UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

Form 10-Q

 

 

(Mark One)

xQUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2014March 31, 2015

Or

 

¨TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from                    to                    

Commission file number 1-11239

 

 

HCA Holdings, Inc.

(Exact name of registrant as specified in its charter)

 

 

 

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)

(615) 344-9551

(Registrant’s telephone number, including area code)

Not Applicable

(Former name, former address and former fiscal year, if changed since last report)

 

 

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    Yes  x    No  ¨

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 ofRegulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).    Yes  x    No  ¨

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, anon-accelerated filer, or a smaller reporting company. See the definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act.

 

Large accelerated filer

 

x

  

Accelerated filer

 

¨

Non-accelerated filer

 

¨  (Do not check if a smaller reporting company)

  

Smaller reporting company

 

¨

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    Yes  ¨    No  x

Indicate the number of shares outstanding of each of the issuer’s classes of common stock as of the latest practicable date.

 

Class of Common Stock

 

Outstanding at October 31, 2014April 30, 2015

Voting common stock, $.01 par value 433,563,800414,320,500 shares

 

 

 


HCA HOLDINGS, INC.

Form 10-Q

September 30, 2014March 31, 2015

 

     Page of
Form  10-Q
 

Part I.

 Financial Information  

Item 1.

 Financial Statements (Unaudited):  
 

Condensed Consolidated Income Statements — for the quarters ended March 31, 2015 and nine months ended September 30, 2014 and 2013

   2  
 

Condensed Consolidated Comprehensive Income Statements — for the quarters ended March 31, 2015 and nine months ended September 30, 2014 and 2013

   3  
 

Condensed Consolidated Balance Sheets — September 30, 2014March 31, 2015 and December 31, 20132014

   4  
 

Condensed Consolidated Statements of Cash Flows — for the nine monthsquarters ended September 30,March 31, 2015 and 2014 and 2013

   5  
 

Notes to Condensed Consolidated Financial Statements

   6  

Item 2.

 

Management’s Discussion and Analysis of Financial Condition and Results of Operations

   2826  

Item 3.

 

Quantitative and Qualitative Disclosures About Market Risk

   4742  

Item 4.

 

Controls and Procedures

   4742  

Part II.

 Other Information  

Item 1.

 

Legal Proceedings

   4742  

Item 1A.

 

Risk Factors

44

Item 2.

Unregistered Sales of Equity Securities and Use of Proceeds

45

Item 5.

Other Information   4945  

Item 6.

 

Exhibits

   5047  

Signatures

   5148  

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATED INCOME STATEMENTS

FOR THE QUARTERS ENDED MARCH 31, 2015 AND NINE MONTHS ENDED SEPTEMBER 30, 2014 AND 2013

Unaudited

(Dollars in millions, except per share amounts)

 

  Quarter Nine Months 
  2014 2013 2014 2013   2015 2014 

Revenues before provision for doubtful accounts

  $9,978   $9,411   $29,619   $28,078    $10,322   $9,683  

Provision for doubtful accounts

   758    955    2,337    2,732     646    851  
  

 

  

 

  

 

  

 

   

 

  

 

 

Revenues

   9,220    8,456    27,282    25,346     9,676    8,832  

Salaries and benefits

   4,211    3,916    12,359    11,681     4,398    4,050  

Supplies

   1,539    1,457    4,603    4,406     1,638    1,532  

Other operating expenses

   1,688    1,564    4,977    4,594     1,717    1,645  

Electronic health record incentive income

   (32  (75  (97  (166   (19  (30

Equity in earnings of affiliates

   (14  (9  (32  (29   (19  (9

Depreciation and amortization

   460    443    1,361    1,292     473    447  

Interest expense

   427    458    1,314    1,392     419    460  

Losses (gains) on sales of facilities

   12    1    (20  13  

Losses on retirement of debt

           226    17  

Gains on sales of facilities

   (9  (21

Legal claim costs

           78             78  
  

 

  

 

  

 

  

 

   

 

  

 

 
   8,291    7,755    24,769    23,200     8,598    8,152  
  

 

  

 

  

 

  

 

   

 

  

 

 

Income before income taxes

   929    701    2,513    2,146     1,078    680  

Provision for income taxes

   318    234    816    704     358    226  
  

 

  

 

  

 

  

 

   

 

  

 

 

Net income

   611    467    1,697    1,442     720    454  

Net income attributable to noncontrolling interests

   93    102    349    310     129    107  
  

 

  

 

  

 

  

 

   

 

  

 

 

Net income attributable to HCA Holdings, Inc.

  $518   $365   $1,348   $1,132    $591   $347  
  

 

  

 

  

 

  

 

   

 

  

 

 

Per share data:

        

Basic earnings per share

  $1.20   $0.82   $3.08   $2.54    $1.41   $0.78  

Diluted earnings per share

  $1.16   $0.79   $2.98   $2.44    $1.36   $0.76  

Shares used in earnings per share calculations (in thousands):

     

Shares used in earnings per share calculations (in millions):

   

Basic

   432,617    447,329    437,832    446,125     420.148    442.150  

Diluted

   447,260    463,569    452,538    463,051     435.309    457.449  

See accompanying notes.

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATED COMPREHENSIVE INCOME STATEMENTS

FOR THE QUARTERS ENDED MARCH 31, 2015 AND NINE MONTHS ENDED SEPTEMBER 30, 2014 AND 2013

Unaudited

(Dollars in millions)

 

  Quarter Nine Months 
  2014 2013 2014 2013   2015 2014 

Net income

  $611   $467   $1,697   $1,442    $720   $454  

Other comprehensive (loss) income before taxes:

        

Foreign currency translation

   (58  60    (18       (51  10  

Unrealized gains (losses) on available-for-sale securities

   2    1    10    (7

Unrealized gains on available-for-sale securities

   1    4  

Defined benefit plans

       8        8           

Pension costs included in salaries and benefits

   3    9    11    24     6    4  
  

 

  

 

  

 

  

 

   

 

  

 

 
   3    17    11    32     6    4  

Change in fair value of derivative financial instruments

   8    (31  (21  9     (23  (10

Interest costs included in interest expense

   34    33    99    97     31    33  
  

 

  

 

  

 

  

 

   

 

  

 

 
   42    2    78    106     8    23  
  

 

  

 

  

 

  

 

   

 

  

 

 

Other comprehensive (loss) income before taxes

   (11  80    81    131     (36  41  

Income taxes (benefits) related to other comprehensive income items

   (4  28    30    48     (15  16  
  

 

  

 

  

 

  

 

   

 

  

 

 

Other comprehensive (loss) income

   (7  52    51    83     (21  25  
  

 

  

 

  

 

  

 

   

 

  

 

 

Comprehensive income

   604    519    1,748    1,525     699    479  

Comprehensive income attributable to noncontrolling interests

   93    102    349    310     129    107  
  

 

  

 

  

 

  

 

   

 

  

 

 

Comprehensive income attributable to HCA Holdings, Inc.

  $511   $417   $1,399   $1,215    $570   $372  
  

 

  

 

  

 

  

 

   

 

  

 

 

See accompanying notes.

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

Unaudited

(Dollars in millions)

 

  September 30,
2014
 December 31,
2013
   March 31,
2015
 December 31,
2014
 
ASSETS      

Current assets:

      

Cash and cash equivalents

  $515   $414    $586   $566  

Accounts receivable, less allowance for doubtful accounts of $5,103 and $5,488

   5,524    5,208  

Accounts receivable, less allowance for doubtful accounts of $4,692 and $5,011

   5,928    5,694  

Inventories

   1,258    1,179     1,287    1,279  

Deferred income taxes

   320    489     304    366  

Other

   910    747     1,025    1,025  
  

 

  

 

   

 

  

 

 
   8,527    8,037     9,130    8,930  

Property and equipment, at cost

   32,301    31,073     33,293    32,980  

Accumulated depreciation

   (18,423  (17,454   (18,901  (18,625
  

 

  

 

   

 

  

 

 
   13,878    13,619     14,392    14,355  

Investments of insurance subsidiaries

   441    448     435    494  

Investments in and advances to affiliates

   167    121     181    165  

Goodwill and other intangible assets

   5,899    5,903     6,415    6,416  

Deferred loan costs

   221    237  

Other

   692    466     735    620  
  

 

  

 

   

 

  

 

 
  $29,825   $28,831    $31,288   $30,980  
  

 

  

 

   

 

  

 

 
LIABILITIES AND STOCKHOLDERS’ DEFICIT      

Current liabilities:

      

Accounts payable

  $1,787   $1,803    $1,973   $2,035  

Accrued salaries

   1,238    1,193     1,180    1,370  

Other accrued expenses

   1,563    1,913     1,982    1,737  

Long-term debt due within one year

   1,044    786     2,037    338  
  

 

  

 

   

 

  

 

 
   5,632    5,695     7,172    5,480  

Long-term debt

   27,426    27,590  

Long-term debt, less debt issuance costs of $220 and $219

   27,406    29,088  

Professional liability risks

   1,045    949     1,095    1,078  

Income taxes and other liabilities

   1,740    1,525     1,837    1,832  

Stockholders’ deficit:

      

Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 433,378,700 shares in 2014 and 439,604,000 shares in 2013

   4    4  

Capital in excess of par value

   872    1,386  

Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 419,179,100 shares in 2015 and 420,477,900 shares in 2014

   4    4  

Accumulated other comprehensive loss

   (206  (257   (344  (323

Retained deficit

   (8,054  (9,403   (7,280  (7,575
  

 

  

 

   

 

  

 

 

Stockholders’ deficit attributable to HCA Holdings, Inc.

   (7,384  (8,270   (7,620  (7,894

Noncontrolling interests

   1,366    1,342     1,398    1,396  
  

 

  

 

   

 

  

 

 
   (6,018  (6,928   (6,222  (6,498
  

 

  

 

   

 

  

 

 
  $29,825   $28,831    $31,288   $30,980  
  

 

  

 

   

 

  

 

 

See accompanying notes.

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

FOR THE NINE MONTHSQUARTERS ENDED SEPTEMBER 30,MARCH 31, 2015 AND 2014 AND 2013

Unaudited

(Dollars in millions)

 

  2014 2013   2015 2014 

Cash flows from operating activities:

      

Net income

  $1,697   $1,442    $720   $454  

Adjustments to reconcile net income to net cash provided by operating activities:

      

Changes in operating assets and liabilities

   (2,945  (3,319

Increase (decrease) in cash from operating assets and liabilities:

   

Accounts receivable

   (895  (1,125

Provision for doubtful accounts

   2,337    2,732     646    851  
  

 

  

 

 

Accounts receivable, net

   (249  (274

Inventories and other assets

   (106  (123

Accounts payable and accrued expenses

   (312  (313

Depreciation and amortization

   1,361    1,292     473    447  

Income taxes

   (61  158     438    144  

Losses (gains) on sales of facilities

   (20  13  

Losses on retirement of debt

   226    17  

Gains on sales of facilities

   (9  (21

Legal claim costs

   78             78  

Amortization of deferred loan costs

   33    41  

Amortization of debt issuance costs

   10    14  

Share-based compensation

   118    81     48    37  

Other

   (3  (3   5      
  

 

  

 

   

 

  

 

 

Net cash provided by operating activities

   2,821    2,454     1,018    443  
  

 

  

 

   

 

  

 

 

Cash flows from investing activities:

      

Purchase of property and equipment

   (1,482  (1,347   (446  (400

Acquisition of hospitals and health care entities

   (97  (463   (28  (19

Disposition of hospitals and health care entities

   38    31  

Disposal of hospitals and health care entities

   15    23  

Change in investments

   22    97     22    (13

Other

   7    8     5      
  

 

  

 

   

 

  

 

 

Net cash used in investing activities

   (1,512  (1,674   (432  (409
  

 

  

 

   

 

  

 

 

Cash flows from financing activities:

      

Issuance of long-term debt

   3,502      

Net change in revolving credit facilities

   (160  630  

Issuances of long-term debt

   1,000    3,502  

Net change in revolving bank credit facilities

   (260  (2,440

Repayment of long-term debt

   (3,525  (1,300   (791  (542

Distributions to noncontrolling interests

   (325  (308   (132  (87

Payment of debt issuance costs

   (49  (5   (11  (48

Repurchase of common stock

   (750    

Repurchases of common stock

   (366    

Distributions to stockholders

   (7  (13   (6  (7

Income tax benefits

   119    70     38    50  

Other

   (13  (75   (38  (26
  

 

  

 

   

 

  

 

 

Net cash used in financing activities

   (1,208  (1,001

Net cash (used in) provided by financing activities

   (566  402  
  

 

  

 

   

 

  

 

 

Change in cash and cash equivalents

   101    (221   20    436  

Cash and cash equivalents at beginning of period

   414    705     566    414  
  

 

  

 

   

 

  

 

 

Cash and cash equivalents at end of period

  $515   $484    $586   $850  
  

 

  

 

   

 

  

 

 

Interest payments

  $1,441   $1,464    $487   $523  

Income tax payments, net

  $758   $476  

Income tax (refunds) payments, net

  $(118 $32  
   

See accompanying notes.

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

Reporting Entity

HCA Holdings, 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 Holdings, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At September 30, 2014,March 31, 2015, these affiliates owned and operated 165168 hospitals, 113 freestanding surgery centers and provided extensive outpatient and ancillary services. HCA Holdings, Inc.’s facilities are located in 20 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 Holdings, 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 $71$74 million and $76$68 million for the quarters ended September 30,March 31, 2015 and 2014, and 2013, respectively, and $206 million and $207 million for the nine months ended September 30, 2014 and 2013, respectively. Operating results for the quarter and the nine months ended September 30, 2014March 31, 2015 are not necessarily indicative of the results that may be expected for the year ending December 31, 2014.2015. 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, 2013.2014.

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (continued)

Revenues

 

Revenues are recorded during the period the health care services are provided, based upon the estimated amounts due from the patients and third-party payers. Third-party payers include federal and state agencies (under Medicare, Medicaid and other programs), managed care health plans (includes the health insurance exchanges, beginning with the first quarter of 2014)exchanges), commercial insurance companies and employers. Estimates of contractual allowances under managed care health plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record a provision for doubtful accounts related to uninsured accounts to record the net self pay revenues at the estimated amounts we expect to collect. Our revenues from third-party payers, and the uninsured and other for the quarters ended March 31, 2015 and nine months ended September 30, 2014 and 2013 are summarized in the following table (dollars in millions):

 

   Quarter 
   2014  Ratio  2013  Ratio 

Medicare

  $2,120    23.0 $1,847    21.8

Managed Medicare

   901    9.8    794    9.4  

Medicaid

   372    4.0    401    4.7  

Managed Medicaid

   510    5.5    386    4.6  

Managed care and other insurers

   5,073    55.0    4,636    54.8  

International (managed care and other insurers)

   323    3.5    287    3.4  
  

 

 

  

 

 

  

 

 

  

 

 

 
   9,299    100.8    8,351    98.7  

Uninsured

   313    3.4    717    8.5  

Other

   366    4.0    343    4.1  
  

 

 

  

 

 

  

 

 

  

 

 

 

Revenues before provision for doubtful accounts

   9,978    108.2    9,411    111.3  

Provision for doubtful accounts

   (758  (8.2  (955  (11.3
  

 

 

  

 

 

  

 

 

  

 

 

 

Revenues

  $    9,220    100.0 $    8,456    100.0
  

 

 

  

 

 

  

 

 

  

 

 

 

   Nine Months 
   2014  Ratio  2013  Ratio 

Medicare

  $6,285    23.0 $5,961    23.5

Managed Medicare

   2,706    9.9    2,441    9.6  

Medicaid

   1,404    5.1    1,098    4.3  

Managed Medicaid

   1,383    5.1    1,165    4.6  

Managed care and other insurers

   14,742    54.0    13,777    54.4  

International (managed care and other insurers)

   983    3.6    868    3.4  
  

 

 

  

 

 

  

 

 

  

 

 

 
   27,503    100.7    25,310    99.8  

Uninsured

   1,019    3.7    1,809    7.1  

Other

   1,097    4.0    959    3.8  
  

 

 

  

 

 

  

 

 

  

 

 

 

Revenues before provision for doubtful accounts

   29,619    108.4    28,078    110.7  

Provision for doubtful accounts

   (2,337  (8.4  (2,732  (10.7
  

 

 

  

 

 

  

 

 

  

 

 

 

Revenues

  $    27,282    100.0 $    25,346    100.0
  

 

 

  

 

 

  

 

 

  

 

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (continued)

Revenues (continued)

During the quarter ended September 30, 2014, we recorded two changes in estimates which had the net effect of increasing revenues $26 million. We recorded $94 million, or $0.13 per diluted share, of Medicare revenues as the estimated settlement amount for certain claims denied by Recovery Audit Contractors (“RAC”) entities conducting reviews on behalf of the Centers for Medicare and Medicaid Services (“CMS”) and currently in the pending appeals process. CMS is offering an administrative agreement to providers willing to withdraw their pending appeals in exchange for a timely partial payment (generally, 68% of the claim amount, subject to certain adjustments). We also recorded a reduction of $68 million, or $0.09 per diluted share, to Medicaid revenues related to the Texas Medicaid Waiver Program. On October 1, 2014, the Texas Health and Human Services Commission (“THHSC”) issued a notice to hospitals participating in the Texas Medicaid Waiver Program. According to the notice, a review conducted by CMS identified certain local government/hospital affiliations it believes may be inconsistent with the waiver. As a result of these findings, CMS notified THHSC that it is deferring the federal portion of the Medicaid payments associated with these affiliations while it completes its review.

   2015   Ratio  2014   Ratio 

Medicare

  $2,234     23.1 $2,125     24.1

Managed Medicare

   1,052     10.9    899     10.2  

Medicaid

   452     4.7    444     5.0  

Managed Medicaid

   549     5.7    421     4.8  

Managed care and other insurers

   5,216     53.9    4,710     53.3  

International (managed care and other insurers)

   321     3.3    326     3.7  
  

 

 

   

 

 

  

 

 

   

 

 

 
   9,824     101.6    8,925     101.1  

Uninsured

   68     0.7    388     4.4  

Other

   430     4.4    370     4.2  
  

 

 

   

 

 

  

 

 

   

 

 

 

Revenues before provision for doubtful accounts

   10,322     106.7    9,683     109.7  

Provision for doubtful accounts

   (646   (6.7  (851   (9.7
  

 

 

   

 

 

  

 

 

   

 

 

 

Revenues

  $    9,676     100.0 $    8,832     100.0
  

 

 

   

 

 

  

 

 

   

 

 

 

Recent Pronouncements

In May 2014, the Financial Accounting Standards Board (“FASB”) and the International Accounting Standards Board issued a final, converged, principles-based standard on revenue recognition. Companies across all industries will use a five-step model to recognize revenue from customer contracts. The new standard, which replaces nearly all existing United States Generally Accepted Accounting Principles (“US GAAP”) and International Financial Reporting Standards revenue recognition guidance, will require significant management judgment in addition to changing the way many companies recognize revenue in their financial statements. The standard iswas originally scheduled to become effective for public entities for annual and interim periods beginning after December 15, 2016. Early adoption iswas originally not to be permitted under US GAAP. During April 2015, the FASB proposed a deferral of the effective date of the new revenue standard by one year, but would permit entities to adopt one year earlier if they choose (i.e., the original effective date). The FASB decided, based on its outreach to various stakeholders and forthcoming exposure drafts, which amend the new revenue standard, that a deferral may be necessary to provide adequate time to effectively implement the new standard. We are evaluatingcontinuing to evaluate the effects the adoption of this standard will have on our financial statements and financial disclosures.

