revenue per equivalent admission |
15.3 |
3.1 |
||||||||||||||
| Same facility % changes from prior year(c): |
||||||||||||||||
| Revenues |
4.5 |
6.3 |
||||||||||||||
| Admissions(a) |
(3.8 |
) |
3.2 |
|||||||||||||
| Equivalent admissions(b) |
(9.0 |
) |
4.2 |
|||||||||||||
| Revenue per equivalent admission |
14.8 |
2.0 |
||||||||||||||
Nine Months |
||||||||||||||||
2020 |
2019 |
|||||||||||||||
Amount |
Ratio |
Amount |
Ratio |
|||||||||||||
| Revenues |
$ |
37,240 |
100.0 |
$ |
37,813 |
100.0 |
||||||||||
| Salaries and benefits |
17,545 |
47.1 |
17,455 |
46.2 |
||||||||||||
| Supplies |
5,999 |
16.1 |
6,249 |
16.5 |
||||||||||||
| Other operating expenses |
6,825 |
18.3 |
7,013 |
18.6 |
||||||||||||
| Equity in earnings of affiliates |
(48 |
) |
(0.1 |
) |
(23 |
) |
(0.1 |
) | ||||||||
| Depreciation and amortization |
2,059 |
5.6 |
1,902 |
4.9 |
||||||||||||
| Interest expense |
1,201 |
3.2 |
1,386 |
3.7 |
||||||||||||
| Losses (gains) on sales of facilities |
6 |
— |
(17 |
) |
— |
|||||||||||
| Losses on retirement of debt |
295 |
0.8 |
211 |
0.6 |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
33,882 |
91.0 |
34,176 |
90.4 |
|||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Income before income taxes |
3,358 |
9.0 |
3,637 |
9.6 |
||||||||||||
| Provision for income taxes |
665 |
1.8 |
765 |
2.0 |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Net income |
2,693 |
7.2 |
2,872 |
7.6 |
||||||||||||
| Net income attributable to noncontrolling interests |
365 |
0.9 |
438 |
1.2 |
||||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| Net income attributable to HCA Healthcare, Inc. |
$ |
2,328 |
6.3 |
$ |
2,434 |
6.4 |
||||||||||
| |
|
|
|
|
|
|
|
|||||||||
| % changes from prior year: |
||||||||||||||||
| Revenues |
(1.5 |
)% |
9.9 |
% |
||||||||||||
| Income before income taxes |
(7.7 |
) |
(5.4 |
) |
||||||||||||
| Net income attributable to HCA Healthcare, Inc. |
(4.4 |
) |
(10.6 |
) |
||||||||||||
| Admissions(a) |
(5.1 |
) |
4.6 |
|||||||||||||
| Equivalent admissions(b) |
(9.8 |
) |
6.2 |
|||||||||||||
| Revenue per equivalent admission |
9.1 |
3.5 |
||||||||||||||
| Same facility % changes from prior year(c): |
||||||||||||||||
| Revenues |
(2.1 |
) |
5.7 |
|||||||||||||
| Admissions(a) |
(5.3 |
) |
2.1 |
|||||||||||||
| Equivalent admissions(b) |
(9.9 |
) |
3.0 |
|||||||||||||
| Revenue per equivalent admission |
8.6 |
2.6 |
||||||||||||||
(a) |
Represents the total number of patients admitted to our hospitals and is used by management and certain investors as a general measure of inpatient volume. |
(b) |
Equivalent admissions are used by management and certain investors as a general measure of combined inpatient and outpatient volume. Equivalent admissions are computed by multiplying admissions (inpatient volume) by the sum of gross inpatient revenues and gross outpatient revenues and then dividing the resulting amount by gross inpatient revenues. The equivalent admissions computation “equates” outpatient revenues to the volume measure (admissions) used to measure inpatient volume, resulting in a general measure of combined inpatient and outpatient volume. |
(c) |
Same facility information excludes the operations of hospitals and their related facilities which were either acquired or divested during the current and prior period. |
Nine Months September 30, 2020 |
Year December 31, 2019 |
|||||||
| Revenues |
$ |
22,406 |
$ |
29,220 |
||||
| Income before income taxes |
2,642 |
3,912 |
||||||
| Net income |
2,071 |
2,993 |
||||||
| Net income attributable to Parent, Subsidiary Issuer and Subsidiary Guarantors |
2,017 |
2,902 |
||||||
| At September 30, 2020 and December 31, 2019: |
||||||||
September 30, 2020 |
December 31, 2019 |
|||||||
| Current assets |
$ |
11,252 |
$ |
6,090 |
||||
| Property and equipment, net |
14,795 |
13,418 |
||||||
| Goodwill and other intangible assets |
5,777 |
5,743 |
||||||
| Total noncurrent assets |
21,640 |
19,977 |
||||||
| Total assets |
32,892 |
26,067 |
||||||
| Current liabilities |
9,528 |
4,504 |
||||||
| Long-term debt, net |
30,457 |
33,227 |
||||||
| Intercompany balances |
2,901 |
(53 |
) | |||||
| Income taxes and other liabilities |
799 |
879 |
||||||
| Total noncurrent liabilities |
34,654 |
34,398 |
||||||
| Stockholders’ deficit attributable to Parent, Subsidiary Issuer and Subsidiary Guarantors |
(11,392 |
) |
(12,941 |
) | ||||
| Noncontrolling interests |
102 |
106 |
||||||
2020 |
2019 |
|||||||
| Number of hospitals in operation at: |
||||||||
| March 31 |
186 |
185 |
||||||
| June 30 |
186 |
184 |
||||||
| September 30 |
187 |
184 |
||||||
| December 31 |
184 |
|||||||
| Number of freestanding outpatient surgical centers in operation at: |
||||||||
| March 31 |
123 |
124 |
||||||
| June 30 |
122 |
125 |
||||||
| September 30 |
121 |
125 |
||||||
| December 31 |
123 |
|||||||
| Licensed hospital beds at(a): |
||||||||
| March 31 |
49,357 |
48,455 |
||||||
| June 30 |
49,403 |
48,483 |
||||||
| September 30 |
49,473 |
48,588 |
||||||
| December 31 |
49,035 |
|||||||
| Weighted average licensed beds(b): |
||||||||
| Quarter: |
||||||||
| First |
49,160 |
48,036 |
||||||
| Second |
49,358 |
48,429 |
||||||
| Third |
49,479 |
48,535 |
||||||
| Fourth |
48,911 |
|||||||
| Year |
48,480 |
|||||||
| Average daily census(c): |
||||||||
| Quarter: |
||||||||
| First |
28,822 |
28,966 |
||||||
| Second |
24,844 |
27,808 |
||||||
| Third |
28,186 |
27,502 |
||||||
| Fourth |
28,274 |
|||||||
| Year |
28,134 |
|||||||
| Admissions(d): |
||||||||
| Quarter: |
||||||||
| First |
528,244 |
523,196 |
||||||
| Second |
452,992 |
518,253 |
||||||
| Third |
506,756 |
527,284 |
||||||
| Fourth |
540,194 |
|||||||
| Year |
2,108,927 |
