Document_and_Entity_Informatio
Document and Entity Information (USD $) | 12 Months Ended | ||
In Millions, except Share data, unless otherwise specified | Dec. 31, 2013 | Jan. 31, 2014 | Jun. 30, 2013 |
Document And Entity Information [Abstract] | ' | ' | ' |
Document Type | '10-K | ' | ' |
Amendment Flag | 'false | ' | ' |
Document Period End Date | 31-Dec-13 | ' | ' |
Document Fiscal Year Focus | '2013 | ' | ' |
Document Fiscal Period Focus | 'FY | ' | ' |
Entity Registrant Name | 'HCA HOLDINGS, INC. | ' | ' |
Entity Central Index Key | '0000860730 | ' | ' |
Current Fiscal Year End Date | '--12-31 | ' | ' |
Entity Well-known Seasoned Issuer | 'Yes | ' | ' |
Entity Current Reporting Status | 'Yes | ' | ' |
Entity Voluntary Filers | 'No | ' | ' |
Entity Filer Category | 'Large Accelerated Filer | ' | ' |
Entity Common Stock, Shares Outstanding | ' | 440,512,800 | ' |
Entity Public Float | ' | ' | $9,867 |
Consolidated_Income_Statements
Consolidated Income Statements (USD $) | 1 Months Ended | 3 Months Ended | 12 Months Ended | |||||||||
In Millions, except Share data in Thousands, unless otherwise specified | Mar. 31, 2013 | Dec. 31, 2013 | Sep. 30, 2013 | Jun. 30, 2013 | Mar. 31, 2013 | Dec. 31, 2012 | Sep. 30, 2012 | Jun. 30, 2012 | Mar. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Income Statement [Abstract] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues before the provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | $38,040 | $36,783 | $32,506 |
Provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3,858 | 3,770 | 2,824 |
Revenues | ' | 8,836 | 8,456 | 8,450 | 8,440 | 8,434 | 8,062 | 8,112 | 8,405 | 34,182 | 33,013 | 29,682 |
Salaries and benefits | ' | ' | ' | ' | ' | ' | ' | ' | ' | 15,646 | 15,089 | 13,440 |
Supplies | ' | ' | ' | ' | ' | ' | ' | ' | ' | 5,970 | 5,717 | 5,179 |
Other operating expenses | ' | ' | ' | ' | ' | ' | ' | ' | ' | 6,237 | 6,048 | 5,470 |
Electronic health record incentive income | ' | ' | ' | ' | ' | ' | ' | ' | ' | -216 | -336 | -210 |
Equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | -29 | -36 | -258 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,753 | 1,679 | 1,465 |
Interest expense | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,848 | 1,798 | 2,037 |
Losses (gains) on sales of facilities | ' | -2 | 1 | -3 | 11 | -6 | -5 | 1 | 1 | 10 | -15 | -142 |
Losses on retirement of debt | 17 | ' | ' | ' | 11 | ' | ' | ' | ' | 17 | ' | 481 |
Legal claim costs | ' | ' | ' | ' | ' | 110 | ' | ' | ' | ' | 175 | ' |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,522 |
Termination of management agreement | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 181 |
Total expenses including equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | 31,236 | 30,119 | 26,121 |
Income before income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,946 | 2,894 | 3,561 |
Provision for income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | 950 | 888 | 719 |
Net income | ' | 554 | 467 | 537 | 438 | 427 | 455 | 485 | 639 | 1,996 | 2,006 | 2,842 |
Net income attributable to noncontrolling interests | ' | ' | ' | ' | ' | ' | ' | ' | ' | 440 | 401 | 377 |
Net income attributable to HCA Holdings, Inc. | ' | $424 | $365 | $423 | $344 | $314 | $360 | $391 | $540 | $1,556 | $1,605 | $2,465 |
Per share data: | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Basic earnings per share | ' | $0.96 | $0.82 | $0.95 | $0.77 | $0.71 | $0.82 | $0.89 | $1.23 | $3.50 | $3.65 | $5.17 |
Diluted earnings per share | ' | $0.92 | $0.79 | $0.91 | $0.74 | $0.68 | $0.78 | $0.85 | $1.18 | $3.37 | $3.49 | $4.97 |
Shares used in earnings per share calculations (in thousands): | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Basic | ' | ' | ' | ' | ' | ' | ' | ' | ' | 445,066 | 440,178 | 476,609 |
Diluted | ' | ' | ' | ' | ' | ' | ' | ' | ' | 461,913 | 459,403 | 495,943 |
Consolidated_Comprehensive_Inc
Consolidated Comprehensive Income Statements (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Statement Of Income And Comprehensive Income [Abstract] | ' | ' | ' |
Net income | $1,996 | $2,006 | $2,842 |
Other comprehensive income (loss) before taxes: | ' | ' | ' |
Foreign currency translation | 18 | 37 | -9 |
Unrealized (losses) gains on available-for-sale securities | -7 | 6 | 2 |
Defined benefit plans | 134 | -89 | -67 |
Pension costs included in salaries and benefits | 38 | 46 | 25 |
Total defined benefit plans | 172 | -43 | -42 |
Change in fair value of derivative financial instruments | 3 | -151 | -311 |
Interest costs included in interest expense | 131 | 122 | 341 |
Total change in fair value of derivative financial instruments | 134 | -29 | 30 |
Other comprehensive income (loss) before taxes | 317 | -29 | -19 |
Income taxes (benefits) related to other comprehensive income items | 117 | -12 | -7 |
Other comprehensive income (loss) | 200 | -17 | -12 |
Comprehensive income | 2,196 | 1,989 | 2,830 |
Comprehensive income attributable to noncontrolling interests | 440 | 401 | 377 |
Comprehensive income attributable to HCA Holdings, Inc. | $1,756 | $1,588 | $2,453 |
Consolidated_Balance_Sheets
Consolidated Balance Sheets (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Millions, unless otherwise specified | ||
Current assets: | ' | ' |
Cash and cash equivalents | $414 | $705 |
Accounts receivable, less allowance for doubtful accounts of $5,488 and $4,846 | 5,208 | 4,672 |
Inventories | 1,179 | 1,086 |
Deferred income taxes | 489 | 385 |
Other | 747 | 915 |
Total current assets | 8,037 | 7,763 |
Property and equipment, at cost: | ' | ' |
Land | 1,487 | 1,429 |
Buildings | 11,211 | 10,720 |
Equipment | 17,519 | 16,430 |
Construction in progress | 856 | 948 |
Property and equipment, at cost | 31,073 | 29,527 |
Accumulated depreciation | -17,454 | -16,342 |
Property and equipment, net | 13,619 | 13,185 |
Investments of insurance subsidiaries | 448 | 515 |
Investments in and advances to affiliates | 121 | 104 |
Goodwill and other intangible assets | 5,903 | 5,539 |
Deferred loan costs | 237 | 290 |
Other | 466 | 679 |
Total assets | 28,831 | 28,075 |
Current liabilities: | ' | ' |
Accounts payable | 1,803 | 1,768 |
Accrued salaries | 1,193 | 1,120 |
Other accrued expenses | 1,913 | 1,849 |
Long-term debt due within one year | 786 | 1,435 |
Total current liabilities | 5,695 | 6,172 |
Long-term debt | 27,590 | 27,495 |
Professional liability risks | 949 | 973 |
Income taxes and other liabilities | 1,525 | 1,776 |
Stockholders' deficit: | ' | ' |
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 439,604,000 shares - 2013 and 443,200,200 shares - 2012 | 4 | 4 |
Capital in excess of par value | 1,386 | 1,753 |
Accumulated other comprehensive loss | -257 | -457 |
Retained deficit | -9,403 | -10,960 |
Stockholders' deficit attributable to HCA Holdings, Inc. | -8,270 | -9,660 |
Noncontrolling interests | 1,342 | 1,319 |
Total stockholders' deficit | -6,928 | -8,341 |
Total liabilities and stockholders' deficit | $28,831 | $28,075 |
Consolidated_Balance_Sheets_Pa
Consolidated Balance Sheets (Parenthetical) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Millions, except Share data, unless otherwise specified | ||
Statement Of Financial Position [Abstract] | ' | ' |
Allowance for Accounts receivable | $5,488 | $4,846 |
Common stock, par value | $0.01 | $0.01 |
Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 |
Common stock, shares outstanding | 439,604,000 | 443,200,200 |
Consolidated_Statements_of_Sto
Consolidated Statements of Stockholders' Deficit (USD $) | Total | Common Stock [Member] | Capital in Excess of Par Value [Member] | Accumulated Other Comprehensive Loss [Member] | Retained Deficit [Member] | Equity Attributable to Noncontrolling Interests [Member] |
In Millions, except Share data | ||||||
Balance at Dec. 31, 2010 | ($10,794) | $4 | $386 | ($428) | ($11,888) | $1,132 |
Balance, shares at Dec. 31, 2010 | ' | 427,459,000 | ' | ' | ' | ' |
Comprehensive income | 2,830 | ' | ' | -12 | 2,465 | 377 |
Issuance of common stock | 2,506 | 1 | 2,505 | ' | ' | ' |
Issuance of common stock, shares | ' | 87,719,000 | ' | ' | ' | ' |
Repurchase of common stock | -1,503 | -1 | -1,502 | ' | ' | ' |
Repurchase of common stock, shares | ' | -80,771,000 | ' | ' | ' | ' |
Share-based benefit plans | 35 | ' | 35 | ' | ' | ' |
Share-based benefit plans, shares | ' | 3,071,000 | ' | ' | ' | ' |
Distributions | -378 | ' | ' | ' | ' | -378 |
Adjustment to the acquired controlling interest in equity investment | 93 | ' | ' | ' | ' | 93 |
Reclassification of equity securities with contingent redemption rights | 141 | ' | 141 | ' | ' | ' |
Other | 56 | ' | 36 | ' | ' | 20 |
Balance at Dec. 31, 2011 | -7,014 | 4 | 1,601 | -440 | -9,423 | 1,244 |
Balance, shares at Dec. 31, 2011 | ' | 437,478,000 | ' | ' | ' | ' |
Comprehensive income | 1,989 | ' | ' | -17 | 1,605 | 401 |
Share-based benefit plans | 169 | ' | 169 | ' | ' | ' |
Share-based benefit plans, shares | ' | 5,722,000 | ' | ' | ' | ' |
Distributions | -3,543 | ' | ' | ' | -3,142 | -401 |
Adjustment to the acquired controlling interest in equity investment | 30 | ' | ' | ' | ' | 30 |
Other | 28 | ' | -17 | ' | ' | 45 |
Balance at Dec. 31, 2012 | -8,341 | 4 | 1,753 | -457 | -10,960 | 1,319 |
Balance, shares at Dec. 31, 2012 | ' | 443,200,000 | ' | ' | ' | ' |
Comprehensive income | 2,196 | ' | ' | 200 | 1,556 | 440 |
Repurchase of common stock | -500 | ' | -500 | ' | ' | ' |
Repurchase of common stock, shares | ' | -10,656,000 | ' | ' | ' | ' |
Share-based benefit plans | 139 | ' | 139 | ' | ' | ' |
Share-based benefit plans, shares | ' | 7,060,000 | ' | ' | ' | ' |
Distributions | -435 | ' | ' | ' | ' | -435 |
Other | 13 | ' | -6 | ' | 1 | 18 |
Balance at Dec. 31, 2013 | ($6,928) | $4 | $1,386 | ($257) | ($9,403) | $1,342 |
Balance, shares at Dec. 31, 2013 | ' | 439,604,000 | ' | ' | ' | ' |
Consolidated_Statements_of_Cas
Consolidated Statements of Cash Flows (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Cash flows from operating activities: | ' | ' | ' |
Net income | $1,996 | $2,006 | $2,842 |
Increase (decrease) in cash from operating assets and liabilities: | ' | ' | ' |
Accounts receivable | -4,395 | -3,896 | -3,248 |
Inventories and other assets | -19 | -122 | -18 |
Accounts payable and accrued expenses | 142 | 355 | 313 |
Provision for doubtful accounts | 3,858 | 3,770 | 2,824 |
Depreciation and amortization | 1,753 | 1,679 | 1,465 |
Income taxes | 143 | 96 | 912 |
Losses (gains) on sales of facilities | 10 | -15 | -142 |
Losses on retirement of debt | 17 | ' | 481 |
Legal claim costs | ' | 175 | ' |
Gain on acquisition of controlling interest in equity investment | ' | ' | -1,522 |
Amortization of deferred loan costs | 55 | 62 | 70 |
Share-based compensation | 113 | 56 | 26 |
Pay-in-kind interest | ' | ' | -78 |
Other | 7 | 9 | 8 |
Net cash provided by (used in) operating activities | 3,680 | 4,175 | 3,933 |
Cash flows from investing activities: | ' | ' | ' |
Purchase of property and equipment | -1,943 | -1,862 | -1,679 |
Acquisition of hospitals and health care entities | -481 | -258 | -1,682 |
Disposal of hospitals and health care entities | 33 | 30 | 281 |
Change in investments | 36 | 16 | 80 |
Other | 9 | 11 | 5 |
Net cash used in investing activities | -2,346 | -2,063 | -2,995 |
Cash flows from financing activities: | ' | ' | ' |
Issuances of long-term debt | ' | 4,850 | 5,500 |
Net change in revolving bank credit facilities | 970 | -685 | -449 |
Repayment of long-term debt | -1,662 | -2,441 | -6,640 |
Distributions to noncontrolling interests | -435 | -401 | -378 |
Payment of debt issuance costs | -5 | -62 | -92 |
Issuance of common stock | ' | ' | 2,506 |
Repurchase of common stock | -500 | ' | -1,503 |
Distributions to stockholders | -16 | -3,148 | -31 |
Income tax benefits | 113 | 174 | 63 |
Other | -90 | -67 | 48 |
Net cash (used in) provided by financing activities | -1,625 | -1,780 | -976 |
Change in cash and cash equivalents | -291 | 332 | -38 |
Cash and cash equivalents at beginning of period | 705 | 373 | 411 |
Cash and cash equivalents at end of period | 414 | 705 | 373 |
Interest payments | 1,832 | 1,723 | 1,987 |
Income tax payments (refunds), net | $694 | $618 | ($256) |
Accounting_Policies
Accounting Policies | 12 Months Ended | ||||||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||||||
Accounting Policies [Abstract] | ' | ||||||||||||||||||||||||
Accounting Policies | ' | ||||||||||||||||||||||||
NOTE 1 — ACCOUNTING POLICIES | |||||||||||||||||||||||||
Reporting Entity and Corporate Reorganization | |||||||||||||||||||||||||
On November 17, 2006, HCA Inc. was acquired by a private investor group, including affiliates of or funds sponsored by Bain Capital Partners, LLC, Kohlberg Kravis Roberts & Co., BAML Capital Partners and HCA founder, Dr. Thomas F. Frist Jr. (collectively, the “Investors”) and by members of management and certain other investors. The transaction was accounted for as a recapitalization in our financial statements, with no adjustments to the historical basis of our assets and liabilities. | |||||||||||||||||||||||||
On November 22, 2010, HCA Inc. reorganized by creating a new holding company structure (the “Corporate Reorganization”). HCA Holdings, Inc. became the parent company, and HCA Inc. became HCA Holdings, Inc.’s 100% owned direct subsidiary. As part of the Corporate Reorganization, HCA Inc.’s outstanding shares of common stock were automatically converted, on a share for share basis, into identical shares of HCA Holdings, Inc.’s common stock. As a result of the Corporate Reorganization, HCA Holdings, Inc. was deemed the successor registrant to HCA Inc. under the Securities Exchange Act of 1934. | |||||||||||||||||||||||||
During March 2011, we completed the initial public offering of 87,719,300 shares of our common stock. Upon the completion of a secondary offering in February 2013, we no longer qualify as a “controlled company” under the applicable New York Stock Exchange (“NYSE”) listing standards and were required to appoint a board of directors comprised of a majority of independent members within one year of such date. Our common stock is traded on the NYSE (symbol “HCA”). | |||||||||||||||||||||||||
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 December 31, 2013, these affiliates owned and operated 165 hospitals, 115 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 Inc. and its affiliates prior to the Corporate Reorganization and to HCA Holdings, Inc. and its affiliates after the Corporate Reorganization. The term “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 preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates. | |||||||||||||||||||||||||
The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method. | |||||||||||||||||||||||||
We have completed various acquisitions and joint venture transactions. The accounts of these entities have been included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. The majority of our expenses are “cost of revenue” items. Costs that could be classified as general and administrative include our corporate office costs, which were $287 million, $248 million and $228 million for the years ended December 31, 2013, 2012 and 2011, respectively. | |||||||||||||||||||||||||
Revenues | |||||||||||||||||||||||||
Revenues consist primarily of net patient service revenues that are recorded based upon established billing rates less allowances for contractual adjustments. 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 the Medicare and Medicaid programs), managed care health plans, 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. Contractual payment terms in managed care agreements are generally based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. 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 (based primarily on historical collection experience) related to these uninsured accounts to record net self pay revenues at the estimated amounts we expect to collect. Our revenues from third party payers and the uninsured for the years ended December 31, are summarized in the following table (dollars in millions): | |||||||||||||||||||||||||
2013 | Ratio | 2012 | Ratio | 2011 | Ratio | ||||||||||||||||||||
Medicare | $ | 7,951 | 23.3 | % | $ | 8,292 | 25.1 | % | $ | 7,653 | 25.8 | % | |||||||||||||
Managed Medicare | 3,279 | 9.6 | 2,954 | 8.9 | 2,442 | 8.2 | |||||||||||||||||||
Medicaid | 1,480 | 4.3 | 1,464 | 4.4 | 1,845 | 6.2 | |||||||||||||||||||
Managed Medicaid | 1,570 | 4.6 | 1,504 | 4.6 | 1,265 | 4.3 | |||||||||||||||||||
Managed care and other insurers | 18,654 | 54.6 | 17,998 | 54.5 | 15,703 | 52.9 | |||||||||||||||||||
International (managed care and other insurers) | 1,175 | 3.4 | 1,060 | 3.2 | 938 | 3.2 | |||||||||||||||||||
34,109 | 99.8 | 33,272 | 100.7 | 29,846 | 100.6 | ||||||||||||||||||||
Uninsured | 2,677 | 7.8 | 2,580 | 7.8 | 1,846 | 6.2 | |||||||||||||||||||
Other | 1,254 | 3.7 | 931 | 2.8 | 814 | 2.7 | |||||||||||||||||||
Revenues before provision for doubtful accounts | 38,040 | 111.3 | 36,783 | 111.3 | 32,506 | 109.5 | |||||||||||||||||||
Provision for doubtful accounts | (3,858 | ) | (11.3 | ) | (3,770 | ) | (11.3 | ) | (2,824 | ) | (9.5 | ) | |||||||||||||
Revenues | $ | 34,182 | 100 | % | $ | 33,013 | 100 | % | $ | 29,682 | 100 | % | |||||||||||||
Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. As a result, there is at least a reasonable possibility recorded estimates will change by a material amount. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement amounts and disproportionate-share funds, which resulted in net increases to revenues, related primarily to cost reports filed during the respective year were $41 million, $50 million and $40 million in 2013, 2012 and 2011, respectively. The adjustments to estimated reimbursement amounts, which resulted in net increases to revenues, related primarily to cost reports filed during previous years were $68 million, $242 million and $30 million in 2013, 2012 and 2011, respectively. The 2012 amount related to cost reports filed during previous years includes two adjustments to Medicare revenues that affected multiple annual cost report periods for the majority of our hospitals (the Rural Floor Provision Settlement increased revenues by approximately $271 million and the implementation of revised Supplemental Security Income ratios reduced revenues by approximately $75 million). Excluding the effect of these Medicare adjustments, the 2012 amount related to previous years would have been $46 million. | |||||||||||||||||||||||||
The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Patients treated at hospitals for nonelective care, who have income at or below 200% of the federal poverty level, are eligible for charity care. The federal poverty level is established by the federal government and is based on income and family size. 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. In implementing the uninsured discount policy, we first attempt to qualify uninsured patients for Medicaid, other federal or state assistance or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied. | |||||||||||||||||||||||||
To quantify the total impact of and trends related to uninsured accounts, we believe it is beneficial to view charity care, uninsured discounts and the provision for doubtful accounts in combination, rather than each separately. A summary of these amounts for the years ended December 31, follows (dollars in millions): | |||||||||||||||||||||||||
2013 | Ratio | 2012 | Ratio | 2011 | Ratio | ||||||||||||||||||||
Charity care | $ | 3,497 | 22 | % | $ | 3,093 | 22 | % | $ | 2,683 | 24 | % | |||||||||||||
Uninsured discounts | 8,210 | 53 | 6,978 | 51 | 5,707 | 51 | |||||||||||||||||||
Provision for doubtful accounts | 3,858 | 25 | 3,770 | 27 | 2,824 | 25 | |||||||||||||||||||
Total uncompensated care | $ | 15,565 | 100 | % | $ | 13,841 | 100 | % | $ | 11,214 | 100 | % | |||||||||||||
A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions): | |||||||||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||||||||
Gross patient charges | $ | 181,141 | $ | 165,614 | $ | 141,516 | |||||||||||||||||||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | 29,606 | 28,533 | 25,554 | ||||||||||||||||||||||
Cost-to-charges ratio | 16.3 | % | 17.2 | % | 18.1 | % | |||||||||||||||||||
Total uncompensated care | $ | 15,565 | $ | 13,841 | $ | 11,214 | |||||||||||||||||||
Multiply by the cost-to-charges ratio | 16.3 | % | 17.2 | % | 18.1 | % | |||||||||||||||||||
Estimated cost of total uncompensated care | $ | 2,537 | $ | 2,381 | $ | 2,030 | |||||||||||||||||||
The sum of charity care, uninsured discounts and the provision for doubtful accounts, as a percentage of the sum of revenues, charity care, uninsured discounts and the provision for doubtful accounts increased from 27.4% for 2011, to 29.5% for 2012 and to 31.3% for 2013. | |||||||||||||||||||||||||
Cash and Cash Equivalents | |||||||||||||||||||||||||
Cash and cash equivalents include highly liquid investments with a maturity of three months or less when purchased. Our insurance subsidiaries’ cash equivalent investments in excess of the amounts required to pay estimated professional liability claims during the next twelve months are not included in cash and cash equivalents as these funds are not available for general corporate purposes. Carrying values of cash and cash equivalents approximate fair value due to the short-term nature of these instruments. | |||||||||||||||||||||||||
Our cash management system provides for daily investment of available balances and the funding of outstanding checks when presented for payment. Outstanding, but unpresented, checks totaling $461 million and $437 million at December 31, 2013 and 2012, respectively, have been included in “accounts payable” in the consolidated balance sheets. Upon presentation for payment, these checks are funded through available cash balances or our credit facility. | |||||||||||||||||||||||||
Accounts Receivable | |||||||||||||||||||||||||
We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. | |||||||||||||||||||||||||