In April 2015, the FASB issued Accounting Standards Update 2015-03,Simplifying the Presentation of Debt Issuance Costs(“ASU 2015-03”), which requires that debt issuance costs be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability. The guidance in the new standard is limited

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (continued)

Recent Pronouncements (continued)

to the presentation of debt issuance costs. The recognition and measurement guidance for debt issuance costs are not affected by ASU 2015-03. We have elected to adopt the new presentation for our March 31, 2015 condensed consolidated financial statements, and the applicable prior year amounts have been reclassified in accordance with ASU 2015-03.

Reclassifications

Certain prior year amounts have been reclassified to conform to the current year presentation.

NOTE 2 — ACQUISITIONS AND DISPOSITIONS

During the nine monthsquarter ended September 30, 2014,March 31, 2015, we paid $14 million to acquire a hospital and $83$28 million to acquire other nonhospital health care entities. During the nine monthsquarter ended September 30, 2013,March 31, 2014, we paid $317$13 million to acquire a hospital and recorded goodwill and identifiable intangible assets of $176$6 million and $125 million, respectively, related to the acquisitions ofacquire other nonhospital health care entities and $146 million related to the acquisition of three hospitals.entities.

During the nine monthsquarter ended September 30, 2014,March 31, 2015, we received proceeds of $38$15 million and recognized net pretax gains of $20$9 million related to sales of real estate and other investments. During the nine monthsquarter ended September 30, 2013,March 31, 2014, we received proceeds of $31$23 million and recognized net pretax lossesgains of $13$21 million related to sales of a hospital facility and real estate and other investments.

NOTE 3 — INCOME TAXES

TheDuring 2014, the IRS Examination Division began an audit of HCA Holdings Inc.’s 2011 and 2012 federal income tax returns during 2014.returns. We are also subject to examination by state and foreign taxing authorities.

Our liability for unrecognized tax benefits was $503$544 million, including accrued interest of $43$62 million, as of September 30, 2014March 31, 2015 ($462548 million and $30$58 million, respectively, as of December 31, 2013)2014). Unrecognized tax

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 3 — INCOME TAXES (continued)

benefits of $180$215 million ($160205 million as of December 31, 2013)2014) would affect the effective rate, if recognized. The provision for income taxes reflects $3 million and $7 million ($2 million and $4 million respectively,($3 million, net of tax) of interest expense related to taxing authority examinations for the quartersquarter ended September 30, 2014 and 2013, respectively. The provision for income taxes reflects $11 million ($7 million, net of tax) of interest expense related to taxing authority examinations and $8 million ($5 million, net of tax) of reductions in interest expense related to taxing authority examinations for the nine months ended September 30, 2014 and 2013, respectively.March 31, 2014.

Depending on the resolution of any IRS, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, the resolution of any tax disputes, 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 declinedecrease within the next 12 months. However, we are currently unable to estimate the range of any possible change.

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 stock options, stock appreciation rights and restricted share units, computed using the treasury stock method.

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 4 — EARNINGS PER SHARE (continued)

The following table sets forth the computation of basic and diluted earnings per share for the quarters ended March 31, 2015 and nine months ended September 30, 2014 (dollars and 2013 (dollarsshares in millions, except per share amounts, and shares in thousands)amounts):

 

   Quarter   Nine Months 
   2014   2013   2014   2013 

Net income attributable to HCA Holdings, Inc.

  $518    $365    $1,348    $1,132  

Weighted average common shares outstanding

   432,617     447,329     437,832     446,125  

Effect of dilutive incremental shares

   14,643     16,240     14,706     16,926  
  

 

 

   

 

 

   

 

 

   

 

 

 

Shares used for diluted earnings per share

   447,260     463,569     452,538     463,051  
  

 

 

   

 

 

   

 

 

   

 

 

 

Earnings per share:

        

Basic earnings per share

  $1.20    $0.82    $3.08    $2.54  

Diluted earnings per share

  $1.16    $0.79    $2.98    $2.44  

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

   2015   2014 

Net income attributable to HCA Holdings, Inc.

  $591    $347  

Weighted average common shares outstanding

   420.148     442.150  

Effect of dilutive incremental shares

   15.161     15.299  
  

 

 

   

 

 

 

Shares used for diluted earnings per share

   435.309     457.449  
  

 

 

   

 

 

 

Earnings per share:

    

Basic earnings per share

  $1.41    $0.78  

Diluted earnings per share

  $1.36    $0.76  

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES

A summary of our insurance subsidiaries’ investments at September 30, 2014March 31, 2015 and December 31, 20132014 follows (dollars in millions):

 

  September 30, 2014   March 31, 2015 
  Amortized
Cost
   Unrealized
Amounts
 Fair
Value
   Amortized
Cost
   Unrealized
Amounts
 Fair
Value
 
  Gains   Losses   Gains   Losses 

Debt securities:

              

States and municipalities

  $449    $19    $(1 $467    $471    $18    $(1 $488  

Money market funds

   37              37     38              38  
  

 

   

 

   

 

  

 

   

 

   

 

   

 

  

 

 
   486     19     (1  504     509     18     (1  526  

Equity securities

   1     2         3     1     3         4  
  

 

   

 

   

 

  

 

   

 

   

 

   

 

  

 

 
  $487    $21    $(1  507    $510    $21    $(1  530  
  

 

   

 

   

 

    

 

   

 

   

 

  

Amounts classified as current assets

        (66        (95
       

 

        

 

 

Investment carrying value

       $441         $435  
       

 

        

 

 

 

  December 31, 2013   December 31, 2014 
  Amortized
Cost
   Unrealized
Amounts
 Fair
Value
   Amortized
Cost
   Unrealized
Amounts
 Fair
Value
 
  Gains   Losses   Gains   Losses 

Debt securities:

              

States and municipalities

  $404    $11    $(3 $412    $477    $18    $(1 $494  

Money market funds

   94              94     61              61  
  

 

   

 

   

 

  

 

   

 

   

 

   

 

  

 

 
   498     11     (3  506     538     18     (1  555  

Equity securities

   2     2         4     1     2         3  
  

 

   

 

   

 

  

 

   

 

   

 

   

 

  

 

 
  $500    $13    $(3  510    $539    $20    $(1  558  
  

 

   

 

   

 

    

 

   

 

   

 

  

Amounts classified as current assets

        (62        (64
       

 

        

 

 

Investment carrying value

       $448         $494  
       

 

        

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued)

At September 30, 2014March 31, 2015 and December 31, 2013,2014, the investments of our insurance subsidiaries were classified as “available-for-sale.” Changes in temporary unrealized gains and losses are recorded as adjustments to other comprehensive income (loss). Amounts classified as current assets at March 31, 2015 include $43 million to be distributed to the Company from an insurance subsidiary.

Scheduled maturities of investments in debt securities at September 30, 2014March 31, 2015 were as follows (dollars in millions):

 

   Amortized
Cost
   Fair
Value
 

Due in one year or less

  $59    $60  

Due after one year through five years

   207     212  

Due after five years through ten years

   97     104  

Due after ten years

   123     128  
  

 

 

   

 

 

 
  $486    $504  
  

 

 

   

 

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued)

   Amortized
Cost
   Fair
Value
 

Due in one year or less

  $71    $71  

Due after one year through five years

   204     208  

Due after five years through ten years

   124     132  

Due after ten years

   110     115  
  

 

 

   

 

 

 
  $509    $526  
  

 

 

   

 

 

 

The average expected maturity of the investments in debt securities at September 30, 2014March 31, 2015 was 4.14.0 years, compared to the average scheduled maturity of 6.15.7 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.

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 two parties based on common notional principal amounts and maturity dates. Pay-fixed interest rate swaps effectively convert LIBOR indexed 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, 2014March 31, 2015 (dollars in millions):

 

  Notional
Amount
   Maturity Date   Fair

Value
   Notional
Amount
   Maturity Date   Fair
Value
 

Pay-fixed interest rate swaps

  $500     December 2014    $(1  $3,000     December 2016    $(154

Pay-fixed interest rate swaps

   3,000     December 2016     (183   1,000     December 2017     (37

Pay-fixed interest rate swaps

   1,000     December 2017     (33

During the next 12 months, we estimate $121$116 million will be reclassified from other comprehensive income (“OCI”) to interest expense.

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 6 — FINANCIAL INSTRUMENTS (continued)

Derivatives — Results of Operations

The following table presents the effect of our interest rate swaps on our results of operations for the nine monthsquarter ended September 30, 2014March 31, 2015 (dollars in millions):

 

Derivatives in Cash Flow Hedging Relationships

  Amount of  Loss

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
   Amount of Loss
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

  $13     Interest expense    $99    $15     Interest expense    $31  

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, 2014,March 31, 2015, we have not been required to post any collateral related to these agreements. If we had breached these provisions at September 30, 2014,March 31, 2015, we would have been required to settle our obligations under the agreements at their aggregate, estimated termination value of $224$197 million.

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE

Accounting Standards Codification 820,Fair Value Measurements and Disclosures(“ASC 820”) emphasizes fair value is a market-based measurement, not an entity-specific measurement. Therefore, a fair value measurement should be determined based on the assumptions market participants would use in pricing the asset or liability. As a basis for considering market participant assumptions in fair value measurements, ASC 820 establishes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).

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, and considers factors specific to the asset or liability.

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. Certain types of cash traded instruments are classified within

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

Cash Traded Investments (continued)

Level 3 of the fair value hierarchy because they trade infrequently and therefore have little or no price transparency. The valuation of these securities involves management’s judgment, after consideration of market factors and the absence of market transparency, market liquidity and observable inputs. Our valuation models derived fair market values compared to tax-equivalent yields of other securities of similar credit worthiness and similar effective maturities.

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.

Although we determined the majority of the inputs used to value our derivatives fall within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with our derivatives utilize Level 3 inputs, such as estimates of current credit spreads to evaluate the likelihood of default by us and our counterparties. We assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions, and at September 30, 2014March 31, 2015 and December 31, 2013,2014, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives.

The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of March 31, 2015 and December 31, 2014, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

  March 31, 2015 
  Fair Value  Fair Value Measurements Using 
   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:

    

States and municipalities

 $488   $   $482   $6  

Money market funds

  38    38          
 

 

 

  

 

 

  

 

 

  

 

 

 
  526    38    482    6  

Equity securities

  4    4          
 

 

 

  

 

 

  

 

 

  

 

 

 

Investments of insurance subsidiaries

  530    42    482    6  

Less amounts classified as current assets

  (95  (38  (57    
 

 

 

  

 

 

  

 

 

  

 

 

 
 $435   $4   $425   $6  
 

 

 

  

 

 

  

 

 

  

 

 

 

Liabilities:

    

Interest rate swaps (Income taxes and other liabilities)

 $191   $   $191   $  

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

 

The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of September 30, 2014 and December 31, 2013, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

  September 30, 2014 
  Fair Value  Fair Value Measurements Using 
   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:

    

States and municipalities

 $467   $   $461   $6  

Money market funds

  37    37          
 

 

 

  

 

 

  

 

 

  

 

 

 
  504    37    461    6  

Equity securities

  3    3          
 

 

 

  

 

 

  

 

 

  

 

 

 

Investments of insurance subsidiaries

  507    40    461    6  

Less amounts classified as current assets

  (66  (37  (29    
 

 

 

  

 

 

  

 

 

  

 

 

 
 $441   $3   $432   $6  
 

 

 

  

 

 

  

 

 

  

 

 

 

Liabilities:

    

Interest rate swaps (Income taxes and other liabilities)

 $217   $   $217   $  

  December 31, 2013 
     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:

    

States and municipalities

 $412   $   $405   $7  

Money market funds

  94    94          
 

 

 

  

 

 

  

 

 

  

 

 

 
  506    94    405    7  

Equity securities

  4    3        1  
 

 

 

  

 

 

  

 

 

  

 

 

 

Investments of insurance subsidiaries

  510    97    405    8  

Less amounts classified as current assets

  (62  (62        
 

 

 

  

 

 

  

 

 

  

 

 

 
 $448   $35   $405   $8  
 

 

 

  

 

 

  

 

 

  

 

 

 

Liabilities:

    

Interest rate swaps (Income taxes and other liabilities)

 $295   $   $295   $ —  

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

The following table summarizes the activity related to the investments of our insurance subsidiaries which have fair value measurements based on significant unobservable inputs (Level 3) during the nine months ended September 30, 2014 (dollars in millions):

Asset balances at December 31, 2013

  $8  

Settlements

   (2
  

 

 

 

Asset balances at September 30, 2014

  $6  
  

 

 

 
   December 31, 2014 
      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:

     

States and municipalities

  $494   $   $488   $6  

Money market funds

   61    61          
  

 

 

  

 

 

  

 

 

  

 

 

 
   555    61    488    6  

Equity securities

   3    3          
  

 

 

  

 

 

  

 

 

  

 

 

 

Investments of insurance subsidiaries

   558    64    488    6  

Less amounts classified as current assets

   (64  (61  (3    
  

 

 

  

 

 

  

 

 

  

 

 

 
  $494   $3   $485   $6  
  

 

 

  

 

 

  

 

 

  

 

 

 

Liabilities:

     

Interest rate swaps (Income taxes and other liabilities)

  $199   $   $199   $ —  

The estimated fair value of our long-term debt was $29.369$31.384 billion and $29.603$30.861 billion at September 30, 2014March 31, 2015 and December 31, 2013,2014, respectively, compared to carrying amounts, excluding debt issuance costs, aggregating $28.470$29.663 billion and $28.376$29.645 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.

NOTE 8 — LONG-TERM DEBT

A summary of long-term debt at September 30, 2014March 31, 2015 and December 31, 2013,2014, including related interest rates at September 30, 2014,March 31, 2015, follows (dollars in millions):

 

  September 30,
2014
  December 31,
2013
 

Senior secured asset-based revolving credit facility (effective interest rate of 1.7%)

 $2,280   $2,440  

Senior secured revolving credit facility

        

Senior secured term loan facilities (effective interest rate of 5.3%)

  5,538    5,598  

Senior secured first lien notes (effective interest rate of 5.8%)

  10,492    9,695  

Other senior secured debt (effective interest rate of 6.6%)

  464    448  
 

 

 

  

 

 

 

First lien debt

  18,774    18,181  

Senior unsecured notes (effective interest rate of 7.2%)

  9,696    10,195  
 

 

 

  

 

 

 

Total debt (average life of 6.2 years, rates averaging 5.9%)

  28,470    28,376  

Less amounts due within one year

  1,044    786  
 

 

 

  

��

 

 
 $27,426   $27,590  
 

 

 

  

 

 

 
   March 31,
2015
   December 31,
2014
 

Senior secured asset-based revolving credit facility (effective interest rate of 1.7%)

  $2,620    $2,880  

Senior secured revolving credit facility

          

Senior secured term loan facilities (effective interest rate of 5.2%)

   5,497     5,517  

Senior secured first lien notes (effective interest rate of 5.5%)

   11,100     11,100  

Other senior secured debt (effective interest rate of 6.1%)

   621     573  
  

 

 

   

 

 

 

First lien debt

   19,838     20,070  

Senior unsecured notes (effective interest rate of 7.1%)

   9,825     9,575  

Less debt issuance costs

   220     219  
  

 

 

   

 

 

 

Total debt (average life of 6.2 years, rates averaging 5.6%)

   29,443     29,426  

Less amounts due within one year

   2,037     338  
  

 

 

   

 

 

 
  $27,406    $29,088  
  

 

 

   

 

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 8 — LONG-TERM DEBT (continued)

2015 Activity

During January 2015, we issued $1.000 billion aggregate principal amount of 5.375% senior notes due 2025. We used a portion of the net proceeds to repay at maturity our $750 million aggregate principal amount of 6.375% senior unsecured notes due 2015.

2014 Activity

During MarchOctober 2014, we issued $3.500$600 million aggregate principal amount of 4.25% senior secured notes due 2019 and $1.400 billion aggregate principal amount of 5.25% senior secured notes compriseddue 2025. During November 2014, we used a portion of the proceeds from the October 2014 debt issuances to redeem all $1.400 billion aggregate principal amount of our outstanding 71/4% senior secured notes due 2020. The pretax loss on retirement of debt related to this redemption was $109 million.

During March 2014, we issued $1.500 billion aggregate principal amount of 3.75% senior secured notes due 2019 and $2.000 billion aggregate principal amount of 5.00% senior secured notes due 2024, and repaid at maturity all $500 million aggregate principal amount of our outstanding 5.75% senior unsecured notes. During April 2014, we used proceeds from the March 2014 debt issuance to redeem all $1.500 billion aggregate principal amount of our outstanding 81/2% senior secured notes due 2019 and all $1.250 billion aggregate principal amount of our outstanding 77/8% senior secured notes due 2020. The pretax loss on retirement of debt related to these redemptions was $226 million.

2013 Activity

During March 2013, we redeemed all $201 million aggregate principal amount of our 9 7/8% senior secured second lien notes due 2017. The pretax loss on retirement of debt related to this redemption was $17 million.

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 9 — CONTINGENCIES AND LEGAL CLAIM COSTS

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 subject to claims 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 or financial position.

Government Investigations, Claims and Litigation

Health care companies are subject to numerous investigations by various governmental agencies. Further, under the federal False Claims Act (“FCA”), private parties have the right to bringqui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our financial position, results of operations and liquidity.

As initially disclosed in 2010, the Civil Division of the Department of Justice (“DOJ”) has contacted the Company in connection with its nationwide review of whether, in certain cases, hospital charges to the federal government relating to implantable cardio-defibrillators (“ICDs”) met the CMSCenters for Medicare & Medicaid Services criteria. In connection with this nationwide review, the DOJ has indicated that it will be reviewing certain ICD billing and medical records at 95 HCA hospitals; the review covers the period from October 2003 to

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 9 — CONTINGENCIES AND LEGAL CLAIM COSTS (continued)

Government Investigations, Claims and Litigation (continued)

the present. In August 2012, HCA, along with non-HCA hospitals across the country subject to the DOJ’s review, received from the DOJ a proposed framework for resolving the DOJ’s review of ICDs. The Company is cooperating in the review. The review could potentially give rise to claims against the Company under the federal FCA or other statutes, regulations or laws. At this time, we cannot predict what effect, if any, this review or any resulting claims could have on the Company.

In July 2012, the Civil Division of the U.S. Attorney’s Office in Miami requested information on reviews assessing the medical necessity of interventional cardiology services provided at any Company facility (other than peer reviews). The Company is cooperatingcooperated with the government’s request and has produced medical records associated with particular reviews at eight hospitals, located primarily in Florida. On February 24, 2015, the United States District Court for the Southern District of Florida unsealed aqui tam action which had been filed under seal on February 16, 2012 and alleges particular FCA violations relating to two specific facilities that were among the subjects of the Miami U.S. Attorney’s Office investigation. On January 30, 2015, the U.S. Attorney’s Office filed with the District Court a formal notice that the Department of Justice had declined to intervene in that action. An additionalqui tam action relating to these topics was unsealed and voluntarily dismissed by the relator. The U.S. Attorney’s Office in Miami is continuing its evaluation of the medical necessity of certain interventional cardiology services at the other hospitals for which the Company produced records. At this time, we cannot predict what effect, if any, the requestqui tam action, or any resulting claims that might result from the U.S. Attorney’s continued review, including any potential claims under the federal FCA, other statutes, regulations or laws, could have on the Company.