|||||||
| Equivalent admissions(e): |
||||||||
| Quarter: |
||||||||
| First |
889,035 |
889,956 |
||||||
| Second |
723,136 |
903,419 |
||||||
| Third |
835,576 |
918,964 |
||||||
| Fourth |
933,996 |
|||||||
| Year |
3,646,335 |
|||||||
2020 |
2019 |
|||||||
| Average length of stay (days)(f): |
||||||||
| Quarter: |
||||||||
| First |
5.0 |
5.0 |
||||||
| Second |
5.0 |
4.9 |
||||||
| Third |
5.1 |
4.8 |
||||||
| Fourth |
4.8 |
|||||||
| Year |
4.9 |
|||||||
| Emergency room visits(g): |
||||||||
| Quarter: |
||||||||
| First |
2,264,707 |
2,287,440 |
||||||
| Second |
1,516,116 |
2,253,337 |
||||||
| Third |
1,813,661 |
2,269,364 |
||||||
| Fourth |
2,350,988 |
|||||||
| Year |
9,161,129 |
|||||||
| Outpatient surgeries(h): |
||||||||
| Quarter: |
||||||||
| First |
226,319 |
240,846 |
||||||
| Second |
170,911 |
253,441 |
||||||
| Third |
232,493 |
249,177 |
||||||
| Fourth |
266,483 |
|||||||
| Year |
1,009,947 |
|||||||
| Inpatient surgeries(i): |
||||||||
| Quarter: |
||||||||
| First |
135,145 |
137,363 |
||||||
| Second |
118,591 |
140,473 |
||||||
| Third |
133,492 |
143,215 |
||||||
| Fourth |
145,584 |
|||||||
| Year |
566,635 |
|||||||
| Days revenues in accounts receivable(j): |
||||||||
| Quarter: |
||||||||
| First |
49 |
53 |
||||||
| Second |
50 |
52 |
||||||
| Third |
44 |
52 |
||||||
| Fourth |
50 |
|||||||
| Outpatient revenues as a % of patient revenues(k): |
||||||||
| Quarter: |
||||||||
| First |
37 |
% |
38 |
% | ||||
| Second |
32 |
% |
39 |
% | ||||
| Third |
36 |
% |
39 |
% | ||||
| Fourth |
39 |
% | ||||||
| Year |
39 |
% | ||||||
(a) |
Licensed beds are those beds for which a facility has been granted approval to operate from the applicable state licensing agency. |
(b) |
Represents the average number of licensed beds, weighted based on periods owned. |
(c) |
Represents the average number of patients in our hospital beds each day. |
(d) |
Represents the total number of patients admitted to our hospitals and is used by management and certain investors as a general measure of inpatient volume. |
(e) |
Equivalent admissions are used by management and certain investors as a general measure of combined inpatient and outpatient volume. Equivalent admissions are computed by multiplying admissions (inpatient volume) by the sum of gross inpatient revenues and gross outpatient revenues and then dividing the resulting amount by gross inpatient revenues. The equivalent admissions computation “equates” outpatient revenues to the volume measure (admissions) used to measure inpatient volume resulting in a general measure of combined inpatient and outpatient volume. |
(f) |
Represents the average number of days admitted patients stay in our hospitals. |
(g) |
Represents the number of patients treated in our emergency rooms. |
(h) |
Represents the number of surgeries performed on patients who were not admitted to our hospitals. Pain management and endoscopy procedures are not included in outpatient surgeries. |
(i) |
Represents the number of surgeries performed on patients who have been admitted to our hospitals. Pain management and endoscopy procedures are not included in inpatient surgeries. |
(j) |
Revenues per day is calculated by dividing revenues for the quarter by the days in the quarter. Days revenues in accounts receivable is then calculated as accounts receivable at the end of the quarter divided by revenues per day. |
(k) |
Represents the percentage of patient revenues related to patients who are not admitted to our hospitals. |
ITEM 2. UNREGISTERED |
SALES OF EQUITY SECURITIES AND USE OF PROCEEDS |
ITEM 6. EXHIBITS |
22 |
— |
|||
31.1 |
— |
|||
31.2 |
— |
|||
32 |
— |
|||
101 |
— |
The following financial information from our quarterly report on Form 10-Q for the quarters and nine months ended September 30, 2020 and 2019, filed with the SEC on October 29, 2020, formatted in Inline Extensible Business Reporting Language: (i) the condensed consolidated balance sheets at September 30, 2020 and December 31, 2019, (ii) the condensed consolidated income statements for the quarters and nine months ended September 30, 2020 and 2019, (iii) the condensed consolidated comprehensive income statements for the quarters and nine months ended September 30, 2020 and 2019, (iv) the condensed consolidated statements of stockholders’ equity (deficit) for the quarters and nine months ended September 30, 2020 and 2019, (v) the condensed consolidated statements of cash flows for the nine months ended September 30, 2020 and 2019 and (vi) the notes to condensed consolidated financial statements. The instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document. | ||
104 |
— |
The cover page from the Company’s Quarterly Report on Form 10-Q for the quarter ended September 30, 2020, formatted in Inline XBRL (included in Exhibit 101). | ||
| HCA Healthcare, Inc. | ||
| By: |
/S/ WILLIAM B. RUTHERFORD | |
William B. Rutherford | ||
Executive Vice President and Chief Financial Officer | ||
EXHIBIT 31.1
CERTIFICATION
I, Samuel N. Hazen, certify that:
1. I have reviewed this quarterly report on Form 10-Q of HCA Healthcare, Inc.;
2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;
3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;
4. The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:
(a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;
(b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;
(c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and
(d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and
5. The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):
(a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and
(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.