Additions to the allowance for doubtful accounts are made by means of the provision for doubtful accounts. Accounts written off as uncollectible are deducted from the allowance for doubtful accounts and subsequent recoveries are added. The amount of the provision for doubtful accounts is based upon management’s assessment of historical and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. The provision for doubtful accounts and the allowance for doubtful accounts relate to “uninsured” amounts due directly from patients (including copayment and deductible amounts from patients who have health care coverage). Accounts are written off when all reasonable internal and external collection efforts have been performed. We consider the return of an account from the secondary collection agency to be the culmination of our reasonable collection efforts and the timing basis for writing off the account balance. Writeoffs are based upon specific identification and the writeoff process requires a writeoff adjustment entry to the patient accounting system. Management relies on the results of detailed reviews of historical writeoffs and recoveries at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information to utilize in estimating the collectibility of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. At both December 31, 2013 and 2012, the allowance for doubtful accounts represented approximately 93% of the $5.927 billion and $5.228 billion, respectively, patient due accounts receivable balance. The patient due accounts receivable balance represents the estimated uninsured portion of our accounts receivable. The estimated uninsured portion of Medicaid pending and uninsured discount pending accounts is included in our patient due accounts receivable balance. Days revenues in accounts receivable were 54 days, 51 days and 52 days at December 31, 2013, 2012 and 2011, respectively. Adverse changes in general economic conditions, patient accounting service center operations, payer mix or trends in federal or state governmental health care coverage could affect our collection of accounts receivable, cash flows and results of operations. | |||||||||||||||||||||||||
Inventories | |||||||||||||||||||||||||
Inventories are stated at the lower of cost (first-in, first-out) or market. | |||||||||||||||||||||||||
Property and Equipment | |||||||||||||||||||||||||
Depreciation expense, computed using the straight-line method, was $1.733 billion in 2013, $1.673 billion in 2012 and $1.461 billion in 2011. Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four to 10 years. | |||||||||||||||||||||||||
When events, circumstances or operating results indicate the carrying values of certain long-lived assets expected to be held and used, might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar facilities and independent appraisals. | |||||||||||||||||||||||||
Long-lived assets to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers. | |||||||||||||||||||||||||
Investments of Insurance Subsidiaries | |||||||||||||||||||||||||
At December 31, 2013 and 2012, the investments of our 100% owned insurance subsidiaries were classified as “available-for-sale” as defined in Accounting Standards Codification (“ASC”) No. 320, Investments — Debt and Equity Securities and are recorded at fair value. The investment securities are held for the purpose of providing a funding source to pay liability claims covered by the insurance subsidiaries. We perform a quarterly assessment of individual investment securities to determine whether declines in market value are temporary or other-than-temporary. Our investment securities evaluation process involves multiple subjective judgments, often involves estimating the outcome of future events, and requires a significant level of professional judgment in determining whether an impairment has occurred. We evaluate, among other things, the financial position and near term prospects of the issuer, conditions in the issuer’s industry, liquidity of the investment, changes in the amount or timing of expected future cash flows from the investment, and recent downgrades of the issuer by a rating agency, to determine if, and when, a decline in the fair value of an investment below amortized cost is considered other-than-temporary. The length of time and extent to which the fair value of the investment is less than amortized cost and our ability and intent to retain the investment, to allow for any anticipated recovery of the investment’s fair value, are important components of our investment securities evaluation process. | |||||||||||||||||||||||||
Goodwill and Intangible Assets | |||||||||||||||||||||||||
Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division or market level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, we compare the fair value of the goodwill to its carrying value. If the fair value of the goodwill is less than its carrying value, an impairment loss is recognized. Fair value of goodwill is estimated based upon internal evaluations of the related long-lived assets for each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2013, 2012 and 2011. Since January 1, 2000, we have recognized total goodwill impairments of $102 million in the aggregate. None of the goodwill impairments related to evaluations of goodwill at the reporting unit level, as all recognized goodwill impairments during this period related to goodwill allocated to asset disposal groups. | |||||||||||||||||||||||||
During 2013, goodwill increased by $265 million related to acquisitions, declined by $1 million related to facility sales and declined by $13 million related to foreign currency translation and other adjustments. During 2012, goodwill increased by $288 million related to acquisitions, declined by $3 million related to facility sales and increased by $3 million related to foreign currency translation and other adjustments. | |||||||||||||||||||||||||
During 2013, identifiable intangible assets increased by $113 million and are being amortized over estimated lives ranging generally from three to 15 years. During 2012, there were no changes in identifiable intangible assets. During 2011, indefinite-lived identifiable intangible assets increased by $269 million. Indefinite-lived identifiable intangible assets are not amortized, but all identifiable intangible assets are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist. | |||||||||||||||||||||||||
Deferred Loan Costs | |||||||||||||||||||||||||
Debt issuance costs are amortized based upon the terms of the respective debt obligations. The gross carrying amount of deferred loan costs at December 31, 2013 and 2012 was $542 million and $571 million, respectively, and accumulated amortization was $305 million and $281 million, respectively. Amortization of deferred loan costs is included in interest expense and was $55 million, $62 million and $70 million for 2013, 2012 and 2011, respectively. | |||||||||||||||||||||||||
Physician Recruiting Agreements | |||||||||||||||||||||||||
In order to recruit physicians to meet the needs of our hospitals and the communities they serve, we enter into minimum revenue guarantee arrangements to assist the recruited physicians during the period they are relocating and establishing their practices. A guarantor is required to recognize, at the inception of a guarantee, a liability for the fair value of the stand-ready obligation undertaken in issuing the guarantee. We expense the total estimated guarantee liability amount at the time the physician recruiting agreement becomes effective as we are not able to justify recording a contract-based asset based upon our analysis of the related control, regulatory and legal considerations. | |||||||||||||||||||||||||
The physician recruiting liability amount of $15 million at both December 31, 2013 and 2012 represents the amount of expense recognized in excess of payments made through December 31, 2013 and 2012. At December 31, 2013 the maximum amount we could have to pay under all effective minimum revenue guarantees was $39 million. | |||||||||||||||||||||||||
Professional Liability Claims | |||||||||||||||||||||||||
Reserves for professional liability risks were $1.279 billion and $1.297 billion at December 31, 2013 and 2012, respectively. The current portion of the reserves, $331 million and $324 million at December 31, 2013 and 2012, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $314 million, $331 million and $244 million for 2013, 2012 and 2011, respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. Loss and loss expense reserves represent the estimated ultimate net cost of all reported and unreported losses incurred through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,600 individual claims and 2,700 individual claims at December 31, 2013 and 2012, respectively, and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During 2013 and 2012, $307 million and $335 million, respectively, of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates. | |||||||||||||||||||||||||
A portion of our professional liability risks is insured through a 100% owned insurance subsidiary. Subject to a $5 million per occurrence self-insured retention, our facilities are insured by our 100% owned insurance subsidiary for losses up to $50 million per occurrence. The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of $15 million per occurrence. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary. | |||||||||||||||||||||||||
The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts include $19 million and $17 million at December 31, 2013 and 2012, respectively, recorded in “other assets”, and $5 million and $32 million at December 31, 2013 and 2012, respectively, recorded in “other current assets”. | |||||||||||||||||||||||||
Financial Instruments | |||||||||||||||||||||||||
Derivative financial instruments are employed to manage risks, including interest rate and foreign currency exposures, and are not used for trading or speculative purposes. We recognize derivative instruments, such as interest rate swap agreements and foreign exchange contracts, in the consolidated balance sheets at fair value. Changes in the fair value of derivatives are recognized periodically either in earnings or in stockholders’ equity, as a component of other comprehensive income (loss), depending on whether the derivative financial instrument qualifies for hedge accounting, and if so, whether it qualifies as a fair value hedge or a cash flow hedge. Generally, changes in fair values of derivatives accounted for as fair value hedges are recorded in earnings, along with the changes in the fair value of the hedged items related to the hedged risk. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income (loss), and subsequently reclassified to earnings to offset the impact of the forecasted transactions when they occur. In the event the forecasted transaction to which a cash flow hedge relates is no longer likely, the amount in other comprehensive income (loss) is recognized in earnings and generally the derivative is terminated. Changes in the fair value of derivatives not qualifying as hedges, and for any portion of a hedge that is ineffective, are reported in earnings. | |||||||||||||||||||||||||
The net interest paid or received on interest rate swaps is recognized as interest expense. Gains and losses resulting from the early termination of interest rate swap agreements are deferred and amortized as adjustments to interest expense over the remaining term of the debt originally associated with the terminated swap. | |||||||||||||||||||||||||
Electronic Health Record Incentive Payments | |||||||||||||||||||||||||
The American Recovery and Reinvestment Act of 2009 provides for Medicare and Medicaid incentive payments for eligible hospitals and professionals that adopt and meaningfully use certified electronic health record (“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. | |||||||||||||||||||||||||
Medicaid EHR incentive calculations and related payment amounts are based upon prior period cost report information available at the time our eligible hospitals adopt, implement or demonstrate meaningful use of certified EHR technology for the applicable period, and are not subject to revision for cost report data filed for a subsequent period. Thus, incentive income recognition occurs at the point our eligible hospitals adopt, implement or demonstrate meaningful use of certified EHR technology for the applicable period, as the cost report information for the full cost report year that will determine the final calculation of the incentive payment is known at that time. | |||||||||||||||||||||||||
Medicare EHR incentive calculations and related initial payment amounts are based upon the most current filed cost report information available at the time our eligible hospitals demonstrate meaningful use of certified EHR technology for the applicable period. However, unlike Medicaid, this initial payment amount will be adjusted based upon an updated calculation using the annual cost report information for the cost report period that began during the applicable payment year. Thus, incentive income recognition occurs at the point our eligible hospitals demonstrate 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 $216 million ($183 million Medicare and $33 million Medicaid), $336 million ($252 million Medicare and $84 million Medicaid) and $210 million ($123 million Medicare and $87 million Medicaid) of electronic health record incentive income during the years ended December 31, 2013, 2012 and 2011, respectively. At December 31, 2013 and 2012, we had $78 million and $113 million, respectively, of deferred EHR incentive income, which represent initial incentive payments received for which EHR incentive income has not been recognized. | |||||||||||||||||||||||||
Noncontrolling Interests in Consolidated Entities | |||||||||||||||||||||||||
The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities. | |||||||||||||||||||||||||
Related Party Transactions — Management Agreement | |||||||||||||||||||||||||
The Investors provided management and advisory services to the Company pursuant to a management agreement among HCA Inc. and the Investors executed in connection with the Investors’ acquisition of HCA Inc. in November 2006. The management agreement was terminated pursuant to its terms upon completion of the initial public offering of our common stock during March 2011, and the Company paid the Investors a final fee of $181 million. The management agreement also provided that the Company pay a 1% fee in connection with certain financing, acquisition, divestiture and change of control transactions. The Company paid the Investors a fee of $26 million related to the initial public offering of our common stock, and this fee was recorded as a cost of the stock offering. | |||||||||||||||||||||||||
Reclassifications | |||||||||||||||||||||||||
Certain prior year amounts have been reclassified to conform to the 2013 presentation. |
ShareBased_Compensation
Share-Based Compensation | 12 Months Ended | ||||||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||||||
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | ' | ||||||||||||||||||||||||
Share-Based Compensation | ' | ||||||||||||||||||||||||
NOTE 2 — SHARE-BASED COMPENSATION | |||||||||||||||||||||||||
Stock Incentive Plan | |||||||||||||||||||||||||
The 2006 Stock Incentive Plan for Key Employees of HCA Holdings Inc. and its Affiliates, as Amended and Restated (the “Stock Incentive Plan”) is designed to promote the long term financial interests and growth of the Company by attracting and retaining management and other personnel and to motivate them to achieve long range goals and further the alignment of interests of participants with those of our stockholders through opportunities for increased stock, or stock-based, ownership in the Company. Portions of the options, stock appreciation rights (“SARs”) and restricted share units (“RSUs”) granted under the Stock Incentive Plan vest solely based upon continued employment over a specific period of time, and portions of the options, SARs and RSUs vest based both upon continued employment over a specific period of time and upon the achievement of predetermined financial targets over time. We granted 4,864,000 and 6,348,000 SARs and 4,858,800 and 4,647,400 RSUs under the Stock Incentive Plan during 2013 and 2012, respectively. At December 31, 2013, there were 25,088,200 stock options and SARs outstanding and exercisable, and there were 32,269,100 shares available for future grants under the Stock Incentive Plan. | |||||||||||||||||||||||||
Stock Option, SAR and RSU Activity | |||||||||||||||||||||||||
The fair value of each stock option and SAR award is estimated on the grant date, using valuation models and the weighted average assumptions indicated in the following table. Awards under the Stock Incentive Plan generally vest based on continued employment (“Time Stock Options and SARs” and “Time RSUs”) and based upon achievement of certain financial targets (“Performance Stock Options and SARs” and “Performance RSUs”). Each grant is valued as a single award with an expected term equal to the average expected term of the component vesting tranches. We use historical exercise behavior data and other factors to estimate the expected term of the options and SARs. The expected term of the share-based award is limited by the contractual term, and employee post-vesting termination behavior is incorporated in the historical exercise behavior data. | |||||||||||||||||||||||||
Compensation cost is recognized on the straight-line attribution method. The straight-line attribution method requires that total compensation expense recognized must at least equal the vested portion of the grant-date fair value. The expected volatility is derived using historical stock price information for our common stock and that of certain peer group companies. The risk-free interest rate is the approximate yield on United States Treasury Strips having a life equal to the expected share-based award life on the date of grant. The expected life is an estimate of the number of years a share-based award will be held before it is exercised. | |||||||||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||||||||
Risk-free interest rate | 1.2 | % | 1.18 | % | 0.89 | % | |||||||||||||||||||
Expected volatility | 45 | % | 50 | % | 41 | % | |||||||||||||||||||
Expected life, in years | 6.25 | 6.25 | 5 | ||||||||||||||||||||||
Expected dividend yield | — | — | — | ||||||||||||||||||||||
Information regarding Time Stock Options and SARs and Performance Stock Options and SARs activity during 2013, 2012 and 2011 is summarized below (share amounts in thousands): | |||||||||||||||||||||||||
Time | Performance | Total | Weighted | Weighted | Aggregate | ||||||||||||||||||||
Stock | Stock | Stock | Average | Average | Intrinsic Value | ||||||||||||||||||||
Options | Options and | Options | Exercise | Remaining | (dollars in millions) | ||||||||||||||||||||
and | SARs | and | Price | Contractual Term | |||||||||||||||||||||
SARs | SARs | ||||||||||||||||||||||||
Options outstanding, December 31, 2010 | 24,517 | 26,009 | 50,526 | $ | 8.58 | ||||||||||||||||||||
Granted | 644 | 644 | 1,288 | 23.35 | |||||||||||||||||||||
Exercised | (3,312 | ) | (1,732 | ) | (5,044 | ) | 6.31 | ||||||||||||||||||
Cancelled | (110 | ) | (348 | ) | (458 | ) | 5.88 | ||||||||||||||||||
Options outstanding, December 31, 2011 | 21,739 | 24,573 | 46,312 | 9.26 | |||||||||||||||||||||
Granted | 3,174 | 3,174 | 6,348 | 27.03 | |||||||||||||||||||||
Exercised | (5,530 | ) | (5,128 | ) | (10,658 | ) | 7.6 | ||||||||||||||||||
Cancelled | (192 | ) | (568 | ) | (760 | ) | 9.49 | ||||||||||||||||||
Options and SARs outstanding, December 31, 2012 | 19,191 | 22,051 | 41,242 | 11.56 | |||||||||||||||||||||
Granted | 2,432 | 2,432 | 4,864 | 37.49 | |||||||||||||||||||||
Exercised | (4,498 | ) | (5,843 | ) | (10,341 | ) | 8.49 | ||||||||||||||||||
Cancelled | (316 | ) | (263 | ) | (579 | ) | 25.5 | ||||||||||||||||||
Options and SARs outstanding, December 31, 2013 | 16,809 | 18,377 | 35,186 | 15.82 | 5.4 years | $ | 1,122 | ||||||||||||||||||
Options and SARs exercisable, December 31, 2013 | 11,960 | 13,527 | 25,487 | $ | 10.55 | 4.1 years | $ | 947 | |||||||||||||||||
The weighted average fair values of stock options and SARs granted during 2013, 2012 and 2011 were $16.68, $13.16 and $8.53 per share, respectively. The total intrinsic value of stock options and SARs exercised in the year ended December 31, 2013 was $334 million. As of December 31, 2013, the unrecognized compensation cost related to nonvested stock options and SARs was $104 million. | |||||||||||||||||||||||||
Information regarding Time RSUs and Performance RSUs activity during 2013, 2012 and 2011 is summarized below (share amounts in thousands): | |||||||||||||||||||||||||
Time RSUs | Performance | Total RSUs | Weighted | ||||||||||||||||||||||
RSUs | Average | ||||||||||||||||||||||||
Grant | |||||||||||||||||||||||||
Date Fair | |||||||||||||||||||||||||
Value | |||||||||||||||||||||||||
RSUs outstanding, December 31, 2010 | — | — | — | — | |||||||||||||||||||||
Granted | 80 | — | 80 | $ | 30 | ||||||||||||||||||||
Vested | — | — | — | — | |||||||||||||||||||||
Cancelled | — | — | — | — | |||||||||||||||||||||
RSUs outstanding, December 31, 2011 | 80 | — | 80 | 30 | |||||||||||||||||||||
Granted | 3,162 | 1,485 | 4,647 | 26.98 | |||||||||||||||||||||
Vested | (4 | ) | — | (4 | ) | 30 | |||||||||||||||||||
Cancelled | (164 | ) | (75 | ) | (239 | ) | 26.99 | ||||||||||||||||||
RSUs outstanding, December 31, 2012 | 3,074 | 1,410 | 4,484 | 27.03 | |||||||||||||||||||||
Granted | 3,305 | 1,554 | 4,859 | 37.43 | |||||||||||||||||||||
Vested | (831 | ) | (352 | ) | (1,183 | ) | 27.3 | ||||||||||||||||||
Cancelled | (449 | ) | (213 | ) | (662 | ) | 31.91 | ||||||||||||||||||
RSUs outstanding, December 31, 2013 | 5,099 | 2,399 | 7,498 | 33.3 | |||||||||||||||||||||
As of December 31, 2013, the unrecognized compensation cost related to RSUs was $185 million. | |||||||||||||||||||||||||