On April 2, 2014, the UK Competition and Markets Authority (“Authority”) issued a final report on its investigation of the private health care market in London. It concluded, among other things, that many private hospitals face little competition in central London, and that there are high barriers to entry. As part of its remedies package, the Authority ordered HCA to sell either: (a) its London Bridge and Princess Grace hospitals; or (b) its Wellington Hospital, including the Hospital Platinum Medical Centre. It also imposed other remedial conditions on HCA and other private health care providers, including: regulation of incentives to referring physicians; increased access to information about fees and performance; and restrictions on future arrangements between private providers and National Health Service private patient units. HCA disagrees with the Authority’s assessment of the competitive conditions for hospitals in London, as well as its proposed divestiture remedy, and has appealed the decision to the Competition Appeal Tribunal. The appeal is expectedCompetition Appeal Tribunal overturned certain of the Authority’s findings and sent the matter back to be decided in 2015.

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 9 — CONTINGENCIES AND LEGAL CLAIM COSTS (continued)

the Authority for further proceedings.

Securities Class Action Litigation

On October 28, 2011, a shareholder action, Schuh v. HCA Holdings, Inc. et al., was filed in the United States District Court for the Middle District of Tennessee seeking monetary relief. The case sought to include as a class all persons who acquired the Company’s stock pursuant or traceable to the Company’s Registration Statement issued in connection with the March 9, 2011 initial public offering. The lawsuit asserted a claim under Section 11 of the Securities Act of 1933 against the Company, certain members of the board of directors, and certain underwriters in the offering. It further asserted a claim under Section 15 of the Securities Act of 1933 against the same members of the board of directors. The action alleged various deficiencies in the Company’s disclosures in the Registration Statement. Subsequently, two additional class action complaints, Kishtah v. HCA Holdings, Inc. et al. and Daniels v. HCA Holdings, Inc. et al., setting forth substantially similar claims against substantially the same defendants were filed in the same federal court on November 16, 2011 and December 12, 2011, respectively. All three of the cases were consolidated. On May 3, 2012, the court appointed New England Teamsters & Trucking Industry Pension Fund as Lead Plaintiff for the consolidated action. On July 13, 2012, the

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 9 — CONTINGENCIES AND LEGAL CLAIM COSTS (continued)

Securities Class Action Litigation (continued)

lead plaintiff filed an amended complaint asserting claims under Sections 11 and 12(a)(2) of the Securities Act of 1933 against the Company, certain members of the board of directors, and certain underwriters in the offering. It further asserts a claim under Section 15 of the Securities Act of 1933 against the same members of the board of directors and Hercules HoldingsHolding II, LLC, a majority shareholder of the Company at the time of the initial public offering. The consolidated complaint alleges deficiencies in the Company’s disclosures in the Registration Statement and Prospectus relating to: (1) the accounting for the Company’s 2006 recapitalization and 2010 reorganization; (2) the Company’s failure to maintain effective internal controls relating to its accounting for such transactions; and (3) the Company’s Medicare and Medicaid revenue growth rates. The Company and other defendants moved to dismiss the amended complaint on September 11, 2012. The Courtcourt granted the motion in part on May 28, 2013. The action proceeded to discovery on the remaining claims. The plaintiffs’ motion for class certification was granted on September 22, 2014. The court certified a class consisting of all persons that acquired HCA stock on or before October 28, 2011 (the date of the lawsuit) pursuant to the Registration Statement issued in connection with the March 9, 2011 initial public offering. We have requested permission fromA request to the trial court of appeals to immediatelyhear an immediate appeal of this ruling.ruling was denied. Trial has been set for January 2016.

In addition to the above described shareholder class actions, on December 8, 2011, a federal shareholder derivative action, Sutton v. Bracken, et al., putatively initiated in the name of the Company, was filed in the United States District Court for the Middle District of Tennessee against certain officers and present and former directors of the Company seeking monetary relief. The action alleges breaches of fiduciary duties by the named officers and directors in connection with the accounting and earnings claims set forth in the shareholder class actions.actions described above. Setting forth substantially similar claims against substantially the same defendants, an additional federal derivative action, Schroeder v. Bracken, et al., was filed in the United States District Court for the Middle District of Tennessee on December 16, 2011, and a state derivative action, Bagot v. Bracken, et al., was filed in Tennessee state court in the Davidson County Circuit Court on December 20, 2011. The federal derivative actions were consolidated in the Middle District of Tennessee and stayed pending developments in the shareholder class actions. The state derivative action had also been stayed pending developments in the shareholder class actions, but that stay has expired. The plaintiff in the state derivative action subsequently filed an amended complaint on September 9, 2013 that added additional allegations made in the shareholder class actions. On September 24, 2013, an additional state derivative action, Steinberg v. Bracken, et al., was filed in Tennessee state court in the Davidson County Circuit Court. This action against our board of directors has been consolidated with the earlier filed state derivative action. The plaintiffs in the consolidated action filed a consolidated complaint on December 4, 2013. The Company has filed a motion to again stay the state derivative action pending developments in the class action, but the Courtcourt has not yet acted on that motion.

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 9 — CONTINGENCIES AND LEGAL CLAIM COSTS (continued)

Health Midwest Litigation

In October 2009, the Health Care Foundation of Greater Kansas City, a nonprofit health foundation, filed suit against HCA Inc. in the Circuit Court of Jackson County, Missouri and alleged that HCA did not fund the level of capital expenditures and uncompensated care agreed to in connection with HCA’s purchase of hospitals from Health Midwest in 2003. The central issue in the case was whether HCA’s construction of new hospitals counted towards its $450 million five-year capital commitments. In addition, the plaintiff alleged that HCA did not make its required capital expenditures in a timely fashion. On January 24, 2013, the Courtcourt ruled in favor of the plaintiff and awarded at least $162 million. The Courtcourt also ordered a court-supervised accounting of HCA’s capital expenditures, as well as of expenditures on charity and uncompensated care during the ten years following the purchase. The Courtcourt also indicated it would award plaintiff attorneys fees, which the parties have stipulated are approximately $12 million for the trial phase. HCA recorded $175 million of legal claim costs in the fourth

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 9 — CONTINGENCIES AND LEGAL CLAIM COSTS (continued)

Health Midwest Litigation (continued)

quarter of 2012 related to this ruling, and consistent with the judge’s order, has been accruing interest on that sum at 9% per annum. On April 25, 2014, the parties stipulated to an additional $78 million shortfall relating to the capital expenditures issue. HCA recorded $78 million of legal claims costs in the first quarter of 2014 as a result of the stipulation, and is accruing interest on that amount at 9% per annum. Pursuant to the terms of the stipulation, the parties have preserved their respective rights to contest the judge’s underlying ruling, whether through motions in the trial court or on appeal. The accounting forOn February 9, 2015, the parties reached an agreement to settle the part of their dispute relating to charity and other uncompensated care for $15 million. The foundation is ongoing.required to use that amount, net of attorneys fees, for charitable activities in the Kansas City area. The parties also agreed on an additional amount for attorneys fees for the plaintiff for the accounting phase of the case. Final judgment in the case currently is not anticipated beforefor sometime in 2015. At this time, we cannot predict what effect, if any, the final judgment could have on the Company. HCA plans to appeal the trial court’s ruling on the breach of contract claim and order for the accountingcapital expenditures issues once the trial court rules on the accounting and enters judgment.

NOTE 10 — CAPITAL STRUCTURE

The changes in stockholders’ deficit, including changes in stockholders’ deficit attributable to HCA Holdings, Inc. and changes in equity attributable to noncontrolling interests, are as follows (dollars and shares in millions):

 

 Equity (Deficit) Attributable to HCA Holdings, Inc. Equity

Attributable to

Noncontrolling

Interests
  Total  Equity (Deficit) Attributable to HCA Holdings, 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
Deficit
  
 Shares

(000)
 Par Value   Shares Par Value  

Balances at December 31, 2013

  439,604   $4   $1,386   $(257 $(9,403 $1,342  $(6,928

Net income

                  1,348    349   1,697  

Balances at December 31, 2014

  420.478   $4   $   $(323 $(7,575 $1,396   $(6,498

Comprehensive income

              (21  591    129    699  

Repurchase of common stock

  (14,555      (750              (750  (5.205      (70      (296      (366

Other comprehensive income

              51            51  

Distributions

                      (325  (325                      (132  (132

Share-based benefit plans

  8,330        242                242    3.906        68                68  

Other

          (6      1        (5          2            5    7  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Balances at September 30, 2014

  433,379   $4   $872   $(206 $(8,054 $1,366   $(6,018

Balances at March 31, 2015

  419.179   $4   $   $(344 $(7,280 $1,398   $(6,222
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

During May 2014,the first quarter of 2015 and pursuant to the Company’s $1.0 billion repurchase program adopted by the Company’s board of directors in February 2015, we repurchased 14,554,6285,205,394 shares of our common stock at aan average price of $51.53$70.24 per share.share through market purchases.

On April 18, 2015, the Company entered into an agreement to repurchase 3,806,460 shares of its common stock beneficially owned by affiliates of Bain Capital Investors, LLC (“the Bain Entities”) and certain charitable organizations that received shares of common stock as charitable contributions from certain partners and other employees of the Bain Entities at a purchase price of $77.26 per share, the closing price of the Company’s common stock on the New York Stock Exchange on April 17, 2015, less a discount of 1% (the “Share Repurchase”). The Share Repurchase was made pursuant to the Company’s existing $1.0 billion repurchase program.

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 10 — CAPITAL STRUCTURE (continued)

 

The components of accumulated other comprehensive loss are as follows (dollars in millions):

 

   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, 2013

  $7    $11   $(88 $(187 $(257

Unrealized gains on available-for-sale securities, net of $4 of income taxes

   6                 6  

Foreign currency translation adjustments, net of $6 income tax benefits

        (12          (12

Change in fair value of derivative instruments, net of $8 income tax benefits

                (13  (13

Expense reclassified into operations from other comprehensive income, net of $4 and $36, respectively, income tax benefits

            7    63    70  
  

 

 

   

 

 

  

 

 

  

 

 

  

 

 

 

Balances at September 30, 2014

  $13    $(1 $(81 $(137 $(206
  

 

 

   

 

 

  

 

 

  

 

 

  

 

 

 
   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, 2014

  $13    $(36 $(174 $(126 $(323

Unrealized gains on available-for-sale securities

   1                 1  

Foreign currency translation adjustments, net of $20 income tax benefit

        (31          (31

Change in fair value of derivative instruments, net of $8 income tax benefit

                (15  (15

Expense reclassified into operations from other comprehensive income, net of $2 and $11, respectively, income tax benefits

            4    20    24  
  

 

 

   

 

 

  

 

 

  

 

 

  

 

 

 

Balances at March 31, 2015

  $14    $(67 $(170 $(121 $(344
  

 

 

   

 

 

  

 

 

  

 

 

  

 

 

 

NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION

We operate in one line of business, which is operating hospitals and related health care entities. Effective January 1, 2013, we reorganized our operational groups intoWe operate in two geographically organized groups: the National and American Groups. The National Group includes 8182 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, South Carolina, Utah and Virginia, and the American Group includes 7779 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and Texas. We also operate seven hospitals in England, and these facilities are included in the Corporate and other group.

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses (gains)gains on sales of facilities, losses on retirement of debt, legal claim costs, 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 ended March 31, 2015 and nine months ended September 30, 2014 and 2013 are summarized in the following table (dollars in millions):

 

  Quarter Nine Months 
  2014 2013 2014 2013   2015   2014 

Revenues:

         

National Group

  $4,387   $3,930   $12,814   $11,875    $4,650    $4,162  

American Group

   4,319    4,082    12,918    12,181     4,501     4,152  

Corporate and other

   514    444    1,550    1,290     525     518  
  

 

  

 

  

 

  

 

   

 

   

 

 
  $9,220   $8,456   $27,282   $25,346    $9,676    $8,832  
  

 

  

 

  

 

  

 

   

 

   

 

 

Equity in earnings of affiliates:

         

National Group

  $(6 $(3 $(12 $(8  $(3  $(3

American Group

   (8  (6  (23  (19   (8   (7

Corporate and other

           3    (2   (8   1  
  

 

  

 

  

 

  

 

   

 

   

 

 
  $(14 $(9 $(32 $(29  $(19  $(9
  

 

  

 

  

 

  

 

   

 

   

 

 

Adjusted segment EBITDA:

         

National Group

  $1,008   $805   $2,810   $2,440    $1,079    $857  

American Group

   927    910    2,911    2,654     948     850  

Corporate and other

   (107  (112  (249  (234   (66   (63
  

 

  

 

  

 

  

 

   

 

   

 

 
  $1,828   $1,603   $5,472   $4,860    $1,961    $1,644  
  

 

  

 

  

 

  

 

   

 

   

 

 

Depreciation and amortization:

         

National Group

  $187   $181   $564   $532    $189    $187  

American Group

   210    206    626    610     221     205  

Corporate and other

   63    56    171    150     63     55  
  

 

  

 

  

 

  

 

   

 

   

 

 
  $460   $443   $1,361   $1,292    $473    $447  
  

 

  

 

  

 

  

 

   

 

   

 

 

Adjusted segment EBITDA

  $1,828   $1,603   $5,472   $4,860    $1,961    $1,644  

Depreciation and amortization

   460    443    1,361    1,292     473     447  

Interest expense

   427    458    1,314    1,392     419     460  

Losses (gains) on sales of facilities

   12    1    (20  13  

Losses on retirement of debt

           226    17  

Gains on sales of facilities

   (9   (21

Legal claim costs

           78              78  
  

 

  

 

  

 

  

 

   

 

   

 

 

Income before income taxes

  $929   $701   $2,513   $2,146    $1,078    $680  
  

 

  

 

  

 

  

 

   

 

   

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION

On November 23, 2010, HCA Holdings, Inc. issued $1.525 billion aggregate principal amount of 7 3/4% senior unsecured notes due 2021. On December 6, 2012, HCA Holdings, Inc. issued $1.000 billion aggregate principal amount of 6.25% senior unsecured notes due 2021. These notes are senior unsecured obligations and are not guaranteed by any of our subsidiaries.

HCA Inc., a direct wholly-owned subsidiary of HCA Holdings, Inc., is the obligor under a significant portion of our other indebtedness, including our senior secured credit facilities, senior secured notes and senior unsecured notes (other than the senior unsecured notes issued by HCA Holdings, Inc.). The senior secured notes and senior unsecured notes issued by HCA Inc. are fully and unconditionally guaranteed by HCA Holdings, Inc. The senior secured credit facilities and senior secured notes are fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, 100% owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our senior secured asset-based revolving credit facility).

Our summarized condensed consolidating comprehensive income statements for the quarters ended March 31, 2015 and nine months ended September 30, 2014, and 2013, condensed consolidating balance sheets at September 30, 2014March 31, 2015 and December 31, 20132014 and condensed consolidating statements of cash flows for the nine monthsquarters ended September 30,March 31, 2015 and 2014, and 2013, segregating HCA Holdings, Inc. issuer, HCA Inc. issuer, the subsidiary guarantors, the subsidiary non-guarantors and eliminations, follow:

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE QUARTER ENDED SEPTEMBER 30, 2014MARCH 31, 2015

(Dollars in millions)

 

 HCA
Holdings,  Inc.
Issuer
 HCA  Inc.
Issuer
 Subsidiary
Guarantors
 Subsidiary
Non-
Guarantors
 Eliminations Condensed
Consolidated
  HCA
Holdings, Inc.
Issuer
 HCA Inc.
Issuer
 Subsidiary
Guarantors
 Subsidiary
Non-
Guarantors
 Eliminations Condensed
Consolidated
 

Revenues before provision for doubtful accounts

 $   $   $5,133   $4,845   $   $9,978   $   $   $5,201   $5,121   $   $10,322  

Provision for doubtful accounts

          457    301        758            296    350        646  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Revenues

          4,676    4,544        9,220            4,905    4,771        9,676  

Salaries and benefits

          2,176    2,035        4,211            2,217    2,181        4,398  

Supplies

          797    742        1,539            854    784        1,638  

Other operating expenses

  4        804    880        1,688    6        820    891        1,717  

Electronic health record incentive income

          (22  (10      (32          (13  (6      (19

Equity in earnings of affiliates

  (542      (3  (11  542    (14  (602      (1  (18  602    (19

Depreciation and amortization

          225    235        460            230    243        473  

Interest expense

  46    536    (115  (40      427    46    595    (174  (48      419  

Losses (gains) on sales of facilities

          16    (4      12  

Gains on sales of facilities

          (9          (9

Management fees

          (178  178                    (178  178          
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
  (492  536    3,700    4,005    542    8,291    (550  595    3,746    4,205    602    8,598  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Income (loss) before income taxes

  492    (536  976    539    (542  929    550    (595  1,159    566    (602  1,078  

Provision (benefit) for income taxes

  (19  (205  365    177        318    (20  (224  428    174        358  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Net income (loss)

  511    (331  611    362    (542  611    570    (371  731    392    (602  720  

Net income attributable to noncontrolling interests

          18    75        93            23    106        129  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Net income (loss) attributable to HCA Holdings, Inc.

 $511   $(331 $593   $287   $(542 $518   $570   $(371 $708   $286   $(602 $591  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Comprehensive income (loss) attributable to HCA Holdings, Inc.

 $511   $(303 $595   $250   $(542 $511   $570   $(366 $712   $256   $(602 $570  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE QUARTER ENDED SEPTEMBER 30, 2013

(Dollars in millions)

   HCA

Holdings,  Inc.

Issuer
  HCA  Inc.

Issuer
  Subsidiary

Guarantors
  Subsidiary

Non-

Guarantors
  Eliminations  Condensed

Consolidated
 

Revenues before provision for doubtful accounts

  $   $   $4,945   $4,466   $   $9,411  

Provision for doubtful accounts

           560    395        955  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Revenues

           4,385    4,071        8,456  

Salaries and benefits

           2,090    1,826        3,916  

Supplies

           773    684        1,457  

Other operating expenses

   2    (1  771    792        1,564  

Electronic health record incentive income

           (53  (22      (75

Equity in earnings of affiliates

   (443          (9  443    (9

Depreciation and amortization

           216    227        443  

Interest expense

   41    549    (104  (28      458  

Losses on sales of facilities

           1            1  

Management fees

           (183  183          
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 
   (400  548    3,511    3,653    443    7,755  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Income (loss) before income taxes

   400    (548  874    418    (443  701  

Provision (benefit) for income taxes

   (17  (214  334    131        234  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Net income (loss)

   417    (334  540    287    (443  467  

Net income attributable to noncontrolling interests

           19    83        102  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Net income (loss) attributable to HCA Holdings, Inc.

  $417   $(334 $521   $204   $(443 $365  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Comprehensive income (loss) attributable to HCA Holdings, Inc.

  $417   $(331 $532   $242   $(443 $417  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30,MARCH 31, 2014

(Dollars in millions)

 

   HCA
Holdings,  Inc.
Issuer
  HCA  Inc.
Issuer
  Subsidiary
Guarantors
  Subsidiary
Non-
Guarantors
  Eliminations  Condensed
Consolidated
 

Revenues before provision for doubtful accounts

  $   $   $15,242   $14,377   $   $29,619  

Provision for doubtful accounts

           1,388    949        2,337  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Revenues

           13,854    13,428        27,282  

Salaries and benefits

           6,393    5,966        12,359  

Supplies

           2,416    2,187        4,603  

Other operating expenses

   14        2,366    2,597        4,977  

Electronic health record incentive income

           (68  (29      (97

Equity in earnings of affiliates

   (1,494      (5  (27  1,494    (32

Depreciation and amortization

           667    694        1,361  

Interest expense

   138    1,629    (349  (104      1,314  

Gains on sales of facilities

           (16  (4      (20

Losses on retirement of debt

       226                226  

Legal claim costs

       78                78  

Management fees

           (528  528          
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 
   (1,342  1,933    10,876    11,808    1,494    24,769  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Income (loss) before income taxes

   1,342    (1,933  2,978    1,620    (1,494  2,513  

Provision (benefit) for income taxes

   (57  (729  1,098    504        816  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Net income (loss)

   1,399    (1,204  1,880    1,116    (1,494  1,697  

Net income attributable to noncontrolling interests

           65    284        349  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Net income (loss) attributable to HCA Holdings, Inc.