| By: |
/S/ SAMUEL N. HAZEN | |
| Samuel N. Hazen | ||
| Chief Executive Officer |
Date: October 29, 2020
EXHIBIT 31.2
CERTIFICATION
I, William B. Rutherford, certify that:
1. I have reviewed this quarterly report on Form 10-Q of HCA Healthcare, Inc.;
2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;
3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;
4. The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:
(a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;
(b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;
(c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and
(d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and
5. The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):
(a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and
(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.
| By: |
/S/ WILLIAM B. RUTHERFORD | |
| William B. Rutherford | ||
| Executive Vice President and Chief Financial Officer |
Date: October 29, 2020
EXHIBIT 32
CERTIFICATION PURSUANT TO
18 U.S.C. SECTION 1350,
AS ADOPTED PURSUANT TO
SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002
In connection with the Quarterly Report of HCA Healthcare, Inc. (the “Company”) on Form 10-Q for the quarter ended September 30, 2020, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), each of the undersigned certifies, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that:
(1) The Report fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934; and
(2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.
| By: |
/S/ SAMUEL N. HAZEN | |
| Samuel N. Hazen | ||
| Chief Executive Officer |
October 29, 2020
| By: |
/S/ WILLIAM B. RUTHERFORD | |
|
William B. Rutherford | ||
| Executive Vice President and Chief Financial Officer |
October 29, 2020
Condensed Consolidated Income Statements - USD ($) shares in Thousands, $ in Millions |
3 Months Ended | 9 Months Ended | ||
|---|---|---|---|---|
Sep. 30, 2020 |
Sep. 30, 2019 |
Sep. 30, 2020 |
Sep. 30, 2019 |
|
| Income Statement [Abstract] | ||||
| Revenues | $ 13,311 | $ 12,694 | $ 37,240 | $ 37,813 |
| Salaries and benefits | 6,097 | 5,971 | 17,545 | 17,455 |
| Supplies | 2,128 | 2,090 | 5,999 | 6,249 |
| Other operating expenses | 2,251 | 2,352 | 6,825 | 7,013 |
| Government stimulus income reversal | 822 | 0 | ||
| Equity in earnings of affiliates | (40) | (4) | (48) | (23) |
| Depreciation and amortization | 694 | 647 | 2,059 | 1,902 |
| Interest expense | 385 | 448 | 1,201 | 1,386 |
| Losses (gains) on sales of facilities | (14) | 0 | 6 | (17) |
| Losses on retirement of debt | 0 | 211 | 295 | 211 |
| Total expenses including equity in earnings of affiliates | 12,323 | 11,715 | 33,882 | 34,176 |
| Income before income taxes | 988 | 979 | 3,358 | 3,637 |
| Provision for income taxes | 209 | 215 | 665 | 765 |
| Net income | 779 | 764 | 2,693 | 2,872 |
| Net income attributable to noncontrolling interests | 111 | 152 | 365 | 438 |
| Net income attributable to HCA Healthcare, Inc. | $ 668 | $ 612 | $ 2,328 | $ 2,434 |
| Per share data: | ||||
| Basic earnings | $ 1.97 | $ 1.80 | $ 6.89 | $ 7.12 |
| Diluted earnings | $ 1.95 | $ 1.76 | $ 6.79 | $ 6.98 |
| Shares used in earnings per share calculations (in millions): | ||||
| Basic | 338,168 | 340,789 | 338,057 | 341,932 |
| Diluted | 343,346 | 347,487 | 343,014 | 348,712 |
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions |
Sep. 30, 2020 |
Dec. 31, 2019 |
|---|---|---|
| Statement of Financial Position [Abstract] | ||
| Debt issuance costs | $ 245 | $ 239 |
| Common stock, par value | $ 0.01 | $ 0.01 |
| Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 |
| Common stock, shares outstanding | 338,370,500 | 338,445,600 |
Condensed Consolidated Statements of Stockholders' Deficit (Parenthetical) - $ / shares |
3 Months Ended | ||||
|---|---|---|---|---|---|
Mar. 31, 2020 |
Dec. 31, 2019 |
Sep. 30, 2019 |
Jun. 30, 2019 |
Mar. 31, 2019 |
|
| Statement of Stockholders' Equity [Abstract] | |||||
| Cash dividends declared, per share | $ 0.43 | $ 0.40 | $ 0.40 | $ 0.40 | $ 0.40 |
Basis of Presentation and Significant Accounting Policies |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2020 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Accounting Policies [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Basis of Presentation and Significant Accounting Policies | NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES Reporting Entity HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At September 30, 2020, these affiliates owned and operated 187 hospitals, 121 freestanding surgery centers and provided extensive outpatient and ancillary services. HCA Healthcare, Inc.’s facilities are located in 21 states and England. The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicated by context, refer to HCA Healthcare, Inc. and its affiliates. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included and are of a normal and recurring nature. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $117 million and $88 million for the quarters ended September 30, 2020 and 2019, respectively, and $289 million and $268 million for the nine months ended September 30, 2020 and 2019, respectively. Operating results for the quarter and nine months ended September 30, 2020 are not necessarily indicative of the results that may be expected for the year ending December 31, 2020. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K for the year ended December 31, 2019. COVID-19 Pandemic and CARES Act Funding On March 11, 2020, the World Health Organization designated COVID-19 as a global pandemic. Patient volumes and the related revenues for most of our services were significantly impacted during the latter portion of the first quarter and the first half of the second quarter and have continued to be impacted into the third quarter of 2020 as various policies were implemented by federal, state and local governments in response to the COVID-19 pandemic that have caused many people to remain at home and forced the closure of or limitations on certain businesses, as well as suspended elective surgical procedures by health care facilities. While many of these restrictions have been eased across the U.S. and most states have lifted moratoriums on non-emergent procedures, some restrictions remain in place, and we are unable to predict the future impact of the pandemic on our operations. During the nine months ended September 30, 2020, we received $4.449 billion of accelerated Medicare payments and $1.674 billion in general and targeted distributions from the Provider Relief Fund (net of amounts returned), both as provided for and established under the Coronavirus Aid, Relief and Economic Security (“CARES”) Act. The Provider Relief Fund distributions were accounted for as government grants, and recognized on a systematic and rational basis as other income, once there is reasonable assurance that the applicable terms and conditions required to retain the funds will be met. Based on our analysis of the compliance and reporting requirements of the Provider Relief Fund and the impact of the pandemic on our operating results from the beginning of the pandemic in March through June 30, 2020, we recognized $822 million related to the general distribution funds during the quarter ended June 30, 2020. During