During 2012, our Board of Directors declared three distributions to the Company’s stockholders and holders of certain vested share-based awards. The distributions totaled $6.50 per share and vested share-based award (subject to limitations for certain awards), or $3.142 billion in the aggregate. Pursuant to the terms of our share-based award plans, the holders of nonvested stock options and SARs received $6.50 per share reductions to the exercise price of the applicable share-based awards (subject to certain limitations for certain share-based awards that resulted in deferred distributions for a portion of the declared distribution, which will be paid upon the vesting of the applicable share-based award). The holders of any nonvested RSUs will be paid the applicable distribution amounts upon the vesting of the applicable RSUs. There were no distributions declared during 2013 and 2011. |
Acquisitions_and_Dispositions
Acquisitions and Dispositions | 12 Months Ended | ||||
Dec. 31, 2013 | |||||
Business Combinations [Abstract] | ' | ||||
Acquisitions and Dispositions | ' | ||||
NOTE 3 — ACQUISITIONS AND DISPOSITIONS | |||||
HealthONE Acquisition | |||||
During October 2011, we completed the acquisition of the Colorado Health Foundation’s (“Foundation”) approximate 40% remaining ownership interest in the HCA-HealthONE LLC (“HealthONE”) joint venture for $1.450 billion. HealthONE’s assets included seven hospitals and 12 freestanding surgery centers in the Denver area. We accounted for our investment in HealthONE using the equity method through October 2011 with our share of their operations all recorded in the line item “Equity in earnings of affiliates” in our consolidated income statements, and we began consolidating HealthONE’s operations in our consolidated income statements beginning November 2011. | |||||
The total cost of the HealthONE acquisition has been allocated to the assets acquired and liabilities assumed based upon their respective fair values in accordance with ASC No. 805, Business Combinations. The purchase price represented a premium over the fair value of the net tangible and identifiable intangible assets acquired due to the value of the expected cash flows and HealthONE’s assembled workforce. | |||||
We identified and analyzed the acquired fixed assets, contracts, contractual commitments and legal contingencies to record the fair value of all assets acquired and liabilities assumed, resulting in goodwill of $2.261 billion being recorded as of December 31, 2011. We also recorded a gain of $1.522 billion related to this acquisition due to the remeasurement of our previous equity investment in HealthONE, based upon our acquisition of the Foundation’s ownership interest and the resulting consolidation of the entire enterprise at estimated fair value. During 2012, we recorded final adjustments to the purchase price allocation which resulted in a $30 million increase to noncontrolling interests, a $26 million reduction to property and equipment and a $56 million increase to goodwill. The amount of tax deductible goodwill is $981 million. | |||||
A summary of the final purchase price allocation, including assumed liabilities, follows (dollars in millions): | |||||
Current assets | $ | 400 | |||
Property and equipment | 1,014 | ||||
Identifiable intangible asset (trade name) | 269 | ||||
Goodwill | 2,317 | ||||
Other assets | 7 | ||||
Liabilities | 152 | ||||
Noncontrolling interests | 123 | ||||
The acquired HealthONE operating results have been included in our consolidated income statements since the acquisition date. The revenues and net income attributable to HCA Holdings, Inc. related to the acquired HealthONE operations for the period from November 1, 2011 through December 31, 2011 were $347 million and $15 million, respectively. The following unaudited pro forma combined summary of operations data gives effect to including the acquired HealthONE operating results in our operating results as if the acquisition had occurred as of January 1, 2011 (dollars in millions): | |||||
Year Ended | |||||
December 31, | |||||
2011 | |||||
Pro forma revenues | $ | 31,383 | |||
Pro forma net income attributable to HCA Holdings, Inc. | 2,507 | ||||
Pro forma adjustments to net income attributable to HCA Holdings, Inc. include adjustments to record HealthONE’s operating results on a consolidated basis and eliminate the equity method operating results, to record depreciation expense based on the estimated fair value assigned to the long-lived assets acquired, to record interest expense assuming the increase in long-term debt used to fund the acquisition had occurred as of January 1, 2011 and to record the related tax effects. This pro forma result is not necessarily indicative of the actual results of operations that would have occurred if the acquisition had occurred on January 1, 2011. | |||||
Other Acquisitions and Dispositions | |||||
During 2013, we paid $277 million and recorded goodwill and identifiable intangible assets of $183 million and $113 million, respectively, related to the acquisition of The Outsource Group, which was acquired by our Parallon affiliate and is included in the Corporate and other Group. During 2013, we also paid $146 million and recorded goodwill of $58 million related to the acquisition of three hospitals, and we paid $57 million to acquire nonhospital health care entities. During 2012, we paid $58 million and assumed liabilities of $33 million to acquire a hospital and paid $200 million to acquire other nonhospital health care entities. During 2011, we paid $136 million to acquire a hospital and $96 million to acquire other nonhospital health care entities. Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values. The purchase price paid in excess of the fair value of identifiable net assets of these acquired entities aggregated $265 million, $232 million and $68 million in 2013, 2012 and 2011, respectively. The consolidated financial statements include the accounts and operations of the acquired entities subsequent to the respective acquisition dates. The pro forma effects of these acquired entities on our results of operations for periods prior to the respective acquisition dates were not significant. | |||||
During 2013, we received proceeds of $33 million and recognized a net pretax loss of $10 million ($7 million after tax) related to the sale of a hospital facility in the American Group and other real estate investments. During 2012, we received proceeds of $30 million and recognized a net pretax gain of $15 million ($9 million after tax) related to the sales of real estate investments. During 2011, we received proceeds of $281 million and recognized a net pretax gain of $142 million ($80 million after tax) related to the sales of a hospital facility in the National Group and our investment in a hospital joint venture. |
Income_Taxes
Income Taxes | 12 Months Ended | ||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||
Income Tax Disclosure [Abstract] | ' | ||||||||||||||||
Income Taxes | ' | ||||||||||||||||
NOTE 4 — INCOME TAXES | |||||||||||||||||
The provision for income taxes consists of the following (dollars in millions): | |||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||
Current: | |||||||||||||||||
Federal | $ | 827 | $ | 604 | $ | (119 | ) | ||||||||||
State | 86 | 58 | (12 | ) | |||||||||||||
Foreign | 44 | 43 | 44 | ||||||||||||||
Deferred: | |||||||||||||||||
Federal | (53 | ) | 167 | 714 | |||||||||||||
State | 20 | (8 | ) | 71 | |||||||||||||
Foreign | 26 | 24 | 21 | ||||||||||||||
$ | 950 | $ | 888 | $ | 719 | ||||||||||||
The provision for income taxes reflects $4 million, $53 million and $100 million ($3 million, $33 million and $63 million net of tax, respectively) reductions in interest related to taxing authority examinations for the years ended December 31, 2013, 2012 and 2011, respectively. Our foreign income before income taxes was $187 million, $178 million and $173 million for the years ended December 31, 2013, 2012 and 2011, respectively. | |||||||||||||||||
A reconciliation of the federal statutory rate to the effective income tax rate follows: | |||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||
Federal statutory rate | 35 | % | 35 | % | 35 | % | |||||||||||
State income taxes, net of federal tax benefit | 2.3 | 2.2 | 2 | ||||||||||||||
Change in liability for uncertain tax positions | 0.5 | — | 1 | ||||||||||||||
Nontaxable gain on acquisition of controlling interest in equity investment | — | — | (13.8 | ) | |||||||||||||
Tax exempt interest income | (0.2 | ) | (0.2 | ) | (0.2 | ) | |||||||||||
Other items, net | 0.3 | (1.4 | ) | (1.4 | ) | ||||||||||||
Effective income tax rate on income applicable to HCA Holdings, Inc. | 37.9 | 35.6 | 22.6 | ||||||||||||||
Income attributable to noncontrolling interests from consolidated partnerships | (5.7 | ) | (4.9 | ) | (2.4 | ) | |||||||||||
Effective income tax rate on income before income taxes | 32.2 | % | 30.7 | % | 20.2 | % | |||||||||||
A summary of the items comprising the deferred tax assets and liabilities at December 31 follows (dollars in millions): | |||||||||||||||||
2013 | 2012 | ||||||||||||||||
Assets | Liabilities | Assets | Liabilities | ||||||||||||||
Depreciation and fixed asset basis differences | $ | — | $ | 229 | $ | — | $ | 292 | |||||||||
Allowances for professional liability and other risks | 365 | — | 355 | — | |||||||||||||
Accounts receivable | 423 | — | 405 | — | |||||||||||||
Compensation | 240 | — | 237 | — | |||||||||||||
Other | 638 | 698 | 744 | 595 | |||||||||||||
$ | 1,666 | $ | 927 | $ | 1,741 | $ | 887 | ||||||||||
At December 31, 2013, state net operating loss carryforwards (expiring in years 2014 through 2033) available to offset future taxable income approximated $17 million. Utilization of net operating loss carryforwards in any one year may be limited. Net deferred tax assets related to such carryforwards are not significant. | |||||||||||||||||
We expect the IRS Examination Division will begin an audit of HCA Holdings, Inc.’s 2011 federal income tax return in 2014. | |||||||||||||||||
The following table summarizes the activity related to our unrecognized tax benefits (dollars in millions): | |||||||||||||||||
2013 | 2012 | ||||||||||||||||
Balance at January 1 | $ | 425 | $ | 445 | |||||||||||||
Additions based on tax positions related to the current year | 21 | 16 | |||||||||||||||
Additions for tax positions of prior years | 25 | 92 | |||||||||||||||
Reductions for tax positions of prior years | (18 | ) | (19 | ) | |||||||||||||
Settlements | (5 | ) | (103 | ) | |||||||||||||
Lapse of applicable statutes of limitations | (3 | ) | (6 | ) | |||||||||||||
Balance at December 31 | $ | 445 | $ | 425 | |||||||||||||
During 2013, we finalized settlements with the IRS resolving all outstanding issues for HCA Inc.’s 2007, 2008 and 2009 tax years. During 2012, we finalized settlements with the IRS for our 2005 and 2006 tax years resolving all outstanding issues, including the timing of recognition of certain patient service revenues, the deductibility of certain debt retirement costs and our method for calculating the tax allowance for doubtful accounts. | |||||||||||||||||
Our liability for unrecognized tax benefits was $462 million, including accrued interest of $30 million and excluding $13 million that was recorded as reductions of the related deferred tax assets, as of December 31, 2013 ($426 million, $14 million and $13 million, respectively, as of December 31, 2012). Unrecognized tax benefits of $160 million ($125 million as of December 31, 2012) would affect the effective rate, if recognized. | |||||||||||||||||
Depending on the resolution of any IRS disputes, the completion of examinations by federal, state or international taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change. |
Earnings_Per_Share
Earnings Per Share | 12 Months Ended | ||||||||||||
Dec. 31, 2013 | |||||||||||||
Earnings Per Share [Abstract] | ' | ||||||||||||
Earnings Per Share | ' | ||||||||||||
NOTE 5 — 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, SARs and RSUs, computed using the treasury stock method. During September 2011, we repurchased 80,771,143 shares of our common stock. During November 2013, we repurchased 10,656,436 shares of our common stock. The following table sets forth the computations of basic and diluted earnings per share for the years ended December 31, 2013, 2012 and 2011 (dollars in millions, except per share amounts, and shares in thousands): | |||||||||||||
2013 | 2012 | 2011 | |||||||||||
Net income attributable to HCA Holdings, Inc | $ | 1,556 | $ | 1,605 | $ | 2,465 | |||||||
Weighted average common shares outstanding | 445,066 | 440,178 | 476,609 | ||||||||||
Effect of dilutive incremental shares | 16,847 | 19,225 | 19,334 | ||||||||||
Shares used for diluted earnings per share | 461,913 | 459,403 | 495,943 | ||||||||||
Earnings per share: | |||||||||||||
Basic earnings per share | $ | 3.5 | $ | 3.65 | $ | 5.17 | |||||||
Diluted earnings per share | $ | 3.37 | $ | 3.49 | $ | 4.97 |
Investments_of_Insurance_Subsi
Investments of Insurance Subsidiaries | 12 Months Ended | ||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||
Investments Debt And Equity Securities [Abstract] | ' | ||||||||||||||||
Investments of Insurance Subsidiaries | ' | ||||||||||||||||
NOTE 6 — INVESTMENTS OF INSURANCE SUBSIDIARIES | |||||||||||||||||
A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions): | |||||||||||||||||
2013 | |||||||||||||||||
Amortized | Unrealized | Fair | |||||||||||||||
Cost | Amounts | Value | |||||||||||||||
Gains | Losses | ||||||||||||||||
Debt securities: | |||||||||||||||||
States and municipalities | $ | 385 | $ | 11 | $ | (3 | ) | $ | 393 | ||||||||
Auction rate securities | 7 | — | — | 7 | |||||||||||||
Asset-backed securities | 12 | — | — | 12 | |||||||||||||
Money market funds | 94 | — | — | 94 | |||||||||||||
498 | 11 | (3 | ) | 506 | |||||||||||||
Equity securities | 2 | 2 | — | 4 | |||||||||||||
$ | 500 | $ | 13 | $ | (3 | ) | 510 | ||||||||||
Amounts classified as current assets | (62 | ) | |||||||||||||||
Investment carrying value | $ | 448 | |||||||||||||||
2012 | |||||||||||||||||
Amortized | Unrealized | Fair | |||||||||||||||
Cost | Amounts | Value | |||||||||||||||
Gains | Losses | ||||||||||||||||
Debt securities: | |||||||||||||||||
States and municipalities | $ | 395 | $ | 23 | $ | — | $ | 418 | |||||||||
Auction rate securities | 74 | — | (6 | ) | 68 | ||||||||||||
Asset-backed securities | 14 | — | — | 14 | |||||||||||||
Money market funds | 67 | — | — | 67 | |||||||||||||
550 | 23 | (6 | ) | 567 | |||||||||||||
Equity securities | 2 | 1 | — | 3 | |||||||||||||
$ | 552 | $ | 24 | $ | (6 | ) | 570 | ||||||||||
Amounts classified as current assets | (55 | ) | |||||||||||||||
Investment carrying value | $ | 515 | |||||||||||||||
At December 31, 2013 and 2012, 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). At December 31, 2013 and 2012, $1 million and $9 million, respectively, of our investments were subject to the restrictions included in insurance bond collateralization and assumed reinsurance contracts. | |||||||||||||||||
Scheduled maturities of investments in debt securities at December 31, 2013 were as follows (dollars in millions): | |||||||||||||||||
Amortized | Fair | ||||||||||||||||
Cost | Value | ||||||||||||||||
Due in one year or less | $ | 110 | $ | 110 | |||||||||||||
Due after one year through five years | 180 | 186 | |||||||||||||||
Due after five years through ten years | 100 | 102 | |||||||||||||||
Due after ten years | 89 | 89 | |||||||||||||||
479 | 487 | ||||||||||||||||
Auction rate securities | 7 | 7 | |||||||||||||||
Asset-backed securities | 12 | 12 | |||||||||||||||
$ | 498 | $ | 506 | ||||||||||||||
The average expected maturity of the investments in debt securities at December 31, 2013 was 3.8 years, compared to the average scheduled maturity of 5.4 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. |
Financial_Instruments
Financial Instruments | 12 Months Ended | ||||||||||||
Dec. 31, 2013 | |||||||||||||
Derivative Instruments And Hedging Activities Disclosure [Abstract] | ' | ||||||||||||
Financial Instruments | ' | ||||||||||||
NOTE 7 — 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 December 31, 2013 (dollars in millions): | |||||||||||||
Notional | Maturity Date | Fair | |||||||||||
Amount | Value | ||||||||||||
Pay-fixed interest rate swaps | $ | 500 | December 2014 | $ | (5 | ) | |||||||
Pay-fixed interest rate swaps | 3,000 | December 2016 | (248 | ) | |||||||||
Pay-fixed interest rate swaps | 1,000 | December 2017 | (42 | ) | |||||||||
During the next 12 months, we estimate $127 million will be reclassified from other comprehensive income (“OCI”) to interest expense. | |||||||||||||
Cross Currency Swaps | |||||||||||||
The Company and certain subsidiaries have incurred obligations and entered into various intercompany transactions where such obligations are denominated in currencies, other than the functional currencies of the parties executing the trade. In order to mitigate the currency exposure risks and better match the cash flows of our obligations and intercompany transactions with cash flows from operations, we enter into various cross currency swaps. At December 31, 2013, we are not party to any cross currency swaps. | |||||||||||||
Derivatives — Results of Operations | |||||||||||||
The following tables present the effect of our interest rate and cross currency swaps on our results of operations for the year ended December 31, 2013 (dollars in millions): | |||||||||||||
Derivatives in Cash Flow Hedging Relationships | Amount of Gain | Location of Loss | Amount of Loss | ||||||||||
Recognized in OCI on | Reclassified from | Reclassified from | |||||||||||
Derivatives, Net of Tax | Accumulated OCI | Accumulated OCI | |||||||||||
into Operations | into Operations | ||||||||||||
Interest rate swaps | $ | 2 | Interest expense | $ | 131 | ||||||||
Derivatives Not Designated as Hedging Instruments | Location of Gain | Amount of Gain | |||||||||||
Recognized in | Recognized in | ||||||||||||
Operations on | Operations on | ||||||||||||
Derivatives | Derivatives | ||||||||||||
Cross currency swap (matured November 2013) | Other operating expenses | $ | 13 | ||||||||||
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 December 31, 2013, we have not been required to post any collateral related to these agreements. If we had breached these provisions at December 31, 2013, we would have been required to settle our obligations under the agreements at their aggregate, estimated termination value of $308 million. |
Assets_and_Liabilities_Measure
Assets and Liabilities Measured at Fair Value | 12 Months Ended | ||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||
Fair Value Disclosures [Abstract] | ' | ||||||||||||||||
Assets and Liabilities Measured at Fair Value | ' | ||||||||||||||||
NOTE 8 — 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 utilizes 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 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 and cross currency swap agreements to manage our exposure to fluctuations in interest rates and foreign currency risks. 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, foreign exchange rates and implied volatilities. To comply with the provisions of ASC 820, 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 December 31, 2013 and 2012, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives. | |||||||||||||||||
The following table summarizes our assets and liabilities measured at fair value on a recurring basis as of December 31, 2013 and 2012, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): | |||||||||||||||||
December 31, 2013 | |||||||||||||||||
Fair Value | Fair Value Measurements Using | ||||||||||||||||
Quoted Prices in | Significant Other | Significant | |||||||||||||||
Active Markets for | Observable Inputs | Unobservable Inputs | |||||||||||||||
Identical Assets | (Level 2) | (Level 3) | |||||||||||||||
and Liabilities | |||||||||||||||||
(Level 1) | |||||||||||||||||
Assets: | |||||||||||||||||
Investments of insurance subsidiaries: | |||||||||||||||||
Debt securities: | |||||||||||||||||
States and municipalities | $ | 393 | $ | — | $ | 393 | $ | — | |||||||||
Auction rate securities | 7 | — | — | 7 | |||||||||||||
Asset-backed securities | 12 | — | 12 | — | |||||||||||||
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 | $ | — | |||||||||
December 31, 2012 | |||||||||||||||||
Fair Value Measurements Using | |||||||||||||||||
Fair Value | Quoted Prices in | Significant Other | Significant | ||||||||||||||
Active Markets for | Observable Inputs | Unobservable Inputs | |||||||||||||||
Identical Assets | (Level 2) | (Level 3) | |||||||||||||||
and Liabilities | |||||||||||||||||
(Level 1) | |||||||||||||||||
Assets: | |||||||||||||||||
Investments of insurance subsidiaries: | |||||||||||||||||
Debt securities: | |||||||||||||||||
States and municipalities | $ | 418 | $ | — | $ | 418 | $ | — | |||||||||
Auction rate securities | 68 | — | — | 68 | |||||||||||||
Asset-backed securities | 14 | — | 14 | — | |||||||||||||
Money market funds | 67 | 67 | — | — | |||||||||||||
567 | 67 | 432 | 68 | ||||||||||||||
Equity securities | 3 | 1 | — | 2 | |||||||||||||
Investments of insurance subsidiaries | 570 | 68 | 432 | 70 | |||||||||||||
Less amounts classified as current assets | (55 | ) | (55 | ) | — | — | |||||||||||
$ | 515 | $ | 13 | $ | 432 | $ | 70 | ||||||||||
Liabilities: | |||||||||||||||||
Cross currency swap (Income taxes and other liabilities) | $ | 13 | $ | — | $ | 13 | $ | — | |||||||||
Interest rate swaps (Income taxes and other liabilities) | 429 | — | 429 | — | |||||||||||||
The following table summarizes the activity related to the auction rate and equity securities investments of our insurance subsidiaries which have fair value measurements based on significant unobservable inputs (Level 3) during the year ended December 31, 2013 (dollars in millions): | |||||||||||||||||
Asset balances at December 31, 2012 | $ | 70 | |||||||||||||||
Unrealized gains included in other comprehensive income | 6 | ||||||||||||||||
Settlements | (68 | ) | |||||||||||||||
Asset balances at December 31, 2013 | $ | 8 | |||||||||||||||