  $1,399   $(1,204 $1,815   $832   $(1,494 $1,348  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Comprehensive income (loss) attributable to HCA Holdings, Inc.

  $1,399   $(1,154 $1,822   $826   $(1,494 $1,399  
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2013

(Dollars in millions)

  HCA
Holdings, Inc.
Issuer
 HCA Inc.
Issuer
 Subsidiary
Guarantors
 Subsidiary
Non-
Guarantors
 Eliminations Condensed
Consolidated
   HCA
Holdings, Inc.
Issuer
 HCA Inc.
Issuer
 Subsidiary
Guarantors
 Subsidiary
Non-
Guarantors
 Eliminations Condensed
Consolidated
 

Revenues before provision for doubtful accounts

  $   $   $14,829   $13,249   $   $28,078    $ —   $ —   $5,030   $4,653   $ —   $9,683  

Provision for doubtful accounts

           1,611    1,121        2,732             537    314        851  
  

 

  

 

  

 

  

 

  

 

  

 

   

 

  

 

  

 

  

 

  

 

  

 

 

Revenues

           13,218    12,128        25,346             4,493    4,339        8,832  

Salaries and benefits

           6,275    5,406        11,681             2,099    1,951        4,050  

Supplies

           2,340    2,066        4,406             814    718        1,532  

Other operating expenses

   4    (1  2,260    2,331        4,594     5        773    867        1,645  

Electronic health record incentive income

           (115  (51      (166           (22  (8      (30

Equity in earnings of affiliates

   (1,303      (2  (27  1,303    (29   (403      (1  (8  403    (9

Depreciation and amortization

           636    656        1,292             218    229        447  

Interest expense

   138    1,651    (319  (78      1,392     46    557    (122  (21      460  

Losses (gains) on sales of facilities

           20    (7      13  

Losses on retirement of debt

       17                17  

Gains on sales of facilities

           (21          (21

Legal claim costs

       78                78  

Management fees

           (547  547                     (174  174          
  

 

  

 

  

 

  

 

  

 

  

 

   

 

  

 

  

 

  

 

  

 

  

 

 
   (1,161  1,667    10,548    10,843    1,303    23,200     (352  635    3,564    3,902    403    8,152  
  

 

  

 

  

 

  

 

  

 

  

 

   

 

  

 

  

 

  

 

  

 

  

 

 

Income (loss) before income taxes

   1,161    (1,667  2,670    1,285    (1,303  2,146     352    (635  929    437    (403  680  

Provision (benefit) for income taxes

   (54  (639  1,005    392        704     (20  (247  352    141        226  
  

 

  

 

  

 

  

 

  

 

  

 

   

 

  

 

  

 

  

 

  

 

  

 

 

Net income (loss)

   1,215    (1,028  1,665    893    (1,303  1,442     372    (388  577    296    (403  454  

Net income attributable to noncontrolling interests

           48    262        310             29    78        107  
  

 

  

 

  

 

  

 

  

 

  

 

   

 

  

 

  

 

  

 

  

 

  

 

 

Net income (loss) attributable to HCA Holdings, Inc.

  $1,215   $(1,028 $1,617   $631   $(1,303 $1,132    $372   $(388 $548   $218   $(403 $347  
  

 

  

 

  

 

  

 

  

 

  

 

   

 

  

 

  

 

  

 

  

 

  

 

 

Comprehensive income (loss) attributable to HCA Holdings, Inc.

  $1,215   $(961 $1,637   $627   $(1,303 $1,215    $372   $(374 $550   $227   $(403 $372  
  

 

  

 

  

 

  

 

  

 

  

 

   

 

  

 

  

 

  

 

  

 

  

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

SEPTEMBER 30, 2014MARCH 31, 2015

(Dollars in millions)

 

 HCA

Holdings,  Inc.

Issuer
 HCA  Inc.

Issuer
 Subsidiary

Guarantors
 Subsidiary

Non-

Guarantors
 Eliminations Condensed

Consolidated
  HCA
Holdings, Inc.
Issuer
 HCA Inc.
Issuer
 Subsidiary
Guarantors
 Subsidiary
Non-
Guarantors
 Eliminations Condensed
Consolidated
 
ASSETS            

Current assets:

            

Cash and cash equivalents

 $   $   $113   $402   $   $515   $   $   $111   $475   $   $586  

Accounts receivable, net

          2,671    2,853        5,524            2,923    3,005        5,928  

Inventories

          748    510        1,258            762    525        1,287  

Deferred income taxes

  320                    320    304                    304  

Other

          369    541        910            375    650        1,025  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
  320        3,901    4,306        8,527    304        4,171    4,655        9,130  

Property and equipment, net

          7,762    6,116        13,878            7,882    6,510        14,392  

Investments of insurance subsidiaries

              441        441                435        435  

Investments in and advances to affiliates

  21,850        16    151    (21,850  167    22,895        16    165    (22,895  181  

Goodwill and other intangible assets

          1,698    4,201        5,899            1,704    4,711        6,415  

Deferred loan costs

  27    194                221  

Other

  476        21    195        692    531        21    183        735  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
 $22,673   $194   $13,398   $15,410   $(21,850 $29,825   $23,730   $   $13,794   $16,659   $(22,895 $31,288  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

LIABILITIES AND

STOCKHOLDERS’ (DEFICIT)

EQUITY

            

Current liabilities:

            

Accounts payable

 $3   $   $1,132   $652   $   $1,787   $4   $   $1,224   $745   $   $1,973  

Accrued salaries

          721    517        1,238            669    511        1,180  

Other accrued expenses

  69    197    458    839        1,563    399    233    494    856        1,982  

Long-term debt due within one year

      952    51    41        1,044        1,931    57    49        2,037  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
  72    1,149    2,362    2,049        5,632    403    2,164    2,444    2,161        7,172  

Long-term debt

  2,525    24,528    187    186        27,426  

Long-term debt, net

  2,500    24,391    222    293        27,406  

Intercompany balances

  26,932    (9,497  (20,763  3,328            27,903    (9,776  (21,842  3,715          

Professional liability risks

              1,045        1,045                
1,095
  
      1,095  

Income taxes and other liabilities

  528    500    486    226        1,740    544    485    453    355        1,837  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
  30,057    16,680    (17,728  6,834        35,843    31,350    17,264    (18,723  7,619        37,510  

Stockholders’ (deficit) equity attributable to HCA Holdings, Inc.

  (7,384  (16,486  31,007    7,329    (21,850  (7,384  (7,620  (17,264  32,405    7,754    (22,895  (7,620

Noncontrolling interests

          119    1,247        1,366            112    1,286        1,398  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
  (7,384  (16,486  31,126    8,576    (21,850  (6,018  (7,620  (17,264  32,517    9,040    (22,895  (6,222
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
 $22,673   $194   $13,398   $15,410   $(21,850 $29,825   $23,730   $   $13,794   $16,659   $(22,895 $31,288  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

DECEMBER 31, 20132014

(Dollars in millions)

 

 HCA

Holdings,  Inc.

Issuer
 HCA Inc.

Issuer
 Subsidiary

Guarantors
 Subsidiary

Non-

Guarantors
 Eliminations Condensed

Consolidated
  HCA
Holdings, Inc.
Issuer
 HCA Inc.
Issuer
 Subsidiary
Guarantors
 Subsidiary
Non-
Guarantors
 Eliminations Condensed
Consolidated
 
ASSETS            

Current assets:

            

Cash and cash equivalents

 $   $   $112   $302   $   $414   $   $   $87   $479   $   $566  

Accounts receivable, net

          2,565    2,643        5,208            2,812    2,882        5,694  

Inventories

          692    487        1,179            756    523        1,279  

Deferred income taxes

  489                    489    366                    366  

Other

          301    446        747    118        376    531        1,025  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
  489        3,670    3,878        8,037    484        4,031    4,415        8,930  

Property and equipment, net

          7,504    6,115        13,619            7,871    6,484        14,355  

Investments of insurance subsidiaries

              448        448                494        494  

Investments in and advances to affiliates

  20,356        13    108    (20,356  121    22,293        16    149    (22,293  165  

Goodwill and other intangible assets

          1,695    4,208        5,903            1,705    4,711        6,416  

Deferred loan costs

  30    207                237  

Other

  250        48    168        466    435        27    158        620  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
 $21,125   $207   $12,930   $14,925   $(20,356 $28,831   $23,212   $   $13,650   $16,411   $(22,293 $30,980  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY            

Current liabilities:

            

Accounts payable

 $1   $   $1,169   $633   $   $1,803   $1   $   $1,272   $762   $   $2,035  

Accrued salaries

          694    499        1,193            783    587        1,370  

Other accrued expenses

  272    353    464    824        1,913    45    317    517    858        1,737  

Long-term debt due within one year

      702    45    39        786        231    56    51        338  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
  273    1,055    2,372    1,995        5,695    46    548    2,628    2,258        5,480  

Long-term debt

  2,525    24,701    181    183        27,590  

Long-term debt, net

  2,499    26,124    185    280        29,088  

Intercompany balances

  26,107    (10,513  (19,428  3,834            28,008    (10,261  (21,582  3,835          

Professional liability risks

              949        949                1,078        1,078  

Income taxes and other liabilities

  490    296    521    218        1,525    553    487    605    187        1,832  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
  29,395    15,539    (16,354  7,179        35,759    31,106    16,898    (18,164  7,638        37,478  

Stockholders’ (deficit) equity attributable to HCA Holdings, Inc.

  (8,270  (15,332  29,185    6,503    (20,356  (8,270  (7,894  (16,898  31,693    7,498    (22,293  (7,894

Noncontrolling interests

          99    1,243        1,342            121    1,275        1,396  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
  (8,270  (15,332  29,284    7,746    (20,356  (6,928  (7,894  (16,898  31,814    8,773    (22,293  (6,498
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 
 $21,125   $207   $12,930   $14,925   $(20,356 $28,831   $23,212   $   $13,650   $16,411   $(22,293 $30,980  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHSQUARTER ENDED SEPTEMBER 30, 2014MARCH 31, 2015

(Dollars in millions)

 

 HCA

Holdings,  Inc.

Issuer
 HCA Inc.

Issuer
 Subsidiary

Guarantors
 Subsidiary

Non-

Guarantors
 Eliminations Condensed

Consolidated
  HCA
Holdings, Inc.
Issuer
 HCA Inc.
Issuer
 Subsidiary
Guarantors
 Subsidiary
Non-
Guarantors
 Eliminations Condensed
Consolidated
 

Cash flows from operating activities:

            

Net income (loss)

 $1,399   $(1,204 $1,880   $1,116   $(1,494 $1,697   $570   $(371 $731   $392   $(602 $720  

Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:

            

Changes in operating assets and liabilities

  18    (151  (1,660  (1,152      (2,945  17    (79  (739  (512      (1,313

Provision for doubtful accounts

          1,388    949        2,337            296    350        646  

Depreciation and amortization

          667    694        1,361            230    243        473  

Income taxes

  (61                  (61  438                    438  

Gains on sales of facilities

          (16  (4      (20          (9          (9

Losses on retirement of debt

      226                226  

Legal claim costs

      78                78  

Amortization of deferred loan costs

  2    31                33  

Amortization of debt issuance costs

  1    9                10  

Share-based compensation

  118                    118    48                    48  

Equity in earnings of affiliates

  (1,494              1,494        (602              602      

Other

      3        (6      (3  16            (11      5  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Net cash (used in) provided by operating activities

  (18  (1,017  2,259    1,597        2,821  

Net cash provided by (used in) operating activities

  488    (441  509    462        1,018  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Cash flows from investing activities:

            

Purchase of property and equipment

          (893  (589      (1,482          (182  (264      (446

Acquisition of hospitals and health care entities

          (7  (90      (97          (10  (18      (28

Disposition of hospitals and health care entities

          31    7        38            14    1        15  

Change in investments

          22            22            6    16        22  

Other

              7        7                5        5  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Net cash used in investing activities

          (847  (665      (1,512          (172  (260      (432
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Cash flows from financing activities:

            

Issuance of long-term debt

      3,502                3,502        1,000                1,000  

Net change in revolving credit facilities

      (160              (160      (260              (260

Repayment of long-term debt

      (3,462  (35  (28      (3,525      (771  (12  (8      (791

Distributions to noncontrolling interests

          (45  (280      (325          (32  (100      (132

Payment of debt issuance costs

      (49              (49      (11              (11

Repurchase of common stock

  (750                  (750

Repurchases of common stock

  (366                  (366

Distributions to stockholders

  (7                  (7  (6                  (6

Changes in intercompany balances with affiliates, net

  654    1,186    (1,331  (509          (116  483    (269  (98        

Income tax benefits

  119                    119    38                    38  

Other

  2            (15      (13  (38                  (38
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Net cash provided by (used in) financing activities

  18    1,017    (1,411  (832      (1,208

Net cash (used in) provided by financing activities

  (488  441    (313  (206      (566
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Change in cash and cash equivalents

          1    100        101            24    (4      20  

Cash and cash equivalents at beginning of period

          112    302        414            87    479        566  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Cash and cash equivalents at end of period

 $   $   $113   $402   $   $515   $   $   $111   $475   $   $586  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHSQUARTER ENDED SEPTEMBER 30, 2013MARCH 31, 2014

(Dollars in millions)

 

 HCA
Holdings,  Inc.
Issuer
 HCA  Inc.
Issuer
 Subsidiary
Guarantors
 Subsidiary
Non-
Guarantors
 Eliminations Condensed
Consolidated
  HCA
Holdings, Inc.
Issuer
 HCA Inc.
Issuer
 Subsidiary
Guarantors
 Subsidiary
Non-
Guarantors
 Eliminations Condensed
Consolidated
 

Cash flows from operating activities:

            

Net income (loss)

 $1,215   $(1,028 $1,665   $893   $(1,303 $1,442   $372   $(388 $577   $296   $(403 $454  

Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:

            

Changes in operating assets and liabilities

  47    (126  (1,848  (1,392     (3,319  20    (95  (934  (552      (1,561

Provision for doubtful accounts

        1,611    1,121       2,732            537    314        851  

Depreciation and amortization

        636    656       1,292            218    229        447  

Income taxes

  158                158    144                    144  

Losses (gains) on sales of facilities

        20    (7     13  

Losses on retirement of debt

     17             17  

Amortization of deferred loan costs

  3    38             41  

Gains on sales of facilities

          (21          (21

Legal claim costs

      78                78  

Amortization of debt issuance costs

  1    13                14  

Share-based compensation

  81                81    37                    37  

Equity in earnings of affiliates

  (1,303           1,303        (403              403      

Other

     7       (10     (3      2        (2        
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

��

 

  

 

 

Net cash provided by (used in) operating activities

  201    (1,092  2,084    1,261       2,454    171    (390  377    285        443  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Cash flows from investing activities:

            

Purchase of property and equipment

        (684  (663     (1,347          (217  (183      (400

Acquisition of hospitals and health care entities

           (463     (463              (19      (19

Disposition of hospitals and health care entities

        17    14       31            19    4        23  

Change in investments

        (6  103       97            (3  (10      (13

Other

           8       8  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Net cash used in investing activities

        (673  (1,001     (1,674          (201  (208      (409
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Cash flows from financing activities:

            

Issuance of long-term debt

      3,502                3,502  

Net change in revolving bank credit facilities

     630             630        (2,440              (2,440

Repayment of long-term debt

     (1,243  (34  (23     (1,300      (522  (12  (8      (542

Distributions to noncontrolling interests

        (34  (274     (308          (17  (70      (87

Payment of debt issuance costs

     (5           (5      (48              (48

Distributions to stockholders

  (13              (13  (7                  (7

Changes in intercompany balances with affiliates, net

  (199  1,710    (1,559  48           (195  (102  223    74          

Income tax benefits

  70                70    50                    50  

Other

  (81        6       (75  (19          (7      (26
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Net cash (used in) provided by financing activities

  (223  1,092    (1,627  (243     (1,001  (171  390    194    (11      402  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Change in cash and cash equivalents

  (22     (216  17       (221     ��    370    66        436  

Cash and cash equivalents at beginning of period

  22       383    300       705            112    302        414  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Cash and cash equivalents at end of period

 $  $  $167   $317   $  $484   $   $   $482   $368   $   $850  
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS

Forward-Looking Statements

This quarterly report on Form 10-Q includes certain disclosures which contain “forward-looking statements.” Forward-looking statements include statements regarding estimated electronic health recordElectronic Health Record (“EHR”) incentive income and related EHR operating expenses, expected share-based compensation expense, expected capital expenditures and expected net claim payments and all other statements that do not relate solely to historical or current facts, and can be identified by the use of words like “may,” “believe,” “will,” “expect,” “project,” “estimate,” “anticipate,” “plan,” “initiative” or “continue.” These forward-looking statements are based on our current plans and expectations and are subject to a number of known and unknown uncertainties and risks, many of which are beyond our control, which could significantly affect current plans and expectations and our future financial position and results of operations. These factors include, but are not limited to, (1) the impact of our substantial indebtedness and the ability to refinance such indebtedness on acceptable terms, (2) the effects related to the implementation of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act (collectively, the “Health Reform Law”), possible delays in or complications related to implementation of the Health Reform Law, court challenges, the possible enactment of additional federal or state health care reforms and possible changes to the Health Reform Law and other federal, state or local laws or regulations affecting the health care industry, (3) the effects related to the continued implementation of the sequestration spending reductions required under the Budget Control Act of 2011, and related legislation extending these reductions, and the potential for future deficit reduction legislation that may alter these spending reductions, which include cuts to Medicare payments, or create additional spending reductions, (4) increases in the amount and risk of collectability of uninsured accounts and deductibles and copayment amounts for insured accounts, (5) the ability to achieve operating and financial targets, and attain expected levels of patient volumes and control the costs of providing services, (6) possible changes in the Medicare, Medicaid and other state programs, including Medicaid upper payment limit programs or Waiver Programs, that may impact reimbursements to health care providers and insurers, (7) the highly competitive nature of the health care business, (8) changes in service mix, revenue mix and surgical volumes, including potential declines in the population covered under managed care agreements, the ability to enter into and renew managed care provider agreements on acceptable terms and the impact of consumer drivenconsumer-driven health plans and physician utilization trends and practices, (9) the efforts of insurers, health care providers and others to contain health care costs, (10) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (11) increases in wages and the ability to attract and retain qualified management and personnel, including affiliated physicians, nurses and medical and technical support personnel, (12) the availability and terms of capital to fund the expansion of our business and improvements to our existing facilities, (13) changes in accounting practices, (14) changes in general economic conditions nationally and regionally in our markets, (15) the emergence and effects related to infectious diseases, including Ebola, (16) future divestitures which may result in charges and possible impairments of long-lived assets, (17) changes in business strategy or development plans, (18) delays in receiving payments for services provided, (19) the outcome of pending and any future tax audits, appealsdisputes and litigation associated with our tax positions, (20) potential adverse impact of known and unknown government investigations, litigation and other claims that may be made against us, (21) our ongoing ability to demonstrate meaningful use of certified EHR technology and recognize income for the related Medicare or Medicaid incentive payments, and (22) other risk factors described in our annual report on Form 10-K for the year ended December 31, 20132014 and our other filings with the Securities and Exchange Commission. As a consequence, current plans, anticipated actions and future financial position and results of operations may differ from those expressed in any forward-looking statements made by or on behalf of HCA. You are cautioned not to unduly rely on such forward-looking statements when evaluating the information presented in this report, which forward-looking statements reflect management’s views only as of the date of this report. We undertake no obligation to revise or update any forward-looking statements, whether as a result of new information, future events or otherwise.