the quarter ended September 30, 2020, we continued to evaluate our operating results and gave consideration to the updated reporting guidelines issued in September by the U.S. Department of Health and Human Services that significantly changed the measurement of Provider Relief Fund distributions providers are able to retain. Based on our assessment of the likelihood of meeting the applicable terms and conditions of the Provider Relief Fund, during the quarter ended September 30, 2020 we reversed the $822 million of government stimulus income recognized during the quarter ended June 30, 2020. On October 8, 2020, we announced our decision to return, or repay early, all of our share of the Provider Relief Fund distributions of approximately $1.6 billion and the approximately $4.4 billion of Medicare accelerated payments. The total accelerated Medicare payments and Provider Relief Fund distributions received are recorded under the caption “government stimulus refund liability” in our condensed consolidated balance sheet at September 30, 20 2 0. The CARES Act also provides for a deferral of payments of the employer portion of Social Security tax incurred during the pandemic, allowing half of such payroll taxes to be deferred until December 2021 and the remaining half until December 2022. At September 30, 2020, the Company had deferred $441 million of Social Security taxes. Additionally, the CARES Act created a payroll tax credit designed to encourage companies to retain employees during the pandemic. During the nine months ended September 30, 2020, the Company evaluated its eligibility for this credit and recorded $60 million of employee retention payroll tax credits pursuant to the CARES Act. These tax credits are recorded as a reduction of salaries and benefits in our condensed consolidated income statement. We believe the extent of the COVID-19 pandemic’s impact on our operating results and financial condition has been and will continue to be driven by many factors, most of which are beyond our control and ability to forecast. Such factors include, but are not limited to, the scope and duration of stay-at-home Revenues Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service out-of-network Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective care, who have income at or below 400% of the federal poverty level, are eligible for charity care. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and nine months ended September 30, 2020 and 2019 are summarized in the following table (dollars in millions):
To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and nine months ended September 30, 2020 and 2019 follows (dollars in millions):
The total uncompensated care amounts include charity care of $3.160 billion and $3.425 billion, respectively, and the related estimated costs of charity care were $376 million and $421 million, for the quarters ended September 30, 2020 and 2019, respectively. The total uncompensated care amounts include charity care of $9.972 billion and $9.641 billion, respectively, and the related estimated costs of charity care were $1.207 billion and $1.167 billion, for the nine months ended September 30, 2020 and 2019, respectively. Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
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Acquisitions and Dispositions |
9 Months Ended |
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Sep. 30, 2020 | |
| Business Combinations [Abstract] | |
| Acquisitions and Dispositions | NOTE 2 — ACQUISITIONS AND DISPOSITIONS During the nine months ended September 30, 2020, we paid $380 million to acquire a . Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values. The purchase price paid in excess of the fair value of identifiable net assets of these acquired entities aggregated $309 million for the nine months ended September 30, 2020. During the nine months ended September 30, 2019, we paid $1.399 billion to acquire a seven-hospital health system in North Carolina and $193 million to acquire other nonhospital health care entities. The consolidated financial statements include the accounts and operations of the acquired entities subsequent to the respective acquisition dates. The pro forma effects of these acquired entities on our results of operations for periods prior to the respective acquisition dates were not significant. During the nine months ended September 30, 2020, we received proceeds of $68 million and recognized a net pretax loss of $6 million related to the sale of a hospital facility in Mississippi and sales of real estate and other investments. During the nine months ended September 30, 2019, we received proceeds of $49 million and recognized a net pretax gain of $17 million related to a sale of a hospital facility in one of our Louisiana markets and sales of real estate and other investments. |
Income Taxes |
9 Months Ended |
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Sep. 30, 2020 | |
| Income Tax Disclosure [Abstract] | |
| Income Taxes | NOTE 3 — INCOME TAXES Our provision for income taxes for the quarters ended September 30, 2020 and 2019 was $209 million and $215 million, respectively, and the effective tax rates were 23.8% and 26.0%, respectively. Our provision for income taxes for the nine months ended September 30, 2020 and 2019 was $665 million and $765 million, respectively, and the effective tax rates were 22.2% and 23.9%, respectively. Our provision for income taxes included tax benefits related to the settlement of employee equity awards of $59 million and $56 million for the nine months ended September 30, 2020 and 2019, respectively. Our liability for unrecognized tax benefits was $523 million, including accrued interest of $74 million, as of September 30, 2020 ($550 million and $62 million, respectively, as of December 31, 2019). Unrecognized tax benefits of $167 million ($160 million as of December 31, 2019) would affect the effective rate, if recognized. The Internal Revenue Service was conducting an examination of the Company’s 2016, 2017 and 2018 federal income tax returns at September 30, 2020. We are also subject to examination by state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change. |
Earnings Per Share |
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| Earnings Per Share [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Earnings Per Share | NOTE 4 — EARNINGS PER SHARE We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards and potential shares, computed using the treasury stock method. The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2020 and 2019 (dollars and shares in millions, except per share amounts):
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Investments of Insurance Subsidiaries |
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| Investments, Debt and Equity Securities [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Investments of Insurance Subsidiaries | NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES A summary of our insurance subsidiaries’ investments at September 30, 2020 and December 31, 2019 follows (dollars in millions):
At September 30, 2020 and December 31, 2019, the investments in debt securities of our insurance subsidiaries were classified as “available-for-sale.” Scheduled maturities of investments in debt securities at September 30, 2020 were as follows (dollars in millions):