The estimated fair value of our long-term debt was $29.603 billion and $30.781 billion at December 31, 2013 and 2012, respectively, compared to carrying amounts aggregating $28.376 billion and $28.930 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. |
LongTerm_Debt
Long-Term Debt | 12 Months Ended | ||||||||
Dec. 31, 2013 | |||||||||
Debt Disclosure [Abstract] | ' | ||||||||
Long-Term Debt | ' | ||||||||
NOTE 9 — LONG-TERM DEBT | |||||||||
A summary of long-term debt at December 31, including related interest rates at December 31, 2013, follows (dollars in millions): | |||||||||
2013 | 2012 | ||||||||
Senior secured asset-based revolving credit facility (effective interest rate of 1.7%) | $ | 2,440 | $ | 1,470 | |||||
Senior secured revolving credit facility | — | — | |||||||
Senior secured term loan facilities (effective interest rate of 5.3%) | 5,598 | 5,958 | |||||||
Senior secured first lien notes (effective interest rate of 7.1%) | 9,695 | 9,688 | |||||||
Other senior secured debt (effective interest rate of 6.8%) | 448 | 423 | |||||||
First lien debt | 18,181 | 17,539 | |||||||
Senior secured second lien notes | — | 197 | |||||||
Senior unsecured notes (effective interest rate of 7.2%) | 10,195 | 11,194 | |||||||
Total debt (average life of 6.3 years, rates averaging 6.3%) | 28,376 | 28,930 | |||||||
Less amounts due within one year | 786 | 1,435 | |||||||
$ | 27,590 | $ | 27,495 | ||||||
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, at a redemption price of 104.938% of the principal amount. The pretax loss on retirement of debt related to this redemption was $17 million. | |||||||||
During November 2013, our $329 million senior secured European term loan facility matured. | |||||||||
2012 Activity | |||||||||
During February 2012, we issued $1.350 billion aggregate principal amount of 5.875% senior secured first lien notes due 2022. After the payment of related fees and expenses, we used the proceeds for general corporate purposes. | |||||||||
During October 2012, we replaced our $2.000 billion senior secured revolving credit facility maturing on November 17, 2015, with a new facility on substantially the same terms other than foregoing a scheduled increase in interest rates and extending the maturity date to November 17, 2016. | |||||||||
During October 2012, we issued $2.500 billion aggregate principal amount of notes, comprised of $1.250 billion of 4.75% senior secured first lien notes due 2023 and $1.250 billion of 5.875% senior unsecured notes due 2023. After the payment of related fees and expenses, we used the proceeds for general corporate purposes. | |||||||||
During December 2012, we issued $1.000 billion aggregate principal amount of 6.25% senior unsecured notes due 2021. After the payment of related fees and expenses, we used the proceeds to pay a distribution to our stockholders and holders of certain vested stock awards. | |||||||||
Senior Secured Credit Facilities And Other First Lien Debt | |||||||||
We have entered into the following senior secured credit facilities: (i) a $2.500 billion asset-based revolving credit facility maturing on September 30, 2016 with a borrowing base of 85% of eligible accounts receivable, subject to customary reserves and eligibility criteria ($2.440 billion outstanding at December 31, 2013) (the “ABL credit facility”); (ii) a $2.000 billion senior secured revolving credit facility maturing on November 17, 2016 (none outstanding at December 31, 2013 without giving effect to certain outstanding letters of credit); (iii) a $512 million senior secured term loan A-2 facility maturing on May 2, 2016; (iv) a $724 million senior secured term loan A-4 facility maturing on February 2, 2016; (v) a $2.367 billion senior secured term loan B-4 facility maturing on May 1, 2018; and (vi) a $1.995 billion senior secured term loan B-5 facility maturing on March 31, 2017. We refer to the facilities described under (ii) through (vi) above, collectively, as the “cash flow credit facility” and, together with the ABL credit facility, the “senior secured credit facilities.” | |||||||||
Borrowings under the senior secured credit facilities bear interest at a rate equal to, at our option, either (a) a base rate determined by reference to the higher of (1) the federal funds rate plus 0.50% or (2) the prime rate of Bank of America or (b) a LIBOR rate for the currency of such borrowing for the relevant interest period, plus, in each case, an applicable margin. The applicable margin for borrowings under the senior secured credit facilities may be reduced subject to attaining certain leverage ratios. | |||||||||
The senior secured credit facilities contain a number of covenants that restrict, subject to certain exceptions, our (and some or all of our subsidiaries’) ability to incur additional indebtedness, repay subordinated indebtedness, create liens on assets, sell assets, make investments, loans or advances, engage in certain transactions with affiliates, pay dividends and distributions, and enter into sale and leaseback transactions. In addition, we are required to satisfy and maintain a maximum total leverage ratio covenant under the cash flow credit facility and, in certain situations under the ABL credit facility, a minimum interest coverage ratio covenant. | |||||||||
Senior secured first lien notes consist of (i) $1.500 billion aggregate principal amount of 8 1/2% senior secured first lien notes due 2019; (ii) $1.250 billion aggregate principal amount of 7 7/8% senior secured first lien notes due 2020; (iii) $1.400 billion aggregate principal amount of 7 1/4% senior secured first lien notes due 2020; (iv) $3.000 billion aggregate principal amount of 6.50% senior secured first lien notes due 2020; (v) $1.350 billion aggregate principal amount of 5.875% first lien notes due 2022; (vi) $1.250 billion aggregate principal amount of 4.75% first lien notes due 2023; and (vii) $55 million of unamortized debt discounts that reduce the senior secured first lien indebtedness. Capital leases and other secured debt totaled $448 million at December 31, 2013. | |||||||||
We use interest rate swap agreements to manage the variable rate exposure of our debt portfolio. At December 31, 2013, we had entered into effective interest rate swap agreements, in a total notional amount of $4.500 billion, in order to hedge a portion of our exposure to variable rate interest payments associated with the senior secured credit facilities. The effect of the interest rate swaps is reflected in the effective interest rates for the senior secured credit facilities. | |||||||||
Senior Unsecured Notes | |||||||||
Senior unsecured notes consist of (i) $6.541 billion aggregate principal amount of senior notes with maturities ranging from 2014 to 2033; (ii) an aggregate principal amount of $246 million medium-term notes with maturities ranging from 2014 to 2025; (iii) an aggregate principal amount of $886 million debentures with maturities ranging from 2015 to 2095; (iv) an aggregate principal amount of $1.525 billion senior notes due 2021 issued by HCA Holdings, Inc.; (v) an aggregate principal amount of $1.000 billion senior notes due 2021 issued by HCA Holdings, Inc.; and (vi) $3 million of unamortized debt discounts that reduce the indebtedness. | |||||||||
General Debt Information | |||||||||
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 (the “1993 Indenture”) dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our ABL credit facility). | |||||||||
All obligations under the ABL credit facility, and the guarantees of those obligations, are secured, subject to permitted liens and other exceptions, by a first-priority lien on substantially all of the receivables of the borrowers and each guarantor under such ABL credit facility (the “Receivables Collateral”). | |||||||||
All obligations under the cash flow credit facility and the guarantees of such obligations are secured, subject to permitted liens and other exceptions, by: | |||||||||
• | a first-priority lien on the capital stock owned by HCA Inc., or by any U.S. guarantor, in each of their respective first-tier subsidiaries; | ||||||||
• | a first-priority lien on substantially all present and future assets of HCA Inc. and of each U.S. guarantor other than (i) “Principal Properties” (as defined in the 1993 Indenture), (ii) certain other real properties and (iii) deposit accounts, other bank or securities accounts, cash, leaseholds, motor-vehicles and certain other exceptions; and | ||||||||
• | a second-priority lien on certain of the Receivables Collateral. | ||||||||
Our senior secured first lien notes and the related guarantees are secured by first-priority liens, subject to permitted liens, on our and our subsidiary guarantors’ assets, subject to certain exceptions, that secure our cash flow credit facility on a first-priority basis and are secured by second-priority liens, subject to permitted liens, on our and our subsidiary guarantors’ assets that secure our ABL credit facility on a first-priority basis and our other cash flow credit facility on a second-priority basis. | |||||||||
Maturities of long-term debt in years 2015 through 2018, excluding amounts under the ABL credit facility, are $1.065 million, $2.282 billion, $2.028 billion and $2.803 billion, respectively. |
Contingencies_and_Legal_Claim_
Contingencies and Legal Claim Costs | 12 Months Ended |
Dec. 31, 2013 | |
Commitments And Contingencies Disclosure [Abstract] | ' |
Contingencies and Legal Claim Costs | ' |
NOTE 10 — 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. 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 bring qui 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 cooperating with the government’s request and has produced medical records associated with particular reviews at eight hospitals, located primarily in Florida. At this time, we cannot predict what effect, if any, the request or any resulting claims, including any potential claims under the federal FCA, other statutes, regulations or laws, could have on the Company. | |
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 Holdings 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 Court granted the motion in part on May 28, 2013. The action is proceeding to discovery on the remaining claims. | |
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. 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 Court 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 Court ruled in favor of the plaintiff and awarded at least $162 million. The Court 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. Should the accounting fail to satisfy the Court concerning HCA’s compliance with its capital and charity care commitments, the amount of the judgment award could substantially increase. The Court also indicated it would award plaintiff attorneys fees, which the parties have stipulated are about $12 million. HCA recorded $175 million of legal claim costs in the fourth quarter of 2012 related to this ruling. The accounting for HCA’s capital expenditures and charity and uncompensated care is ongoing and will likely not be concluded before the fourth quarter of 2014. HCA plans to appeal the trial court’s ruling on the breach of contract claim and order for the accounting once the trial court rules on the accounting and enters final judgment. |
Leases
Leases | 12 Months Ended | ||||
Dec. 31, 2013 | |||||
Leases [Abstract] | ' | ||||
Leases | ' | ||||
NOTE 11 — LEASES | |||||
We lease medical office buildings and certain equipment under operating lease agreements. Commitments relating to noncancellable operating leases for each of the next five years and thereafter are as follows (dollars in millions): | |||||
For the Year Ended December 31, | |||||
2014 | $ | 293 | |||
2015 | 267 | ||||
2016 | 215 | ||||
2017 | 175 | ||||
2018 | 132 | ||||
Thereafter | 740 | ||||
1,822 | |||||
Less sublease income | (30 | ) | |||
$ | 1,792 | ||||
Capital_Stock
Capital Stock | 12 Months Ended |
Dec. 31, 2013 | |
Equity [Abstract] | ' |
Capital Stock | ' |
NOTE 12 — CAPITAL STOCK | |
The amended and restated certificate of incorporation authorizes the Company to issue up to 1,800,000,000 shares of common stock, and our amended and restated by-laws set the number of directors constituting the board of directors of the Company at not less than three members, the exact number to be determined from time to time by resolution adopted by the affirmative vote of a majority of the total number of directors then in office. | |
During March 2011, we completed the initial public offering of 87,719,300 shares of our common stock at a price of $30.00 per share and realized net proceeds (after costs of the offering) of $2.506 billion. During September 2011, we repurchased 80,771,143 shares of our common stock beneficially owned by affiliates of Bank of America Corporation at a purchase price of $18.61 per share, the closing price of the Company’s common stock on the New York Stock Exchange on September 14, 2011. The shares repurchased represented approximately 15.6% of our total shares outstanding at the time of the repurchase. During November 2013, we repurchased 10,656,436 shares of our common stock at a price of $46.92 per share. | |
Distributions | |
During 2012, our Board of Directors declared three distributions to the Company’s stockholders and holders of certain vested share-based awards. The distributions totaled $6.50 per share and vested share-based award (subject to limitations for certain awards), or $3.142 billion in the aggregate. Pursuant to the terms of our share-based award plans, the holders of nonvested stock options and SARs received $6.50 per share reductions to the exercise price of the applicable share-based awards (subject to certain limitations for certain share-based awards that resulted in deferred distributions for a portion of the declared distribution, which will be paid upon the vesting of the applicable share-based award). The holders of nonvested RSUs will be paid the applicable distribution amounts upon the vesting of the applicable RSUs. There were no distributions declared during 2013 and 2011. |
Employee_Benefit_Plans
Employee Benefit Plans | 12 Months Ended |
Dec. 31, 2013 | |
Compensation And Retirement Disclosure [Abstract] | ' |
Employee Benefit Plans | ' |
NOTE 13 — EMPLOYEE BENEFIT PLANS | |
We maintain contributory, defined contribution benefit plans that are available to employees who meet certain minimum requirements. Certain of the plans require that we match specified percentages of participant contributions up to certain maximum levels (generally, 100% of the first 3% to 9%, depending upon years of vesting service, of compensation deferred by participants). The cost of these plans totaled $374 million for 2013, $371 million for 2012 and $322 million for 2011. Our contributions are funded periodically during each year. | |
We maintain the noncontributory, nonqualified Restoration Plan to provide certain retirement benefits for eligible employees. Eligibility for the Restoration Plan is based upon earning eligible compensation in excess of the Social Security Wage Base and attaining 1,000 or more hours of service during the plan year. Company credits to participants’ account balances (the Restoration Plan is not funded) depend upon participants’ compensation, years of vesting service and certain IRS limitations related to the HCA 401(k) plan. Benefits expense under this plan was $29 million for 2013, $20 million for 2012 and $25 million for 2011. Accrued benefits liabilities under this plan totaled $137 million at December 31, 2013 and $120 million at December 31, 2012. | |
We maintain a Supplemental Executive Retirement Plan (“SERP”) for certain executives. The plan is designed to ensure that upon retirement the participant receives the value of a prescribed life annuity from the combination of the SERP and our other benefit plans. Benefits expense under the plan was $43 million for 2013, $51 million for 2012 and $33 million for 2011. Accrued benefits liabilities under this plan totaled $214 million at December 31, 2013 and $242 million at December 31, 2012. | |
We maintain defined benefit pension plans which resulted from certain hospital acquisitions in prior years. Benefits expense under these plans was $37 million for 2013, $49 million for 2012, and $39 million for 2011. Accrued benefits liabilities under these plans totaled $81 million at December 31, 2013 and $196 million at December 31, 2012. |
Segment_and_Geographic_Informa
Segment and Geographic Information | 12 Months Ended | ||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||
Segment Reporting [Abstract] | ' | ||||||||||||||||
Segment and Geographic Information | ' | ||||||||||||||||
NOTE 14 — SEGMENT AND GEOGRAPHIC INFORMATION | |||||||||||||||||
We operate in one line of business, which is operating hospitals and related health care entities. Effective January 1, 2013, we reorganized our operational groups into two geographically organized groups: the National and American Groups. The acquired HealthONE operating results have been included in the American Group operating results for periods subsequent to November 1, 2011. Prior to November 1, 2011, the American Group recorded its share of the HealthONE operating results in equity in earnings of affiliates. | |||||||||||||||||
At December 31, 2013, the National Group included 82 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, South Carolina, Utah and Virginia, and the American Group included 77 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and Texas. We also operate six hospitals in England, and these facilities are included in the Corporate and other group. | |||||||||||||||||
Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses (gains) on sales of facilities, losses on retirement of debt, legal claim costs, gain on acquisition of controlling interest in equity investment, termination of management agreement, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions): | |||||||||||||||||
For the Years Ended December 31, | |||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||
Revenues: | |||||||||||||||||
National Group | $ | 15,968 | $ | 15,505 | $ | 14,741 | |||||||||||
American Group | 16,487 | 16,115 | 13,714 | ||||||||||||||
Corporate and other | 1,727 | 1,393 | 1,227 | ||||||||||||||
$ | 34,182 | $ | 33,013 | $ | 29,682 | ||||||||||||
Equity in earnings of affiliates: | |||||||||||||||||
National Group | $ | (9 | ) | $ | (9 | ) | $ | (7 | ) | ||||||||
American Group | (24 | ) | (28 | ) | (251 | ) | |||||||||||
Corporate and other | 4 | 1 | — | ||||||||||||||
$ | (29 | ) | $ | (36 | ) | $ | (258 | ) | |||||||||
Adjusted segment EBITDA: | |||||||||||||||||
National Group | $ | 3,301 | $ | 3,325 | $ | 3,052 | |||||||||||
American Group | 3,662 | 3,575 | 3,141 | ||||||||||||||
Corporate and other | (389 | ) | (369 | ) | (132 | ) | |||||||||||
$ | 6,574 | $ | 6,531 | $ | 6,061 | ||||||||||||
Depreciation and amortization: | |||||||||||||||||
National Group | $ | 718 | $ | 694 | $ | 639 | |||||||||||
American Group | 835 | 816 | 680 | ||||||||||||||
Corporate and other | 200 | 169 | 146 | ||||||||||||||
$ | 1,753 | $ | 1,679 | $ | 1,465 | ||||||||||||
For the Years Ended December 31, | |||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||
Adjusted segment EBITDA | $ | 6,574 | $ | 6,531 | $ | 6,061 | |||||||||||
Depreciation and amortization | 1,753 | 1,679 | 1,465 | ||||||||||||||
Interest expense | 1,848 | 1,798 | 2,037 | ||||||||||||||
Losses (gains) on sales of facilities | 10 | (15 | ) | (142 | ) | ||||||||||||
Losses on retirement of debt | 17 | — | 481 | ||||||||||||||
Legal claim costs | — | 175 | — | ||||||||||||||
Gain on acquisition of controlling interest in equity investment | — | — | (1,522 | ) | |||||||||||||
Termination of management agreement | — | — | 181 | ||||||||||||||
Income before income taxes | $ | 2,946 | $ | 2,894 | $ | 3,561 | |||||||||||
As of December 31, | |||||||||||||||||
2013 | 2012 | ||||||||||||||||
Assets: | |||||||||||||||||
National Group | $ | 10,206 | $ | 9,451 | |||||||||||||
American Group | 13,911 | 13,744 | |||||||||||||||
Corporate and other | 4,714 | 4,880 | |||||||||||||||
$ | 28,831 | $ | 28,075 | ||||||||||||||
National | American | Corporate | Total | ||||||||||||||
Group | Group | and Other | |||||||||||||||
Goodwill and other intangible assets: | |||||||||||||||||
Balance at December 31, 2012 | $ | 1,035 | $ | 4,189 | $ | 315 | $ | 5,539 | |||||||||
Acquisitions | 68 | 13 | 297 | 378 | |||||||||||||
Dispositions | — | (1 | ) | — | (1 | ) | |||||||||||
Foreign currency translation and other | 1 | (11 | ) | (3 | ) | (13 | ) | ||||||||||
Balance at December 31, 2013 | $ | 1,104 | $ | 4,190 | $ | 609 | $ | 5,903 | |||||||||
Other_Comprehensive_Loss
Other Comprehensive Loss | 12 Months Ended | ||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||
Equity [Abstract] | ' | ||||||||||||||||||||
Other Comprehensive Loss | ' | ||||||||||||||||||||
NOTE 15 — OTHER COMPREHENSIVE LOSS | |||||||||||||||||||||
The components of accumulated other comprehensive loss are as follows (dollars in millions): | |||||||||||||||||||||
Unrealized | Foreign | Defined | Change | Total | |||||||||||||||||
Gains on | Currency | Benefit | in Fair | ||||||||||||||||||
Available- | Translation | Plans | Value of | ||||||||||||||||||
for-Sale | Adjustments | Derivative | |||||||||||||||||||
Securities | Instruments | ||||||||||||||||||||
Balances at December 31, 2010 | $ | 6 | $ | (19 | ) | $ | (143 | ) | $ | (272 | ) | $ | (428 | ) | |||||||
Unrealized gains on available-for-sale securities, net of $1 of income taxes | 1 | — | — | — | 1 | ||||||||||||||||
Foreign currency translation adjustments, net of $3 income tax benefit | — | (6 | ) | — | — | (6 | ) | ||||||||||||||
Defined benefit plans, net of $25 income tax benefit | — | — | (42 | ) | — | (42 | ) | ||||||||||||||
Change in fair value of derivative instruments, net of $114 income tax benefit | — | — | — | (197 | ) | (197 | ) | ||||||||||||||
Expense reclassified into operations from other comprehensive income, net of $9 and $125, respectively, income tax benefits | — | — | 16 | 216 | 232 | ||||||||||||||||