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Health Care Reform

The Health Reform Law changes how health care services are covered, delivered and reimbursed through expanded coverage of uninsured individuals, reduced growth in Medicare program spending, reductions in Medicare and Medicaid Disproportionate Share Hospital payments, and the establishment of programs in which reimbursement is tied to quality and integration. In addition, the Health Reform Law reforms certain aspects of health insurance, expands existing efforts to tie Medicare and Medicaid payments to performance and quality, and contains provisions intended to strengthen fraud and abuse enforcement. Most of the provisions of the Health Reform Law that seek to decrease the number of uninsured became effective January 1, 2014. Based on the Congressional Budget Office’s April 2014March 2015 projection, by 2022,2025, the Health Reform Law will expand coverage to 2627 million additional individuals. This increased coverage will occur through a combination of public program expansion and private sector health insurance and other reforms. TheMost of the provisions of the Health Reform Law that seek to decrease the number of uninsured became effective January 1, 2014. However, the employer mandate, which requires firms with 50 or more full-time employees to offer health insurance or pay fines, has been delayed and will not be fully implemented until January 1, 2016. In addition, a number of states have opted out of the Medicaid expansion, but these states could choose to implement the expansion at a later date. It is unclear how many states will ultimately implement the Medicaid expansion provisions of the law.

ThirdFirst Quarter 20142015 Operations Summary

Revenues increased to $9.220$9.676 billion in the thirdfirst quarter of 20142015 from $8.456$8.832 billion in the thirdfirst quarter of 2013.2014. Net income attributable to HCA Holdings, Inc. totaled $518$591 million, or $1.16$1.36 per diluted share, for the quarter ended September 30, 2014,March 31, 2015, compared to $365$347 million, or $0.79$0.76 per diluted share, for the quarter ended September 30, 2013. ThirdMarch 31, 2014. First quarter 2015 results include net gains on sales of facilities of $9 million, or $0.01 per diluted share. First quarter 2014 results include net lossesgains on sales of facilities of $12$21 million, or $0.02$0.03 per diluted share. Third quarter 2013 results include net losses on salesshare, and legal claim costs of facilities of $1 million.$78 million, or $0.11 per diluted share. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 447.3435.309 million shares for the quarter ended September 30, 2014March 31, 2015 and 463.6457.449 million shares for the quarter ended September 30, 2013.March 31, 2014. During May 2014 and the first quarter of 2015, we repurchased 14.628.583 million and 5.205 million shares of our common stock.stock, respectively.

Revenues increased 9.0%9.5% on a consolidated basis and increased 8.1%8.5% on a same facility basis for the quarter ended September 30, 2014,March 31, 2015, compared to the quarter ended September 30, 2013.March 31, 2014. The increase in consolidated revenues can be attributed primarily to the combined impact of a 3.3%1.5% increase in revenue per equivalent admission and a 5.5%7.9% increase in equivalent admissions. The same facility revenues increase resulted primarily from the combined impact of a 3.8%1.6% increase in same facility revenue per equivalent admission and a 4.1%6.8% increase in same facility equivalent admissions.

During the quarter ended September 30, 2014,March 31, 2015, consolidated admissions and same facility admissions increased 3.9%5.8% and 2.8%5.1%, respectively, compared to the quarter ended September 30, 2013.March 31, 2014. Inpatient surgeries increased 3.0% on both a consolidated basis and a same facility basis during the quarter ended March 31, 2015, compared to the quarter ended March 31, 2014. Outpatient surgeries increased 1.9% on a consolidated basis and 1.4% on a same facility basis during the quarter ended September 30, 2014,March 31, 2015, compared to the quarter ended September 30, 2013. Outpatient surgeriesMarch 31, 2014. Emergency department visits increased 3.3%12.3% on a consolidated basis and 1.9%11.5% on a same facility basis during the quarter ended September 30, 2014,March 31, 2015, compared to the quarter ended September 30, 2013. Emergency department visits increased 8.6% on a consolidated basis and 7.3% on a same facility basis during the quarter ended September 30, 2014, compared to the quarter ended September 30, 2013.March 31, 2014.

For the quarter ended September 30, 2014,March 31, 2015, the provision for doubtful accounts declined $197$205 million, compared to the quarter ended September 30, 2013.March 31, 2014. The self-pay revenue deductions for charity care and uninsured discounts increased $159declined $33 million and $29increased $225 million, respectively, during the thirdfirst quarter of 2014,2015, compared to the thirdfirst quarter of 2013.2014. The sum of the provision for doubtful accounts, uninsured discounts and charity care, as a

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

ThirdFirst Quarter 20142015 Operations Summary (continued)

 

charity care, as a percentage of the sum of revenues, provision for doubtful accounts, uninsured discounts and charity care, was 29.8%29.6% for the thirdfirst quarter of 2014,2015, compared to 31.7%31.6% for the thirdfirst quarter of 2013.2014. Same facility uninsured admissions declined 14.8%12.5% for the quarter ended September 30, 2014,March 31, 2015, compared to the quarter ended September 30, 2013.March 31, 2014. We believe these favorable trends are primarily due to previously uninsured patients obtaining medical coverage through the health insurance exchanges and Medicaid expansion programs.

Electronic health record incentive income declined $43$11 million, from $75$30 million in the thirdfirst quarter of 20132014 to $32$19 million in the thirdfirst quarter of 2014.2015. Share-based compensation expense increased $11 million, from $30$37 million in the thirdfirst quarter of 20132014 to $41$48 million in the thirdfirst quarter of 2014.2015.

Cash flows from operating activities increased $228$575 million from $900$443 million for the thirdfirst quarter of 20132014 to $1.128$1.018 billion for the thirdfirst quarter of 2014.2015. The increase is related primarily to the combined impact of a $144$266 million increase in net income and a $58$294 million benefit from changes in income taxes.

Results of Operations

Revenue/Volume Trends

Our revenues depend upon inpatient occupancy levels, the ancillary services and therapy programs ordered by physicians and provided to patients, the volume of outpatient procedures and the charge and negotiated payment rates for such services. Gross charges typically do not reflect what our facilities are actually paid. Our facilities have entered into agreements with third-party payers, including government programs and managed care health plans, under which the facilities are paid based upon the cost of providing services, predetermined rates per diagnosis, fixed per diem rates or discounts from gross charges. We do not pursue collection of amounts related to patients who meet our guidelines to qualify for charity care; therefore, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. These discounts are similar to those provided to many local managed care plans. After the discounts are applied, we are still unable to collect a significant portion of uninsured patients’ accounts, and we record significant provisions for doubtful accounts (based upon our historical collection experience) related to uninsured patients in the period the services are provided.

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of Operations (continued)

Revenue/Volume Trends (continued)

 

Revenues increased 9.0%9.5% from $8.456$8.832 billion in the thirdfirst quarter of 20132014 to $9.220$9.676 billion in the thirdfirst quarter of 2014.2015. Revenues are recorded during the period the health care services are provided, based upon the estimated amounts due from the patients and third-party payers. Third-party payers include federal and state agencies (under Medicare, Medicaid and other programs), managed care health plans (includes the health insurance exchanges, beginning with the first quarter of 2014)exchanges), commercial insurance companies and employers. Estimates of contractual allowances under managed care health plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record a provision for doubtful accounts related to uninsured accounts to record the net self pay revenues at the estimated amounts we expect to collect. Our revenues from our third-party payers, the uninsured and other revenues for the quarters ended March 31, 2015 and nine months ended September 30, 2014 and 2013 are summarized in the following tablestable (dollars in millions):

 

  Quarter 
  2014 Ratio 2013 Ratio   2015   Ratio 2014   Ratio 

Medicare

  $2,120    23.0 $1,847    21.8  $2,234     23.1 $2,125     24.1

Managed Medicare

   901    9.8    794    9.4     1,052     10.9    899     10.2  

Medicaid

   372    4.0    401    4.7     452     4.7    444     5.0  

Managed Medicaid

   510    5.5    386    4.6     549     5.7    421     4.8  

Managed care and other insurers

   5,073    55.0    4,636    54.8     5,216     53.9    4,710     53.3  

International (managed care and other insurers)

   323    3.5    287    3.4     321     3.3    326     3.7  
  

 

  

 

  

 

  

 

   

 

   

 

  

 

   

 

 
   9,299    100.8    8,351    98.7     9,824     101.6    8,925     101.1  

Uninsured

   313    3.4    717    8.5     68     0.7    388     4.4  

Other

   366    4.0    343    4.1     430     4.4    370     4.2  
  

 

  

 

  

 

  

 

   

 

   

 

  

 

   

 

 

Revenues before provision for doubtful accounts

   9,978    108.2    9,411    111.3     10,322     106.7    9,683     109.7  

Provision for doubtful accounts

   (758  (8.2  (955  (11.3   (646   (6.7  (851   (9.7
  

 

  

 

  

 

  

 

   

 

   

 

  

 

   

 

 

Revenues

  $9,220    100.0 $8,456    100.0  $9,676     100.0 $8,832     100.0
  

 

  

 

  

 

  

 

   

 

   

 

  

 

   

 

 

Consolidated and same facility revenue per equivalent admission increased 1.5% and 1.6%, respectively, in the first quarter of 2015, compared to the first quarter of 2014. Consolidated and same facility equivalent admissions increased 7.9% and 6.8%, respectively, in the first quarter of 2015, compared to the first quarter of 2014. Consolidated and same facility admissions increased 5.8% and 5.1%, respectively, in the first quarter of 2015, compared to the first quarter of 2014. Consolidated and same facility outpatient surgeries increased 1.9% and 1.4%, respectively, in the first quarter of 2015, compared to the first quarter of 2014. Consolidated and same facility inpatient surgeries each increased 3.0% in the first quarter of 2015, compared to the first quarter of 2014. Consolidated and same facility emergency department visits increased 12.3% and 11.5%, respectively, in the first quarter of 2015, compared to the first quarter of 2014.

   Nine Months 
   2014  Ratio  2013  Ratio 

Medicare

  $6,285    23.0 $5,961    23.5

Managed Medicare

   2,706    9.9    2,441    9.6  

Medicaid

   1,404    5.1    1,098    4.3  

Managed Medicaid

   1,383    5.1    1,165    4.6  

Managed care and other insurers

   14,742    54.0    13,777    54.4  

International (managed care and other insurers)

   983    3.6    868    3.4  
  

 

 

  

 

 

  

 

 

  

 

 

 
   27,503    100.7    25,310    99.8  

Uninsured

   1,019    3.7    1,809    7.1  

Other

   1,097    4.0    959    3.8  
  

 

 

  

 

 

  

 

 

  

 

 

 

Revenues before provision for doubtful accounts

   29,619    108.4    28,078    110.7  

Provision for doubtful accounts

   (2,337  (8.4  (2,732  (10.7
  

 

 

  

 

 

  

 

 

  

 

 

 

Revenues

  $27,282    100.0 $25,346    100.0
  

 

 

  

 

 

  

 

 

  

 

 

 

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of Operations (continued)

Revenue/Volume Trends (continued)

 

During the quarter ended September 30, 2014, we recorded two changes in estimates which had the net effect of increasing revenues $26 million. We recorded $94 million, or $0.13 per diluted share, of Medicare revenues as the estimated settlement amount for certain claims denied by Recovery Audit Contractors (“RAC”) entities conducting reviews on behalf of the Centers for Medicare and Medicaid Services (“CMS”) and currently pending in the appeals process. CMS is offering an administrative agreement to providers willing to withdraw their pending appeals in exchange for a timely partial payment (generally, 68% of the claim amount, subject to certain adjustments). We also recorded a reduction of $68 million, or $0.09 per diluted share, to Medicaid revenues related to the Texas Medicaid Waiver Program. On October 1, 2014, the Texas Health and Human Services Commission (“THHSC”) issued a notice to hospitals participating in the Texas Medicaid Waiver Program. According to the notice, a review conducted by CMS identified certain local government/hospital affiliations it believes may be inconsistent with the waiver. As a result of these findings, CMS notified THHSC that it is deferring the federal portion of the Medicaid payments associated with these affiliations while it completes its review.

Consolidated and same facility revenue per equivalent admission increased 3.3% and 3.8%, respectively, in the third quarter of 2014, compared to the third quarter of 2013. Consolidated and same facility equivalent admissions increased 5.5% and 4.1%, respectively, in the third quarter of 2014, compared to the third quarter of 2013. Consolidated and same facility admissions increased 3.9% and 2.8%, respectively, in the third quarter of 2014, compared to the third quarter of 2013. Consolidated and same facility outpatient surgeries increased 3.3% and 1.9%, respectively, in the third quarter of 2014, compared to the third quarter of 2013. Consolidated and same facility inpatient surgeries increased 1.9% and 1.4%, respectively, in the third quarter of 2014, compared to the third quarter of 2013. Consolidated and same facility emergency department visits increased 8.6% and 7.3%, respectively, in the third quarter of 2014, compared to the third quarter of 2013.

To quantify the total impact of and trends related to uninsured accounts, we believe it is beneficial to view the direct uninsured revenue deductions (charity care and uninsured discounts) and provision for doubtful accounts in combination, rather than each separately. At September 30, 2014,March 31, 2015, our allowance for doubtful accounts represented approximately 93%92% of the $5.475$5.111 billion total patient due accounts receivable balance. The patient due accounts receivable balance represents the estimated uninsured portion of our accounts receivable. A summary of these adjustments to revenues amounts, related to uninsured accounts, for the quarters ended March 31, 2015 and nine months ended September 30, 2014 and 2013 follows (dollars in millions):

 

   Quarter  Nine Months 
   2014   Ratio  2013   Ratio  2014   Ratio  2013   Ratio 

Charity care

  $1,035     26 $876     22 $2,860     24 $2,578     23

Uninsured discounts

   2,119     54    2,090     54    6,562     56    6,058     53  

Provision for doubtful accounts

   758     20    955     24    2,337     20    2,732     24  
  

 

 

   

 

 

  

 

 

   

 

 

  

 

 

   

 

 

  

 

 

   

 

 

 

Totals

  $3,912     100 $3,921     100 $11,759     100 $11,368     100
  

 

 

   

 

 

  

 

 

   

 

 

  

 

 

   

 

 

  

 

 

   

 

 

 

   2015   Ratio  2014   Ratio 

Charity care

  $892     22 $925     23

Uninsured discounts

   2,526     62    2,301     56  

Provision for doubtful accounts

   646     16    851     21  
  

 

 

   

 

 

  

 

 

   

 

 

 

Totals

  $4,064     100 $4,077     100
  

 

 

   

 

 

  

 

 

   

 

 

 

Same facility uninsured admissions declined by 5,6344,198 admissions, or 12.5%, in the first quarter of 2015, compared to the first quarter of 2014. Same facility uninsured admissions in 2014, compared to 2013, declined 8.8% in the fourth quarter of 2014, declined 14.8%, in the third quarter of 2014, compared to the third quarter of 2013. Same facility uninsured admissions declined 14.7% in the second quarter of 2014 compared toand increased 2.1% in the secondfirst quarter of 2013.We2014. We believe these declines were primarily due to previously uninsured patients obtaining medical coverage through the health insurance exchanges and Medicaid expansion programs. Same facility

The approximate percentages of our admissions related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and other insurers and the uninsured admissions increased by 2.1%for the quarters ended March 31, 2015 and 2014 are set forth in the first quarter of 2014, compared to the first quarter of 2013. Same facility uninsured admissions in 2013, compared to 2012, increased 8.3% in the fourth quarter of 2013, increased 10.1% in the third quarter of 2013, increased 6.3% in the second quarter of 2013 and increased 5.4% in the first quarter of 2013.following table.

   2015  2014 

Medicare

   32  33

Managed Medicare

   15    14  

Medicaid

   6    8  

Managed Medicaid

   12    9  

Managed care and other insurers

   29    28  

Uninsured

   6    8  
  

 

 

  

 

 

 
   100  100
  

 

 

  

 

 

 

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of Operations (continued)

Revenue/Volume Trends (continued)

 

The approximate percentages of our admissions related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and other insurers and the uninsured for the quarters and nine months ended September 30, 2014 and 2013 are set forth in the following table.

   Quarter  Nine Months 
   2014  2013  2014  2013 

Medicare

   31  31  32  32

Managed Medicare

   14    13    14    13  

Medicaid

   7    8    7    8  

Managed Medicaid

   11    9    10    9  

Managed care and other insurers

   30    30    30    30  

Uninsured

   7    9    7    8  
  

 

 

  

 

 

  

 

 

  

 

 

 
   100  100  100  100
  

 

 

  

 

 

  

 

 

  

 

 

 

The approximate percentages of our inpatient revenues, before provision for doubtful accounts, related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and other insurers and the uninsured for the quarters ended March 31, 2015 and nine months ended September 30, 2014 and 2013 are set forth in the following table.

 

  Quarter Nine Months 
  2014 2013 2014 2013   2015 2014 

Medicare

   31  27  30  29   29  30

Managed Medicare

   11    10    11    11     13    11  

Medicaid

   5    7    6    6     6    6  

Managed Medicaid

   5    4    5    4     6    5  

Managed care and other insurers

   48    47    47    46     46    46  

Uninsured

       5    1    4         2  
  

 

  

 

  

 

  

 

   

 

  

 

 
   100  100  100  100   100  100
  

 

  

 

  

 

  

 

   

 

  

 

 

At September 30, 2014,March 31, 2015, we had 7880 hospitals in the states of Texas and Florida. During the thirdfirst quarter of 2014, 55%2015, 56% of our admissions and 45%47% of our revenues were generated by these hospitals. Uninsured admissions in Texas and Florida represented 67% of our uninsured admissions during the thirdfirst quarter of 2014.2015.

We receive a significant portion of our revenues from government health programs, principally Medicare and Medicaid, which are highly regulated and subject to frequent and substantial changes. In 2011, CMSthe Centers for Medicare & Medicaid Services (“CMS”) approved a Medicaid waiver that allows Texas to continue receiving supplemental Medicaid reimbursement while expanding its Medicaid managed care program. Thus, Texas is operating pursuant to a Waiver Program. The Texas Medicaid Waiver Program includes two primary components: the continuation of an indigent care component and the establishment of a Delivery System Reform Incentive Payment (“DSRIP”) component. Initiatives under the DSRIP program are designed to provide incentive payments to hospitals and other providers for their investments in delivery system reforms that increase access to health care, improve the quality of care and enhance the health of patients and families they serve. We provide indigent care services in several communities in the state of Texas, in affiliation with other hospitals. The state of Texas has been involved in efforts to increase the indigent care provided by private hospitals. As a result of additional indigent care being provided by private hospitals, public hospital districts or counties in Texas have available funds that were previously devoted to indigent care. The public hospital districts or counties are under no contractual or legal obligation to provide such

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of Operations (continued)

Revenue/Volume Trends (continued)

indigent care. The public hospital districts or counties have elected to transfer some portion of these available funds to the state’s Medicaid program. Such action is at the sole discretion of the public hospital districts or counties. It is anticipated that these contributions to the state will be matched with federal Medicaid funds. The state then may make supplemental payments to hospitals in the state for Medicaid services rendered. Hospitals receiving Medicaid supplemental payments may include those that are providing additional indigent care services. Our Texas Medicaid revenues included $23$77 million (all DSRIP related) and $124 million ($3826 million DSRIP related and $86 million indigent care related) during the third quarters of 2014 and 2013, respectively, and $346 million ($66 million DSRIP related and $280$51 million indigent care related) and $275$113 million ($5021 million DSRIP related and $225$92 million indigent care related) during the first nine monthsquarters of 20142015 and 2013,2014, respectively, of Medicaid supplemental payments. During the third quarter of 2014, we recorded a $68 million reduction to Medicaid revenues related to the Texas Medicaid Waiver Program.

