☒ | 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 |
Delaware | 27-3865930 | |
(State or other jurisdiction of incorporation or organization) | (I.R.S. Employer Identification No.) | |
One Park Plaza Nashville, Tennessee | 37203 | |
(Address of principal executive offices) | (Zip Code) |
Title of each class | Trading Symbol(s) | Name of each exchange on which registered | ||
Voting common stock, $.01 par value | HCA | New York Stock Exchange |
Large accelerated filer | ☒ | Accelerated filer | ☐ | |||
Non-accelerated filer | ☐ | Smaller reporting company | ☐ | |||
Emerging growth company | ☐ |
Class of Common Stock | Outstanding at | |
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. | ||||||
Item 3. | ||||||
Item 4. | ||||||
Part II. | Other Information | |||||
Item 1. | ||||||
Item 1A. | ||||||
Item 2. | ||||||
Item 6. | ||||||
36 |
Quarter | Nine Months | |||||||||||||||||||||||
2020 | 2019 | 2020 | 2019 | 2021 | 2020 | |||||||||||||||||||
Revenues | $ | 13,311 | $ | 12,694 | $ | 37,240 | $ | 37,813 | $ | 13,977 | $ | 12,861 | ||||||||||||
Salaries and benefits | 6,097 | 5,971 | 17,545 | 17,455 | 6,301 | 6,118 | ||||||||||||||||||
Supplies | 2,128 | 2,090 | 5,999 | 6,249 | 2,224 | 2,123 | ||||||||||||||||||
Other operating expenses | 2,251 | 2,352 | 6,825 | 7,013 | 2,421 | 2,427 | ||||||||||||||||||
Government stimulus income reversal | 822 | — | 0 | — | ||||||||||||||||||||
Equity in earnings of affiliates | (40 | ) | (4 | ) | (48 | ) | (23 | ) | (21 | ) | (7 | ) | ||||||||||||
Depreciation and amortization | 694 | 647 | 2,059 | 1,902 | 697 | 674 | ||||||||||||||||||
Interest expense | 385 | 448 | 1,201 | 1,386 | 384 | 428 | ||||||||||||||||||
Losses (gains) on sales of facilities | (14 | ) | 0 | 6 | (17 | ) | ||||||||||||||||||
Gains on sales of facilities | (2 | ) | (7 | ) | ||||||||||||||||||||
Losses on retirement of debt | 0 | 211 | 295 | 211 | 0 | 295 | ||||||||||||||||||
12,323 | 11,715 | 33,882 | 34,176 | 12,004 | 12,051 | |||||||||||||||||||
Income before income taxes | 988 | 979 | 3,358 | 3,637 | 1,973 | 810 | ||||||||||||||||||
Provision for income taxes | 209 | 215 | 665 | 765 | 393 | 112 | ||||||||||||||||||
Net income | 779 | 764 | 2,693 | 2,872 | 1,580 | 698 | ||||||||||||||||||
Net income attributable to noncontrolling interests | 111 | 152 | 365 | 438 | 157 | 117 | ||||||||||||||||||
Net income attributable to HCA Healthcare, Inc. | $ | 668 | $ | 612 | $ | 2,328 | $ | 2,434 | $ | 1,423 | $ | 581 | ||||||||||||
Per share data: | ||||||||||||||||||||||||
Basic earnings | $ | 1.97 | $ | 1.80 | $ | 6.89 | $ | 7.12 | $ | 4.21 | $ | 1.72 | ||||||||||||
Diluted earnings | $ | 1.95 | $ | 1.76 | $ | 6.79 | $ | 6.98 | $ | 4.14 | $ | 1.69 | ||||||||||||
Shares used in earnings per share calculations (in millions): | ||||||||||||||||||||||||
Basic | 338.168 | 340.789 | 338.057 | 341.932 | 338.123 | 338.242 | ||||||||||||||||||
Diluted | 343.346 | 347.487 | 343.014 | 348.712 | 343.321 | 344.096 |
Quarter | Nine Months | |||||||||||||||||||||||
2020 | 2019 | 2020 | 2019 | 2021 | 2020 | |||||||||||||||||||
Net income | $ | 779 | $ | 764 | $ | 2,693 | $ | 2,872 | $ | 1,580 | $ | 698 | ||||||||||||
Other comprehensive income (loss) before taxes: | ||||||||||||||||||||||||
Foreign currency translation | 42 | (30 | ) | (39 | ) | (48 | ) | 8 | (73 | ) | ||||||||||||||
Unrealized gains on available-for-sale | 1 | 2 | 13 | 16 | ||||||||||||||||||||
Unrealized losses on available-for-sale | (11 | ) | (5 | ) | ||||||||||||||||||||
Defined benefit plans | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||||||||||||
Pension costs included in salaries and benefits | 4 | 3 | 12 | 10 | 7 | 4 | ||||||||||||||||||
7 | 4 | |||||||||||||||||||||||
4 | 3 | 12 | 10 | |||||||||||||||||||||
Change in fair value of derivative financial instruments | 0 | (7 | ) | (66 | ) | (59 | ) | 1 | (60 | ) | ||||||||||||||
Interest expense (benefits) included in interest expense | 9 | (4 | ) | 15 | (15 | ) | 9 | (1 | ) | |||||||||||||||
9 | (11 | ) | (51 | ) | (74 | ) | 10 | (61 | ) | |||||||||||||||
Other comprehensive income (loss) before taxes | 56 | (36 | ) | (65 | ) | (96 | ) | 14 | (135 | ) | ||||||||||||||
Income taxes (benefits) related to other comprehensive income items | 9 | (6 | ) | (10 | ) | (16 | ) | 3 | (24 | ) | ||||||||||||||
Other comprehensive income (loss) | 47 | (30 | ) | (55 | ) | (80 | ) | 11 | (111 | ) | ||||||||||||||
Comprehensive income | 826 | 734 | 2,638 | 2,792 | 1,591 | 587 | ||||||||||||||||||
Comprehensive income attributable to noncontrolling interests | 111 | 152 | 365 | 438 | 157 | 117 | ||||||||||||||||||
Comprehensive income attributable to HCA Healthcare, Inc. | $ | 715 | $ | 582 | $ | 2,273 | $ | 2,354 | $ | 1,434 | $ | 470 | ||||||||||||
September 30, 2020 | December 31, 2019 | March 31, 2021 | December 31, 2020 | |||||||||||||
ASSETS | ||||||||||||||||
Current assets: | ||||||||||||||||
Cash and cash equivalents | $ | 6,588 | $ | 621 | $ | 1,030 | $ | 1,793 | ||||||||
Accounts receivable | 6,433 | 7,380 | 7,424 | 7,051 | ||||||||||||
Inventories | 1,950 | 1,849 | 2,068 | 2,025 | ||||||||||||
Other | 1,295 | 1,346 | 1,514 | 1,464 | ||||||||||||
16,266 | 11,196 | 12,036 | 12,333 | |||||||||||||
Property and equipment, at cost | 48,775 | 47,235 | 49,877 | 49,317 | ||||||||||||
Accumulated depreciation | (25,834 | ) | (24,520 | ) | (26,689 | ) | (26,118 | ) | ||||||||