Balances at December 31, 2011 | 7 | (25 | ) | (169 | ) | (253 | ) | (440 | ) | ||||||||||||
Unrealized gains on available-for-sale securities, net of $2 of income taxes | 4 | — | — | — | 4 | ||||||||||||||||
Foreign currency translation adjustments, net of $13 of income taxes | — | 24 | — | — | 24 | ||||||||||||||||
Defined benefit plans, net of $33 income tax benefit | — | — | (56 | ) | — | (56 | ) | ||||||||||||||
Change in fair value of derivative instruments, net of $55 income tax benefit | — | — | — | (96 | ) | (96 | ) | ||||||||||||||
Expense reclassified into operations from other comprehensive income, net of $17 and $44, respectively, income tax benefits | — | — | 29 | 78 | 107 | ||||||||||||||||
Balances at December 31, 2012 | 11 | (1 | ) | (196 | ) | (271 | ) | (457 | ) | ||||||||||||
Unrealized losses on available-for-sale securities, net of $3 income tax benefit | (4 | ) | — | — | — | (4 | ) | ||||||||||||||
Foreign currency translation adjustments, net of $6 of income taxes | — | 12 | — | — | 12 | ||||||||||||||||
Defined benefit plans, net of $50 of income taxes | — | — | 84 | — | 84 | ||||||||||||||||
Change in fair value of derivative instruments, net of $1 of income taxes | — | — | — | 2 | 2 | ||||||||||||||||
Expense reclassified into operations from other comprehensive income, net of $14 and $49, respectively, income tax benefits | — | — | 24 | 82 | 106 | ||||||||||||||||
Balances at December 31, 2013 | $ | 7 | $ | 11 | $ | (88 | ) | $ | (187 | ) | $ | (257 | ) | ||||||||
Accrued_Expenses_and_Allowance
Accrued Expenses and Allowance for Doubtful Accounts | 12 Months Ended | ||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||
Text Block [Abstract] | ' | ||||||||||||||||
Accrued Expenses and Allowance for Doubtful Accounts | ' | ||||||||||||||||
NOTE 16 — ACCRUED EXPENSES AND ALLOWANCE FOR DOUBTFUL ACCOUNTS | |||||||||||||||||
A summary of other accrued expenses at December 31 follows (dollars in millions): | |||||||||||||||||
2013 | 2012 | ||||||||||||||||
Professional liability risks | $ | 331 | $ | 324 | |||||||||||||
Interest | 392 | 409 | |||||||||||||||
Taxes other than income | 252 | 235 | |||||||||||||||
Legal claim costs | 189 | 175 | |||||||||||||||
Other | 749 | 706 | |||||||||||||||
$ | 1,913 | $ | 1,849 | ||||||||||||||
A summary of activity for the allowance of doubtful accounts follows (dollars in millions): | |||||||||||||||||
Balance | Provision | Accounts | Balance | ||||||||||||||
at | for | Written | at End | ||||||||||||||
Beginning | Doubtful | off, | of Year | ||||||||||||||
of Year | Accounts | Net of | |||||||||||||||
Recoveries | |||||||||||||||||
Allowance for doubtful accounts: | |||||||||||||||||
Year ended December 31, 2011 | $ | 3,939 | $ | 2,824 | $ | (2,657 | ) | $ | 4,106 | ||||||||
Year ended December 31, 2012 | 4,106 | 3,770 | (3,030 | ) | 4,846 | ||||||||||||
Year ended December 31, 2013 | 4,846 | 3,858 | (3,216 | ) | 5,488 |
Supplemental_Condensed_Consoli
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information | 12 Months Ended | ||||||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||||||
Text Block [Abstract] | ' | ||||||||||||||||||||||||
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information | ' | ||||||||||||||||||||||||
NOTE 17 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION AND OTHER COLLATERAL-RELATED INFORMATION | |||||||||||||||||||||||||
On November 22, 2010, HCA Inc. reorganized by creating a new holding company structure. HCA Holdings, Inc. became the parent company, and HCA Inc. became HCA Holdings, Inc.’s 100% owned direct subsidiary. 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. | |||||||||||||||||||||||||
The senior secured credit facilities and senior secured notes described in Note 9 are jointly and severally, and 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 ABL credit facility). | |||||||||||||||||||||||||
Our condensed consolidating balance sheets at December 31, 2013 and 2012 and condensed consolidating statements of comprehensive income and cash flows for each of the three years in the period ended December 31, 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 YEAR ENDED DECEMBER 31, 2013 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Revenues before provision for doubtful accounts | $ | — | $ | — | $ | 20,042 | $ | 17,998 | $ | — | $ | 38,040 | |||||||||||||
Provision for doubtful accounts | — | — | 2,262 | 1,596 | — | 3,858 | |||||||||||||||||||
Revenues | — | — | 17,780 | 16,402 | — | 34,182 | |||||||||||||||||||
Salaries and benefits | — | — | 8,387 | 7,259 | — | 15,646 | |||||||||||||||||||
Supplies | — | — | 3,158 | 2,812 | — | 5,970 | |||||||||||||||||||
Other operating expenses | 8 | (2 | ) | 2,998 | 3,233 | — | 6,237 | ||||||||||||||||||
Electronic health record incentive income | — | — | (142 | ) | (74 | ) | — | (216 | ) | ||||||||||||||||
Equity in earnings of affiliates | (1,875 | ) | — | (2 | ) | (27 | ) | 1,875 | (29 | ) | |||||||||||||||
Depreciation and amortization | — | — | 855 | 898 | — | 1,753 | |||||||||||||||||||
Interest expense | 184 | 2,253 | (523 | ) | (66 | ) | — | 1,848 | |||||||||||||||||
Losses (gains) on sales of facilities | — | — | 20 | (10 | ) | — | 10 | ||||||||||||||||||
Loss on retirement of debt | — | 17 | — | — | — | 17 | |||||||||||||||||||
Management fees | — | — | (632 | ) | 632 | — | — | ||||||||||||||||||
(1,683 | ) | 2,268 | 14,119 | 14,657 | 1,875 | 31,236 | |||||||||||||||||||
Income (loss) before income taxes | 1,683 | (2,268 | ) | 3,661 | 1,745 | (1,875 | ) | 2,946 | |||||||||||||||||
Provision (benefit) for income taxes | (73 | ) | (860 | ) | 1,362 | 521 | — | 950 | |||||||||||||||||
Net income (loss) | 1,756 | (1,408 | ) | 2,299 | 1,224 | (1,875 | ) | 1,996 | |||||||||||||||||
Net income attributable to noncontrolling interests | — | — | 69 | 371 | — | 440 | |||||||||||||||||||
Net income (loss) attributable to HCA Holdings, Inc. | $ | 1,756 | $ | (1,408 | ) | $ | 2,230 | $ | 853 | $ | (1,875 | ) | $ | 1,556 | |||||||||||
Comprehensive income (loss) attributable to HCA Holdings, Inc. | $ | 1,756 | $ | (1,324 | ) | $ | 2,338 | $ | 861 | $ | (1,875 | ) | $ | 1,756 | |||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT | |||||||||||||||||||||||||
FOR THE YEAR ENDED DECEMBER 31, 2012 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Revenues before provision for doubtful accounts | $ | — | $ | — | $ | 19,415 | $ | 17,368 | $ | — | $ | 36,783 | |||||||||||||
Provision for doubtful accounts | — | — | 2,144 | 1,626 | — | 3,770 | |||||||||||||||||||
Revenues | — | — | 17,271 | 15,742 | — | 33,013 | |||||||||||||||||||
Salaries and benefits | — | — | 7,959 | 7,130 | — | 15,089 | |||||||||||||||||||
Supplies | — | — | 2,995 | 2,722 | — | 5,717 | |||||||||||||||||||
Other operating expenses | 3 | 5 | 3,013 | 3,027 | — | 6,048 | |||||||||||||||||||
Electronic health record incentive income | — | — | (219 | ) | (117 | ) | — | (336 | ) | ||||||||||||||||
Equity in earnings of affiliates | (1,668 | ) | — | (5 | ) | (31 | ) | 1,668 | (36 | ) | |||||||||||||||
Depreciation and amortization | — | — | 821 | 858 | — | 1,679 | |||||||||||||||||||
Interest expense | 123 | 2,167 | (468 | ) | (24 | ) | — | 1,798 | |||||||||||||||||
Losses (gains) on sales of facilities | — | — | 3 | (18 | ) | — | (15 | ) | |||||||||||||||||
Legal claim costs | — | 175 | — | — | — | 175 | |||||||||||||||||||
Management fees | — | — | (569 | ) | 569 | — | — | ||||||||||||||||||
(1,542 | ) | 2,347 | 13,530 | 14,116 | 1,668 | 30,119 | |||||||||||||||||||
Income (loss) before income taxes | 1,542 | (2,347 | ) | 3,741 | 1,626 | (1,668 | ) | 2,894 | |||||||||||||||||
Provision (benefit) for income taxes | (46 | ) | (839 | ) | 1,313 | 460 | — | 888 | |||||||||||||||||
Net income (loss) | 1,588 | (1,508 | ) | 2,428 | 1,166 | (1,668 | ) | 2,006 | |||||||||||||||||
Net income attributable to noncontrolling interests | — | — | 62 | 339 | — | 401 | |||||||||||||||||||
Net income (loss) attributable to HCA Holdings, Inc. | $ | 1,588 | $ | (1,508 | ) | $ | 2,366 | $ | 827 | $ | (1,668 | ) | $ | 1,605 | |||||||||||
Comprehensive income (loss) attributable to HCA Holdings, Inc. | $ | 1,588 | $ | (1,526 | ) | $ | 2,339 | $ | 855 | $ | (1,668 | ) | $ | 1,588 | |||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT | |||||||||||||||||||||||||
FOR THE YEAR ENDED DECEMBER 31, 2011 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Revenues before provision for doubtful accounts | $ | — | $ | — | $ | 18,126 | $ | 14,380 | $ | — | $ | 32,506 | |||||||||||||
Provision for doubtful accounts | — | — | 1,644 | 1,180 | — | 2,824 | |||||||||||||||||||
Revenues | — | — | 16,482 | 13,200 | — | 29,682 | |||||||||||||||||||
Salaries and benefits | — | — | 7,584 | 5,856 | — | 13,440 | |||||||||||||||||||
Supplies | — | — | 2,851 | 2,328 | — | 5,179 | |||||||||||||||||||
Other operating expenses | — | 4 | 2,741 | 2,725 | — | 5,470 | |||||||||||||||||||
Electronic health record incentive income | — | — | (126 | ) | (84 | ) | — | (210 | ) | ||||||||||||||||
Equity in earnings of affiliates | (2,531 | ) | — | (86 | ) | (172 | ) | 2,531 | (258 | ) | |||||||||||||||
Depreciation and amortization | — | — | 777 | 688 | — | 1,465 | |||||||||||||||||||
Interest expense | 120 | 2,390 | (342 | ) | (131 | ) | — | 2,037 | |||||||||||||||||
Gains on sales of facilities | — | — | (127 | ) | (15 | ) | — | (142 | ) | ||||||||||||||||
Gain on acquisition of controlling interest in equity investment | — | — | — | (1,522 | ) | — | (1,522 | ) | |||||||||||||||||
Losses on retirement of debt | — | 481 | — | — | — | 481 | |||||||||||||||||||
Termination of management agreement | — | 181 | — | — | — | 181 | |||||||||||||||||||
Management fees | — | — | (491 | ) | 491 | — | — | ||||||||||||||||||
(2,411 | ) | 3,056 | 12,781 | 10,164 | 2,531 | 26,121 | |||||||||||||||||||
Income (loss) before income taxes | 2,411 | (3,056 | ) | 3,701 | 3,036 | (2,531 | ) | 3,561 | |||||||||||||||||
Provision (benefit) for income taxes | (42 | ) | (1,068 | ) | 1,271 | 558 | — | 719 | |||||||||||||||||
Net income (loss) | 2,453 | (1,988 | ) | 2,430 | 2,478 | (2,531 | ) | 2,842 | |||||||||||||||||
Net income attributable to noncontrolling interests | — | — | 63 | 314 | — | 377 | |||||||||||||||||||
Net income (loss) attributable to HCA Holdings, Inc. | $ | 2,453 | $ | (1,988 | ) | $ | 2,367 | $ | 2,164 | $ | (2,531 | ) | $ | 2,465 | |||||||||||
Comprehensive income (loss) attributable to HCA Holdings, Inc. | $ | 2,453 | $ | (1,969 | ) | $ | 2,341 | $ | 2,159 | $ | (2,531 | ) | $ | 2,453 | |||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING BALANCE SHEET | |||||||||||||||||||||||||
31-Dec-13 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
ASSETS | |||||||||||||||||||||||||
Current assets: | |||||||||||||||||||||||||
Cash and cash equivalents | $ | — | $ | — | $ | 112 | $ | 302 | $ | — | $ | 414 | |||||||||||||
Accounts receivable, net | — | — | 2,565 | 2,643 | — | 5,208 | |||||||||||||||||||
Inventories | — | — | 692 | 487 | — | 1,179 | |||||||||||||||||||
Deferred income taxes | 489 | — | — | — | — | 489 | |||||||||||||||||||
Other | — | — | 301 | 446 | — | 747 | |||||||||||||||||||
489 | — | 3,670 | 3,878 | — | 8,037 | ||||||||||||||||||||
Property and equipment, net | — | — | 7,504 | 6,115 | — | 13,619 | |||||||||||||||||||
Investments of insurance subsidiaries | — | — | — | 448 | — | 448 | |||||||||||||||||||
Investments in and advances to affiliates | 20,356 | — | 13 | 108 | (20,356 | ) | 121 | ||||||||||||||||||
Goodwill and other intangible assets | — | — | 1,695 | 4,208 | — | 5,903 | |||||||||||||||||||
Deferred loan costs | 30 | 207 | — | — | — | 237 | |||||||||||||||||||
Other | 250 | — | 48 | 168 | — | 466 | |||||||||||||||||||
$ | 21,125 | $ | 207 | $ | 12,930 | $ | 14,925 | $ | (20,356 | ) | $ | 28,831 | |||||||||||||
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY | |||||||||||||||||||||||||
Current liabilities: | |||||||||||||||||||||||||
Accounts payable | $ | 1 | $ | — | $ | 1,169 | $ | 633 | $ | — | $ | 1,803 | |||||||||||||
Accrued salaries | — | — | 694 | 499 | — | 1,193 | |||||||||||||||||||
Other accrued expenses | 272 | 353 | 464 | 824 | — | 1,913 | |||||||||||||||||||
Long-term debt due within one year | — | 702 | 45 | 39 | — | 786 | |||||||||||||||||||
273 | 1,055 | 2,372 | 1,995 | — | 5,695 | ||||||||||||||||||||
Long-term debt | 2,525 | 24,701 | 181 | 183 | — | 27,590 | |||||||||||||||||||
Intercompany balances | 26,107 | (10,513 | ) | (19,428 | ) | 3,834 | — | — | |||||||||||||||||
Professional liability risks | — | — | — | 949 | — | 949 | |||||||||||||||||||
Income taxes and other liabilities | 490 | 296 | 521 | 218 | — | 1,525 | |||||||||||||||||||
29,395 | 15,539 | (16,354 | ) | 7,179 | — | 35,759 | |||||||||||||||||||
Stockholders’ (deficit) equity attributable to HCA Holdings, Inc. | (8,270 | ) | (15,332 | ) | 29,185 | 6,503 | (20,356 | ) | (8,270 | ) | |||||||||||||||
Noncontrolling interests | — | — | 99 | 1,243 | — | 1,342 | |||||||||||||||||||
(8,270 | ) | (15,332 | ) | 29,284 | 7,746 | (20,356 | ) | (6,928 | ) | ||||||||||||||||
$ | 21,125 | $ | 207 | $ | 12,930 | $ | 14,925 | $ | (20,356 | ) | $ | 28,831 | |||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING BALANCE SHEET | |||||||||||||||||||||||||
31-Dec-12 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
ASSETS | |||||||||||||||||||||||||
Current assets: | |||||||||||||||||||||||||
Cash and cash equivalents | $ | 22 | $ | — | $ | 383 | $ | 300 | $ | — | $ | 705 | |||||||||||||
Accounts receivable, net | — | — | 2,448 | 2,224 | — | 4,672 | |||||||||||||||||||
Inventories | — | — | 629 | 457 | — | 1,086 | |||||||||||||||||||
Deferred income taxes | 385 | — | — | — | — | 385 | |||||||||||||||||||
Other | 122 | — | 342 | 451 | — | 915 | |||||||||||||||||||
529 | — | 3,802 | 3,432 | — | 7,763 | ||||||||||||||||||||
Property and equipment, net | — | — | 7,417 | 5,768 | — | 13,185 | |||||||||||||||||||
Investments of insurance subsidiaries | — | — | — | 515 | — | 515 | |||||||||||||||||||
Investments in and advances to affiliates | 18,481 | — | 16 | 88 | (18,481 | ) | 104 | ||||||||||||||||||
Goodwill and other intangible assets | — | — | 1,697 | 3,842 | — | 5,539 | |||||||||||||||||||
Deferred loan costs | 32 | 258 | — | — | — | 290 | |||||||||||||||||||
Other | 469 | — | 31 | 179 | — | 679 | |||||||||||||||||||
$ | 19,511 | $ | 258 | $ | 12,963 | $ | 13,824 | $ | (18,481 | ) | $ | 28,075 | |||||||||||||
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY | |||||||||||||||||||||||||
Current liabilities: | |||||||||||||||||||||||||
Accounts payable | $ | — | $ | — | $ | 1,203 | $ | 565 | $ | — | $ | 1,768 | |||||||||||||
Accrued salaries | — | — | 638 | 482 | — | 1,120 | |||||||||||||||||||
Other accrued expenses | 30 | 567 | 464 | 788 | — | 1,849 | |||||||||||||||||||
Long-term debt due within one year | — | 1,360 | 39 | 36 | — | 1,435 | |||||||||||||||||||
30 | 1,927 | 2,344 | 1,871 | — | 6,172 | ||||||||||||||||||||
Long-term debt | 2,525 | 24,304 | 173 | 493 | — | 27,495 | |||||||||||||||||||
Intercompany balances | 26,131 | (12,407 | ) | (17,130 | ) | 3,406 | — | — | |||||||||||||||||
Professional liability risks | — | — | — | 973 | — | 973 | |||||||||||||||||||
Income taxes and other liabilities | 485 | 442 | 629 | 220 | — | 1,776 | |||||||||||||||||||
29,171 | 14,266 | (13,984 | ) | 6,963 | — | 36,416 | |||||||||||||||||||
Stockholders’ (deficit) equity attributable to HCA Holdings, Inc. | (9,660 | ) | (14,008 | ) | 26,847 | 5,642 | (18,481 | ) | (9,660 | ) | |||||||||||||||
Noncontrolling interests | — | — | 100 | 1,219 | — | 1,319 | |||||||||||||||||||
(9,660 | ) | (14,008 | ) | 26,947 | 6,861 | (18,481 | ) | (8,341 | ) | ||||||||||||||||
$ | 19,511 | $ | 258 | $ | 12,963 | $ | 13,824 | $ | (18,481 | ) | $ | 28,075 | |||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS | |||||||||||||||||||||||||
FOR THE YEAR ENDED DECEMBER 31, 2013 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Cash flows from operating activities: | |||||||||||||||||||||||||
Net income (loss) | $ | 1,756 | $ | (1,408 | ) | $ | 2,299 | $ | 1,224 | $ | (1,875 | ) | $ | 1,996 | |||||||||||
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||||||||||||||||
Change in operating assets and liabilities | (11 | ) | 17 | (2,320 | ) | (1,958 | ) | — | (4,272 | ) | |||||||||||||||
Provision for doubtful accounts | — | — | 2,262 | 1,596 | — | 3,858 | |||||||||||||||||||
Depreciation and amortization | — | — | 855 | 898 | — | 1,753 | |||||||||||||||||||
Income taxes | 143 | — | — | — | — | 143 | |||||||||||||||||||
Losses (gains) on sales of facilities | — | — | 20 | (10 | ) | — | 10 | ||||||||||||||||||
Loss on retirement of debt | — | 17 | — | — | — | 17 | |||||||||||||||||||
Amortization of deferred loan costs | 3 | 52 | — | — | — | 55 | |||||||||||||||||||
Share-based compensation | 113 | — | — | — | — | 113 | |||||||||||||||||||
Equity in earnings of affiliates | (1,875 | ) | — | — | — | 1,875 | — | ||||||||||||||||||
Other | — | 9 | 2 | (4 | ) | — | 7 | ||||||||||||||||||
Net cash provided by (used in) operating activities | 129 | (1,313 | ) | 3,118 | 1,746 | — | 3,680 | ||||||||||||||||||
Cash flows from investing activities: | |||||||||||||||||||||||||
Purchase of property and equipment | — | — | (921 | ) | (1,022 | ) | — | (1,943 | ) | ||||||||||||||||
Acquisition of hospitals and health care entities | — | — | — | (481 | ) | — | (481 | ) | |||||||||||||||||
Disposal of hospitals and health care entities | — | — | 17 | 16 | — | 33 | |||||||||||||||||||
Change in investments | — | — | (16 | ) | 52 | — | 36 | ||||||||||||||||||
Other | — | — | — | 9 | — | 9 | |||||||||||||||||||
Net cash used in investing activities | — | — | (920 | ) | (1,426 | ) | — | (2,346 | ) | ||||||||||||||||
Cash flows from financing activities: | |||||||||||||||||||||||||
Net change in revolving bank credit facilities | — | 970 | — | — | — | 970 | |||||||||||||||||||
Repayment of long-term debt | — | (1,254 | ) | (34 | ) | (374 | ) | — | (1,662 | ) | |||||||||||||||
Distributions to noncontrolling interests | — | — | (71 | ) | (364 | ) | — | (435 | ) | ||||||||||||||||
Payment of debt issuance costs | — | (5 | ) | — | — | — | (5 | ) | |||||||||||||||||
Repurchase of common stock | (500 | ) | — | — | — | — | (500 | ) | |||||||||||||||||
Distributions to stockholders | (16 | ) | — | — | — | — | (16 | ) | |||||||||||||||||
Income tax benefits | 113 | — | — | — | — | 113 | |||||||||||||||||||
Changes in intercompany balances with affiliates, net | 342 | 1,602 | (2,364 | ) | 420 | — | — | ||||||||||||||||||
Other | (90 | ) | — | — | — | — | (90 | ) | |||||||||||||||||
Net cash (used in) provided by financing activities | (151 | ) | 1,313 | (2,469 | ) | (318 | ) | — | (1,625 | ) | |||||||||||||||
Change in cash and cash equivalents | (22 | ) | — | (271 | ) | 2 | — | (291 | ) | ||||||||||||||||
Cash and cash equivalents at beginning of period | 22 | — | 383 | 300 | — | 705 | |||||||||||||||||||
Cash and cash equivalents at end of period | $ | — | $ | — | $ | 112 | $ | 302 | $ | — | $ | 414 | |||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS | |||||||||||||||||||||||||
FOR THE YEAR ENDED DECEMBER 31, 2012 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Cash flows from operating activities: | |||||||||||||||||||||||||
Net income (loss) | $ | 1,588 | $ | (1,508 | ) | $ | 2,428 | $ | 1,166 | $ | (1,668 | ) | $ | 2,006 | |||||||||||
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||||||||||||||||
Change in operating assets and liabilities | 57 | (28 | ) | (1,927 | ) | (1,765 | ) | — | (3,663 | ) | |||||||||||||||
Provision for doubtful accounts | — | — | 2,144 | 1,626 | — | 3,770 | |||||||||||||||||||
Depreciation and amortization | — | — | 821 | 858 | — | 1,679 | |||||||||||||||||||
Income taxes | 96 | — | — | — | — | 96 | |||||||||||||||||||
Losses (gains) on sales of facilities | — | — | 3 | (18 | ) | — | (15 | ) | |||||||||||||||||
Legal claim costs | — | 175 | — | — | — | 175 | |||||||||||||||||||
Amortization of deferred loan costs | 2 | 60 | — | — | — | 62 | |||||||||||||||||||
Share-based compensation | 56 | — | — | — | — | 56 | |||||||||||||||||||
Equity in earnings of affiliates | (1,668 | ) | — | — | — | 1,668 | — | ||||||||||||||||||
Other | — | 14 | (1 | ) | (4 | ) | — | 9 | |||||||||||||||||
Net cash provided by (used in) operating activities | 131 | (1,287 | ) | 3,468 | 1,863 | — | 4,175 | ||||||||||||||||||
Cash flows from investing activities: | |||||||||||||||||||||||||
Purchase of property and equipment | — | — | (1,039 | ) | (823 | ) | — | (1,862 | ) | ||||||||||||||||
Acquisition of hospitals and health care entities | — | — | (110 | ) | (148 | ) | — | (258 | ) | ||||||||||||||||
Disposal of hospitals and health care entities | — | — | 2 | 28 | — | 30 | |||||||||||||||||||
Change in investments | — | — | (11 | ) | 27 | — | 16 | ||||||||||||||||||
Other | — | — | (2 | ) | 13 | — | 11 | ||||||||||||||||||
Net cash used in investing activities | — | — | (1,160 | ) | (903 | ) | — | (2,063 | ) | ||||||||||||||||
Cash flows from financing activities: | |||||||||||||||||||||||||
Issuances of long-term debt | 1,000 | 3,850 | — | — | — | 4,850 | |||||||||||||||||||
Net change in revolving bank credit facilities | — | (685 | ) | — | — | — | (685 | ) | |||||||||||||||||
Repayment of long-term debt | — | (2,309 | ) | (20 | ) | (112 | ) | — | (2,441 | ) | |||||||||||||||
Distributions to noncontrolling interests | — | — | (60 | ) | (341 | ) | — | (401 | ) | ||||||||||||||||
Payment of debt issuance costs | (12 | ) | (50 | ) | — | — | — | (62 | ) | ||||||||||||||||
Distributions to stockholders | (3,148 | ) | — | — | — | — | (3,148 | ) | |||||||||||||||||
Income tax benefits | 174 | — | — | — | — | 174 | |||||||||||||||||||
Changes in intercompany balances with affiliates, net | 1,938 | 481 | (1,960 | ) | (459 | ) | — | — | |||||||||||||||||
Other | (61 | ) | — | — | (6 | ) | — | (67 | ) | ||||||||||||||||
Net cash (used in) provided by financing activities | (109 | ) | 1,287 | (2,040 | ) | (918 | ) | — | (1,780 | ) | |||||||||||||||
Change in cash and cash equivalents | 22 | — | 268 | 42 | — | 332 | |||||||||||||||||||
