Segment and Geographic Information

12 Months Ended

Dec. 31, 2020

Segment Reporting [Abstract]

Segment and Geographic Information

NOTE 14 — 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. At December 31, 2020, the National Group included 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 included 82 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, 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 and 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, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions):

	For the Years Ended December 31,
	2020			2019			2018
Revenues:
National Group	$	25,694		$	25,913		$	22,581
American Group		23,593			23,173			21,959
Corporate and other		2,246			2,250			2,137
	$	51,533		$	51,336		$	46,677
Equity in earnings of affiliates:
National Group	$	(28	)	$	(2	)	$	(4	)
American Group		(42	)		(44	)		(40	)
Corporate and other		16			3			15
	$	(54	)	$	(43	)	$	(29	)
Adjusted segment EBITDA:
National Group	$	5,532		$	5,634		$	4,980
American Group		5,333			4,904			4,593
Corporate and other		(828	)		(681	)		(624	)
	$	10,037		$	9,857		$	8,949
Depreciation and amortization:
National Group	$	1,216		$	1,161		$	946
American Group		1,164			1,117			1,027
Corporate and other		341			318			305
	$	2,721		$	2,596		$	2,278

	For the Years Ended December 31,
	2020		2019			2018
Adjusted segment EBITDA	$	10,037	$	9,857		$	8,949
Depreciation and amortization		2,721		2,596			2,278
Interest expense		1,584		1,824			1,755
Losses (gains) on sales of facilities		7		(18	)		(428	)
Losses on retirement of debt		295		211			9
Income before income taxes	$	5,430	$	5,244		$	5,335
	December 31,
	2020		2019			2018
Assets:
National Group	$	18,913	$	18,290		$	14,839
American Group		20,760		20,608			19,122
Corporate and other		7,817		6,160			5,246
	$	47,490	$	45,058		$	39,207

	National Group			American Group			Corporate and Other			Total
Goodwill and other intangible assets:
Balance at December 31, 2017	$	1,474		$	5,265		$	655		$	7,394
Acquisitions		132			504			—			636
Foreign currency translation, amortization and other		(9	)		(40	)		(28	)		(77	)
Balance at December 31, 2018		1,597			5,729			627			7,953
Acquisitions		155			39			138			332
Foreign currency translation, amortization and other		(13	)		(3	)		—			(16	)
Balance at December 31, 2019		1,739			5,765			765			8,269
Acquisitions		38			27			279			344
Foreign currency translation, amortization and other		(2	)		(17	)		(16	)		(35	)
Balance at December 31, 2020	$	1,775		$	5,775		$	1,028		$	8,578