The average expected maturity of the investments in debt securities at September 30, 2020 was 5.5 years, compared to the average scheduled maturity of 9.8 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to their scheduled maturity date. |
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Financial Instruments |
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| Derivative Instruments and Hedging Activities Disclosure [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Financial Instruments | NOTE 6 — FINANCIAL INSTRUMENTS Interest Rate Swap Agreements We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between us and our counterparties based on common notional principal amounts and maturity dates. Pay-fixed interest rate swaps effectively convert variable rate obligations to fixed interest rate obligations. The interest payments under these agreements are settled on a net basis. The net interest payments, based on the notional amounts in these agreements, generally match the timing of the related liabilities for the interest rate swap agreements which have been designated as cash flow hedges. The notional amounts of the swap agreements represent amounts used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions. The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at September 30, 2020 (dollars in millions):
During the next 12 months, we estimate $36 million will be reclassified from other comprehensive income (“OCI”) and will be included in interest expense. Derivatives — Results of Operations The following table presents the effect of our interest rate swaps on our results of operations for the nine months ended September 30, 2020 (dollars in millions):
Credit-risk-related Contingent Features We have agreements with each of our derivative counterparties that contain a provision where we could be declared in default on our derivative obligations if repayment of the underlying indebtedness is accelerated by the lender due to our default on the indebtedness. As of September 30, 2020, we have not been required to post any collateral related to these agreements. If we had breached these provisions at September 30, 2020, we would have been required to settle our obligations under the agreements at their aggregate, estimated termination value of $55 million. |
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Assets and Liabilities Measured at Fair Value |
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| Fair Value Disclosures [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Assets and Liabilities Measured at Fair Value | NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE Accounting Standards Codification 820, Fair Value Measurements and Disclosures Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment. Cash Traded Investments Our cash traded investments are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. Derivative Financial Instruments We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments. The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of September 30, 2020 and December 31, 2019, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):
The estimated fair value of our long-term debt was $34.739 billion and $37.026 billion at September 30, 2020 and December 31, 2019, respectively, compared to carrying amounts, excluding debt issuance costs and discounts, aggregating $31.209 billion and $33.961 billion, respectively. The estimates of fair value are generally based upon the quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities. |
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Long-Term Debt |
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| Debt Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Long-Term Debt | NOTE 8 — LONG-TERM DEBT A summary of long-term debt at September 30, 2020 and December 31, 2019, including related interest rates at September 30, 2020, follows (dollars in millions):
During February 2020, we issued $2.700 billion aggregate principal amount of 3.50% senior notes due 2030. During March 2020, we used the net proceeds for the redemption of all $1.000 billion outstanding aggregate principal amount of HCA Healthcare, Inc.’s 6.25% senior notes due 2021 and, together with available funds, for the redemption of all $2.000 billion outstanding aggregate principal amount of HCA Inc.’s 7.50% senior notes due 2022. The pretax loss on retirement of debt was $295 million. In response to the risks the COVID-19 pandemic presents to our business, during March 2020, we entered into a credit agreement that provides for a 364-day secured term loan facility for an aggregate principal amount of up to $2.000 billion. The facility will mature in March 2021. If drawn, amounts outstanding under the credit agreement will bear interest at either (i) the LIBOR rate plus 2.50% or (ii) an alternate base rate as defined in the credit agreement. As of September 30, 2020 there were no amounts outstanding nor draw notices pending under the facility. |
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Contingencies |
9 Months Ended |
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Sep. 30, 2020 | |
| Commitments and Contingencies Disclosure [Abstract] | |
| Contingencies | NOTE 9 — CONTINGENCIES We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity. Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam Texas operates a state Medicaid program pursuant to a waiver from the Centers for Medicare & Medicaid Services (“CMS”) under Section 1115 of the Social Security Act (“Program”). The Program includes uncompensated-care pools; payments from these pools are intended to defray the uncompensated costs of services provided by our and other hospitals to Medicaid eligible or uninsured individuals. Separately, we and other hospitals provide charity care services in several communities in the state. In 2018, the Civil Division of the U.S. Department of Justice and the U.S. Attorney’s Office for the Southern District of Texas requested information about whether the Program, as operated in Harris County, complied with the laws and regulations applicable to provider related donations, and the Company cooperated with that request. On May 21, 2019, a qui tam qui tam qui tam |
Share Repurchase Transactions and Other Comprehensive Loss |
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| Federal Home Loan Banks [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Share Repurchases Transactions and Other Comprehensive Loss | NOTE 10 — SHARE REPURCHASE TRANSACTIONS AND OTHER COMPREHENSIVE LOSS During January 2020 and 2019, our Board of Directors authorized share repurchase programs for up to $4 billion ($2 billion for each authorization) of our outstanding common stock. In response to the risks the COVID-19 pandemic presents to our business, during March 2020, we announced the suspension of our share repurchase programs and expect to evaluate the resumption of the programs at a future date. During the quarter ended March 31, 2020, we repurchased 3.287 million shares of our common stock at an average price of $134.18 per share through market purchases pursuant to the $2.0 billion share repurchase program authorized during January 2019, and we made no repurchases during the quarters ended June 30, 2020 or September 30, 2020. At September 30, 2020, we had $2.800 billion of repurchase authorization available under the January 2019 and 2020 authorizations. The components of accumulated other comprehensive loss are as follows (dollars in millions):