22,941 | 22,715 | 23,188 | 23,199 | |||||||||||||
Investments of insurance subsidiaries | 390 | 315 | 393 | 388 | ||||||||||||
Investments in and advances to affiliates | 335 | 249 | 427 | 422 | ||||||||||||
Goodwill and other intangible assets | 8,570 | 8,269 | 8,575 | 8,578 | ||||||||||||
Right-of-use | 1,972 | 1,834 | 2,083 | 2,024 | ||||||||||||
Other | 542 | 480 | 575 | 546 | ||||||||||||
$ | 51,016 | $ | 45,058 | $ | 47,277 | $ | 47,490 | |||||||||
LIABILITIES AND STOCKHOLDERS’ EQUITY (DEFICIT) | ||||||||||||||||
LIABILITIES AND STOCKHOLDERS’ EQUITY | ||||||||||||||||
Current liabilities: | ||||||||||||||||
Accounts payable | $ | 3,270 | $ | 2,905 | $ | 3,524 | $ | 3,535 | ||||||||
Accrued salaries | 1,971 | 1,775 | 1,767 | 1,720 | ||||||||||||
Other accrued expenses | 2,843 | 2,932 | 3,117 | 3,240 | ||||||||||||
Government stimulus refund liability | 6,123 | — | ||||||||||||||
Long-term debt due within one year | 172 | 145 | 234 | 209 | ||||||||||||
14,379 | 7,757 | 8,642 | 8,704 | |||||||||||||
Long-term debt, less debt issuance costs and discounts of $245 and $239 | 30,792 | 33,577 | ||||||||||||||
Long-term debt, less debt issuance costs and discounts of $229 and $236 | 30,838 | 30,795 | ||||||||||||||
Professional liability risks | 1,434 | 1,370 | 1,553 | 1,486 | ||||||||||||
Right-of-use | 1,635 | 1,499 | 1,730 | 1,673 | ||||||||||||
Income taxes and other liabilities | 1,477 | 1,420 | 2,032 | 1,940 | ||||||||||||
Stockholders’ equity (deficit): | ||||||||||||||||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 338,370,500 shares in 2020 and | 3 | 3 | ||||||||||||||
Stockholders’ equity: | ||||||||||||||||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 333,714,500 shares — 2021 and 339,425,600 shares — 2020 | 3 | 3 | ||||||||||||||
Capital in excess of par value | 185 | — | 0 | 294 | ||||||||||||
Accumulated other comprehensive loss | (515 | ) | (460 | ) | (491 | ) | (502 | ) | ||||||||
Retained deficit | (647 | ) | (2,351 | ) | ||||||||||||
Retained earnings | 735 | 777 | ||||||||||||||
Stockholders’ deficit attributable to HCA Healthcare, Inc. | (974 | ) | (2,808 | ) | ||||||||||||
Stockholders’ equity attributable to HCA Healthcare, Inc. | 247 | 572 | ||||||||||||||
Noncontrolling interests | 2,273 | 2,243 | 2,235 | 2,320 | ||||||||||||
1,299 | (565 | ) | 2,482 | 2,892 | ||||||||||||
$ | 51,016 | $ | 45,058 | $ | 47,277 | $ | 47,490 | |||||||||
Equity (Deficit) Attributable to HCA Healthcare, Inc. | Equity Attributable to Noncontrolling Interests | Total | 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 | Common Stock | Capital in Excess of Par Value | Accumulated Other Comprehensive Loss | Retained Earnings (Deficit ) | |||||||||||||||||||||||||||||||||||||||||||||||||
Shares (in millions) | Par Value | Shares (in millions) | Par Value | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Balances, December 31, 2018 | 342.895 | $ | 3 | $ | — | $ | (381 | ) | $ | (4,572 | ) | $ | 2,032 | $ | (2,918 | ) | ||||||||||||||||||||||||||||||||||||||||
Comprehensive income | 7 | 1,039 | 142 | 1,188 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Repurchase of common stock | (2.106 | ) | 32 | (310 | ) | (278 | ) | |||||||||||||||||||||||||||||||||||||||||||||||||
Share-based benefit plans | 2.242 | (29 | ) | (29 | ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
Cash dividends declared ($0.40 per share) | (140 | ) | (140 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Distributions | (136 | ) | (136 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Other | (3 | ) | 61 | 58 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Balances, March 31, 2019 | 343.031 | 3 | — | (374 | ) | (3,983 | ) | 2,099 | (2,255 | ) | ||||||||||||||||||||||||||||||||||||||||||||||
Comprehensive income | (57 | ) | 783 | 144 | 870 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Repurchase of common stock | (1.928 | ) | (107 | ) | (135 | ) | (242 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||
Share-based benefit plans | 0.414 | 118 | 118 | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Cash dividends declared ($0.40 per share) | (139 | ) | (139 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Distributions | (111 | ) | (111 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Other | (11 | ) | (11 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Balances, June 30, 2019 | 341.517 | 3 | — | (431 | ) | (3,474 | ) | 2,132 | (1,770 | ) | ||||||||||||||||||||||||||||||||||||||||||||||
Comprehensive income | (30 | ) | 612 | 152 | 734 | |||||||||||||||||||||||||||||||||||||||||||||||||||
Repurchase of common stock | (1.846 | ) | (132 | ) | (107 | ) | (239 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||
Share-based benefit plans | 0.382 | 128 | 128 | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Cash dividends declared ($0.40 per share) | (138 | ) | (138 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Distributions | (157 | ) | (157 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Other | 4 | (9 | ) | (5 | ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
Balances, September 30, 2019 | 340.053 | 3 | — | (461 | ) | (3,107 | ) | 2,118 | (1,447 | ) | ||||||||||||||||||||||||||||||||||||||||||||||