Cash and cash equivalents at beginning of period | — | — | 115 | 258 | — | 373 | |||||||||||||||||||
Cash and cash equivalents at end of period | $ | 22 | $ | — | $ | 383 | $ | 300 | $ | — | $ | 705 | |||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS | |||||||||||||||||||||||||
FOR THE YEAR ENDED DECEMBER 31, 2011 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Cash flows from operating activities: | |||||||||||||||||||||||||
Net income (loss) | $ | 2,453 | $ | (1,988 | ) | $ | 2,430 | $ | 2,478 | $ | (2,531 | ) | $ | 2,842 | |||||||||||
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||||||||||||||||
Change in operating assets and liabilities | 6 | 71 | (1,755 | ) | (1,275 | ) | — | (2,953 | ) | ||||||||||||||||
Provision for doubtful accounts | — | — | 1,644 | 1,180 | — | 2,824 | |||||||||||||||||||
Depreciation and amortization | — | — | 777 | 688 | — | 1,465 | |||||||||||||||||||
Income taxes | 912 | — | — | — | — | 912 | |||||||||||||||||||
Gains on sales of facilities | — | — | (127 | ) | (15 | ) | — | (142 | ) | ||||||||||||||||
Gain on acquisition of controlling interest in equity investment | — | — | — | (1,522 | ) | — | (1,522 | ) | |||||||||||||||||
Losses on retirement of debt | — | 481 | — | — | — | 481 | |||||||||||||||||||
Amortization of deferred loan costs | — | 70 | — | — | — | 70 | |||||||||||||||||||
Share-based compensation | 26 | — | — | — | — | 26 | |||||||||||||||||||
Pay-in-kind interest | — | (78 | ) | — | — | — | (78 | ) | |||||||||||||||||
Equity in earnings of affiliates | (2,531 | ) | — | — | — | 2,531 | — | ||||||||||||||||||
Other | — | 9 | — | (1 | ) | — | 8 | ||||||||||||||||||
Net cash provided by (used in) operating activities | 866 | (1,435 | ) | 2,969 | 1,533 | — | 3,933 | ||||||||||||||||||
Cash flows from investing activities: | |||||||||||||||||||||||||
Purchase of property and equipment | — | — | (910 | ) | (769 | ) | — | (1,679 | ) | ||||||||||||||||
Acquisition of hospitals and health care entities | — | — | (142 | ) | (1,540 | ) | — | (1,682 | ) | ||||||||||||||||
Disposal of hospitals and health care entities | — | — | 200 | 81 | — | 281 | |||||||||||||||||||
Change in investments | — | — | 34 | 46 | — | 80 | |||||||||||||||||||
Other | — | — | — | 5 | — | 5 | |||||||||||||||||||
Net cash used in investing activities | — | — | (818 | ) | (2,177 | ) | — | (2,995 | ) | ||||||||||||||||
Cash flows from financing activities: | |||||||||||||||||||||||||
Issuances of long-term debt | — | 5,500 | — | — | — | 5,500 | |||||||||||||||||||
Net change in revolving bank credit facilities | — | (449 | ) | — | — | — | (449 | ) | |||||||||||||||||
Repayment of long-term debt | — | (6,577 | ) | (17 | ) | (46 | ) | — | (6,640 | ) | |||||||||||||||
Distributions to noncontrolling interests | — | — | (77 | ) | (301 | ) | — | (378 | ) | ||||||||||||||||
Payment of debt issuance costs | — | (92 | ) | — | — | — | (92 | ) | |||||||||||||||||
Issuance of common stock | 2,506 | — | — | — | — | 2,506 | |||||||||||||||||||
Repurchase of common stock | (1,503 | ) | — | — | — | — | (1,503 | ) | |||||||||||||||||
Distributions to stockholders | (31 | ) | — | — | — | — | (31 | ) | |||||||||||||||||
Income tax benefits | 63 | — | — | — | — | 63 | |||||||||||||||||||
Changes in intercompany balances with affiliates, net | (1,918 | ) | 3,053 | (2,098 | ) | 963 | — | — | |||||||||||||||||
Other | 11 | — | — | 37 | — | 48 | |||||||||||||||||||
Net cash provided by (used in) financing activities | (872 | ) | 1,435 | (2,192 | ) | 653 | — | (976 | ) | ||||||||||||||||
Change in cash and cash equivalents | (6 | ) | — | (41 | ) | 9 | — | (38 | ) | ||||||||||||||||
Cash and cash equivalents at beginning of period | 6 | — | 156 | 249 | — | 411 | |||||||||||||||||||
Cash and cash equivalents at end of period | $ | — | $ | — | $ | 115 | $ | 258 | $ | — | $ | 373 | |||||||||||||
Healthtrust, Inc. — The Hospital Company (“Healthtrust”) is the first-tier subsidiary of HCA Inc. The common stock of Healthtrust has been pledged as collateral for the senior secured credit facilities and senior secured notes described in Note 9. Rule 3-16 of Regulation S-X under the Securities Act requires the filing of separate financial statements for any affiliate of the registrant whose securities constitute a substantial portion of the collateral for any class of securities registered or being registered. We believe the separate financial statements requirement applies to Healthtrust due to the pledge of its common stock as collateral for the senior secured notes. Due to the corporate structure relationship of HCA and Healthtrust, HCA’s operating subsidiaries are also the operating subsidiaries of Healthtrust. The corporate structure relationship, combined with the application of push-down accounting in Healthtrust’s consolidated financial statements related to HCA’s debt and financial instruments, results in the consolidated financial statements of Healthtrust being substantially identical to the consolidated financial statements of HCA. The consolidated financial statements of HCA and Healthtrust present the identical amounts for revenues, expenses, net income, assets, liabilities, total stockholders’ deficit, net cash provided by operating activities, net cash used in investing activities and net cash used in financing activities. Certain individual line items in the HCA consolidated statements of stockholders’ deficit are combined into one line item in the Healthtrust consolidated statements of stockholder’s deficit. | |||||||||||||||||||||||||
Reconciliations of the HCA Holdings, Inc. Consolidated Statements of Stockholders’ Deficit presentation to the Healthtrust, Inc. — The Hospital Company Consolidated Statements of Stockholder’s Deficit presentation for the years ended December 31, 2013, 2012 and 2011 are as follows (dollars in millions): | |||||||||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||||||||
Presentation in HCA Holdings, Inc. Consolidated Statements of Stockholders’ Deficit: | |||||||||||||||||||||||||
Share-based benefit plans | $ | 139 | $ | 169 | $ | 35 | |||||||||||||||||||
Reclassification of certain equity securities with contingent redemption rights | — | — | 141 | ||||||||||||||||||||||
Other | (6 | ) | (17 | ) | 36 | ||||||||||||||||||||
Presentation in Healthtrust, Inc. — The Hospital Company Consolidated Statements of Stockholder’s Deficit: | |||||||||||||||||||||||||
Distributions from HCA Holdings, Inc., net of contributions to HCA Holdings, Inc. | $ | 133 | $ | 152 | $ | 212 | |||||||||||||||||||
Due to the consolidated financial statements of Healthtrust being substantially identical to the consolidated financial statements of HCA, except for the items presented in the table above, the separate consolidated financial statements of Healthtrust are not presented. | |||||||||||||||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
QUARTERLY CONSOLIDATED FINANCIAL INFORMATION | |||||||||||||||||||||||||
(UNAUDITED) | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
2013 | |||||||||||||||||||||||||
First | Second | Third | Fourth | ||||||||||||||||||||||
Revenues | $ | 8,440 | $ | 8,450 | $ | 8,456 | $ | 8,836 | |||||||||||||||||
Net income | $ | 438 | (a) | $ | 537 | (b) | $ | 467 | (c) | $ | 554 | (d) | |||||||||||||
Net income attributable to HCA Holdings, Inc. | $ | 344 | (a) | $ | 423 | (b) | $ | 365 | (c) | $ | 424 | (d) | |||||||||||||
Basic earnings per share | $ | 0.77 | $ | 0.95 | $ | 0.82 | $ | 0.96 | |||||||||||||||||
Diluted earnings per share | $ | 0.74 | $ | 0.91 | $ | 0.79 | $ | 0.92 | |||||||||||||||||
2012 | |||||||||||||||||||||||||
First | Second | Third | Fourth | ||||||||||||||||||||||
Revenues | $ | 8,405 | $ | 8,112 | $ | 8,062 | $ | 8,434 | |||||||||||||||||
Net income | $ | 639 | (e) | $ | 485 | (f) | $ | 455 | (g) | $ | 427 | (h) | |||||||||||||
Net income attributable to HCA Holdings, Inc. | $ | 540 | (e) | $ | 391 | (f) | $ | 360 | (g) | $ | 314 | (h) | |||||||||||||
Basic earnings per share | $ | 1.23 | $ | 0.89 | $ | 0.82 | $ | 0.71 | |||||||||||||||||
Diluted earnings per share | $ | 1.18 | $ | 0.85 | $ | 0.78 | $ | 0.68 | |||||||||||||||||
(a) | First quarter results include $11 million of losses on sales of facilities (See NOTE 3 of the notes to consolidated financial statements) and $11 million of loss on retirement of debt (See NOTE 9 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(b) | Second quarter results include $3 million of gains on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(c) | Third quarter results include $1 million of losses on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(d) | Fourth quarter results include $2 million of gains on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(e) | First quarter results include $1 million of losses on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(f) | Second quarter results include $1 million of losses on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(g) | Third quarter results include $5 million of gains on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(h) | Fourth quarter results include $6 million of gains on sales of facilities (See NOTE 3 of the notes to consolidated financial statements) and $110 million of legal claim costs (See NOTE 10 of the notes to consolidated financial statements). |
Accounting_Policies_Policies
Accounting Policies (Policies) | 12 Months Ended | ||||||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||||||
Accounting Policies [Abstract] | ' | ||||||||||||||||||||||||
Basis of Presentation | ' | ||||||||||||||||||||||||
Basis of Presentation | |||||||||||||||||||||||||
The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates. | |||||||||||||||||||||||||
The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method. | |||||||||||||||||||||||||
We have completed various acquisitions and joint venture transactions. The accounts of these entities have been included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. The majority of our expenses are “cost of revenue” items. Costs that could be classified as general and administrative include our corporate office costs, which were $287 million, $248 million and $228 million for the years ended December 31, 2013, 2012 and 2011, respectively. | |||||||||||||||||||||||||
Revenues | ' | ||||||||||||||||||||||||
Revenues | |||||||||||||||||||||||||
Revenues consist primarily of net patient service revenues that are recorded based upon established billing rates less allowances for contractual adjustments. 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 the Medicare and Medicaid programs), managed care health plans, 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. Contractual payment terms in managed care agreements are generally based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. 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 (based primarily on historical collection experience) related to these uninsured accounts to record net self pay revenues at the estimated amounts we expect to collect. Our revenues from third party payers and the uninsured for the years ended December 31, are summarized in the following table (dollars in millions): | |||||||||||||||||||||||||
2013 | Ratio | 2012 | Ratio | 2011 | Ratio | ||||||||||||||||||||
Medicare | $ | 7,951 | 23.3 | % | $ | 8,292 | 25.1 | % | $ | 7,653 | 25.8 | % | |||||||||||||
Managed Medicare | 3,279 | 9.6 | 2,954 | 8.9 | 2,442 | 8.2 | |||||||||||||||||||
Medicaid | 1,480 | 4.3 | 1,464 | 4.4 | 1,845 | 6.2 | |||||||||||||||||||
Managed Medicaid | 1,570 | 4.6 | 1,504 | 4.6 | 1,265 | 4.3 | |||||||||||||||||||
Managed care and other insurers | 18,654 | 54.6 | 17,998 | 54.5 | 15,703 | 52.9 | |||||||||||||||||||
International (managed care and other insurers) | 1,175 | 3.4 | 1,060 | 3.2 | 938 | 3.2 | |||||||||||||||||||
34,109 | 99.8 | 33,272 | 100.7 | 29,846 | 100.6 | ||||||||||||||||||||
Uninsured | 2,677 | 7.8 | 2,580 | 7.8 | 1,846 | 6.2 | |||||||||||||||||||
Other | 1,254 | 3.7 | 931 | 2.8 | 814 | 2.7 | |||||||||||||||||||
Revenues before provision for doubtful accounts | 38,040 | 111.3 | 36,783 | 111.3 | 32,506 | 109.5 | |||||||||||||||||||
Provision for doubtful accounts | (3,858 | ) | (11.3 | ) | (3,770 | ) | (11.3 | ) | (2,824 | ) | (9.5 | ) | |||||||||||||
Revenues | $ | 34,182 | 100 | % | $ | 33,013 | 100 | % | $ | 29,682 | 100 | % | |||||||||||||
Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. As a result, there is at least a reasonable possibility recorded estimates will change by a material amount. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement amounts and disproportionate-share funds, which resulted in net increases to revenues, related primarily to cost reports filed during the respective year were $41 million, $50 million and $40 million in 2013, 2012 and 2011, respectively. The adjustments to estimated reimbursement amounts, which resulted in net increases to revenues, related primarily to cost reports filed during previous years were $68 million, $242 million and $30 million in 2013, 2012 and 2011, respectively. The 2012 amount related to cost reports filed during previous years includes two adjustments to Medicare revenues that affected multiple annual cost report periods for the majority of our hospitals (the Rural Floor Provision Settlement increased revenues by approximately $271 million and the implementation of revised Supplemental Security Income ratios reduced revenues by approximately $75 million). Excluding the effect of these Medicare adjustments, the 2012 amount related to previous years would have been $46 million. | |||||||||||||||||||||||||
The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Patients treated at hospitals for nonelective care, who have income at or below 200% of the federal poverty level, are eligible for charity care. The federal poverty level is established by the federal government and is based on income and family size. 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. In implementing the uninsured discount policy, we first attempt to qualify uninsured patients for Medicaid, other federal or state assistance or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied. | |||||||||||||||||||||||||
To quantify the total impact of and trends related to uninsured accounts, we believe it is beneficial to view charity care, uninsured discounts and the provision for doubtful accounts in combination, rather than each separately. A summary of these amounts for the years ended December 31, follows (dollars in millions): | |||||||||||||||||||||||||
2013 | Ratio | 2012 | Ratio | 2011 | Ratio | ||||||||||||||||||||
Charity care | $ | 3,497 | 22 | % | $ | 3,093 | 22 | % | $ | 2,683 | 24 | % | |||||||||||||
Uninsured discounts | 8,210 | 53 | 6,978 | 51 | 5,707 | 51 | |||||||||||||||||||
Provision for doubtful accounts | 3,858 | 25 | 3,770 | 27 | 2,824 | 25 | |||||||||||||||||||
Total uncompensated care | $ | 15,565 | 100 | % | $ | 13,841 | 100 | % | $ | 11,214 | 100 | % | |||||||||||||
A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions): | |||||||||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||||||||
Gross patient charges | $ | 181,141 | $ | 165,614 | $ | 141,516 | |||||||||||||||||||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | 29,606 | 28,533 | 25,554 | ||||||||||||||||||||||
Cost-to-charges ratio | 16.3 | % | 17.2 | % | 18.1 | % | |||||||||||||||||||
Total uncompensated care | $ | 15,565 | $ | 13,841 | $ | 11,214 | |||||||||||||||||||
Multiply by the cost-to-charges ratio | 16.3 | % | 17.2 | % | 18.1 | % | |||||||||||||||||||
Estimated cost of total uncompensated care | $ | 2,537 | $ | 2,381 | $ | 2,030 | |||||||||||||||||||
The sum of charity care, uninsured discounts and the provision for doubtful accounts, as a percentage of the sum of revenues, charity care, uninsured discounts and the provision for doubtful accounts increased from 27.4% for 2011, to 29.5% for 2012 and to 31.3% for 2013. | |||||||||||||||||||||||||
Cash and Cash Equivalents | ' | ||||||||||||||||||||||||
Cash and Cash Equivalents | |||||||||||||||||||||||||
Cash and cash equivalents include highly liquid investments with a maturity of three months or less when purchased. Our insurance subsidiaries’ cash equivalent investments in excess of the amounts required to pay estimated professional liability claims during the next twelve months are not included in cash and cash equivalents as these funds are not available for general corporate purposes. Carrying values of cash and cash equivalents approximate fair value due to the short-term nature of these instruments. | |||||||||||||||||||||||||
Our cash management system provides for daily investment of available balances and the funding of outstanding checks when presented for payment. Outstanding, but unpresented, checks totaling $461 million and $437 million at December 31, 2013 and 2012, respectively, have been included in “accounts payable” in the consolidated balance sheets. Upon presentation for payment, these checks are funded through available cash balances or our credit facility. | |||||||||||||||||||||||||
Accounts Receivable | ' | ||||||||||||||||||||||||
Accounts Receivable | |||||||||||||||||||||||||
We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. | |||||||||||||||||||||||||
Additions to the allowance for doubtful accounts are made by means of the provision for doubtful accounts. Accounts written off as uncollectible are deducted from the allowance for doubtful accounts and subsequent recoveries are added. The amount of the provision for doubtful accounts is based upon management’s assessment of historical and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. The provision for doubtful accounts and the allowance for doubtful accounts relate to “uninsured” amounts due directly from patients (including copayment and deductible amounts from patients who have health care coverage). Accounts are written off when all reasonable internal and external collection efforts have been performed. We consider the return of an account from the secondary collection agency to be the culmination of our reasonable collection efforts and the timing basis for writing off the account balance. Writeoffs are based upon specific identification and the writeoff process requires a writeoff adjustment entry to the patient accounting system. Management relies on the results of detailed reviews of historical writeoffs and recoveries at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information to utilize in estimating the collectibility of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. At both December 31, 2013 and 2012, the allowance for doubtful accounts represented approximately 93% of the $5.927 billion and $5.228 billion, respectively, patient due accounts receivable balance. The patient due accounts receivable balance represents the estimated uninsured portion of our accounts receivable. The estimated uninsured portion of Medicaid pending and uninsured discount pending accounts is included in our patient due accounts receivable balance. Days revenues in accounts receivable were 54 days, 51 days and 52 days at December 31, 2013, 2012 and 2011, respectively. Adverse changes in general economic conditions, patient accounting service center operations, payer mix or trends in federal or state governmental health care coverage could affect our collection of accounts receivable, cash flows and results of operations. | |||||||||||||||||||||||||
Inventories | ' | ||||||||||||||||||||||||
Inventories | |||||||||||||||||||||||||
Inventories are stated at the lower of cost (first-in, first-out) or market. | |||||||||||||||||||||||||
Property and Equipment | ' | ||||||||||||||||||||||||
Property and Equipment | |||||||||||||||||||||||||
Depreciation expense, computed using the straight-line method, was $1.733 billion in 2013, $1.673 billion in 2012 and $1.461 billion in 2011. Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four to 10 years. | |||||||||||||||||||||||||
When events, circumstances or operating results indicate the carrying values of certain long-lived assets expected to be held and used, might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar facilities and independent appraisals. | |||||||||||||||||||||||||
Long-lived assets to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers. | |||||||||||||||||||||||||
Investments of Insurance Subsidiaries | ' | ||||||||||||||||||||||||
Investments of Insurance Subsidiaries | |||||||||||||||||||||||||
At December 31, 2013 and 2012, the investments of our 100% owned insurance subsidiaries were classified as “available-for-sale” as defined in Accounting Standards Codification (“ASC”) No. 320, Investments — Debt and Equity Securities and are recorded at fair value. The investment securities are held for the purpose of providing a funding source to pay liability claims covered by the insurance subsidiaries. We perform a quarterly assessment of individual investment securities to determine whether declines in market value are temporary or other-than-temporary. Our investment securities evaluation process involves multiple subjective judgments, often involves estimating the outcome of future events, and requires a significant level of professional judgment in determining whether an impairment has occurred. We evaluate, among other things, the financial position and near term prospects of the issuer, conditions in the issuer’s industry, liquidity of the investment, changes in the amount or timing of expected future cash flows from the investment, and recent downgrades of the issuer by a rating agency, to determine if, and when, a decline in the fair value of an investment below amortized cost is considered other-than-temporary. The length of time and extent to which the fair value of the investment is less than amortized cost and our ability and intent to retain the investment, to allow for any anticipated recovery of the investment’s fair value, are important components of our investment securities evaluation process. | |||||||||||||||||||||||||
Goodwill and Intangible Assets | ' | ||||||||||||||||||||||||
Goodwill and Intangible Assets | |||||||||||||||||||||||||
Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division or market level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, we compare the fair value of the goodwill to its carrying value. If the fair value of the goodwill is less than its carrying value, an impairment loss is recognized. Fair value of goodwill is estimated based upon internal evaluations of the related long-lived assets for each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2013, 2012 and 2011. Since January 1, 2000, we have recognized total goodwill impairments of $102 million in the aggregate. None of the goodwill impairments related to evaluations of goodwill at the reporting unit level, as all recognized goodwill impairments during this period related to goodwill allocated to asset disposal groups. | |||||||||||||||||||||||||
During 2013, goodwill increased by $265 million related to acquisitions, declined by $1 million related to facility sales and declined by $13 million related to foreign currency translation and other adjustments. During 2012, goodwill increased by $288 million related to acquisitions, declined by $3 million related to facility sales and increased by $3 million related to foreign currency translation and other adjustments. | |||||||||||||||||||||||||
During 2013, identifiable intangible assets increased by $113 million and are being amortized over estimated lives ranging generally from three to 15 years. During 2012, there were no changes in identifiable intangible assets. During 2011, indefinite-lived identifiable intangible assets increased by $269 million. Indefinite-lived identifiable intangible assets are not amortized, but all identifiable intangible assets are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist. | |||||||||||||||||||||||||
Deferred Loan Costs | ' | ||||||||||||||||||||||||
Deferred Loan Costs | |||||||||||||||||||||||||
Debt issuance costs are amortized based upon the terms of the respective debt obligations. The gross carrying amount of deferred loan costs at December 31, 2013 and 2012 was $541 million and $571 million, respectively, and accumulated amortization was $305 million and $281 million, respectively. Amortization of deferred loan costs is included in interest expense and was $55 million, $62 million and $70 million for 2013, 2012 and 2011, respectively. | |||||||||||||||||||||||||
Physician Recruiting Agreements | ' | ||||||||||||||||||||||||
Physician Recruiting Agreements | |||||||||||||||||||||||||
In order to recruit physicians to meet the needs of our hospitals and the communities they serve, we enter into minimum revenue guarantee arrangements to assist the recruited physicians during the period they are relocating and establishing their practices. A guarantor is required to recognize, at the inception of a guarantee, a liability for the fair value of the stand-ready obligation undertaken in issuing the guarantee. We expense the total estimated guarantee liability amount at the time the physician recruiting agreement becomes effective as we are not able to justify recording a contract-based asset based upon our analysis of the related control, regulatory and legal considerations. | |||||||||||||||||||||||||
The physician recruiting liability amount of $15 million at both December 31, 2013 and 2012 represents the amount of expense recognized in excess of payments made through December 31, 2013 and 2012. At December 31, 2013 the maximum amount we could have to pay under all effective minimum revenue guarantees was $39 million. | |||||||||||||||||||||||||
Professional Liability Claims | ' | ||||||||||||||||||||||||
Professional Liability Claims | |||||||||||||||||||||||||
Reserves for professional liability risks were $1.279 billion and $1.297 billion at December 31, 2013 and 2012, respectively. The current portion of the reserves, $331 million and $324 million at December 31, 2013 and 2012, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $314 million, $331 million and $244 million for 2013, 2012 and 2011, respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. Loss and loss expense reserves represent the estimated ultimate net cost of all reported and unreported losses incurred through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,600 individual claims and 2,700 individual claims at December 31, 2013 and 2012, respectively, and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During 2013 and 2012, $307 million and $335 million, respectively, of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates. | |||||||||||||||||||||||||
A portion of our professional liability risks is insured through a 100% owned insurance subsidiary. Subject to a $5 million per occurrence self-insured retention, our facilities are insured by our 100% owned insurance subsidiary for losses up to $50 million per occurrence. The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of $15 million per occurrence. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary. | |||||||||||||||||||||||||
The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts include $19 million and $17 million at December 31, 2013 and 2012, respectively, recorded in “other assets”, and $5 million and $32 million at December 31, 2013 and 2012, respectively, recorded in “other current assets”. | |||||||||||||||||||||||||
Financial Instruments | ' | ||||||||||||||||||||||||
Financial Instruments | |||||||||||||||||||||||||
Derivative financial instruments are employed to manage risks, including interest rate and foreign currency exposures, and are not used for trading or speculative purposes. We recognize derivative instruments, such as interest rate swap agreements and foreign exchange contracts, in the consolidated balance sheets at fair value. Changes in the fair value of derivatives are recognized periodically either in earnings or in stockholders’ equity, as a component of other comprehensive income (loss), depending on whether the derivative financial instrument qualifies for hedge accounting, and if so, whether it qualifies as a fair value hedge or a cash flow hedge. Generally, changes in fair values of derivatives accounted for as fair value hedges are recorded in earnings, along with the changes in the fair value of the hedged items related to the hedged risk. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income (loss), and subsequently reclassified to earnings to offset the impact of the forecasted transactions when they occur. In the event the forecasted transaction to which a cash flow hedge relates is no longer likely, the amount in other comprehensive income (loss) is recognized in earnings and generally the derivative is terminated. Changes in the fair value of derivatives not qualifying as hedges, and for any portion of a hedge that is ineffective, are reported in earnings. | |||||||||||||||||||||||||
The net interest paid or received on interest rate swaps is recognized as interest expense. Gains and losses resulting from the early termination of interest rate swap agreements are deferred and amortized as adjustments to interest expense over the remaining term of the debt originally associated with the terminated swap. | |||||||||||||||||||||||||
Electronic Health Record Incentive Payments | ' | ||||||||||||||||||||||||
Electronic Health Record Incentive Payments | |||||||||||||||||||||||||
The American Recovery and Reinvestment Act of 2009 provides for Medicare and Medicaid incentive payments for eligible hospitals and professionals that adopt and meaningfully use certified electronic health record (“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. | |||||||||||||||||||||||||
Medicaid EHR incentive calculations and related payment amounts are based upon prior period cost report information available at the time our eligible hospitals adopt, implement or demonstrate meaningful use of certified EHR technology for the applicable period, and are not subject to revision for cost report data filed for a subsequent period. Thus, incentive income recognition occurs at the point our eligible hospitals adopt, implement or demonstrate meaningful use of certified EHR technology for the applicable period, as the cost report information for the full cost report year that will determine the final calculation of the incentive payment is known at that time. | |||||||||||||||||||||||||
Medicare EHR incentive calculations and related initial payment amounts are based upon the most current filed cost report information available at the time our eligible hospitals demonstrate meaningful use of certified EHR technology for the applicable period. However, unlike Medicaid, this initial payment amount will be adjusted based upon an updated calculation using the annual cost report information for the cost report period that began during the applicable payment year. Thus, incentive income recognition occurs at the point our eligible hospitals demonstrate 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 $216 million ($183 million Medicare and $33 million Medicaid), $336 million ($252 million Medicare and $84 million Medicaid) and $210 million ($123 million Medicare and $87 million Medicaid) of electronic health record incentive income during the years ended December 31, 2013, 2012 and 2011, respectively. At December 31, 2013 and 2012, we had $78 million and $113 million, respectively, of deferred EHR incentive income, which represent initial incentive payments received for which EHR incentive income has not been recognized. | |||||||||||||||||||||||||
Noncontrolling Interests in Consolidated Entities | ' | ||||||||||||||||||||||||
Noncontrolling Interests in Consolidated Entities | |||||||||||||||||||||||||
The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities. | |||||||||||||||||||||||||
Related Party Transactions - Management Agreement | ' | ||||||||||||||||||||||||
Related Party Transactions — Management Agreement | |||||||||||||||||||||||||
The Investors provided management and advisory services to the Company pursuant to a management agreement among HCA Inc. and the Investors executed in connection with the Investors’ acquisition of HCA Inc. in November 2006. The management agreement was terminated pursuant to its terms upon completion of the initial public offering of our common stock during March 2011, and the Company paid the Investors a final fee of $181 million. The management agreement also provided that the Company pay a 1% fee in connection with certain financing, acquisition, divestiture and change of control transactions. The Company paid the Investors a fee of $26 million related to the initial public offering of our common stock, and this fee was recorded as a cost of the stock offering. | |||||||||||||||||||||||||
Reclassifications | ' | ||||||||||||||||||||||||
Reclassifications | |||||||||||||||||||||||||
Certain prior year amounts have been reclassified to conform to the 2013 presentation. | |||||||||||||||||||||||||
Fair Value Measurements and Disclosures | ' | ||||||||||||||||||||||||
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 utilizes 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 | ' | ||||||||||||||||||||||||
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 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 | ' | ||||||||||||||||||||||||
Derivative Financial Instruments | |||||||||||||||||||||||||
We have entered into interest rate and cross currency swap agreements to manage our exposure to fluctuations in interest rates and foreign currency risks. 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, foreign exchange rates and implied volatilities. To comply with the provisions of ASC 820, 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 December 31, 2013 and 2012, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives. |
Accounting_Policies_Tables
Accounting Policies (Tables) | 12 Months Ended | ||||||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||||||
Accounting Policies [Abstract] | ' | ||||||||||||||||||||||||
Schedule of Revenues from Third Party Payers and Uninsured | ' | ||||||||||||||||||||||||
Our revenues from third party payers and the uninsured for the years ended December 31, are summarized in the following table (dollars in millions): | |||||||||||||||||||||||||
2013 | Ratio | 2012 | Ratio | 2011 | Ratio | ||||||||||||||||||||
Medicare | $ | 7,951 | 23.3 | % | $ | 8,292 | 25.1 | % | $ | 7,653 | 25.8 | % | |||||||||||||
Managed Medicare | 3,279 | 9.6 | 2,954 | 8.9 | 2,442 | 8.2 | |||||||||||||||||||
Medicaid | 1,480 | 4.3 | 1,464 | 4.4 | 1,845 | 6.2 | |||||||||||||||||||
Managed Medicaid | 1,570 | 4.6 | 1,504 | 4.6 | 1,265 | 4.3 | |||||||||||||||||||
Managed care and other insurers | 18,654 | 54.6 | 17,998 | 54.5 | 15,703 | 52.9 | |||||||||||||||||||
International (managed care and other insurers) | 1,175 | 3.4 | 1,060 | 3.2 | 938 | 3.2 | |||||||||||||||||||
34,109 | 99.8 | 33,272 | 100.7 | 29,846 | 100.6 | ||||||||||||||||||||
Uninsured | 2,677 | 7.8 | 2,580 | 7.8 | 1,846 | 6.2 | |||||||||||||||||||
Other | 1,254 | 3.7 | 931 | 2.8 | 814 | 2.7 | |||||||||||||||||||
Revenues before provision for doubtful accounts | 38,040 | 111.3 | 36,783 | 111.3 | 32,506 | 109.5 | |||||||||||||||||||
Provision for doubtful accounts | (3,858 | ) | (11.3 | ) | (3,770 | ) | (11.3 | ) | (2,824 | ) | (9.5 | ) | |||||||||||||
Revenues | $ | 34,182 | 100 | % | $ | 33,013 | 100 | % | $ | 29,682 | 100 | % | |||||||||||||
Schedule of Revenue Deductions Related to Uninsured Accounts | ' | ||||||||||||||||||||||||
A summary of these amounts for the years ended December 31, follows (dollars in millions): | |||||||||||||||||||||||||
2013 | Ratio | 2012 | Ratio | 2011 | Ratio | ||||||||||||||||||||
Charity care | $ | 3,497 | 22 | % | $ | 3,093 | 22 | % | $ | 2,683 | 24 | % | |||||||||||||
Uninsured discounts | 8,210 | 53 | 6,978 | 51 | 5,707 | 51 | |||||||||||||||||||
Provision for doubtful accounts | 3,858 | 25 | 3,770 | 27 | 2,824 | 25 | |||||||||||||||||||
Total uncompensated care | $ | 15,565 | 100 | % | $ | 13,841 | 100 | % | $ | 11,214 | 100 | % | |||||||||||||
Schedule of Estimated Cost of Uncompensated Care | ' | ||||||||||||||||||||||||
A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions): | |||||||||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||||||||
Gross patient charges | $ | 181,141 | $ | 165,614 | $ | 141,516 | |||||||||||||||||||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | 29,606 | 28,533 | 25,554 | ||||||||||||||||||||||
Cost-to-charges ratio | 16.3 | % | 17.2 | % | 18.1 | % | |||||||||||||||||||
Total uncompensated care | $ | 15,565 | $ | 13,841 | $ | 11,214 | |||||||||||||||||||
Multiply by the cost-to-charges ratio | 16.3 | % | 17.2 | % | 18.1 | % | |||||||||||||||||||
Estimated cost of total uncompensated care | $ | 2,537 | $ | 2,381 | $ | 2,030 | |||||||||||||||||||
ShareBased_Compensation_Tables
Share-Based Compensation (Tables) | 12 Months Ended | ||||||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||||||
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | ' | ||||||||||||||||||||||||
Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models | ' | ||||||||||||||||||||||||
The expected life is an estimate of the number of years a share-based award will be held before it is exercised. | |||||||||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||||||||
Risk-free interest rate | 1.2 | % | 1.18 | % | 0.89 | % | |||||||||||||||||||
Expected volatility | 45 | % | 50 | % | 41 | % | |||||||||||||||||||
Expected life, in years | 6.25 | 6.25 | 5 | ||||||||||||||||||||||
Expected dividend yield | — | — | — | ||||||||||||||||||||||
Schedule of Stock Option Activity | ' | ||||||||||||||||||||||||
Information regarding Time Stock Options and SARs and Performance Stock Options and SARs activity during 2013, 2012 and 2011 is summarized below (share amounts in thousands): | |||||||||||||||||||||||||
Time | Performance | Total | Weighted | Weighted | Aggregate | ||||||||||||||||||||
Stock | Stock | Stock | Average | Average | Intrinsic Value | ||||||||||||||||||||
Options | Options and | Options | Exercise | Remaining | (dollars in millions) | ||||||||||||||||||||
and | SARs | and | Price | Contractual Term | |||||||||||||||||||||
SARs | SARs | ||||||||||||||||||||||||
Options outstanding, December 31, 2010 | 24,517 | 26,009 | 50,526 | $ | 8.58 | ||||||||||||||||||||
Granted | 644 | 644 | 1,288 | 23.35 | |||||||||||||||||||||
Exercised | (3,312 | ) | (1,732 | ) | (5,044 | ) | 6.31 | ||||||||||||||||||
Cancelled | (110 | ) | (348 | ) | (458 | ) | 5.88 | ||||||||||||||||||
Options outstanding, December 31, 2011 | 21,739 | 24,573 | 46,312 | 9.26 | |||||||||||||||||||||
Granted | 3,174 | 3,174 | 6,348 | 27.03 | |||||||||||||||||||||
Exercised | (5,530 | ) | (5,128 | ) | (10,658 | ) | 7.6 | ||||||||||||||||||
Cancelled | (192 | ) | (568 | ) | (760 | ) | 9.49 | ||||||||||||||||||
Options and SARs outstanding, December 31, 2012 | 19,191 | 22,051 | 41,242 | 11.56 | |||||||||||||||||||||
Granted | 2,432 | 2,432 | 4,864 | 37.49 | |||||||||||||||||||||
Exercised | (4,498 | ) | (5,843 | ) | (10,341 | ) | 8.49 | ||||||||||||||||||
Cancelled | (316 | ) | (263 | ) | (579 | ) | 25.5 | ||||||||||||||||||
Options and SARs outstanding, December 31, 2013 | 16,809 | 18,377 | 35,186 | 15.82 | 5.4 years | $ | 1,122 | ||||||||||||||||||
Options and SARs exercisable, December 31, 2013 | 11,960 | 13,527 | 25,487 | $ | 10.55 | 4.1 years | $ | 947 | |||||||||||||||||
Schedule of Restricted Stock Units Activity | ' | ||||||||||||||||||||||||
Information regarding Time RSUs and Performance RSUs activity during 2013, 2012 and 2011 is summarized below (share amounts in thousands): | |||||||||||||||||||||||||
Time RSUs | Performance | Total RSUs | Weighted | ||||||||||||||||||||||
RSUs | Average | ||||||||||||||||||||||||
Grant | |||||||||||||||||||||||||
Date Fair | |||||||||||||||||||||||||
Value | |||||||||||||||||||||||||
RSUs outstanding, December 31, 2010 | — | — | — | — | |||||||||||||||||||||
Granted | 80 | — | 80 | $ | 30 | ||||||||||||||||||||
Vested | — | — | — | — | |||||||||||||||||||||
Cancelled | — | — | — | — | |||||||||||||||||||||
RSUs outstanding, December 31, 2011 | 80 | — | 80 | 30 | |||||||||||||||||||||
Granted | 3,162 | 1,485 | 4,647 | 26.98 | |||||||||||||||||||||
Vested | (4 | ) | — | (4 | ) | 30 | |||||||||||||||||||
Cancelled | (164 | ) | (75 | ) | (239 | ) | 26.99 | ||||||||||||||||||
RSUs outstanding, December 31, 2012 | 3,074 | 1,410 | 4,484 | 27.03 | |||||||||||||||||||||
Granted | 3,305 | 1,554 | 4,859 | 37.43 | |||||||||||||||||||||
Vested | (831 | ) | (352 | ) | (1,183 | ) | 27.3 | ||||||||||||||||||
Cancelled | (449 | ) | (213 | ) | (662 | ) | 31.91 | ||||||||||||||||||
RSUs outstanding, December 31, 2013 | 5,099 | 2,399 | 7,498 | 33.3 | |||||||||||||||||||||
Acquisitions_and_Dispositions_
Acquisitions and Dispositions (Tables) | 12 Months Ended | ||||
Dec. 31, 2013 | |||||
Business Combinations [Abstract] | ' | ||||
Schedule of Allocation of Purchase Price, Including Assumed Liabilities | ' | ||||
A summary of the final purchase price allocation, including assumed liabilities, follows (dollars in millions): | |||||
Current assets | $ | 400 | |||
Property and equipment | 1,014 | ||||
Identifiable intangible asset (trade name) | 269 | ||||
Goodwill | 2,317 | ||||
Other assets | 7 | ||||
Liabilities | 152 | ||||
Noncontrolling interests | 123 | ||||
Schedule of Pro Forma Summary of Operations | ' | ||||
The following unaudited pro forma combined summary of operations data gives effect to including the acquired HealthONE operating results in our operating results as if the acquisition had occurred as of January 1, 2011 (dollars in millions): | |||||
Year Ended | |||||
December 31, | |||||
2011 | |||||
Pro forma revenues | $ | 31,383 | |||
Pro forma net income attributable to HCA Holdings, Inc. | 2,507 |
Income_Taxes_Tables
Income Taxes (Tables) | 12 Months Ended | ||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||
Income Tax Disclosure [Abstract] | ' | ||||||||||||||||
Schedule of Provision for Income Taxes | ' | ||||||||||||||||
The provision for income taxes consists of the following (dollars in millions): | |||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||
Current: | |||||||||||||||||
Federal | $ | 827 | $ | 604 | $ | (119 | ) | ||||||||||
State | 86 | 58 | (12 | ) | |||||||||||||
Foreign | 44 | 43 | 44 | ||||||||||||||
Deferred: | |||||||||||||||||
Federal | (53 | ) | 167 | 714 | |||||||||||||
State | 20 | (8 | ) | 71 | |||||||||||||
Foreign | 26 | 24 | 21 | ||||||||||||||
$ | 950 | $ | 888 | $ | 719 | ||||||||||||
Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate | ' | ||||||||||||||||
A reconciliation of the federal statutory rate to the effective income tax rate follows: | |||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||
Federal statutory rate | 35 | % | 35 | % | 35 | % | |||||||||||
State income taxes, net of federal tax benefit | 2.3 | 2.2 | 2 | ||||||||||||||
Change in liability for uncertain tax positions | 0.5 | — | 1 | ||||||||||||||
Nontaxable gain on acquisition of controlling interest in equity investment | — | — | (13.8 | ) | |||||||||||||
Tax exempt interest income | (0.2 | ) | (0.2 | ) | (0.2 | ) | |||||||||||
Other items, net | 0.3 | (1.4 | ) | (1.4 | ) | ||||||||||||
Effective income tax rate on income applicable to HCA Holdings, Inc. | 37.9 | 35.6 | 22.6 | ||||||||||||||
Income attributable to noncontrolling interests from consolidated partnerships | (5.7 | ) | (4.9 | ) | (2.4 | ) | |||||||||||
Effective income tax rate on income before income taxes | 32.2 | % | 30.7 | % | 20.2 | % | |||||||||||
Schedule of Deferred Tax Assets and Liabilities | ' | ||||||||||||||||
A summary of the items comprising the deferred tax assets and liabilities at December 31 follows (dollars in millions): | |||||||||||||||||
2013 | 2012 | ||||||||||||||||
Assets | Liabilities | Assets | Liabilities | ||||||||||||||
Depreciation and fixed asset basis differences | $ | — | $ | 229 | $ | — | $ | 292 | |||||||||
Allowances for professional liability and other risks | 365 | — | 355 | — | |||||||||||||
Accounts receivable | 423 | — | 405 | — | |||||||||||||
Compensation | 240 | — | 237 | — | |||||||||||||
Other | 638 | 698 | 744 | 595 | |||||||||||||