On October 1, 2014, the THHSCTexas Health and Human Services Commission issued a notice to hospitals participating in the Texas Medicaid Waiver Program. According to the notice,Program indicating that a review conducted by CMS identified certain local government/hospital affiliations it believes may be inconsistent with the waiver. As a resultDuring the third quarter of these findings, CMS notified THHSC that it is deferring2014, we ceased recognizing the federal portionestimated Medicaid revenues related to certain components of the Texas Medicaid payments associated with these affiliations while it completes its review, and we expect to cease recognizing certain indigent care related revenues while the review and the deferralWaiver Program.

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of the federal portion of the payments continue.Operations (continued)

Revenue/Volume Trends (continued)

In addition, we receive supplemental payments in several other states. We are aware these supplemental payment programs are currently being reviewed by certain state agencies and some states have made waiver requests to CMS to replace their existing supplemental payment programs. It is possible these reviews and waiver requests will result in the restructuring of such supplemental payment programs and could result in the payment programs being reduced or eliminated. Because deliberations about these programs are ongoing, we are unable to estimate the financial impact the program structure modifications, if any, may have on our results of operations.

Electronic Health Record Incentive Payments

The American Recovery and Reinvestment Act of 2009 provides for Medicare and Medicaid incentive payments, beginning in 2011, for eligible hospitals and professionals that adopt and meaningfully use certified EHR technology. We recognize income related to Medicare and Medicaid incentive payments using a gain contingency model that is based upon when our eligible hospitals have demonstrated meaningful use of certified EHR technology for the applicable period and the cost report information for the full cost report year that will determine the final calculation of the incentive payment is available.

We recognized $32$19 million and $75 million of electronic health record incentive income, primarily related to Medicare, during the third quarters of 2014 and 2013, respectively. We recognized $97 million and $166$30 million of electronic health record incentive income, primarily related to Medicare, during the first nine monthsquarters of 20142015 and 2013,2014, respectively. At September 30, 2014,March 31, 2015, we had no$28 million of deferred EHR incentive income.

We have incurred and will continue to incur both capital costs and operating expenses in order to implement our certifiedincome, which represents payments received for which EHR technology and meet meaningful use requirements. These expenses are ongoing and are projected to continue over all stages of implementation of meaningful use. The timing of recognizing the expenses mayincentive income has not correlate with the receipt of the incentive payments and the recognition of income. We incurred $21 million and $26 million during the third quarters of 2014 and 2013, respectively, and $96 million and $85 million during the first nine months of 2014 and 2013, respectively, of operating expenses to implement our certified EHR technology and meet meaningful use.

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of Operations (continued)

Electronic Health Record Incentive Payments (continued)

been recognized.

For 2014,2015, we estimate EHR incentive income will be recognized in the range of $110$40 million to $130 million and that related EHR operating expenses will be in the range of $110 million to $130$50 million. Actual incentive payments and EHR operating expenses could vary from these estimates due to certain factors such as availability of federal funding for both Medicare and Medicaid incentive payments and our ability to continue to demonstrate meaningful use of certified EHR technology. The failure of our ability to continue to demonstrate meaningful use of EHR technology could have a material, adverse effect on our results of operations.

Operating Results Summary

The following is a comparative summary of results from operations for the quarters and nine months ended September 30, 2014 and 2013 (dollars in millions):

  Quarter 
  2014  2013 
  Amount  Ratio  Amount  Ratio 

Revenues before provision for doubtful accounts

 $9,978    $9,411   

Provision for doubtful accounts

  758     955   
 

 

 

   

 

 

  

Revenues

  9,220    100.0    8,456    100.0  

Salaries and benefits

  4,211    45.7    3,916    46.3  

Supplies

  1,539    16.7    1,457    17.2  

Other operating expenses

  1,688    18.3    1,564    18.5  

Electronic health record incentive income

  (32  (0.3  (75  (0.9

Equity in earnings of affiliates

  (14  (0.2  (9  (0.1

Depreciation and amortization

  460    5.0    443    5.3  

Interest expense

  427    4.6    458    5.4  

Losses on sales of facilities

  12    0.1    1      
 

 

 

  

 

 

  

 

 

  

 

 

 
  8,291    89.9    7,755    91.7  
 

 

 

  

 

 

  

 

 

  

 

 

 

Income before income taxes

  929    10.1    701    8.3  

Provision for income taxes

  318    3.5    234    2.8  
 

 

 

  

 

 

  

 

 

  

 

 

 

Net income

  611    6.6    467    5.5  

Net income attributable to noncontrolling interests

  93    1.0    102    1.2  
 

 

 

  

 

 

  

 

 

  

 

 

 

Net income attributable to HCA Holdings, Inc.

 $518    5.6   $365    4.3  
 

 

 

  

 

 

  

 

 

  

 

 

 

% changes from prior year:

    

Revenues

  9.0   4.9 

Income before income taxes

  32.4     3.6   

Net income attributable to HCA Holdings, Inc.

  42.0     1.5   

Admissions(a)

  3.9     0.5   

Equivalent admissions(b)

  5.5     0.9   

Revenue per equivalent admission

  3.3     3.9   

Same facility % changes from prior year(c):

    

Revenues

  8.1     4.5   

Admissions(a)

  2.8     0.7   

Equivalent admissions(b)

  4.1     1.1   

Revenue per equivalent admission

  3.8     3.4   

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of Operations (continued)

Operating Results Summary (continued)

The following is a comparative summary of results from operations for the quarters ended March 31, 2015 and 2014 (dollars in millions):

  Nine Months 
  2014  2013 
  Amount  Ratio  Amount  Ratio 

Revenues before provision for doubtful accounts

 $29,619    $28,078   

Provision for doubtful accounts

  2,337     2,732   
 

 

 

   

 

 

  

Revenues

  27,282    100.0    25,346    100.0  

Salaries and benefits

  12,359    45.3    11,681    46.1  

Supplies

  4,603    16.9    4,406    17.4  

Other operating expenses

  4,977    18.2    4,594    18.1  

Electronic health record incentive income

  (97  (0.4  (166  (0.7

Equity in earnings of affiliates

  (32  (0.1  (29  (0.1

Depreciation and amortization

  1,361    5.1    1,292    5.0  

Interest expense

  1,314    4.8    1,392    5.5  

Losses (gains) on sales of facilities

  (20  (0.1  13    0.1  

Losses on retirement of debt

  226    0.8    17    0.1  

Legal claim costs

  78    0.3          
 

 

 

  

 

 

  

 

 

  

 

 

 
  24,769    90.8    23,200    91.5  
 

 

 

  

 

 

  

 

 

  

 

 

 

Income before income taxes

  2,513    9.2    2,146    8.5  

Provision for income taxes

  816    3.0    704    2.8  
 

 

 

  

 

 

  

 

 

  

 

 

 

Net income

  1,697    6.2    1,442    5.7  

Net income attributable to noncontrolling interests

  349    1.3    310    1.2  
 

 

 

  

 

 

  

 

 

  

 

 

 

Net income attributable to HCA Holdings, Inc.

 $1,348    4.9   $1,132    4.5  
 

 

 

  

 

 

  

 

 

  

 

 

 

% changes from prior year:

    

Revenues

  7.6   3.1 

Income before income taxes

  17.1     (8.2 

Net income attributable to HCA Holdings, Inc.

  19.1     (12.3 

Admissions(a)

  2.1     0.6   

Equivalent admissions(b)

  3.3     0.5   

Revenue per equivalent admission

  4.2     2.6   

Same facility % changes from prior year(c):

    

Revenues

  6.4     2.9   

Admissions(a)

  1.1     0.7   

Equivalent admissions(b)

  2.0     0.5   

Revenue per equivalent admission

  4.3     2.3   

   2015  2014 
   Amount  Ratio  Amount  Ratio 

Revenues before provision for doubtful accounts

  $10,322    $9,683   

Provision for doubtful accounts

   646     851   
  

 

 

   

 

 

  

Revenues

   9,676    100.0    8,832    100.0  

Salaries and benefits

   4,398    45.5    4,050    45.9  

Supplies

   1,638    16.9    1,532    17.3  

Other operating expenses

   1,717    17.7    1,645    18.6  

Electronic health record incentive income

   (19  (0.2  (30  (0.3

Equity in earnings of affiliates

   (19  (0.2  (9  (0.1

Depreciation and amortization

   473    5.0    447    5.0  

Interest expense

   419    4.3    460    5.2  

Gains on sales of facilities

   (9  (0.1  (21  (0.2

Legal claim costs

           78    0.9  
  

 

 

  

 

 

  

 

 

  

 

 

 
   8,598    88.9    8,152    92.3  
  

 

 

  

 

 

  

 

 

  

 

 

 

Income before income taxes

   1,078    11.1    680    7.7  

Provision for income taxes

   358    3.7    226    2.6  
  

 

 

  

 

 

  

 

 

  

 

 

 

Net income

   720    7.4    454    5.1  

Net income attributable to noncontrolling interests

   129    1.3    107    1.2  
  

 

 

  

 

 

  

 

 

  

 

 

 

Net income attributable to HCA Holdings, Inc.

  $591    6.1   $347    3.9  
  

 

 

  

 

 

  

 

 

  

 

 

 

% changes from prior year:

     

Revenues

   9.5   4.6 

Income before income taxes

   58.6     6.3   

Net income attributable to HCA Holdings, Inc.

   70.5     0.8   

Admissions(a)

   5.8     0.2   

Equivalent admissions(b)

   7.9     0.7   

Revenue per equivalent admission

   1.5     3.9   

Same facility % changes from prior year(c):

     

Revenues

   8.5     3.4   

Admissions(a)

   5.1     (0.6 

Equivalent admissions(b)

   6.8     (0.3 

Revenue per equivalent admission

   1.6     3.7   

 

(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.

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of Operations (continued)

 

Quarters Ended September 30,March 31, 2015 and 2014 and 2013

Net income attributable to HCA Holdings, Inc. totaled $518$591 million, or $1.16$1.36 per diluted share, for the thirdfirst quarter of 20142015 compared to $365$347 million, or $0.79$0.76 per diluted share, for the thirdfirst quarter of 2013. During the2014. First quarter ended September 30, 2014, we recorded $942015 results include net gains on sales of facilities of $9 million, or $0.13$0.01 per diluted share, of Medicare revenues as the estimated settlement amount for certain claims denied by RAC entities conducting reviews on behalf of CMS and currently pending in the appeals process. CMS is offering an administrative agreement to providers willing to withdraw their pending appeals in exchange for a timely partial payment (generally, 68% of the claim amount, subject to certain adjustments). We also recorded a reduction of $68 million, or $0.09 per diluted share, to Medicaid revenues related to the Texas Medicaid Waiver Program. On October 1, 2014, the THHSC issued a notice to hospitals participating in the Texas Medicaid Waiver Program. According to the notice, a review conducted by CMS identified certain local government/hospital affiliations it believes may be inconsistent with the waiver. As a result of these findings, CMS notified THHSC that it is deferring the federal portion of the Medicaid payments associated with these affiliations while it completes its review. All revenue amounts and revenue-related statistics for the third quarter of 2014 include the impact of these changes in estimates and the resulting $26 million net increase in revenues. Thirdshare. First quarter 2014 results include net lossesgains on sales of facilities of $12$21 million, or $0.02$0.03 per diluted share. Third quarter 2013 results include net losses on salesshare, and legal claim costs of facilities of $1 million.$78 million, or $0.11 per diluted share. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 447.3 million shares and 463.6435.309 million shares for the quartersquarter ended September 30,March 31, 2015 and 457.449 million shares for the quarter ended March 31, 2014. During 2014 and 2013, respectively. During May 2014,the first quarter of 2015, we repurchased 14.628.583 million and 5.205 million shares of our common stock.stock, respectively.

For the thirdfirst quarter of 2014,2015, consolidated and same facility admissions increased 3.9%5.8% and 2.8%5.1%, respectively, compared to the thirdfirst quarter of 2013.2014. Consolidated and same facility outpatient surgical volumes increased 3.3%1.9% and 1.9%1.4%, respectively, during the thirdfirst quarter of 2014,2015, compared to the thirdfirst quarter of 2013.2014. Consolidated and same facility inpatient surgeries each increased 1.9% and 1.4%, respectively,3.0% in the thirdfirst quarter of 2014,2015, compared to the thirdfirst quarter of 2013.2014. Consolidated and same facility emergency department visits increased 8.6%12.3% and 7.3%11.5%, respectively, during the quarter ended September 30, 2014,March 31, 2015, compared to the quarter ended September 30, 2013.March 31, 2014.

Revenues before provision for doubtful accounts increased 6.0%6.6% for the thirdfirst quarter of 20142015 compared to the thirdfirst quarter of 2013.2014. The provision for doubtful accounts declined $197$205 million from $955$851 million in the thirdfirst quarter of 20132014 to $758$646 million in the thirdfirst quarter of 2014.2015. The provision for doubtful accounts relates primarily to uninsured amounts due directly from patients, including copayment and deductible amounts for patients who have health care coverage. The self-pay revenue deductions for charity care and uninsured discounts increased $159declined $33 million and $29increased $225 million, respectively, during the thirdfirst quarter of 2014,2015, compared to the thirdfirst quarter of 2013.2014. The sum of the provision for doubtful accounts, uninsured discounts and charity care, as a percentage of the sum of revenues, the provision for doubtful accounts, uninsured discounts and charity care, was 29.8%29.6% for the thirdfirst quarter of 2014,2015, compared to 31.7%31.6% for the thirdfirst quarter of 2013.2014. We believe this decline is primarily due to previously uninsured patients obtaining medical coverage through the health insurance exchanges and Medicaid expansion programs. At September 30, 2014,March 31, 2015, our allowance for doubtful accounts represented approximately 93%92% of the $5.475$5.111 billion total patient due accounts receivable balance, including accounts, net of estimated contractual discounts, related to patients for which eligibility for Medicaid coverage or uninsured discounts was being evaluated.

Revenues increased 9.0%9.5% due to the combined impact of revenue per equivalent admission growth of 3.3%1.5% and a 5.5%7.9% increase in equivalent admissions for the thirdfirst quarter of 20142015 compared to the thirdfirst quarter of 2013.2014. Same facility revenues increased 8.1%8.5% due to the combined impact of a 3.8%1.6% increase in same facility revenue per equivalent admission and a 4.1%6.8% increase in same facility equivalent admissions for the thirdfirst quarter of 20142015 compared to the thirdfirst quarter of 2013.2014.

Salaries and benefits, as a percentage of revenues, were 45.5% in the first quarter of 2015 and 45.9% in the first quarter of 2014. Salaries and benefits per equivalent admission increased 0.6% in the first quarter of 2015 compared to the first quarter of 2014. Same facility labor rate increases averaged 2.5% for the first quarter of 2015 compared to the first quarter of 2014.

Supplies, as a percentage of revenues, were 16.9% in the first quarter of 2015 and 17.3% in the first quarter of 2014. Supply costs per equivalent admission declined 0.9% in the first quarter of 2015 compared to the first quarter of 2014. Supply costs per equivalent admission increased 0.5% for pharmacy supplies and declined 0.3% for medical devices and 1.2% for general medical and surgical items in the first quarter of 2015 compared to the first quarter of 2014.

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of Operations (continued)

Quarters Ended September 30,March 31, 2015 and 2014 and 2013 (continued)

 

Salaries and benefits, as a percentage of revenues, were 45.7% in the third quarter of 2014 and 46.3% in the third quarter of 2013. Salaries and benefits per equivalent admission increased 1.9% in the third quarter of 2014 compared to the third quarter of 2013. Same facility labor rate increases averaged 2.6% for the third quarter of 2014 compared to the third quarter of 2013.

Supplies, as a percentage of revenues, were 16.7% in the third quarter of 2014 and 17.2% in the third quarter of 2013. Supply costs per equivalent admission increased 0.1% in the third quarter of 2014 compared to the third quarter of 2013. Supply costs per equivalent admission increased 1.0% for medical devices and 3.1% for pharmacy supplies, and declined 0.9% for general medical and surgical items in the third quarter of 2014 compared to the third quarter of 2013.

Other operating expenses, as a percentage of revenues, were 18.3%17.7% in the thirdfirst quarter of 20142015 and 18.5%18.6% in the thirdfirst quarter of 2013.2014. Other operating expenses is primarily comprised of contract services, professional fees, repairs and maintenance, rents and leases, utilities, insurance (including professional liability insurance) and nonincome taxes. Provisions for losses related to professional liability risks were $96$92 million and $78$96 million for the thirdfirst quarters of 20142015 and 2013,2014, respectively.

We recognized $32$19 million and $75$30 million of electronic health record incentive income primarily related to Medicare incentives during the thirdfirst quarters of 20142015 and 2013,2014, respectively.

Equity in earnings of affiliates was $14$19 million and $9 million in the thirdfirst quarters of 20142015 and 2013,2014, respectively.

Depreciation and amortization increased $17$26 million, from $443$447 million in the thirdfirst quarter of 20132014 to $460$473 million in the thirdfirst quarter of 2014.2015.

Interest expense declined from $458$460 million in the thirdfirst quarter of 20132014 to $427$419 million in the thirdfirst quarter of 2014.2015. The decline in interest expense was due to a decline in the average interest rate. Our average debt balance was $28.576$29.412 billion for the thirdfirst quarter of 20142015 compared to $28.177$28.302 billion for the thirdfirst quarter of 2013.2014. The average effective interest rate for our long term debt declined from 6.4% for the quarter ended September 30, 2013 to 5.9% for the quarter ended September 30, 2014.

During the third quarters of 2014 and 2013, we recorded net losses on sales of facilities of $12 million and $1 million, respectively.

The effective tax rates were 38.0% and 39.1% for the third quarters of 2014 and 2013, respectively. The effective tax rate computations exclude net income attributable to noncontrolling interests as it relates to consolidated partnerships.

Net income attributable to noncontrolling interests declined from $102 million for the third quarter of 2013 to $93 million for the third quarter of 2014. The decline in net income attributable to noncontrolling interests related primarily to declines in operating results of hospital joint ventures in a Texas market and a Georgia market.