Comprehensive income | 1 | 1,071 | 202 | 1,274 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Repurchase of common stock | (2.069 | ) | (95 | ) | (177 | ) | (272 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||
Share-based benefit plans | 0.462 | 96 | 96 | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Cash dividends declared ($0.40 per share) | (138 | ) | (138 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Distributions | (138 | ) | (138 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Other | (1 | ) | 61 | 60 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Balances, December 31, 2019 | 338.446 | 3 | — | (460 | ) | (2,351 | ) | 2,243 | (565 | ) | ||||||||||||||||||||||||||||||||||||||||||||||
Balances, December 31 , 2019 | 338.446 | $ | 3 | $ | — | $ | (460 | ) | $ | (2,351 | ) | $ | 2,243 | $ | (565 | ) | ||||||||||||||||||||||||||||||||||||||||
Comprehensive income | (111 | ) | 581 | 117 | 587 | (111 | ) | 581 | 117 | 587 | ||||||||||||||||||||||||||||||||||||||||||||||
Repurchase of common stock | (3.287 | ) | 35 | (476 | ) | (441 | ) | (3.287 | ) | (441 | ) | (441 | ) | |||||||||||||||||||||||||||||||||||||||||||
Share-based benefit plans | 2.449 | (33 | ) | (33 | ) | 2.449 | 2 | (35 | ) | (33 | ) | |||||||||||||||||||||||||||||||||||||||||||||
Cash dividends declared ($0.43 per share) | (148 | ) | (148 | ) | (148 | ) | (148 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||
Distributions | (154 | ) | (154 | ) | (154 | ) | (154 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||
Other | (2 | ) | 53 | 51 | (2 | ) | 53 | 51 | ||||||||||||||||||||||||||||||||||||||||||||||||
Balances, March 31, 2020 | 337.608 | 3 | — | (571 | ) | (2,394 | ) | 2,259 | (703 | ) | 337.608 | 3 | — | (571 | ) | (2,394 | ) | 2,259 | (703 | ) | ||||||||||||||||||||||||||||||||||||
Comprehensive income | 9 | 1,079 | 137 | 1,225 | 9 | 1,079 | 137 | 1,225 | ||||||||||||||||||||||||||||||||||||||||||||||||
Share-based benefit plans | 0.352 | 93 | 93 | 0.352 | 93 | 93 | ||||||||||||||||||||||||||||||||||||||||||||||||||
Distributions | (45 | ) | (45 | ) | (45 | ) | (45 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||
Other | (5 | ) | 3 | (2 | ) | (5 | ) | 3 | (2 | ) | ||||||||||||||||||||||||||||||||||||||||||||||
Balances, June 30, 2020 | 337.960 | 3 | 88 | (562 | ) | (1,315 | ) | 2,354 | 568 | 337.960 | 3 | 88 | (562 | ) | (1,315 | ) | 2,354 | 568 | ||||||||||||||||||||||||||||||||||||||
Comprehensive income | 47 | 668 | 111 | 826 | 47 | 668 | 111 | 826 | ||||||||||||||||||||||||||||||||||||||||||||||||
Share-based benefit plans | 0.410 | 97 | 97 | 0.410 | 97 | 97 | ||||||||||||||||||||||||||||||||||||||||||||||||||
Distributions | (194 | ) | (194 | ) | (194 | ) | (194 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||
Other | 2 | 2 | 2 | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Balances, September 30, 2020 | 338.370 | $ | 3 | $ | 185 | $ | (515 | ) | $ | (647 | ) | $ | 2,273 | $ | 1,299 | 338.370 | 3 | 185 | (515 | ) | (647 | ) | 2,273 | 1,299 | ||||||||||||||||||||||||||||||||
Comprehensive income | 13 | 1,426 | 268 | 1,707 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Share-based benefit plans | 1.056 | 108 | 108 | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Cash dividends declared ($ 0.43 per share) | (2 | ) | (2 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Distributions | (233 | ) | (233 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Other | 1 | 12 | 13 | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Balances, December 31, 2020 | 339.426 | 3 | 294 | (502 | ) | 777 | 2,320 | 2,892 | ||||||||||||||||||||||||||||||||||||||||||||||||
Comprehensive income | 11 | 1,423 | 157 | 1,591 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Repurchase of common stock | (8.477 | ) | (225 | ) | (1,302 | ) | (1,527 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||
Share-based benefit plans | 2.765 | (75 | ) | (75 | ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
Cash dividends declared ($0.48 per share) | (163 | ) | (163 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Distributions | (234 | ) | (234 | ) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Other | 6 | (8 | ) | (2 | ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
Balances, March 31 , 2021 | 333.714 | $ | 3 | $ | — | $ | (491 | ) | $ | 735 | $ | 2,235 | $ | 2,482 | ||||||||||||||||||||||||||||||||||||||||||
2020 | 2019 | 2021 | 2020 | |||||||||||||
Cash flows from operating activities: | ||||||||||||||||
Net income | $ | 2,693 | $ | 2,872 | $ | 1,580 | $ | 698 | ||||||||
Adjustments to reconcile net income to net cash provided by operating activities: | ||||||||||||||||
Increase (decrease) in cash from operating assets and liabilities: | ||||||||||||||||
Accounts receivable | 930 | (93 | ) | (371 | ) | 464 | ||||||||||
Inventories and other assets | (36 | ) | (95 | ) | (85 | ) | (196 | ) | ||||||||
Accounts payable and accrued expenses | 542 | (118 | ) | (371 | ) | (784 | ) | |||||||||
Government stimulus refund liability | 6,123 | — | ||||||||||||||
Depreciation and amortization | 2,059 | 1,902 | 697 | 674 | ||||||||||||
Income taxes | (114 | ) | 51 | 406 | 121 | |||||||||||
Losses (gains) on sales of facilities | 6 | (17 | ) | |||||||||||||
Gains on sales of facilities | (2 | ) | (7 | ) | ||||||||||||
Losses on retirement of debt | 295 | 211 | 0 | 295 | ||||||||||||