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Segment and Geographic Information |
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| Segment Reporting [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Segment and Geographic Information | NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION We operate in one line of business, which is operating hospitals and related health care entities. We operate in two geographically organized groups: the National and American Groups. The National Group includes 96 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, North Carolina, South Carolina, Utah and Virginia, and the American Group includes 84 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Mississippi, Missouri, Tennessee and Texas. We also operate seven hospitals in England, and these facilities are included in the Corporate and other group. Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses (gains) on sales of facilities, losses on retirement of debt, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2020 and 2019 are summarized in the following table (dollars in millions):
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Basis of Presentation and Significant Accounting Policies (Policies) |
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| Basis of Presentation | Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included and are of a normal and recurring nature. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $117 million and $88 million for the quarters ended September 30, 2020 and 2019, respectively, and $289 million and $268 million for the nine months ended September 30, 2020 and 2019, respectively. Operating results for the quarter and nine months ended September 30, 2020 are not necessarily indicative of the results that may be expected for the year ending December 31, 2020. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K for the year ended December 31, 2019. COVID-19 Pandemic and CARES Act Funding On March 11, 2020, the World Health Organization designated COVID-19 as a global pandemic. Patient volumes and the related revenues for most of our services were significantly impacted during the latter portion of the first quarter and the first half of the second quarter and have continued to be impacted into the third quarter of 2020 as various policies were implemented by federal, state and local governments in response to the COVID-19 pandemic that have caused many people to remain at home and forced the closure of or limitations on certain businesses, as well as suspended elective surgical procedures by health care facilities. While many of these restrictions have been eased across the U.S. and most states have lifted moratoriums on non-emergent procedures, some restrictions remain in place, and we are unable to predict the future impact of the pandemic on our operations. During the nine months ended September 30, 2020, we received $4.449 billion of accelerated Medicare payments and $1.674 billion in general and targeted distributions from the Provider Relief Fund (net of amounts returned), both as provided for and established under the Coronavirus Aid, Relief and Economic Security (“CARES”) Act. The Provider Relief Fund distributions were accounted for as government grants, and recognized on a systematic and rational basis as other income, once there is reasonable assurance that the applicable terms and conditions required to retain the funds will be met. Based on our analysis of the compliance and reporting requirements of the Provider Relief Fund and the impact of the pandemic on our operating results from the beginning of the pandemic in March through June 30, 2020, we recognized $822 million related to the general distribution funds during the quarter ended June 30, 2020. During the quarter ended September 30, 2020, we continued to evaluate our operating results and gave consideration to the updated reporting guidelines issued in September by the U.S. Department of Health and Human Services that significantly changed the measurement of Provider Relief Fund distributions providers are able to retain. Based on our assessment of the likelihood of meeting the applicable terms and conditions of the Provider Relief Fund, during the quarter ended September 30, 2020 we reversed the $822 million of government stimulus income recognized during the quarter ended June 30, 2020. On October 8, 2020, we announced our decision to return, or repay early, all of our share of the Provider Relief Fund distributions of approximately $1.6 billion and the approximately $4.4 billion of Medicare accelerated payments. The total accelerated Medicare payments and Provider Relief Fund distributions received are recorded under the caption “government stimulus refund liability” in our condensed consolidated balance sheet at September 30, 20 2 0. The CARES Act also provides for a deferral of payments of the employer portion of Social Security tax incurred during the pandemic, allowing half of such payroll taxes to be deferred until December 2021 and the remaining half until December 2022. At September 30, 2020, the Company had deferred $441 million of Social Security taxes. Additionally, the CARES Act created a payroll tax credit designed to encourage companies to retain employees during the pandemic. During the nine months ended September 30, 2020, the Company evaluated its eligibility for this credit and recorded $60 million of employee retention payroll tax credits pursuant to the CARES Act. These tax credits are recorded as a reduction of salaries and benefits in our condensed consolidated income statement. We believe the extent of the COVID-19 pandemic’s impact on our operating results and financial condition has been and will continue to be driven by many factors, most of which are beyond our control and ability to forecast. Such factors include, but are not limited to, the scope and duration of stay-at-home |
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| Revenues | Revenues Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service out-of-network Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective care, who have income at or below 400% of the federal poverty level, are eligible for charity care. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and nine months ended September 30, 2020 and 2019 are summarized in the following table (dollars in millions):
To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and nine months ended September 30, 2020 and 2019 follows (dollars in millions):
The total uncompensated care amounts include charity care of $3.160 billion and $3.425 billion, respectively, and the related estimated costs of charity care were $376 million and $421 million, for the quarters ended September 30, 2020 and 2019, respectively. The total uncompensated care amounts include charity care of $9.972 billion and $9.641 billion, respectively, and the related estimated costs of charity care were $1.207 billion and $1.167 billion, for the nine months ended September 30, 2020 and 2019, respectively. |