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of Operations (continued)

Nine months ended September 30, 2014 and 2013

Net income attributable to HCA Holdings, Inc. totaled $1.348 billion, or $2.98 per diluted share, in the nine months ended September 30, 2014 compared to $1.132 billion, or $2.44 per diluted share, in the nine months ended September 30, 2013. The net effect of two changes in estimates recorded during the third quarter of 2014 (one to increase Medicare revenues $94 million and the other to reduce Medicaid revenues $68 million) resulted in a net increase to revenues of $26 million, or $0.04 per diluted share. All revenue amounts and revenue-related statistics for the nine months ended September 30, 2014 include the impact of these changes in estimates and the resulting $26 million net increase in revenues. The first nine months of 2014 results include losses on retirement of debt of $226 million, or $0.32 per diluted share, net gains on sales of facilities of $20 million, or $0.03 per diluted share, and legal claim costs of $78 million, or $0.11 per diluted share. The first nine months of 2013 results include net losses on sales of facilities of $13 million, or $0.02 per diluted share, and losses on retirement of debt of $17 million, or $0.02 per diluted share. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 452.5 million shares and 463.1 million shares for the nine months ended September 30, 2014 and 2013, respectively. During May 2014, we repurchased 14.6 million shares of our common stock.

For the first nine months of 2014, consolidated and same facility admissions increased 2.1% and 1.1%, respectively, compared to the first nine months of 2013. Consolidated and same facility outpatient surgical volumes increased 1.4% and declined 0.1%, respectively, during the first nine months of 2014, compared to the first nine months of 2013. Consolidated and same facility inpatient surgeries increased 1.6% and 1.0%, respectively, in the first nine months of 2014, compared to the first nine months of 2013. Consolidated and same facility emergency department visits increased 5.5% and 4.3%, respectively, during the nine months ended September 30, 2014, compared to the nine months ended September 30, 2013.

Revenues before provision for doubtful accounts increased 5.5% for the first nine months of 2014 compared to the first nine months of 2013. Provision for doubtful accounts declined $395 million from $2.732 billion in the first nine months of 2013 to $2.337 billion in the first nine months of 2014. The provision for doubtful accounts relates primarily to uninsured amounts due directly from patients, including copayment and deductible amounts for patients who have health care coverage. The self-pay revenue deductions for charity care and uninsured discounts increased $282 million and $504 million, respectively, during the first nine months of 2014, compared to the first nine months of 2013. The sum of the provision for doubtful accounts, uninsured discounts and charity care, as a percentage of the sum of revenues, the provision for doubtful accounts, uninsured discounts and charity care, was 30.1% for the first nine months of 2014, compared to 31.0% for the first nine months of 2013. At September 30, 2014, our allowance for doubtful accounts represented approximately 93% of the $5.475 billion total patient due accounts receivable balance, including accounts, net of estimated contractual discounts, related to patients for which eligibility for Medicaid coverage or uninsured discounts was being evaluated.

Revenues increased 7.6% due to the combined impact of revenue per equivalent admission growth of 4.2% and an increase of 3.3% in equivalent admissions for the first nine months of 2014 compared to the first nine months of 2013. Same facility revenues increased 6.4% due to the combined impact of a 4.3% increase in same facility revenue per equivalent admission and a 2.0% increase in same facility equivalent admissions for the first nine months of 2014 compared to the first nine months of 2013.

Salaries and benefits, as a percentage of revenues, were 45.3% in the first nine months of 2014 and 46.1% in the first nine months of 2013. Salaries and benefits per equivalent admission increased 2.4% in the first nine months of 2014 compared to the first nine months of 2013. Same facility labor rate increases averaged 2.3% for the first nine months of 2014 compared to the first nine months of 2013.

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of Operations (continued)

Nine months ended September 30, 2014 and 2013 (continued)

Supplies, as a percentage of revenues, were 16.9% in the first nine months of 2014 and 17.4% in the first nine months of 2013. Supply cost per equivalent admission increased 1.2% in the first nine months of 2014 compared to the first nine months of 2013. Supply costs per equivalent admission increased 1.7% for medical devices, 3.6% for pharmacy supplies and 0.3% for general medical and surgical items in the first nine months of 2014 compared to the first nine months of 2013.

Other operating expenses, as a percentage of revenues, increased to 18.2% in the first nine months of 2014 from 18.1% in the first nine months of 2013. Other operating expenses is primarily comprised of contract services, professional fees, repairs and maintenance, rents and leases, utilities, insurance (including professional liability insurance) and nonincome taxes. Provisions for losses related to professional liability risks were $288 million and $237 million for the first nine months of 2014 and 2013, respectively.

We recognized $97 million and $166 million of electronic health record incentive income primarily related to Medicare incentives during the first nine months of 2014 and 2013, respectively.

Equity in earnings of affiliates was $32 million and $29 million in the first nine months of 2014 and 2013, respectively.

Depreciation and amortization increased $69 million, from $1.292 billion in the first nine months of 2013 to $1.361 billion in the first nine months of 2014.

Interest expense declined from $1.392 billion in the first nine months of 2013 to $1.314 billion in the first nine months of 2014 which was primarily due to a decline in the average interest rate. Our average debt balance was $28.636 billion for the first nine months of 2014 compared to $28.385 billion for the first nine months of 2013. The average effective interest rate for our long term debtterm-debt declined from 6.6% for the nine monthsquarter ended September 30, 2013March 31, 2014 to 6.1%5.8% for the nine monthsquarter ended September 30, 2014.March 31, 2015.

During the first nine monthsquarters of 20142015 and 2013,2014, we recorded net gains on sales of facilities of $20$9 million and net losses on sales of facilities of $13$21 million, respectively.

During March 2014, we issued $3.500 billion aggregate principal amount of notes, comprised of $1.500 billion aggregate principal amount of 3.75% senior secured notes due 2019 and $2.000 billion aggregate principal amount of 5.00% senior secured notes due 2024 and repaid at maturity all $500 million aggregate principal amount of our outstanding 5.75% senior unsecured notes. During April 2014, we used proceeds from the March 2014 debt issuance to redeem all $1.500 billion aggregate principal amount of our outstanding 8 1/2% senior secured notes due 2019 and all $1.250 billion aggregate principal amount of our outstanding 7  7/8% senior secured notes due 2020. The pretax loss on retirement of debt related to these redemptions was $226 million. During March 2013, we redeemed all $201 million aggregate principal amount of our 9  7/8% senior secured second lien notes due 2017. The pretax loss on retirement of debt related to this redemption was $17 million.

We recorded $78 million of legal claim costs during the first nine monthsquarter of 2014 to increase the estimate of our legal liability in the previously disclosed lawsuit alleging we did not make the full level of capital expenditures and uncompensated care agreed to in the connection with the purchase of the hospitals from Health Midwest in 2003.

The effective tax rates were 37.7% and 38.3%39.4% for the first nine monthsquarters of 20142015 and 2013,2014, respectively. The effective tax rate computations exclude net income attributable to noncontrolling interests as it relates to consolidated partnerships.

Net income attributable to noncontrolling interests increased from $107 million for the first quarter of 2014 to $129 million for the first quarter of 2015. The increase in net income attributable to noncontrolling interests related primarily to increases in operating results of hospital joint ventures in a Texas market and an Oklahoma market.

Liquidity and Capital Resources

Cash provided by operating activities totaled $1.018 billion in the first quarter of 2015 compared to $443 million in the first quarter of 2014. The $575 million increase in cash provided by operating activities in the first quarter of 2015 compared to the first quarter of 2014 related primarily to a $266 million increase in net income and a $294 million benefit from changes in income taxes. The combined interest payments and net tax payments in the first quarter of 2015 and 2014 were $369 million and $555 million, respectively. Working capital totaled $1.958 billion at March 31, 2015 and $3.450 billion at December 31, 2014. The $1.492 billion decline in working capital related primarily to a $1.699 billion increase in long-term debt due within one year.

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Results of Operations (continued)

Nine months ended September 30, 2014 and 2013 (continued)

Net income attributable to noncontrolling interests increased from $310 million for the first nine months of 2013 to $349 million for the first nine months of 2014. The increase in net income attributable to noncontrolling interests related primarily to growth in operating results of hospital joint ventures in two Texas markets and our group purchasing organization.

Liquidity and Capital Resources (continued)

Cash provided by operating activities totaled $2.821 billion in the first nine months of 2014 compared to $2.454 billion in the first nine months of 2013. The $367 million increase in cash provided by operating activities in the first nine months of 2014 compared to the first nine months of 2013 related primarily to a $255 million increase in net income and a $69 million benefit from the change in depreciation and amortization, as the benefit from the noncash gains (losses) on sales of facilities, losses on retirement of debt and legal claim costs was offset by increased tax payments. The combined interest payments and net tax payments in the first nine months of 2014 and 2013 were $2.199 billion and $1.940 billion, respectively. Working capital totaled $2.895 billion at September 30, 2014 and $2.342 billion at December 31, 2013.

Cash used in investing activities was $1.512 billion$432 million in the first nine monthsquarter of 20142015 compared to $1.674 billion$409 million in the first nine monthsquarter of 2013.2014. Excluding acquisitions, capital expenditures were $1.482 billion$446 million in the first nine monthsquarter of 20142015 and $1.347 billion$400 million in the first nine monthsquarter of 2013.2014. We expended $14 million for the acquisition of a hospital facility and $83$28 million to acquire nonhospital health care facilities during the first nine monthsquarter of 2014.2015. We expended $317$13 million for the acquisition of a hospital facility and $6 million to acquire nonhospital health care entities and $146 million for three hospital, during the first nine monthsquarter of 2013,2014. Capital expenditures, excluding acquisitions, are expected to approximate $2.2$2.5 billion in 2014.2015. At September 30, 2014,March 31, 2015, there were projects under construction which had estimated additional costs to complete and equip over the next five years of approximately $2.22$2.1 billion. We expect to finance capital expenditures with internally generated and borrowed funds. We received $38$15 million and $31$23 million from sales of health care entities and real estate and other investments during the first nine monthsquarters of 20142015 and 2013,2014, respectively. We received $22 million of net cash flows from our investments of $22 million and $97 million in the first nine monthsquarter of 20142015 and 2013, respectively.paid $13 million to increase investments during the first quarter of 2014.

Cash used in financing activities totaled $1.208 billion$566 million in the first nine monthsquarter of 20142015 compared to $1.001 billion$402 million of cash provided by financing activities in the first nine monthsquarter of 2013.2014. During the first nine monthsquarter of 2014,2015, net cash flows used in financing activities included a net decline of $183$51 million in our indebtedness, repurchaserepurchases of common stock of $750$366 million, distributions to noncontrolling interests of $325$132 million, payments of debt issuance costs of $49$11 million, distributions to stockholders of $7$6 million and receipts of $119$38 million of income tax benefits for certain items (primarily related to employee exercises of stock options). During the first nine monthsquarter of 2013,2014, net cash flows used inprovided by financing activities included a net debt repaymentsincrease of $670$520 million in our indebtedness, distributions to noncontrolling interests of $308$87 million, payments of debt issuance costs of $48 million, distributions to stockholders of $13 million, payment of debt issuance costs of $5$7 million and receipts of $70$50 million of income tax benefits for certain items (primarily related to employee exercises of stock options).

We are a highly leveraged company with significant debt service requirements. Our debt totaled $28.470$29.443 billion at September 30, 2014.March 31, 2015. Our interest expense was $1.314 billion$419 million for the first nine monthsquarter of 20142015 and $1.392 billion$460 million for the first nine monthsquarter of 2013.2014. The decline in interest expense was due to the decline in the average interest rate.

In addition to cash flows from operations, available sources of capital include amounts available under our senior secured credit facilities ($2.1632.587 billion and $4.351$2.337 billion available as of SeptemberMarch 31, 2015 and April 30, 2014 and

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Liquidity and Capital Resources (continued)

October 31, 2014,2015, respectively) and anticipated access to public and private debt markets. The

During January 2015, we issued $1.000 billion aggregate principal amount of 5.375% senior notes due 2025. We used a portion of the net proceeds to repay at October 31, 2014 reflects the recent amendment tomaturity our $750 million aggregate principal amount of 6.375% senior securedasset-based revolving credit facility, which increased the revolving credit commitments by $750 million.unsecured notes due 2015.

During October 2014, we issued $2.000 billion aggregate principal amount of notes, comprised of $600 million aggregate principal amount of 4.25% senior secured notes due 2019 and $1.400 billion aggregate principal amount of 5.25% senior secured notes due 2025. During November 2014, we expect to useused a portion of the proceeds from the October 2014 debt issuanceissuances to redeem all $1.400 billion aggregate principal amount of our outstanding 7 1/4% senior secured notes due 2020. The pretax loss on retirement of debt related to this redemption is expected to be approximately $108was $109 million.

During October 2014, the HCA Holdings, Inc. Board of Directors authorized a share repurchase program for up to $1.000 billion of our outstanding common stock. Repurchases will be made from time to time in the open market, through privately negotiated transactions, or otherwise.

During March 2014, we issued $3.500 billion aggregate principal amount of notes, comprised of $1.500 billion aggregate principal amount of 3.75% senior secured notes due 2019 and $2.000 billion aggregate principal amount of 5.00% senior secured notes due 2024, and repaid at maturity all $500 million aggregate principal amount of our outstanding 5.75% senior unsecured notes. During April 2014, we used proceeds from the March 2014 debt issuance to redeem all $1.500 billion aggregate principal amount of our outstanding 8 1/2% senior secured notes due 2019 and all $1.250 billion aggregate principal amount of our outstanding 7 7/8% senior secured notes due 2020. The pretax loss on retirement of debt related to these redemptions was $226 million.

During March 2013, we redeemed all $201 million aggregate principal amount of our 9ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

 7FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

/Liquidity and Capital Resources (continued)8% senior secured second lien notes due 2017. The pretax loss on retirement of debt related to this redemption was $17 million.

Investments of our professional liability insurance subsidiaries, to maintain statutory equity and pay claims, totaled $507$530 million and $510$558 million at September 30, 2014March 31, 2015 and December 31, 2013,2014, respectively. An insurance subsidiary maintained net reserves for professional liability risks of $336$277 million and $315$347 million at September 30, 2014March 31, 2015 and December 31, 2013,2014, respectively. Our facilities are insured by a 100% owned insurance subsidiary for losses up to $50 million per occurrence; however, this coverage is subject to a $5$15 million per occurrence self-insured retention. Net reserves for the self-insured professional liability risks retained were $1.009$1.120 billion and $940 million$1.035 billion at September 30, 2014March 31, 2015 and December 31, 2013,2014, respectively. Claims payments, net of reinsurance recoveries, during the next 12 months are expected to approximate $320$325 million. We estimate that approximately $254$273 million of the expected net claim payments during the next 12 months will relate to claims subject to the self-insured retention.

Management believes that cash flows from operations, amounts available under our senior secured credit facilities and our anticipated access to public and private debt markets will be sufficient to meet expected liquidity needs during the next 12 months.

Market Risk

We are exposed to market risk related to changes in market values of securities. The investments in debt and equity securities of our 100% owned insurance subsidiaries were $504$526 million and $3$4 million, respectively, at September 30, 2014.March 31, 2015. These investments are carried at fair value, with changes in unrealized gains and losses being recorded as adjustments to other comprehensive income. At September 30, 2014,March 31, 2015, we had a net unrealized gain of $20 million on the insurance subsidiaries’ investment securities.

We are exposed to market risk related to market illiquidity. Investments in debt and equity securities of our 100% owned insurance subsidiaries could be impaired by the inability to access the capital markets. Should the

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Liquidity and Capital Resources (continued)

Market Risk (continued)

100% owned insurance subsidiaries require significant amounts of cash in excess of normal cash requirements to pay claims and other expenses on short notice, we may have difficulty selling these investments in a timely manner or be forced to sell them at a price less than what we might otherwise have been able to in a normal market environment. We may be required to recognize other-than-temporary impairments on our investment securities in future periods should issuers default on interest payments or should the fair market valuations of the securities deteriorate due to ratings downgrades or other issue-specific factors.

We are also exposed to market risk related to changes in interest rates, and we periodically enter into interest rate swap agreements to manage our exposure to these fluctuations. Our interest rate swap agreements involve the exchange of fixed and variable rate interest payments between two parties, based on common notional principal amounts and maturity dates. The notional amounts of the swap agreements represent balances 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 interest payments under these agreements are settled on a net basis. These derivatives have been recognized in the financial statements at their respective fair values. Changes in the fair value of these derivatives, which are designated as cash flow hedges, are included in other comprehensive income, and changes in the fair value of derivatives which have not been designated as hedges are recorded in operations.

With respect to our interest-bearing liabilities, approximately $3.319$4.119 billion of long-term debt at September 30, 2014March 31, 2015 was subject to variable rates of interest, while the remaining balance in long-term debt of $25.151$25.324 billion at September 30, 2014March 31, 2015 was subject to fixed rates of interest. Both the general level of interest rates and, for the senior secured credit facilities, our leverage affect our variable interest rates. Our variable debt is comprised primarily

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Liquidity and Capital Resources (continued)

Market Risk (continued)

of amounts outstanding under the senior secured credit facilities. Borrowings under the senior secured credit facilities bear interest at a rate equal to an applicable margin plus, at our option, either (a) a base rate determined by reference to the higher of (1) the federal funds rate plus 0.50% and (2) the prime rate of Bank of America or (b) a LIBOR rate for the currency of such borrowing for the relevant interest period. The applicable margin for borrowings under the senior secured credit facilities may fluctuate according to a leverage ratio. The average effective interest rate for our long-term debt declined from 6.6% for the nine monthsquarter ended September 30, 2013March 31, 2014 to 6.1%5.8% for the nine monthsquarter ended September 30, 2014.March 31, 2015.

The estimated fair value of our total long-term debt was $29.369$31.384 billion at September 30, 2014.March 31, 2015. The estimates of fair value are based upon the quoted market prices for the same or similar issues of long-term debt with the same maturities. Based on a hypothetical 1% increase in interest rates, the potential annualized reduction to future pretax earnings would be approximately $33$41 million. To mitigate the impact of fluctuations in interest rates, we generally target a portion of our debt portfolio to be maintained at fixed rates.

Our international operations and the related market risks associated with foreign currencies are currently insignificant to our results of operations and financial position.

Tax Examinations

The IRS Examination Division began an audit of HCA Holdings, Inc.’s 2011 and 2012 federal income tax returns during 2014. We are also subject to examination by state and foreign taxing authorities.

Management believes HCA Holdings, Inc. and its affiliates properly reported taxable income and paid taxes in accordance with applicable laws and agreements established with taxing authorities and final resolution of any

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Tax Examinations (continued)

disputes will not have a material, adverse effect on our results of operations or financial position. However, if payments due upon final resolution of any issues exceed our recorded estimates, such resolutions could have a material, adverse effect on our results of operations or financial position.