Amortization of debt issuance costs and discounts | 22 | 23 | 8 | 7 | ||||||||||||
Share-based compensation | 229 | 263 | 97 | 82 | ||||||||||||
Other | 66 | 98 | 29 | 21 | ||||||||||||
Net cash provided by operating activities | 12,815 | 5,097 | 1,988 | 1,375 | ||||||||||||
Cash flows from investing activities: | ||||||||||||||||
Purchase of property and equipment | (2,087 | ) | (2,884 | ) | (654 | ) | (853 | ) | ||||||||
Acquisition of hospitals and health care entities | (380 | ) | (1,592 | ) | (22 | ) | (328 | ) | ||||||||
Sales of hospitals and health care entities | 68 | 49 | 20 | 35 | ||||||||||||
Change in investments | (40 | ) | 35 | (2 | ) | (1 | ) | |||||||||
Other | (44 | ) | 17 | 9 | 2 | |||||||||||
Net cash used in investing activities | (2,483 | ) | (4,375 | ) | (649 | ) | (1,145 | ) | ||||||||
Cash flows from financing activities: | ||||||||||||||||
Issuances of long-term debt | 2,700 | 6,451 | 0 | 2,700 | ||||||||||||
Net change in revolving bank credit facilities | (2,480 | ) | (30 | ) | ||||||||||||
Net change in revolving credit facilities | 80 | 1,440 | ||||||||||||||
Repayment of long-term debt | (3,403 | ) | (5,289 | ) | (47 | ) | (3,327 | ) | ||||||||
Distributions to noncontrolling interests | (393 | ) | (404 | ) | (234 | ) | (154 | ) | ||||||||
Payment of debt issuance costs | (35 | ) | (71 | ) | 0 | (34 | ) | |||||||||
Payment of dividends | (153 | ) | (414 | ) | (169 | ) | (152 | ) | ||||||||
Repurchases of common stock | (441 | ) | (759 | ) | ||||||||||||
Repurchase of common stock | (1,527 | ) | (441 | ) | ||||||||||||
Other | (156 | ) | (145 | ) | (207 | ) | (141 | ) | ||||||||
Net cash used in financing activities | (4,361 | ) | (661 | ) | (2,104 | ) | (109 | ) | ||||||||
Effect of exchange rate changes on cash and cash equivalents | (4 | ) | (4 | ) | 2 | (11 | ) | |||||||||
Change in cash and cash equivalents | 5,967 | 57 | (763 | ) | 110 | |||||||||||
Cash and cash equivalents at beginning of period | 621 | 502 | 1,793 | 621 | ||||||||||||
Cash and cash equivalents at end of period | $ | 6,588 | $ | 559 | $ | 1,030 | $ | 731 | ||||||||
Interest payments | $ | 1,230 | $ | 1,492 | $ | 375 | $ | 468 | ||||||||
Income tax payments, net | $ | 779 | $ | 714 | ||||||||||||
Income tax refunds, net | $ | (13 | ) | $ | (9 | ) |
Quarter | ||||||||||||||||||||||||||||||||
2020 | Ratio | 2019 | Ratio | 2021 | Ratio | 2020 | Ratio | |||||||||||||||||||||||||
Medicare | $ | 2,603 | 19.6 | % | $ | 2,592 | 20.4 | % | $ | 2,559 | 18.3 | % | $ | 2,743 | 21.3 | % | ||||||||||||||||
Managed Medicare | 1,760 | 13.2 | 1,615 | 12.7 | 2,053 | 14.7 | 1,826 | 14.2 | ||||||||||||||||||||||||
Medicaid | 445 | 3.3 | 361 | 2.8 | 527 | 3.8 | 414 | 3.2 | ||||||||||||||||||||||||
Managed Medicaid | 707 | 5.3 | 641 | 5.0 | 725 | 5.2 | 666 | 5.2 | ||||||||||||||||||||||||
Managed care and insurers | 6,752 | 50.7 | 6,554 | 51.7 | 6,885 | 49.1 | 6,645 | 51.6 | ||||||||||||||||||||||||
International (managed care and insurers) | 307 | 2.3 | 282 | 2.2 | 333 | 2.4 | 292 | 2.3 | ||||||||||||||||||||||||
Other | 737 | 5.6 | 649 | 5.2 | 895 | 6.5 | 275 | 2.2 | ||||||||||||||||||||||||
Revenues | $ | 13,311 | 100.0 | % | $ | 12,694 | 100.0 | % | $ | 13,977 | 100.0 | % | $ | 12,861 | 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 | 2021 | 2020 | |||||||||||||||||||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ | 11,170 | $ | 11,060 | $ | 32,428 | $ | 32,619 | $ | 11,643 | $ | 11,342 | ||||||||||||
Cost-to-charges | 12.0 | % | 12.3 | % | 12.1 | % | 12.1 | % | 11.4 | % | 11.9 | % | ||||||||||||
Total uncompensated care | $ | 7,023 | $ | 7,923 | $ | 21,625 | $ | 22,703 | $ | 6,821 | $ | 7,873 | ||||||||||||
Multiply by the cost-to-charges | 12.0 | % | 12.3 | % | 12.1 | % | 12.1 | % | 11.4 | % | 11.9 | % | ||||||||||||
Estimated cost of total uncompensated care | $ | 843 | $ | 975 | $ | 2,617 | $ | 2,747 | $ | 778 | $ | 937 | ||||||||||||
Quarter | Nine Months | |||||||||||||||
2020 | 2019 | 2020 | 2019 | |||||||||||||
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 | ||||||||||||
Earnings per share: | ||||||||||||||||
Basic earnings | $ | 1.97 | $ | 1.80 | $ | 6.89 | $ | 7.12 | ||||||||
Diluted earnings | $ | 1.95 | $ | 1.76 | $ | 6.79 | $ | 6.98 |
2021 | 2020 | |||||||
Net income attributable to HCA Healthcare, Inc. | $ | 1,423 | $ | 581 | ||||
Weighted average common shares outstanding | 338.123 | 338.242 | ||||||
Effect of dilutive incremental shares | 5.198 | 5.854 | ||||||
Shares used for diluted earnings per share | 343.321 | 344.096 | ||||||
Earnings per share: | ||||||||
Basic earnings | $ | 4.21 | $ | 1.72 | ||||
Diluted earnings | $ | 4.14 | $ | 1.69 |
September 30, 2020 | March 31, 2021 | |||||||||||||||||||||||||||||||
Amortized Cost | Unrealized Amounts | Fair Value | Amortized Cost | Unrealized Amounts | Fair Value | |||||||||||||||||||||||||||
Gains | Losses | Gains | Losses | |||||||||||||||||||||||||||||
Debt securities | $ | 384 | $ | 31 | $ | — | $ | 415 | $ | 376 | $ | 22 | $ | (1 | ) | $ | 397 | |||||||||||||||
Money market funds and other | 71 | — | — | 71 | 104 | — | — | 104 | ||||||||||||||||||||||||
$ | 480 | $ | 22 | $ | (1 | ) | 501 | |||||||||||||||||||||||||
$ | 455 | $ | 31 | $ | — | 486 | ||||||||||||||||||||||||||
Amounts classified as current assets | (96 | ) | (108 | ) | ||||||||||||||||||||||||||||
Investment carrying value | $ | 390 | $ | 393 | ||||||||||||||||||||||||||||