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| Reclassifications | Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
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Basis of Presentation and Significant Accounting Policies (Tables) |
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Sep. 30, 2020 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Accounting Policies [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Revenues from Third Party Payers, Uninsured and Other Payers | Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and nine months ended September 30, 2020 and 2019 are summarized in the following table (dollars in millions):
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| Schedule of Estimated Cost of Uncompensated Care | A summary of the estimated cost of total uncompensated care for the quarters and nine months ended September 30, 2020 and 2019 follows (dollars in millions):
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Earnings Per Share (Tables) |
9 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2020 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Earnings Per Share [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Computations of Basic and Diluted Earnings Per Share | The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2020 and 2019 (dollars and shares in millions, except per share amounts):
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Investments of Insurance Subsidiaries (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2020 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Investments, Debt and Equity Securities [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Investments | A summary of our insurance subsidiaries’ investments at September 30, 2020 and December 31, 2019 follows (dollars in millions):
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| Schedule of Maturities of Investments | Scheduled maturities of investments in debt securities at September 30, 2020 were as follows (dollars in millions):
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Financial Instruments (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2020 | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Derivative Instruments and Hedging Activities Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges | The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at September 30, 2020 (dollars in millions):
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| Effect of Interest Rate on Results of Operations | The following table presents the effect of our interest rate swaps on our results of operations for the nine months ended September 30, 2020 (dollars in millions):
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Assets and Liabilities Measured at Fair Value (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2020 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fair Value Disclosures [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Assets Measured at Fair Value on Recurring Basis | The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of September 30, 2020 and December 31, 2019, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):
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Long-Term Debt (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2020 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Debt Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Long-Term Debt | A summary of long-term debt at September 30, 2020 and December 31, 2019, including related interest rates at September 30, 2020, follows (dollars in millions):
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Share Repurchase Transactions and Other Comprehensive Loss (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2020 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Federal Home Loan Banks [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Components of Accumulated Other Comprehensive Loss | The components of accumulated other comprehensive loss are as follows (dollars in millions):
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Segment and Geographic Information (Tables) |
9 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Segment Reporting [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA and Depreciation and Amortization | The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2020 and 2019 are summarized in the following table (dollars in millions):
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Basis of Presentation and Significant Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | ||
|---|---|---|---|---|
Sep. 30, 2020 |
Sep. 30, 2019 |
Sep. 30, 2020 |
Sep. 30, 2019 |
|
| Accounting Policies [Abstract] | ||||
| Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ 11,170 | $ 11,060 | $ 32,428 | $ 32,619 |
| Cost-to-charges ratio (patient care costs as percentage of gross patient charges) | 12.00% | 12.30% | 12.10% | 12.10% |
| Total uncompensated care | $ 7,023 | $ 7,923 | $ 21,625 | $ 22,703 |
| Multiply by the cost-to-charges ratio | 12.00% | 12.30% | 12.10% | 12.10% |
| Estimated cost of total uncompensated care | $ 843 | $ 975 | $ 2,617 | $ 2,747 |
Acquisitions and Dispositions - Additional Information (Detail) $ in Millions |
9 Months Ended | |
|---|---|---|
|
Sep. 30, 2020
USD ($)
Hospital
|
Sep. 30, 2019
USD ($)
Hospital
|
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| Business Acquisition [Line Items] | ||
| Number of hospitals purchased | Hospital | 1 | 7 |
| Proceeds from sale of business | $ 68 | $ 49 |
| Real Estate and Other Investments [Member] | ||
| Business Acquisition [Line Items] | ||
| Gain (loss) on sales of real estate | 6 | 17 |
| Proceeds from sale of business | 68 | 49 |
| Hospitals [Member] | ||
| Business Acquisition [Line Items] | ||
| Aggregate purchase price | 1,399 | |
| Nonhospital Health Care [Member] | ||
| Business Acquisition [Line Items] | ||
| Aggregate purchase price | $ 193 | |
| Hospital and other nonhospital health care entities [Member] | ||
| Business Acquisition [Line Items] | ||
| Aggregate purchase price | 380 | |
| Fair value of identifiable net assets | $ 309 | |
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | |||
|---|---|---|---|---|---|
Sep. 30, 2020 |
Sep. 30, 2019 |
Sep. 30, 2020 |
Sep. 30, 2019 |
Dec. 31, 2019 |
|
| Income Tax Contingency [Line Items] | |||||
| Effective tax rate | 23.80% | 26.00% | 22.20% | 23.90% | |
| Provision for tax benefits related to settlement of employee awards | $ 59 | $ 56 | |||
| Provision for income taxes | $ 209 | $ 215 | 665 | $ 765 | |
| Liability for unrecognized tax benefits | 523 | 523 | $ 550 | ||
| Unrecognized tax benefits, accrued interest | 74 | 74 | 62 | ||
| Unrecognized tax benefits that would impact effective tax rate | $ 167 | $ 167 | $ 160 | ||
Earnings Per Share - Schedule of Computations of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions |
3 Months Ended | 9 Months Ended | ||
|---|---|---|---|---|
Sep. 30, 2020 |
Sep. 30, 2019 |
Sep. 30, 2020 |
Sep. 30, 2019 |
|
| Earnings Per Share [Abstract] | ||||
| Net income attributable to HCA Healthcare, Inc. | $ 668 | $ 612 | $ 2,328 | $ 2,434 |
| Weighted average common shares outstanding | 338,168 | 340,789 | 338,057 | 341,932 |