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Operating Data

 

  2014   2013   2015   2014 

Number of hospitals in operation at:

        

March 31

   165     162     168     165  

June 30

   165     161       165  

September 30

   165     162       165  

December 31

     165       166  

Number of freestanding outpatient surgical centers in operation at:

        

March 31

   115     113     113     115  

June 30

   115     114       115  

September 30

   113     114       113  

December 31

     115       113  

Licensed hospital beds at(a):

        

March 31

   43,000     41,891     43,500     43,000  

June 30

   43,025     41,792       43,025  

September 30

   43,241     42,038       43,241  

December 31

     42,896       43,356  

Weighted average licensed beds(b):

        

Quarter:

        

First

   42,958     41,867     43,451     42,958  

Second

   43,020     41,842       43,020  

Third

   43,226     42,005       43,226  

Fourth

     42,809       43,321  

Year

     42,133       43,132  

Average daily census(c):

        

Quarter:

        

First

   24,414     24,147     26,039     24,414  

Second

   23,468     22,523       23,468  

Third

   23,372     22,099       23,372  

Fourth

     22,666       24,094  

Year

     22,853       23,835  

Admissions(d):

        

Quarter:

        

First

   445,100     444,200     470,900     445,100  

Second

   442,800     433,000       442,800  

Third

   449,400     432,600       449,400  

Fourth

     434,300       458,000  

Year

     1,744,100       1,795,300  

Equivalent admissions(e):

        

Quarter:

        

First

   713,000     708,000     769,400     713,000  

Second

   734,200     708,700       734,200  

Third

   751,300     711,800       751,300  

Fourth

     716,200       760,200  

Year

     2,844,700       2,958,700  

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

Operating Data (continued)

 

  2014 2013   2015 2014 

Average length of stay (days)(f):

      

Quarter:

      

First

   4.9    4.9     5.0    4.9  

Second

   4.8    4.7      4.8  

Third

   4.8    4.7      4.8  

Fourth

    4.8      4.8  

Emergency room visits(g):

      

Quarter:

      

First

   1,765,000    1,749,300     1,982,000    1,765,000  

Second

   1,849,800    1,726,400      1,849,800  

Third

   1,886,700    1,738,100      1,886,700  

Fourth

    1,754,300      1,949,200  

Year

    6,968,100      7,450,700  

Outpatient surgeries(h):

      

Quarter:

      

First

   210,500    211,100     214,500    210,500  

Second

   225,000    222,200      225,000  

Third

   222,700    215,600      222,700  

Fourth

    233,000      233,400  

Year

    881,900      891,600  

Inpatient surgeries(i):

      

Quarter:

      

First

   126,300    124,700     130,100    126,300  

Second

   128,700    126,500      128,700  

Third

   131,300    128,900      131,300  

Fourth

    128,700      132,600  

Year

    508,800      518,900  

Days revenues in accounts receivable(j):

      

Quarter:

      

First

   56    52     55    56  

Second

   54    53      54  

Third

   55    54      55  

Fourth

    54      54  

Outpatient revenues as a % of patient revenues(k):

      

Quarter:

      

First

   37  37   38  37

Second

   38  38    38

Third

   38  38    38

Fourth

    39    39

Year

    38    38

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

BALANCE SHEET DATA

 

  % of Accounts Receivable   % of Accounts Receivable 
  Under 91 Days 91 – 180 Days Over 180 Days   Under 91 Days 91 – 180 Days Over 180 Days 

Accounts receivable aging at September 30, 2014(l):

    

Accounts receivable aging at March 31, 2015(l):

    

Medicare and Medicaid

   14  1  2   15  1  1

Managed care and other discounted

   21    5    6     24    5    6  

Uninsured

   16    8    27     13    7    28  
  

 

  

 

  

 

   

 

  

 

  

 

 

Total

   51  14  35   52  13  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, 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 the revenues for the quarter by the days in the quarter. Days revenues in accounts receivable is then calculated as accounts receivable, net of allowance for doubtful accounts, at the end of the quarter divided by the revenues per day. “Revenues” used in this computation are net of the provision for doubtful accounts.

(k)

Represents the percentage of patient revenues related to patients who are not admitted to our hospitals.

(l)

Accounts receivable aging data is based upon consolidated gross accounts receivable of $10.627$10.620 billion (each 1% is equivalent to approximately $106 million of gross accounts receivable).

ITEM 3.    QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

The information called for by this item is provided under the caption “Market Risk” under Item 2, “Management’s Discussion and Analysis of Financial Condition and Results of Operations.”

ITEM 4.    CONTROLS AND PROCEDURES

Evaluation of Disclosure Controls and Procedures

HCA’s chief executive officer and chief financial officer have reviewed and evaluated the effectiveness of HCA’s disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) promulgated under the Securities Exchange Act of 1934) as of the end of the period covered by this quarterly report. Based on that evaluation, the chief executive officer and chief financial officer have concluded HCA’s disclosure controls and procedures were effective.

Changes in Internal Control Over Financial Reporting

During the period covered by this report, there have been no changes in our internal control over financial reporting that have materially affected or are reasonably likely to materially affect our internal control over financial reporting.

PART II. OTHER INFORMATION

ITEM 1.    LEGAL PROCEEDINGS

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 subject to claims for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could materially and adversely affecthave a material, adverse effect on our results of operations andor financial position in a given period.position.

Government Investigations, Claims and Litigation

Health care companies are subject to numerous investigations by various governmental agencies. Further, under the federal False Claims Act (“FCA”), private parties have the right to bringqui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our financial position, results of operations and liquidity.

As initially disclosed in 2010, the Civil Division of the Department of Justice (“DOJ”) has contacted the Company in connection with its nationwide review of whether, in certain cases, hospital charges to the federal government relating to implantable cardio-defibrillators (“ICDs”) met the CMS criteria. In connection with this nationwide review, the DOJ has indicated that it will be reviewing certain ICD billing and medical records at 95 HCA hospitals; the review covers the period from October 2003 to the present. In August 2012, HCA, along with non-HCA hospitals across the country subject to the DOJ’s review, received from the DOJ a proposed framework for resolving the DOJ’s review of ICDs. The Company is cooperating in the review. The review could potentially give rise to claims against the Company under the federal FCA or other statutes, regulations or laws. At this time, we cannot predict what effect, if any, this review or any resulting claims could have on the Company.

In July 2012, the Civil Division of the U.S. Attorney’s Office in Miami requested information on reviews assessing the medical necessity of interventional cardiology services provided at any Company facility (other

than peer reviews). The Company is cooperatingcooperated with the government’s request and has produced medical records associated with particular reviews at eight hospitals, located primarily in Florida. On February 24, 2015, the United States District Court for the Southern District of Florida unsealed aqui tam action which had been filed under seal on February 16, 2012 and alleges particular FCA violations relating to two specific facilities that were among the subjects of the Miami U.S. Attorney’s Office investigation. On January 30, 2015, the U.S. Attorney’s Office filed with the District Court a formal notice that the Department of Justice had declined to intervene in that action. An additionalqui tam action relating to these topics was unsealed and voluntarily dismissed by the relator. The U.S. Attorney’s Office in Miami is continuing its evaluation of the medical necessity of certain interventional cardiology services at the other hospitals for which the Company produced records. At this time, we cannot predict what effect, if any, the requestqui tam action, or any resulting claims that might result from the U.S. Attorney’s continued review, including any potential claims under the federal FCA, other statutes, regulations or laws, could have on the Company.

On April 2, 2014, the UK Competition and Markets Authority (“Authority”) issued a final report on its investigation of the private health care market in London. It concluded, among other things, that many private hospitals face little competition in central London, and that there are high barriers to entry. As part of its remedies package, the Authority ordered HCA to sell either: (a) its London Bridge and Princess Grace hospitals; or (b) its Wellington Hospital, including the Hospital Platinum Medical Centre. It also imposed other remedial conditions on HCA and other private health care providers, including: regulation of incentives to referring physicians; increased access to information about fees and performance; and restrictions on future arrangements between private providers and National Health Service private patient units. HCA disagrees with the Authority’s assessment of the competitive conditions for hospitals in London, as well as its proposed divestiture remedy, and has appealed the decision to the Competition Appeal Tribunal. The appeal is expectedCompetition Appeal Tribunal overturned certain of the Authority’s findings and sent the matter back to be decided in 2015.the Authority for further proceedings.

Securities Class Action Litigation

On October 28, 2011, a shareholder action, Schuh v. HCA Holdings, Inc. et al., was filed in the United States District Court for the Middle District of Tennessee seeking monetary relief. The case sought to include as a class all persons who acquired the Company’s stock pursuant or traceable to the Company’s Registration Statement issued in connection with the March 9, 2011 initial public offering. The lawsuit asserted a claim under Section 11 of the Securities Act of 1933 against the Company, certain members of the board of directors, and certain underwriters in the offering. It further asserted a claim under Section 15 of the Securities Act of 1933 against the same members of the board of directors. The action alleged various deficiencies in the Company’s disclosures in the Registration Statement. Subsequently, two additional class action complaints, Kishtah v. HCA Holdings, Inc. et al. and Daniels v. HCA Holdings, Inc. et al., setting forth substantially similar claims against substantially the same defendants were filed in the same federal court on November 16, 2011 and December 12, 2011, respectively. All three of the cases were consolidated. On May 3, 2012, the court appointed New England Teamsters & Trucking Industry Pension Fund as Lead Plaintiff for the consolidated action. On July 13, 2012, the lead plaintiff filed an amended complaint asserting claims under Sections 11 and 12(a)(2) of the Securities Act of 1933 against the Company, certain members of the board of directors, and certain underwriters in the offering. It further asserts a claim under Section 15 of the Securities Act of 1933 against the same members of the board of directors and Hercules HoldingsHolding II, LLC, a majority shareholder of the Company at the time of the initial public offering. The consolidated complaint alleges deficiencies in the Company’s disclosures in the Registration Statement and Prospectus relating to: (1) the accounting for the Company’s 2006 recapitalization and 2010 reorganization; (2) the Company’s failure to maintain effective internal controls relating to its accounting for such transactions; and (3) the Company’s Medicare and Medicaid revenue growth rates. The Company and other defendants moved to dismiss the amended complaint on September 11, 2012. The Courtcourt granted the motion in part on May 28, 2013. The action proceeded to discovery on the remaining claims. The plaintiffs’ motion for class certification was granted on September 22, 2014. The court certified a class consisting of all persons that acquired HCA stock on or before October 28, 2011 (the date of the lawsuit) pursuant to the Registration Statement issued in connection with the March 9, 2011 initial public offering. We have requested permission fromA request to the trial court of appeals to immediatelyhear an immediate appeal of this ruling.ruling was denied. Trial has been set for January 2016.

In addition to the above described shareholder class actions, on December 8, 2011, a federal shareholder derivative action, Sutton v. Bracken, et al., putatively initiated in the name of the Company, was filed in the United States District Court for the Middle District of Tennessee against certain officers and present and former directors of the Company seeking monetary relief. The action alleges breaches of fiduciary duties by the named officers and directors in connection with the accounting and earnings claims set forth in the shareholder class actions.actions described above. Setting forth substantially similar claims against substantially the same defendants, an additional federal derivative action, Schroeder v. Bracken, et al., was filed in the United States District Court for the Middle

District of Tennessee on December 16, 2011, and a state derivative action, Bagot v. Bracken, et al., was filed in Tennessee state court in the Davidson County Circuit Court on December 20, 2011. The federal derivative actions were consolidated in the Middle District of Tennessee and stayed pending developments in the shareholder class actions. The state derivative action had also been stayed pending developments in the shareholder class actions, but that stay has expired. The plaintiff in the state derivative action subsequently filed an amended complaint on September 9, 2013 that added additional allegations made in the shareholder class actions. On September 24, 2013, an additional state derivative action, Steinberg v. Bracken, et al., was filed in Tennessee state court in the Davidson County Circuit Court. This action against our board of directors has been consolidated with the earlier filed state derivative action. The plaintiffs in the consolidated action filed a consolidated complaint on December 4, 2013. The Company has filed a motion to again stay the state derivative action pending developments in the class action, but the Courtcourt has not yet acted on that motion.

Health Midwest Litigation

In October 2009, the Health Care Foundation of Greater Kansas City, a nonprofit health foundation, filed suit against HCA Inc. in the Circuit Court of Jackson County, Missouri and alleged that HCA did not fund the level of capital expenditures and uncompensated care agreed to in connection with HCA’s purchase of hospitals from Health Midwest in 2003. The central issue in the case was whether HCA’s construction of new hospitals counted towards its $450 million five-year capital commitments. In addition, the plaintiff alleged that HCA did not make its required capital expenditures in a timely fashion. On January 24, 2013, the Courtcourt ruled in favor of the plaintiff and awarded at least $162 million. The Courtcourt also ordered a court-supervised accounting of HCA’s capital expenditures, as well as of expenditures on charity and uncompensated care during the ten years following the purchase. The Courtcourt also indicated it would award plaintiff attorneys fees, which the parties have stipulated are approximately $12 million for the trial phase. HCA recorded $175 million of legal claim costs in the fourth quarter of 2012 related to this ruling, and consistent with the judge’s order, has been accruing interest on that sum at 9% per annum. On April 25, 2014, the parties stipulated to an additional $78 million shortfall relating to the capital expenditures issue. HCA recorded $78 million of legal claims costs in the first quarter of 2014 as a result of the stipulation, and is accruing interest on that amount at 9% per annum. Pursuant to the terms of the stipulation, the parties have preserved their respective rights to contest the judge’s underlying ruling, whether through motions in the trial court or on appeal. The accounting forOn February 9, 2015, the parties reached an agreement to settle the part of their dispute relating to charity and other uncompensated care for $15 million. The foundation is ongoing.required to use that amount, net of attorneys fees, for charitable activities in the Kansas City area. The parties also agreed on an additional amount for attorneys fees for the plaintiff for the accounting phase of the case. Final judgment in the case currently is not anticipated beforefor sometime in 2015. At this time, we cannot predict what effect, if any, the final judgment could have on the Company. HCA plans to appeal the trial court’s ruling on the breach of contract claim and order for the accountingcapital expenditures issues once the trial court rules on the accounting and enters judgment.

General Liability and Other Claims

We are subject to claims for additional income taxes and related interest.

We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or for wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants have asked for punitive damages against us, which may not be covered by insurance. In the opinion of management, the ultimate resolution of these pending claims and legal proceedings will not have a material, adverse effect on our results of operations or financial position.

ITEM 1A.    RISK FACTORS

Reference is made to the factors set forth under the caption “Forward-Looking Statements” in Part I, Item 2 of this Form 10-Q and other risk factors described in our annual report on Form 10-K for the year ended December 31, 2013,2014, which are incorporated herein by reference. There have not been any material changes to the risk factors previously disclosed in our annual report on Form 10-K for the year ended December 31, 2013.2014.

ITEM 2.    UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

On February 2, 2015, our Board of Directors authorized a share repurchase program for up to $1 billion of our outstanding common stock. Repurchases made during the first quarter of 2015, as detailed below, were made pursuant to this authorization. The repurchases were made in the open market.

The following table provides certain information with respect to our repurchases of common stock from January 1, 2015 through March 31, 2015 (dollars in millions, except per share amounts).

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, 2015 through January 31, 2015

       $         $  

February 1, 2015 through February 28, 2015

   4,064,352    $69.22     4,064,352    $719  

March 1, 2015 through March 31, 2015

   1,141,042    $73.87     1,141,042    $634  
  

 

 

     

 

 

   

Total for First Quarter 2015

   5,205,394    $70.24     5,205,394    $634  
  

 

 

     

 

 

   

ITEM 5.    OTHER INFORMATION

Voting Results from 2015 Annual Meeting of Stockholders

At our Annual Meeting of Stockholders (the “Annual Meeting”) held on April 30, 2015 at our corporate headquarters in Nashville, Tennessee, a total of 378,257,449 shares of our common stock, out of a total of 419,503,619 shares of common stock outstanding and entitled to vote, were present in person or represented by proxies. The following proposals were voted on and approved by our stockholders at the Annual Meeting:

1. Election to the Company’s Board of Directors of the following 11 director nominees for a one-year term:

   For   Withheld   Broker Non-Votes 

R. Milton Johnson

   343,518,448     13,663,356     21,075,645  

Robert J. Dennis

   347,706,957     9,474,847     21,075,645  

Nancy-Ann DeParle

   353,397,085     3,784,719     21,075,645  

Thomas F. Frist III

   341,115,948     16,065,856     21,075,645  

William R. Frist

   341,425,345     15,756,459     21,075,645  

Ann H. Lamont

   346,214,318     10,967,486     21,075,645  

Jay O. Light

   347,800,213     9,381,591     21,075,645  

Geoffrey G. Meyers

   348,592,317     8,589,487     21,075,645  

Michael W. Michelson

   341,116,547     16,065,257     21,075,645  

Wayne J. Riley, M.D.

   351,600,997     5,580,807     21,075,645  

John W. Rowe, M.D.

   353,443,884     3,737,920     21,075,645  

2. Ratification of the selection of Ernst & Young LLP as the Company’s independent registered public accounting firm for the year ending December 31, 2015:

For

 

Against

 

Abstentions

 

Broker Non-Votes

368,841,829 7,242,429 2,173,191 0

3. Adoption of a non-binding advisory resolution on the Company’s executive compensation as described in the Company’s 2015 proxy statement:

For

 

Against

 

Abstentions

 

Broker Non-Votes

292,887,103 60,000,937 4,293,764 21,075,645

Board of Directors Compensation Program

On April 30, 2015, our Board of Directors approved a revised Board of Directors Compensation program, effective immediately, pursuant to which each independent director will receive quarterly payment of the following cash compensation, as applicable (prorated for partial years):

$100,000 annual retainer for service as a Board member;

$30,000 annual retainer for service as the non-management and independent presiding director;

$15,000 annual retainer for service as a member of the Audit and Compliance Committee;

$10,000 annual retainer for service as a member on each of the Compensation Committee, Nominating and Corporate Governance Committee or Patient Safety and Quality of Care Committee;

$30,000 annual retainer for service as Chair of the Audit and Compliance Committee;

$20,000 annual retainer for service as Chair of the Compensation Committee; and

$17,500 annual retainer for service as Chair of each of the Nominating and Corporate Governance Committee or Patient Safety and Quality of Care Committee.

In addition to the director compensation described above, each independent director will receive an annual board equity award with a value of $175,000, awarded upon joining the Board of Directors (prorated at the time of hire for months of service) and at each annual meeting of the stockholders thereafter. These equity grants consist of restricted share units ultimately payable in shares of our common stock. These restricted share units vest as to 100% of the award on the first anniversary of the grant date, subject to the director’s continued service on our Board of Directors. The restricted share units will also immediately vest upon the occurrence of a Change in Control (as defined in the applicable grant agreement). The directors may elect to defer receipt of shares under the restricted share units. Directors will also be reimbursed for their reasonable expenses incurred in connection with their service.

ITEM 6.    EXHIBITS

(a) List of Exhibits:

 

  10.1

HCA Holdings, Inc. 2015 Senior Officer Performance Excellence Program (filed as Exhibit 10.1 to the Company’s Current Report on Form 8-K filed April 2, 2015 and incorporated herein by reference).*

  10.2

Form 2015 PEP Restricted Share Unit Agreement (Officers) (filed as Exhibit 10.2 to the Company’s Current Report on Form 8-K filed April 2, 2015 and incorporated herein by reference).*

  10.3

Form of Director Restricted Share Unit Agreement (Annual Award) Under the 2006 Stock Incentive Plan for Key Employees of HCA Holdings, Inc. and its Affiliates, as Amended and Restated.*

  31.1    

Certification of Chief Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

  31.2    

Certification of Chief Financial Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

  32    

Certification Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.

101    

The following financial information from our quarterly report on Form 10-Q for the quarters ended March 31, 2015 and nine months ended September 30, 2014, and 2013, filed with the SEC on November 4, 2014,May 5, 2015, formatted in Extensible Business Reporting Language: (i) the condensed consolidated balance sheets at September 30, 2014March 31, 2015 and December 31, 2013,2014, (ii) the condensed consolidated income statements for the quarters ended March 31, 2015 and nine months ended September 30, 2014, and 2013, (iii) the condensed consolidated comprehensive income statements for the quarters ended March 31, 2015 and nine months ended September 30, 2014, and 2013, (iv) the condensed consolidated statements of cash flows for the nine monthsquarters ended September 30,March 31, 2015 and 2014 and 2013 and (v) the notes to condensed consolidated financial statements.

*Management compensatory plan or arrangement.

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

 

HCA Holdings, Inc.

By:

 

/s/    WILLIAM B. RUTHERFORD

 William B. Rutherford
 Executive Vice President and Chief Financial Officer

Date: November 4, 2014May 5, 2015

 

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