December 31, 2019 | ||||||||||||||||
Amortized Cost | Unrealized Amounts | Fair Value | ||||||||||||||
Gains | Losses | |||||||||||||||
Debt securities | $ | 359 | $ | 18 | $ | — | $ | 377 | ||||||||
Money market funds and other | 85 | — | — | 85 | ||||||||||||
$ | 444 | $ | 18 | $ | — | 462 | ||||||||||
Amounts classified as current assets | (147 | ) | ||||||||||||||
Investment carrying value | $ | 315 | ||||||||||||||
December 31, 2020 | ||||||||||||||||
Amortized Cost | Unrealized Amounts | Fair Value | ||||||||||||||
Gains | Losses | |||||||||||||||
Debt securities | $ | 384 | $ | 32 | $ | — | $ | 416 | ||||||||
Money market funds and other | 88 | — | — | 88 | ||||||||||||
$ | 472 | $ | 32 | $ | — | 504 | ||||||||||
Amounts classified as current assets | (116 | ) | ||||||||||||||
Investment carrying value | $ | 388 | ||||||||||||||
Amortized Cost | Fair Value | Amortized Cost | Fair Value | |||||||||||||
Due in one year or less | $ | 4 | $ | 4 | $ | 4 | $ | 4 | ||||||||
Due after one year through five years | 127 | 135 | 144 | 152 | ||||||||||||
Due after five years through ten years | 175 | 192 | 157 | 167 | ||||||||||||
Due after ten years | 78 | 84 | 71 | 74 | ||||||||||||
$ | 376 | $ | 397 | |||||||||||||
$ | 384 | $ | 415 | |||||||||||||
Notional Amount | Maturity Date | Fair Value | Notional Amount | Maturity Date | Fair Value | |||||||||||||||||||
Pay-fixed interest rate swaps | $ | 2,000 | December 2021 | $ | (34 | ) | $ | 2,000 | December 2021 | $ | (20 | ) | ||||||||||||
Pay-fixed interest rate swaps | 500 | December 2022 | (21 | ) | 500 | December 2022 | (16 | ) |
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 | Amount of Gain Recognized in OCI on Derivatives, Net of Tax | Location of Loss Reclassified from Accumulated OCI into Operations | Amount of Loss Reclassified from Accumulated OCI into Operations | ||||||||||||||||||
Interest rate swaps | $ | 51 | Interest expense | $ | 15 | $ | 1 | Interest expense | $ | 9 |
September 30, 2020 | March 31, 2021 | |||||||||||||||||||||||||||||||
Fair Value Measurements Using | 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) | 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 | $ | 415 | $ | — | $ | 415 | $ | — | $ | 397 | $ | — | $ | 397 | $ | — | ||||||||||||||||
Money market funds and other | 71 | 71 | — | — | 104 | 104 | — | — | ||||||||||||||||||||||||
Investments of insurance subsidiaries | 486 | 71 | 415 | — | 501 | 104 | 397 | — | ||||||||||||||||||||||||
Less amounts classified as current assets | (96 | ) | (70 | ) | (26 | ) | — | (108 | ) | (101 | ) | (7 | ) | — | ||||||||||||||||||
$ | 390 | $ | 1 | $ | 389 | $ | — | $ | 393 | $ | 3 | $ | 390 | $ | — | |||||||||||||||||
Liabilities: | ||||||||||||||||||||||||||||||||
Interest rate swaps (Income taxes and other liabilities) | $ | 55 | $ | — | $ | 55 | $ | — | $ | 36 | $ | — | $ | 36 | $ | — | ||||||||||||||||
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 | $ | 377 | $ | — | $ | 377 | $ | — | ||||||||||||||||||||||||
Money market funds and other | 85 | 85 | — | — | ||||||||||||||||||||||||||||
Investments of insurance subsidiaries | 462 | 85 | 377 | — | ||||||||||||||||||||||||||||
Less amounts classified as current assets | (147 | ) | (83 | ) | (64 | ) | — | |||||||||||||||||||||||||
$ | 315 | $ | 2 | $ | 313 | $ | — | |||||||||||||||||||||||||
Interest rate swaps (Other) | $ | 3 | $ | — | $ | 3 | $ | — | ||||||||||||||||||||||||
Liabilities: | ||||||||||||||||||||||||||||||||
Interest rate swaps (Income taxes and other liabilities) | $ | 7 | $ | — | $ | 7 | $ | — |
December 31, 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 | $ | 416 | $ | — | $ | 416 | $ | — | ||||||||
Money market funds and other | 88 | 88 | — | — | ||||||||||||
Investments of insurance subsidiaries | 504 | 88 | 416 | — | ||||||||||||
Less amounts classified as current assets | (116 | ) | (87 | ) | (29 | ) | — | |||||||||
$ | 388 | $ | 1 | $ | 387 | $ | — | |||||||||
Liabilities: | ||||||||||||||||
Interest rate swaps (Income taxes and other liabilities) | $ | 46 | $ | — | $ | 46 | $ | — |
September 30, 2020 | December 31, 2019 | March 31, 2021 | December 31, 2020 | |||||||||||||
Senior secured asset-based revolving credit facility | $ | 0 | $ | 2,480 | ||||||||||||
Senior secured asset-based revolving credit facility (effective interest rate of 1.4%) | $ | 80 | $ | 0 | ||||||||||||
Senior secured revolving credit facility | 0 | 0 | 0 | 0 | ||||||||||||
Senior secured 364-day term loan facility | 0 | 0 | ||||||||||||||
Senior secured term loan facilities (effective interest rate of 2.8%) | 3,684 | 3,725 | 3,657 | 3,671 | ||||||||||||
Senior secured notes (effective interest rate of 5.1%) | 13,850 | 13,850 | 13,850 | 13,850 | ||||||||||||
Other senior secured debt (effective interest rate of 5.0%) | 723 | 654 | ||||||||||||||
Other senior secured debt (effective interest rate of 4.6%) | 762 | 767 | ||||||||||||||
Senior secured debt | 18,257 | 20,709 | 18,349 | 18,288 | ||||||||||||
Senior unsecured notes (effective interest rate of 5.5%) | 12,952 | 13,252 | 12,952 | 12,952 | ||||||||||||
Debt issuance costs and discounts | (245 | ) | (239 | ) | (229 | ) | (236 | ) | ||||||||
Total debt (average life of 9.1 years, rates averaging 5.0%) | 30,964 | 33,722 | ||||||||||||||
Total debt (average life of 8.6 years, rates averaging 5.0%) | 31,072 | 31,004 | ||||||||||||||