| Effect of dilutive incremental shares | 5,178 | 6,698 | 4,957 | 6,780 |
| Shares used for diluted earnings per share | 343,346 | 347,487 | 343,014 | 348,712 |
| Basic earnings | $ 1.97 | $ 1.80 | $ 6.89 | $ 7.12 |
| Diluted earnings | $ 1.95 | $ 1.76 | $ 6.79 | $ 6.98 |
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions |
Sep. 30, 2020 |
Dec. 31, 2019 |
|---|---|---|
| Debt Securities, Available-for-sale [Line Items] | ||
| Amounts classified as current assets | $ (96) | $ (147) |
| Investment carrying value | 390 | 315 |
| Amortized Cost | 455 | 444 |
| Unrealized Amounts, Gains | 31 | 18 |
| Fair Value | 486 | 462 |
| Money Market Funds and Other [Member] | ||
| Debt Securities, Available-for-sale [Line Items] | ||
| Amortized Cost | 71 | 85 |
| Fair Value | 71 | 85 |
| Debt Securities [Member] | States and Municipalities [Member] | ||
| Debt Securities, Available-for-sale [Line Items] | ||
| Amortized Cost | 384 | 359 |
| Unrealized Amounts, Gains | 31 | 18 |
| Fair Value | $ 415 | $ 377 |
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions |
Sep. 30, 2020
USD ($)
|
|---|---|
| Investments, Debt and Equity Securities [Abstract] | |
| Due in one year or less, Amortized Cost | $ 4 |
| Due after one year through five years, Amortized Cost | 127 |
| Due after five years through ten years, Amortized Cost | 175 |
| Due after ten years, Amortized Cost | 78 |
| Amortized Cost, Total | 384 |
| Due in one year or less, Fair Value | 4 |
| Due after one year through five years, Fair Value | 135 |
| Due after five years through ten years, Fair Value | 192 |
| Due after ten years, Fair Value | 84 |
| Fair Value, Total | $ 415 |
Investments of Insurance Subsidiaries - Additional Information (Detail) |
9 Months Ended |
|---|---|
Sep. 30, 2020 | |
| Investments, Debt and Equity Securities [Abstract] | |
| Available for sale securities expected maturity of debt securities | 5 years 6 months |
| Available for sale securities average scheduled maturity | 9 years 9 months 18 days |
Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) - Pay-Fixed Interest Rate Swaps [Member] $ in Millions |
9 Months Ended |
|---|---|
|
Sep. 30, 2020
USD ($)
| |
| Maturity Date, 2021 [Member] | |
| Derivative Instruments, Gain (Loss) [Line Items] | |
| Notional Amount | $ 2,000 |
| Fair Value | $ (34) |
| Maturity Date | 2021-12 |
| Maturity Date, 2022 [Member] | |
| Derivative Instruments, Gain (Loss) [Line Items] | |
| Notional Amount | $ 500 |
| Fair Value | $ (21) |
| Maturity Date | 2022-12 |
Financial Instruments - Additional Information (Detail) $ in Millions |
9 Months Ended |
|---|---|
|
Sep. 30, 2020
USD ($)
| |
| Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
| Estimated amount reclassified from other comprehensive income and be included in interest expense | $ 36 |
| Estimated termination value | $ 55 |
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) $ in Millions |
9 Months Ended |
|---|---|
|
Sep. 30, 2020
USD ($)
| |
| Derivative Instruments, Gain (Loss) [Line Items] | |
| Amount of Loss Recognized in OCI on Derivatives, Net of Tax | $ (51) |
| Interest Rate Swaps [Member] | |
| Derivative Instruments, Gain (Loss) [Line Items] | |
| Amount of Loss Recognized in OCI on Derivatives, Net of Tax | 51 |
| Interest Rate Swaps [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | |
| Derivative Instruments, Gain (Loss) [Line Items] | |
| Interest rate swaps | $ 15 |
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions |
Sep. 30, 2020 |
Dec. 31, 2019 |
|---|---|---|
| Fair Value Disclosures [Abstract] | ||
| Estimated fair value of long-term debt | $ 34,739 | $ 37,026 |
| Carrying amounts of long-term debt | $ 31,209 | $ 33,961 |
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) |
9 Months Ended |
|---|---|
Sep. 30, 2020 | |
| Debt Instrument [Line Items] | |
| Total debt average term | 9 years 1 month 6 days |
| Total debt average rate | 5.00% |
| Senior Secured Term Loan Facilities [Member] | |
| Debt Instrument [Line Items] | |
| Effective interest rate | 2.80% |
| Senior Secured Notes [Member] | |
| Debt Instrument [Line Items] | |
| Effective interest rate | 5.10% |
| Other Senior Secured Debt [Member] | |
| Debt Instrument [Line Items] | |
| Effective interest rate | 5.00% |
| Senior Unsecured Notes [Member] | |
| Debt Instrument [Line Items] | |
| Effective interest rate | 5.50% |
Share Repurchase Transactions and Other Comprehensive Loss - Additional Information (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions |
3 Months Ended | |||
|---|---|---|---|---|
Mar. 31, 2020 |
Sep. 30, 2020 |
Jan. 31, 2020 |
Jan. 31, 2019 |
|
| Share repurchase program authorized amount | $ 2,000 | $ 2,000 | ||
| Repurchase of common stock, shares | 3,287 | |||
| Repurchase price of common stock, per share | $ 134.18 | |||
| Board of Directors Chairman [Member] | ||||
| Share repurchase program authorized amount | $ 4,000 | $ 2,000 | ||
| Share repurchase program, remaining authorized repurchase amount | $ 2,800 |
Share Repurchase Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) $ in Millions |
9 Months Ended |
|---|---|
|
Sep. 30, 2020
USD ($)
| |
| Equity [Abstract] | |
| Unrealized gains on available-for-sale securities, income tax expense | $ 3 |
| Foreign currency translation adjustments, income tax benefit | 3 |
| Change in fair value of derivative instruments, income tax benefit | 15 |
| Defined benefit plans, Expense reclassified into operations from other comprehensive income, Income tax benefits | 2 |
| Change in fair value of derivative instruments, Expense reclassified into operations from other comprehensive income, Income tax benefits | $ 3 |
Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization and Assets (Detail) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | ||
|---|---|---|---|---|
Sep. 30, 2020 |
Sep. 30, 2019 |
Sep. 30, 2020 |
Sep. 30, 2019 |
|
| Segment Reporting Information [Line Items] | ||||
| Revenues | $ 13,311 | $ 12,694 | $ 37,240 | $ 37,813 |
| Equity in earnings of affiliates | (40) | (4) | (48) | (23) |
| Adjusted segment EBITDA | 2,053 | 2,285 | 6,919 | 7,119 |
| Depreciation and amortization | 694 | 647 | 2,059 | 1,902 |
| Interest expense | 385 | 448 | 1,201 | 1,386 |
| Losses (gains) on sales of facilities | (14) | 0 | 6 | (17) |
| Losses on retirement of debt | 0 | 211 | 295 | 211 |
| Income before income taxes | 988 | 979 | 3,358 | 3,637 |
| National Group [Member] | ||||
| Segment Reporting Information [Line Items] | ||||
| Revenues | 6,633 | 6,398 | 18,653 | 19,159 |
| Equity in earnings of affiliates | (23) | 2 | (26) | (3) |
| Adjusted segment EBITDA | 1,128 | 1,270 | 3,828 | 4,088 |
| Depreciation and amortization | 312 | 291 | 930 | 839 |
| American Group [Member] | ||||
| Segment Reporting Information [Line Items] | ||||
| Revenues | 6,073 | 5,780 | 16,920 | 17,001 |
| Equity in earnings of affiliates | (15) | (10) | (26) | (32) |
| Adjusted segment EBITDA | 1,130 | 1,185 | 3,653 | 3,443 |
| Depreciation and amortization | 286 | 277 | 868 | 828 |
| Corporate and Other [Member] | ||||
| Segment Reporting Information [Line Items] | ||||
| Revenues | 605 | 516 | 1,667 | 1,653 |
| Equity in earnings of affiliates | (2) | 4 | 4 | 12 |
| Adjusted segment EBITDA | (205) | (170) | (562) | (412) |
| Depreciation and amortization | $ 96 | $ 79 | $ 261 | $ 235 |