Less amounts due within one year | 172 | 145 | 234 | 209 | ||||||||||||
$ | 30,838 | $ | 30,795 | |||||||||||||
$ | 30,792 | $ | 33,577 | |||||||||||||
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 | $ | 14 | $ | (283 | ) | $ | (187 | ) | $ | (4 | ) | $ | (460 | ) | ||||||
Unrealized gains on available-for-sale | 10 | 10 | ||||||||||||||||||
Foreign currency translation adjustments, net of $3 income tax benefit | (36 | ) | (36 | ) | ||||||||||||||||
Change in fair value of derivative instruments, net of $15 income tax benefit | (51 | ) | (51 | ) | ||||||||||||||||
Expense reclassified into operations from other comprehensive income, net of $2 and $3 income tax benefits, respectively | 10 | 12 | 22 | |||||||||||||||||
Balances at September 30, 2020 | $ | 24 | $ | (319 | ) | $ | (177 | ) | $ | (43 | ) | $ | (515 | ) | ||||||
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, 2020 | $ | 25 | $ | (271 | ) | $ | (220 | ) | $ | (36 | ) | $ | (502 | ) | ||||||
Unrealized losses on available-for-sale | (9 | ) | (9 | ) | ||||||||||||||||
Foreign currency translation adjustments, net of $1 of income tax | 7 | 7 | ||||||||||||||||||
Change in fair value of derivative instruments | 1 | 1 | ||||||||||||||||||
Expense reclassified into operations from other comprehensive income, net of $2 and $2 income tax benefits, respectively | 5 | 7 | 12 | |||||||||||||||||
Balances at March 31, 2021 | $ | 16 | $ | (264 | ) | $ | (215 | ) | $ | (28 | ) | $ | (491 | ) | ||||||
�� |
Quarter | Nine Months | |||||||||||||||||||||||
2020 | 2019 | 2020 | 2019 | 202 1 | 2020 | |||||||||||||||||||
Revenues: | ||||||||||||||||||||||||
National Group | $ | 6,633 | $ | 6,398 | $ | 18,653 | $ | 19,159 | $ | 7,056 | $ | 6,474 | ||||||||||||
American Group | 6,073 | 5,780 | 16,920 | 17,001 | 6,291 | 5,744 | ||||||||||||||||||
Corporate and other | 605 | 516 | 1,667 | 1,653 | 630 | 643 | ||||||||||||||||||
$ | 13,311 | $ | 12,694 | $ | 37,240 | $ | 37,813 | $ | 13,977 | $ | 12,861 | |||||||||||||
Equity in earnings of affiliates: | ||||||||||||||||||||||||
National Group | $ | (23 | ) | $ | 2 | $ | (26 | ) | $ | (3 | ) | |||||||||||||
American Group | (15 | ) | (10 | ) | (26 | ) | (32 | ) | ||||||||||||||||
Corporate and other | (2 | ) | 4 | 4 | 12 | |||||||||||||||||||
$ | (40 | ) | $ | (4 | ) | $ | (48 | ) | $ | (23 | ) | |||||||||||||
Adjusted segment EBITDA: | ||||||||||||||||||||||||
National Group | $ | 1,128 | $ | 1,270 | $ | 3,828 | $ | 4,088 | ||||||||||||||||
American Group | 1,130 | 1,185 | 3,653 | 3,443 | ||||||||||||||||||||
Corporate and other | �� | (205 | ) | (170 | ) | (562 | ) | (412 | ) | |||||||||||||||
$ | 2,053 | $ | 2,285 | $ | 6,919 | $ | 7,119 | |||||||||||||||||
Depreciation and amortization: | ||||||||||||||||||||||||
National Group | $ | 312 | $ | 291 | $ | 930 | $ | 839 | ||||||||||||||||
American Group | 286 | 277 | 868 | 828 | ||||||||||||||||||||
Corporate and other | 96 | 79 | 261 | 235 | ||||||||||||||||||||
$ | 694 | $ | 647 | $ | 2,059 | $ | 1,902 | |||||||||||||||||
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 | ||||||||||||||||
2021 | 2020 | |||||||
Equity in earnings of affiliates: | ||||||||
National Group | $ | (7 | ) | $ | 1 | |||
American Group | (12 | ) | (9 | ) | ||||
Corporate and other | (2 | ) | 1 | |||||
$ | (21 | ) | $ | (7 | ) | |||
Adjusted segment EBITDA: | ||||||||
National Group | $ | 1,705 | $ | 1,215 | ||||
American Group | 1,501 | 1,115 | ||||||
Corporate and other | (154 | ) | (130 | ) | ||||
$ | 3,052 | $ | 2,200 | |||||
Depreciation and amortization: | ||||||||
National Group | $ | 323 | $ | 306 | ||||
American Group | 293 | 287 | ||||||
Corporate and other | 81 | 81 | ||||||
$ | 697 | $ | 674 | |||||
Adjusted segment EBITDA | $ | 3,052 | $ | 2,200 | ||||
Depreciation and amortization | 697 | 674 | ||||||
Interest expense | 384 | 428 | ||||||
Gains on sales of facilities | (2 | ) | (7 | ) | ||||
Losses on retirement of debt | 0 | 295 | ||||||
Income before income taxes | $ | 1,973 | $ | 810 | ||||
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 | % | ||||||||
2021 | Ratio | 2020 | Ratio | |||||||||||||
Medicare | $ | 2,559 | 18.3 | % | $ | 2,743 | 21.3 | % | ||||||||
Managed Medicare | 2,053 | 14.7 | 1,826 | 14.2 | ||||||||||||
Medicaid | 527 | 3.8 | 414 | 3.2 | ||||||||||||
Managed Medicaid | 725 | 5.2 | 666 | 5.2 | ||||||||||||
Managed care and insurers | 6,885 | 49.1 | 6,645 | 51.6 | ||||||||||||
International (managed care and insurers) | 333 | 2.4 | 292 | 2.3 | ||||||||||||
Other | 895 | 6.5 | 275 | 2.2 | ||||||||||||
Revenues | $ | 13,977 | 100.0 | % | $ | 12,861 | 100.0 | % | ||||||||
Quarter | Nine Months | |||||||||||||||||||||||
2020 | 2019 | 2020 | 2019 | 2021 | 2020 | |||||||||||||||||||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ | 11,170 | $ | 11,060 | $ | 32,428 | $ | 32,619 | $ | 11,643 | $ | 11,342 | ||||||||||||
Cost-to-charges | 12.0 | % | 12.3 | % | 12.1 | % | 12.1 | % | 11.4 | % | 11.9 | % | ||||||||||||
Total uncompensated care | $ | 7,023 | $ | 7,923 | $ | 21,625 | $ | 22,703 | $ | 6,821 | $ | 7,873 | ||||||||||||
Multiply by the cost-to-charges | 12.0 | % | 12.3 | % | 12.1 | % | 12.1 | % | 11.4 | % | 11.9 | % | ||||||||||||
Estimated cost of total uncompensated care | $ | 843 | $ | 975 | $ | 2,617 | $ | 2,747 | $ | 778 | $ | 937 | ||||||||||||
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 | % | |||||||||
2021 | 2020 | |||||||
Medicare | 24 | % | 27 | % | ||||
Managed Medicare | 22 | 20 | ||||||
Medicaid | 5 | 5 | ||||||
Managed Medicaid | 12 | 12 | ||||||
Managed care and insurers | 30 | 28 | ||||||
Uninsured | 7 | 8 | ||||||
100 | % | 100 | % | |||||
Quarter | Nine Months | |||||||||||||||||||||||
2020 | 2019 | 2020 | 2019 | 2021 | 2020 | |||||||||||||||||||
Medicare | 25 | % | 28 | % | 27 | % | 28 | % | 24 | % | 29 | % | ||||||||||||
Managed Medicare | 15 | 14 | 15 | 15 | 17 | 16 | ||||||||||||||||||
Medicaid | 5 | 4 | 5 | 4 | 5 | 4 | ||||||||||||||||||
Managed Medicaid | 6 | 6 | 6 | 5 | 6 | 5 | ||||||||||||||||||
Managed care and insurers | 49 | 47 | 47 | 47 | 48 | 46 | ||||||||||||||||||
Uninsured | — | 1 | — | 1 | ||||||||||||||||||||
100 | % | 100 | % | 100 | % | 100 | % | 100 | % | 100 | % | |||||||||||||
Quarter | ||||||||||||||||||||||||||||||||
2020 | 2019 | 2021 | 2020 | |||||||||||||||||||||||||||||
Amount | Ratio | Amount | Ratio | Amount | Ratio | Amount | Ratio | |||||||||||||||||||||||||
Revenues | $ | 13,311 | 100.0 | $ | 12,694 | 100.0 | $ | 13,977 | 100.0 | $ | 12,861 | 100.0 | ||||||||||||||||||||
Salaries and benefits | 6,097 | 45.8 | 5,971 | 47.0 | 6,301 | 45.1 | 6,118 | 47.6 | ||||||||||||||||||||||||
Supplies | 2,128 | 16.0 | 2,090 | 16.5 | 2,224 | 15.9 | 2,123 | 16.5 | ||||||||||||||||||||||||
Other operating expenses | 2,251 | 16.9 | 2,352 | 18.5 | 2,421 | 17.4 | 2,427 | 18.9 | ||||||||||||||||||||||||
Government stimulus income reversal | 822 | 6.2 | — | — | ||||||||||||||||||||||||||||
Equity in earnings of affiliates | (40 | ) | (0.3 | ) | (4 | ) | — | (21 | ) | (0.2 | ) | (7 | ) | (0.1 | ) | |||||||||||||||||
Depreciation and amortization | 694 | 5.2 | 647 | 5.1 | 697 | 5.0 | 674 | 5.3 | ||||||||||||||||||||||||
Interest expense | 385 | 2.9 | 448 | 3.5 | 384 | 2.7 | 428 | 3.3 | ||||||||||||||||||||||||
Gains on sales of facilities | (14 | ) | ( 0.1 | ) | — | — | (2 | ) | — | (7 | ) | (0.1 | ) | |||||||||||||||||||
Losses on retirement of debt | — | — | 211 | 1.7 | — | — | 295 | 2.3 | ||||||||||||||||||||||||
12,323 | 92.6 | 11,715 | 92.3 | 12,004 | 85.9 | 12,051 | 93.7 | |||||||||||||||||||||||||
Income before income taxes | 988 | 7.4 | 979 | 7.7 | 1,973 | 14.1 | 810 | 6.3 | ||||||||||||||||||||||||
Provision for income taxes | 209 | 1.5 | 215 | 1.7 | 393 | 2.8 | 112 | 0.9 | ||||||||||||||||||||||||
Net income | 779 | 5.9 | 764 | 6.0 | 1,580 | 11.3 | 698 | 5.4 | ||||||||||||||||||||||||
Net income attributable to noncontrolling interests | 111 | 0.9 | 152 | 1.2 | 157 | 1.1 | 117 | 0.9 | ||||||||||||||||||||||||
Net income attributable to HCA Healthcare, Inc. | $ | 668 | 5.0 | $ | 612 | 4.8 | $ | 1,423 | 10.2 | $ | 581 | 4.5 | ||||||||||||||||||||
% changes from prior year: | ||||||||||||||||||||||||||||||||
Revenues | 4.9 | % | 10.9 | % | 8.7 | % | 2.7 | % | ||||||||||||||||||||||||
Income before income taxes | 0.9 | (8.4 | ) | 143.6 | (44.5 | ) | ||||||||||||||||||||||||||
Net income attributable to HCA Healthcare, Inc. | 9.0 | (19.3 | ) | 145.0 | (44.1 | ) | ||||||||||||||||||||||||||
Admissions(a) | (3.9 | ) | 5.9 | (4.1 | ) | 1.0 | ||||||||||||||||||||||||||
Equivalent admissions(b) | (9.1 | ) | 7.5 | (6.4 | ) | (0.1 | ) | |||||||||||||||||||||||||
Revenue per equivalent admission | 15.3 | 3.1 | 16.1 | 2.9 | ||||||||||||||||||||||||||||
Same facility % changes from prior year(c): | ||||||||||||||||||||||||||||||||
Revenues | 4.5 | 6.3 | 9.0 | 1.2 | ||||||||||||||||||||||||||||
Admissions(a) | (3.8 | ) | 3.2 | (4.2 | ) | 0.6 | ||||||||||||||||||||||||||
Equivalent admissions(b) | (9.0 | ) | 4.2 | (6.5 | ) | (0.4 | ) | |||||||||||||||||||||||||
Revenue per equivalent admission | 14.8 | 2.0 | 16.6 | 1.6 |
(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. |
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 |
(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 | Quarter March 31, 2021 | Year December 31, 2020 | |||||||||||||
Revenues | $ | 22,406 | $ | 29,220 | $ | 8,401 | $ | 31,040 | ||||||||
Income before income taxes | 2,642 | 3,912 | 1,479 | 4,016 | ||||||||||||
Net income | 2,071 | 2,993 | 1,168 | 3,172 | ||||||||||||
Net income attributable to Parent, Subsidiary Issuer and Subsidiary Guarantors | 2,017 | 2,902 | 1,148 | 3,091 | ||||||||||||
At September 30, 2020 and December 31, 2019: | ||||||||||||||||
At March 31, 2021 and December 31, 2020: | ||||||||||||||||
September 30, 2020 | December 31, 2019 | March 31, 2021 | December 31, 2020 | |||||||||||||
Current assets | $ | 11,252 | $ | 6,090 | $ | 7,198 | $ | 7,442 | ||||||||
Property and equipment, net | 14,795 | 13,418 | 14,934 | 14,939 | ||||||||||||
Goodwill and other intangible assets | 5,777 | 5,743 | 5,762 | 5,763 | ||||||||||||
Total noncurrent assets | 21,640 | 19,977 | 21,801 | 21,771 | ||||||||||||
Total assets | 32,892 | 26,067 | 28,999 | 29,213 | ||||||||||||
Current liabilities | 9,528 | 4,504 | 5,178 | 5,316 | ||||||||||||
Long-term debt, net | 30,457 | 33,227 | 30,488 | 30,444 | ||||||||||||
Intercompany balances | 2,901 | (53 | ) | 2,324 | 2,090 | |||||||||||
Income taxes and other liabilities | 799 | 879 | 1,230 | 1,004 | ||||||||||||
Total noncurrent liabilities | 34,654 | 34,398 | 34,559 | 34,035 | ||||||||||||
Stockholders’ deficit attributable to Parent, Subsidiary Issuer and Subsidiary Guarantors | (11,392 | ) | (12,941 | ) | (10,845 | ) | (10,247 | ) | ||||||||
Noncontrolling interests | 102 | 106 | 107 | 109 |
2020 | 2019 | 2021 | 2020 | |||||||||||||
Number of hospitals in operation at: | ||||||||||||||||
March 31 | 186 | 185 | 186 | 186 | ||||||||||||
June 30 | 186 | 184 | 186 | |||||||||||||
September 30 | 187 | 184 | 187 | |||||||||||||
December 31 | 184 | 185 | ||||||||||||||
Number of freestanding outpatient surgical centers in operation at: | ||||||||||||||||
March 31 | 123 | 124 | 121 | 123 | ||||||||||||
June 30 | 122 | 125 | 122 | |||||||||||||
September 30 | 121 | 125 | 121 | |||||||||||||
December 31 | 123 | 121 | ||||||||||||||
Licensed hospital beds at(a): | ||||||||||||||||
March 31 | 49,357 | 48,455 | 49,561 | 49,357 | ||||||||||||
June 30 | 49,403 | 48,483 | 49,403 | |||||||||||||
September 30 | 49,473 | 48,588 | 49,473 | |||||||||||||
December 31 | 49,035 | 49,265 | ||||||||||||||
Weighted average licensed beds(b): | ||||||||||||||||
Weighted average licensed beds in service(b): | ||||||||||||||||
Quarter: | ||||||||||||||||
First | 49,160 | 48,036 | 42,363 | 42,177 | ||||||||||||
Second | 49,358 | 48,429 | 42,309 | |||||||||||||
Third | 49,479 | 48,535 | 42,426 | |||||||||||||
Fourth | 48,911 | 42,072 | ||||||||||||||
Year | 48,480 | 42,246 | ||||||||||||||
Average daily census(c): | ||||||||||||||||
Quarter: | ||||||||||||||||
First | 28,822 | 28,966 | 29,678 | 28,822 | ||||||||||||
Second | 24,844 | 27,808 | 24,844 | |||||||||||||
Third | 28,186 | 27,502 | 28,186 | |||||||||||||
Fourth | 28,274 | 29,065 | ||||||||||||||
Year | 28,134 | 27,734 | ||||||||||||||
Admissions(d): | ||||||||||||||||
Quarter: | ||||||||||||||||
First | 528,244 | 523,196 | 506,380 | 528,244 | ||||||||||||
Second | 452,992 | 518,253 | 452,992 | |||||||||||||
Third | 506,756 | 527,284 | 506,756 | |||||||||||||
Fourth | 540,194 | 521,917 | ||||||||||||||
Year | 2,108,927 | 2,009,909 | ||||||||||||||
Equivalent admissions(e): | ||||||||||||||||
Quarter: | ||||||||||||||||
First | 889,035 | 889,956 | 832,489 | 889,035 | ||||||||||||
Second | 723,136 | 903,419 | 723,136 | |||||||||||||
Third | 835,576 | 918,964 | 835,576 | |||||||||||||
Fourth | 933,996 | 864,583 | ||||||||||||||
Year | 3,646,335 | 3,312,330 |
2020 | 2019 | 2021 | 2020 | |||||||||||||
Average length of stay (days)(f): | ||||||||||||||||
Quarter: | ||||||||||||||||
First | 5.0 | 5.0 | 5.3 | 5.0 | ||||||||||||
Second | 5.0 | 4.9 | 5.0 | |||||||||||||
Third | 5.1 | 4.8 | 5.1 | |||||||||||||
Fourth | 4.8 | 5.1 | ||||||||||||||
Year | 4.9 | 5.1 | ||||||||||||||
Emergency room visits(g): | ||||||||||||||||
Quarter: | ||||||||||||||||
First | 2,264,707 | 2,287,440 | 1,841,778 | 2,264,707 | ||||||||||||
Second | 1,516,116 | 2,253,337 | 1,516,116 | |||||||||||||
Third | 1,813,661 | 2,269,364 | 1,813,661 | |||||||||||||
Fourth | 2,350,988 | 1,855,823 | ||||||||||||||
Year | 9,161,129 | 7,450,307 | ||||||||||||||
Outpatient surgeries(h): | ||||||||||||||||
Quarter: | ||||||||||||||||
First | 226,319 | 240,846 | 231,228 | 226,319 | ||||||||||||
Second | 170,911 | 253,441 | 170,911 | |||||||||||||
Third | 232,493 | 249,177 | 232,493 | |||||||||||||
Fourth | 266,483 | 252,760 | ||||||||||||||
Year | 1,009,947 | 882,483 | ||||||||||||||
Inpatient surgeries(i): | ||||||||||||||||
Quarter: | ||||||||||||||||
First | 135,145 | 137,363 | 127,590 | 135,145 | ||||||||||||
Second | 118,591 | 140,473 | 118,591 | |||||||||||||
Third | 133,492 | 143,215 | 133,492 | |||||||||||||
Fourth | 145,584 | 135,157 | ||||||||||||||
Year | 566,635 | 522,385 | ||||||||||||||
Days revenues in accounts receivable(j): | ||||||||||||||||
Quarter: | ||||||||||||||||
First | 49 | 53 | 48 | 49 | ||||||||||||
Second | 50 | 52 | 50 | |||||||||||||
Third | 44 | 52 | 44 | |||||||||||||
Fourth | 50 | 45 | ||||||||||||||
Outpatient revenues as a % of patient revenues(k): | ||||||||||||||||
Quarter: | ||||||||||||||||
First | 37 | % | 38 | % | 36 | % | 37 | % | ||||||||
Second | 32 | % | 39 | % | 32 | % | ||||||||||
Third | 36 | % | 39 | % | 36 | % | ||||||||||
Fourth | 39 | % | 35 | % | ||||||||||||
Year | 39 | % | 35 | % |
(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 in service, 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 |
Period | Total Number of Shares Purchased | Average Price Paid per Share | Total Number of Shares Purchased as Part of Publicly Announced Plans or Programs | Approximate Dollar Value of Shares That May Yet Be Purchased Under Publicly Announced Plans or Programs | ||||||||||||
January 1, 2021 through January 31, 2021 | — | $ | — | — | $ | 2,800 | ||||||||||
February 1, 2021 through February 28, 2021 | 4,057,692 | $ | 175.39 | 4,057,692 | $ | 8,089 | ||||||||||
March 1, 2021 through March 31, 2021 | 4,419,044 | $ | 184.44 | 4,419,044 | $ | 7,274 | ||||||||||
Total for first quarter 2021 | 8,476,736 | $ | 180.11 | 8,476,736 | $ | 7,274 | ||||||||||
ITEM 6. EXHIBITS |
10.1 | — | |||
22 | — | |||
31.1 | — | |||
31.2 | — | |||
32 | — | |||
101 | — | The following financial information from our quarterly report on Form 10-Q for the | ||
104 | — | The cover page from the Company’s Quarterly Report on Form 10-Q for the quarter ended |
* | Management compensatory plan or arrangement. |
HCA Healthcare, Inc. | ||
By: | /S/ WILLIAM B. RUTHERFORD | |
William B. Rutherford | ||
Executive Vice President and Chief Financial Officer |