$ | 1,666 | $ | 927 | $ | 1,741 | $ | 887 | ||||||||||
Schedule of Activity Related to Unrecognized Tax Benefits | ' | ||||||||||||||||
The following table summarizes the activity related to our unrecognized tax benefits (dollars in millions): | |||||||||||||||||
2013 | 2012 | ||||||||||||||||
Balance at January 1 | $ | 425 | $ | 445 | |||||||||||||
Additions based on tax positions related to the current year | 21 | 16 | |||||||||||||||
Additions for tax positions of prior years | 25 | 92 | |||||||||||||||
Reductions for tax positions of prior years | (18 | ) | (19 | ) | |||||||||||||
Settlements | (5 | ) | (103 | ) | |||||||||||||
Lapse of applicable statutes of limitations | (3 | ) | (6 | ) | |||||||||||||
Balance at December 31 | $ | 445 | $ | 425 | |||||||||||||
Earnings_Per_Share_Tables
Earnings Per Share (Tables) | 12 Months Ended | ||||||||||||
Dec. 31, 2013 | |||||||||||||
Earnings Per Share [Abstract] | ' | ||||||||||||
Schedule of Computations of Basic and Diluted Earnings Per Share | ' | ||||||||||||
The following table sets forth the computations of basic and diluted earnings per share for the years ended December 31, 2013, 2012 and 2011 (dollars in millions, except per share amounts, and shares in thousands): | |||||||||||||
2013 | 2012 | 2011 | |||||||||||
Net income attributable to HCA Holdings, Inc | $ | 1,556 | $ | 1,605 | $ | 2,465 | |||||||
Weighted average common shares outstanding | 445,066 | 440,178 | 476,609 | ||||||||||
Effect of dilutive incremental shares | 16,847 | 19,225 | 19,334 | ||||||||||
Shares used for diluted earnings per share | 461,913 | 459,403 | 495,943 | ||||||||||
Earnings per share: | |||||||||||||
Basic earnings per share | $ | 3.5 | $ | 3.65 | $ | 5.17 | |||||||
Diluted earnings per share | $ | 3.37 | $ | 3.49 | $ | 4.97 |
Investments_of_Insurance_Subsi1
Investments of Insurance Subsidiaries (Tables) | 12 Months Ended | ||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||
Investments Debt And Equity Securities [Abstract] | ' | ||||||||||||||||
Schedule of Investments | ' | ||||||||||||||||
A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions): | |||||||||||||||||
2013 | |||||||||||||||||
Amortized | Unrealized | Fair | |||||||||||||||
Cost | Amounts | Value | |||||||||||||||
Gains | Losses | ||||||||||||||||
Debt securities: | |||||||||||||||||
States and municipalities | $ | 385 | $ | 11 | $ | (3 | ) | $ | 393 | ||||||||
Auction rate securities | 7 | — | — | 7 | |||||||||||||
Asset-backed securities | 12 | — | — | 12 | |||||||||||||
Money market funds | 94 | — | — | 94 | |||||||||||||
498 | 11 | (3 | ) | 506 | |||||||||||||
Equity securities | 2 | 2 | — | 4 | |||||||||||||
$ | 500 | $ | 13 | $ | (3 | ) | 510 | ||||||||||
Amounts classified as current assets | (62 | ) | |||||||||||||||
Investment carrying value | $ | 448 | |||||||||||||||
2012 | |||||||||||||||||
Amortized | Unrealized | Fair | |||||||||||||||
Cost | Amounts | Value | |||||||||||||||
Gains | Losses | ||||||||||||||||
Debt securities: | |||||||||||||||||
States and municipalities | $ | 395 | $ | 23 | $ | — | $ | 418 | |||||||||
Auction rate securities | 74 | — | (6 | ) | 68 | ||||||||||||
Asset-backed securities | 14 | — | — | 14 | |||||||||||||
Money market funds | 67 | — | — | 67 | |||||||||||||
550 | 23 | (6 | ) | 567 | |||||||||||||
Equity securities | 2 | 1 | — | 3 | |||||||||||||
$ | 552 | $ | 24 | $ | (6 | ) | 570 | ||||||||||
Amounts classified as current assets | (55 | ) | |||||||||||||||
Investment carrying value | $ | 515 | |||||||||||||||
Schedule of Maturities of Investments | ' | ||||||||||||||||
Scheduled maturities of investments in debt securities at December 31, 2013 were as follows (dollars in millions): | |||||||||||||||||
Amortized | Fair | ||||||||||||||||
Cost | Value | ||||||||||||||||
Due in one year or less | $ | 110 | $ | 110 | |||||||||||||
Due after one year through five years | 180 | 186 | |||||||||||||||
Due after five years through ten years | 100 | 102 | |||||||||||||||
Due after ten years | 89 | 89 | |||||||||||||||
479 | 487 | ||||||||||||||||
Auction rate securities | 7 | 7 | |||||||||||||||
Asset-backed securities | 12 | 12 | |||||||||||||||
$ | 498 | $ | 506 | ||||||||||||||
Financial_Instruments_Tables
Financial Instruments (Tables) | 12 Months Ended | ||||||||||||
Dec. 31, 2013 | |||||||||||||
Derivative Instruments And Hedging Activities Disclosure [Abstract] | ' | ||||||||||||
Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges | ' | ||||||||||||
The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at December 31, 2013 (dollars in millions): | |||||||||||||
Notional | Maturity Date | Fair | |||||||||||
Amount | Value | ||||||||||||
Pay-fixed interest rate swaps | $ | 500 | December 2014 | $ | (5 | ) | |||||||
Pay-fixed interest rate swaps | 3,000 | December 2016 | (248 | ) | |||||||||
Pay-fixed interest rate swaps | 1,000 | December 2017 | (42 | ) | |||||||||
Effect of Interest Rate on Results of Operations | ' | ||||||||||||
The following tables present the effect of our interest rate and cross currency swaps on our results of operations for the year ended December 31, 2013 (dollars in millions): | |||||||||||||
Derivatives in Cash Flow Hedging Relationships | Amount of Gain | Location of Loss | Amount of Loss | ||||||||||
Recognized in OCI on | Reclassified from | Reclassified from | |||||||||||
Derivatives, Net of Tax | Accumulated OCI | Accumulated OCI | |||||||||||
into Operations | into Operations | ||||||||||||
Interest rate swaps | $ | 2 | Interest expense | $ | 131 | ||||||||
Effect of Interest Cross Currency Swaps on Results of Operations | ' | ||||||||||||
The following tables present the effect of our interest rate and cross currency swaps on our results of operations for the year ended December 31, 2013 (dollars in millions): | |||||||||||||
Derivatives Not Designated as Hedging Instruments | Location of Gain | Amount of Gain | |||||||||||
Recognized in | Recognized in | ||||||||||||
Operations on | Operations on | ||||||||||||
Derivatives | Derivatives | ||||||||||||
Cross currency swap (matured November 2013) | Other operating expenses | $ | 13 |
Assets_and_Liabilities_Measure1
Assets and Liabilities Measured at Fair Value (Tables) | 12 Months Ended | ||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||
Fair Value Disclosures [Abstract] | ' | ||||||||||||||||
Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis | ' | ||||||||||||||||
The following table summarizes our assets and liabilities measured at fair value on a recurring basis as of December 31, 2013 and 2012, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): | |||||||||||||||||
December 31, 2013 | |||||||||||||||||
Fair Value | Fair Value Measurements Using | ||||||||||||||||
Quoted Prices in | Significant Other | Significant | |||||||||||||||
Active Markets for | Observable Inputs | Unobservable Inputs | |||||||||||||||
Identical Assets | (Level 2) | (Level 3) | |||||||||||||||
and Liabilities | |||||||||||||||||
(Level 1) | |||||||||||||||||
Assets: | |||||||||||||||||
Investments of insurance subsidiaries: | |||||||||||||||||
Debt securities: | |||||||||||||||||
States and municipalities | $ | 393 | $ | — | $ | 393 | $ | — | |||||||||
Auction rate securities | 7 | — | — | 7 | |||||||||||||
Asset-backed securities | 12 | — | 12 | — | |||||||||||||
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 | $ | — | |||||||||
December 31, 2012 | |||||||||||||||||
Fair Value Measurements Using | |||||||||||||||||
Fair Value | Quoted Prices in | Significant Other | Significant | ||||||||||||||
Active Markets for | Observable Inputs | Unobservable Inputs | |||||||||||||||
Identical Assets | (Level 2) | (Level 3) | |||||||||||||||
and Liabilities | |||||||||||||||||
(Level 1) | |||||||||||||||||
Assets: | |||||||||||||||||
Investments of insurance subsidiaries: | |||||||||||||||||
Debt securities: | |||||||||||||||||
States and municipalities | $ | 418 | $ | — | $ | 418 | $ | — | |||||||||
Auction rate securities | 68 | — | — | 68 | |||||||||||||
Asset-backed securities | 14 | — | 14 | — | |||||||||||||
Money market funds | 67 | 67 | — | — | |||||||||||||
567 | 67 | 432 | 68 | ||||||||||||||
Equity securities | 3 | 1 | — | 2 | |||||||||||||
Investments of insurance subsidiaries | 570 | 68 | 432 | 70 | |||||||||||||
Less amounts classified as current assets | (55 | ) | (55 | ) | — | — | |||||||||||
$ | 515 | $ | 13 | $ | 432 | $ | 70 | ||||||||||
Liabilities: | |||||||||||||||||
Cross currency swap (Income taxes and other liabilities) | $ | 13 | $ | — | $ | 13 | $ | — | |||||||||
Interest rate swaps (Income taxes and other liabilities) | 429 | — | 429 | — | |||||||||||||
Schedule Related to Auction Rate and Equity Securities Investments of Insurance Subsidiaries at Fair Value | ' | ||||||||||||||||
The following table summarizes the activity related to the auction rate and equity securities investments of our insurance subsidiaries which have fair value measurements based on significant unobservable inputs (Level 3) during the year ended December 31, 2013 (dollars in millions): | |||||||||||||||||
Asset balances at December 31, 2012 | $ | 70 | |||||||||||||||
Unrealized gains included in other comprehensive income | 6 | ||||||||||||||||
Settlements | (68 | ) | |||||||||||||||
Asset balances at December 31, 2013 | $ | 8 | |||||||||||||||
LongTerm_Debt_Tables
Long-Term Debt (Tables) | 12 Months Ended | ||||||||
Dec. 31, 2013 | |||||||||
Debt Disclosure [Abstract] | ' | ||||||||
Schedule of Long-Term Debt | ' | ||||||||
A summary of long-term debt at December 31, including related interest rates at December 31, 2013, follows (dollars in millions): | |||||||||
2013 | 2012 | ||||||||
Senior secured asset-based revolving credit facility (effective interest rate of 1.7%) | $ | 2,440 | $ | 1,470 | |||||
Senior secured revolving credit facility | — | — | |||||||
Senior secured term loan facilities (effective interest rate of 5.3%) | 5,598 | 5,958 | |||||||
Senior secured first lien notes (effective interest rate of 7.1%) | 9,695 | 9,688 | |||||||
Other senior secured debt (effective interest rate of 6.8%) | 448 | 423 | |||||||
First lien debt | 18,181 | 17,539 | |||||||
Senior secured second lien notes | — | 197 | |||||||
Senior unsecured notes (effective interest rate of 7.2%) | 10,195 | 11,194 | |||||||
Total debt (average life of 6.3 years, rates averaging 6.3%) | 28,376 | 28,930 | |||||||
Less amounts due within one year | 786 | 1,435 | |||||||
$ | 27,590 | $ | 27,495 | ||||||
Leases_Tables
Leases (Tables) | 12 Months Ended | ||||
Dec. 31, 2013 | |||||
Leases [Abstract] | ' | ||||
Schedule of Commitments Relating to Noncancellable Operating Leases | ' | ||||
Commitments relating to noncancellable operating leases for each of the next five years and thereafter are as follows (dollars in millions): | |||||
For the Year Ended December 31, | |||||
2014 | $ | 293 | |||
2015 | 267 | ||||
2016 | 215 | ||||
2017 | 175 | ||||
2018 | 132 | ||||
Thereafter | 740 | ||||
1,822 | |||||
Less sublease income | (30 | ) | |||
$ | 1,792 | ||||
Segment_and_Geographic_Informa1
Segment and Geographic Information (Tables) | 12 Months Ended | ||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||
Segment Reporting [Abstract] | ' | ||||||||||||||||
Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization and Assets | ' | ||||||||||||||||
The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions): | |||||||||||||||||
For the Years Ended December 31, | |||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||
Revenues: | |||||||||||||||||
National Group | $ | 15,968 | $ | 15,505 | $ | 14,741 | |||||||||||
American Group | 16,487 | 16,115 | 13,714 | ||||||||||||||
Corporate and other | 1,727 | 1,393 | 1,227 | ||||||||||||||
$ | 34,182 | $ | 33,013 | $ | 29,682 | ||||||||||||
Equity in earnings of affiliates: | |||||||||||||||||
National Group | $ | (9 | ) | $ | (9 | ) | $ | (7 | ) | ||||||||
American Group | (24 | ) | (28 | ) | (251 | ) | |||||||||||
Corporate and other | 4 | 1 | — | ||||||||||||||
$ | (29 | ) | $ | (36 | ) | $ | (258 | ) | |||||||||
Adjusted segment EBITDA: | |||||||||||||||||
National Group | $ | 3,301 | $ | 3,325 | $ | 3,052 | |||||||||||
American Group | 3,662 | 3,575 | 3,141 | ||||||||||||||
Corporate and other | (389 | ) | (369 | ) | (132 | ) | |||||||||||
$ | 6,574 | $ | 6,531 | $ | 6,061 | ||||||||||||
Depreciation and amortization: | |||||||||||||||||
National Group | $ | 718 | $ | 694 | $ | 639 | |||||||||||
American Group | 835 | 816 | 680 | ||||||||||||||
Corporate and other | 200 | 169 | 146 | ||||||||||||||
$ | 1,753 | $ | 1,679 | $ | 1,465 | ||||||||||||
For the Years Ended December 31, | |||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||
Adjusted segment EBITDA | $ | 6,574 | $ | 6,531 | $ | 6,061 | |||||||||||
Depreciation and amortization | 1,753 | 1,679 | 1,465 | ||||||||||||||
Interest expense | 1,848 | 1,798 | 2,037 | ||||||||||||||
Losses (gains) on sales of facilities | 10 | (15 | ) | (142 | ) | ||||||||||||
Losses on retirement of debt | 17 | — | 481 | ||||||||||||||
Legal claim costs | — | 175 | — | ||||||||||||||
Gain on acquisition of controlling interest in equity investment | — | — | (1,522 | ) | |||||||||||||
Termination of management agreement | — | — | 181 | ||||||||||||||
Income before income taxes | $ | 2,946 | $ | 2,894 | $ | 3,561 | |||||||||||
As of December 31, | |||||||||||||||||
2013 | 2012 | ||||||||||||||||
Assets: | |||||||||||||||||
National Group | $ | 10,206 | $ | 9,451 | |||||||||||||
American Group | 13,911 | 13,744 | |||||||||||||||
Corporate and other | 4,714 | 4,880 | |||||||||||||||
$ | 28,831 | $ | 28,075 | ||||||||||||||
National | American | Corporate | Total | ||||||||||||||
Group | Group | and Other | |||||||||||||||
Goodwill and other intangible assets: | |||||||||||||||||
Balance at December 31, 2012 | $ | 1,035 | $ | 4,189 | $ | 315 | $ | 5,539 | |||||||||
Acquisitions | 68 | 13 | 297 | 378 | |||||||||||||
Dispositions | — | (1 | ) | — | (1 | ) | |||||||||||
Foreign currency translation and other | 1 | (11 | ) | (3 | ) | (13 | ) | ||||||||||
Balance at December 31, 2013 | $ | 1,104 | $ | 4,190 | $ | 609 | $ | 5,903 | |||||||||
Other_Comprehensive_Loss_Table
Other Comprehensive Loss (Tables) | 12 Months Ended | ||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||
Equity [Abstract] | ' | ||||||||||||||||||||
Components of Accumulated Other Comprehensive Loss | ' | ||||||||||||||||||||
The components of accumulated other comprehensive loss are as follows (dollars in millions): | |||||||||||||||||||||
Unrealized | Foreign | Defined | Change | Total | |||||||||||||||||
Gains on | Currency | Benefit | in Fair | ||||||||||||||||||
Available- | Translation | Plans | Value of | ||||||||||||||||||
for-Sale | Adjustments | Derivative | |||||||||||||||||||
Securities | Instruments | ||||||||||||||||||||
Balances at December 31, 2010 | $ | 6 | $ | (19 | ) | $ | (143 | ) | $ | (272 | ) | $ | (428 | ) | |||||||
Unrealized gains on available-for-sale securities, net of $1 of income taxes | 1 | — | — | — | 1 | ||||||||||||||||
Foreign currency translation adjustments, net of $3 income tax benefit | — | (6 | ) | — | — | (6 | ) | ||||||||||||||
Defined benefit plans, net of $25 income tax benefit | — | — | (42 | ) | — | (42 | ) | ||||||||||||||
Change in fair value of derivative instruments, net of $114 income tax benefit | — | — | — | (197 | ) | (197 | ) | ||||||||||||||
Expense reclassified into operations from other comprehensive income, net of $9 and $125, respectively, income tax benefits | — | — | 16 | 216 | 232 | ||||||||||||||||
Balances at December 31, 2011 | 7 | (25 | ) | (169 | ) | (253 | ) | (440 | ) | ||||||||||||
Unrealized gains on available-for-sale securities, net of $2 of income taxes | 4 | — | — | — | 4 | ||||||||||||||||
Foreign currency translation adjustments, net of $13 of income taxes | — | 24 | — | — | 24 | ||||||||||||||||
Defined benefit plans, net of $33 income tax benefit | — | — | (56 | ) | — | (56 | ) | ||||||||||||||
Change in fair value of derivative instruments, net of $55 income tax benefit | — | — | — | (96 | ) | (96 | ) | ||||||||||||||
Expense reclassified into operations from other comprehensive income, net of $17 and $44, respectively, income tax benefits | — | — | 29 | 78 | 107 | ||||||||||||||||
Balances at December 31, 2012 | 11 | (1 | ) | (196 | ) | (271 | ) | (457 | ) | ||||||||||||
Unrealized losses on available-for-sale securities, net of $3 income tax benefit | (4 | ) | — | — | — | (4 | ) | ||||||||||||||
Foreign currency translation adjustments, net of $6 of income taxes | — | 12 | — | — | 12 | ||||||||||||||||
Defined benefit plans, net of $50 of income taxes | — | — | 84 | — | 84 | ||||||||||||||||
Change in fair value of derivative instruments, net of $1 of income taxes | — | — | — | 2 | 2 | ||||||||||||||||
Expense reclassified into operations from other comprehensive income, net of $14 and $49, respectively, income tax benefits | — | — | 24 | 82 | 106 | ||||||||||||||||
Balances at December 31, 2013 | $ | 7 | $ | 11 | $ | (88 | ) | $ | (187 | ) | $ | (257 | ) | ||||||||
Accrued_Expenses_and_Allowance1
Accrued Expenses and Allowance for Doubtful Accounts (Tables) | 12 Months Ended | ||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||
Text Block [Abstract] | ' | ||||||||||||||||
Summary of Other Accrued Expenses | ' | ||||||||||||||||
A summary of other accrued expenses at December 31 follows (dollars in millions): | |||||||||||||||||
2013 | 2012 | ||||||||||||||||
Professional liability risks | $ | 331 | $ | 324 | |||||||||||||
Interest | 392 | 409 | |||||||||||||||
Taxes other than income | 252 | 235 | |||||||||||||||
Legal claim costs | 189 | 175 | |||||||||||||||
Other | 749 | 706 | |||||||||||||||
$ | 1,913 | $ | 1,849 | ||||||||||||||
Summary of Allowance of Doubtful Accounts | ' | ||||||||||||||||
A summary of activity for the allowance of doubtful accounts follows (dollars in millions): | |||||||||||||||||
Balance | Provision | Accounts | Balance | ||||||||||||||
at | for | Written | at End | ||||||||||||||
Beginning | Doubtful | off, | of Year | ||||||||||||||
of Year | Accounts | Net of | |||||||||||||||
Recoveries | |||||||||||||||||
Allowance for doubtful accounts: | |||||||||||||||||
Year ended December 31, 2011 | $ | 3,939 | $ | 2,824 | $ | (2,657 | ) | $ | 4,106 | ||||||||
Year ended December 31, 2012 | 4,106 | 3,770 | (3,030 | ) | 4,846 | ||||||||||||
Year ended December 31, 2013 | 4,846 | 3,858 | (3,216 | ) | 5,488 |
Supplemental_Condensed_Consoli1
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information (Tables) | 12 Months Ended | ||||||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||||||
Text Block [Abstract] | ' | ||||||||||||||||||||||||
Schedule of Condensed Consolidating Comprehensive Income Statement | ' | ||||||||||||||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT | |||||||||||||||||||||||||
FOR THE YEAR ENDED DECEMBER 31, 2013 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Revenues before provision for doubtful accounts | $ | — | $ | — | $ | 20,042 | $ | 17,998 | $ | — | $ | 38,040 | |||||||||||||
Provision for doubtful accounts | — | — | 2,262 | 1,596 | — | 3,858 | |||||||||||||||||||
Revenues | — | — | 17,780 | 16,402 | — | 34,182 | |||||||||||||||||||
Salaries and benefits | — | — | 8,387 | 7,259 | — | 15,646 | |||||||||||||||||||
Supplies | — | — | 3,158 | 2,812 | — | 5,970 | |||||||||||||||||||
Other operating expenses | 8 | (2 | ) | 2,998 | 3,233 | — | 6,237 | ||||||||||||||||||
Electronic health record incentive income | — | — | (142 | ) | (74 | ) | — | (216 | ) | ||||||||||||||||
Equity in earnings of affiliates | (1,875 | ) | — | (2 | ) | (27 | ) | 1,875 | (29 | ) | |||||||||||||||
Depreciation and amortization | — | — | 855 | 898 | — | 1,753 | |||||||||||||||||||
Interest expense | 184 | 2,253 | (523 | ) | (66 | ) | — | 1,848 | |||||||||||||||||
Losses (gains) on sales of facilities | — | — | 20 | (10 | ) | — | 10 | ||||||||||||||||||
Loss on retirement of debt | — | 17 | — | — | — | 17 | |||||||||||||||||||
Management fees | — | — | (632 | ) | 632 | — | — | ||||||||||||||||||
(1,683 | ) | 2,268 | 14,119 | 14,657 | 1,875 | 31,236 | |||||||||||||||||||
Income (loss) before income taxes | 1,683 | (2,268 | ) | 3,661 | 1,745 | (1,875 | ) | 2,946 | |||||||||||||||||
Provision (benefit) for income taxes | (73 | ) | (860 | ) | 1,362 | 521 | — | 950 | |||||||||||||||||
Net income (loss) | 1,756 | (1,408 | ) | 2,299 | 1,224 | (1,875 | ) | 1,996 | |||||||||||||||||
Net income attributable to noncontrolling interests | — | — | 69 | 371 | — | 440 | |||||||||||||||||||
Net income (loss) attributable to HCA Holdings, Inc. | $ | 1,756 | $ | (1,408 | ) | $ | 2,230 | $ | 853 | $ | (1,875 | ) | $ | 1,556 | |||||||||||
Comprehensive income (loss) attributable to HCA Holdings, Inc. | $ | 1,756 | $ | (1,324 | ) | $ | 2,338 | $ | 861 | $ | (1,875 | ) | $ | 1,756 | |||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT | |||||||||||||||||||||||||
FOR THE YEAR ENDED DECEMBER 31, 2012 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Revenues before provision for doubtful accounts | $ | — | $ | — | $ | 19,415 | $ | 17,368 | $ | — | $ | 36,783 | |||||||||||||
Provision for doubtful accounts | — | — | 2,144 | 1,626 | — | 3,770 | |||||||||||||||||||
Revenues | — | — | 17,271 | 15,742 | — | 33,013 | |||||||||||||||||||
Salaries and benefits | — | — | 7,959 | 7,130 | — | 15,089 | |||||||||||||||||||
Supplies | — | — | 2,995 | 2,722 | — | 5,717 | |||||||||||||||||||
Other operating expenses | 3 | 5 | 3,013 | 3,027 | — | 6,048 | |||||||||||||||||||
Electronic health record incentive income | — | — | (219 | ) | (117 | ) | — | (336 | ) | ||||||||||||||||
Equity in earnings of affiliates | (1,668 | ) | — | (5 | ) | (31 | ) | 1,668 | (36 | ) | |||||||||||||||
Depreciation and amortization | — | — | 821 | 858 | — | 1,679 | |||||||||||||||||||
Interest expense | 123 | 2,167 | (468 | ) | (24 | ) | — | 1,798 | |||||||||||||||||
Losses (gains) on sales of facilities | — | — | 3 | (18 | ) | — | (15 | ) | |||||||||||||||||
Legal claim costs | — | 175 | — | — | — | 175 | |||||||||||||||||||
Management fees | — | — | (569 | ) | 569 | — | — | ||||||||||||||||||
(1,542 | ) | 2,347 | 13,530 | 14,116 | 1,668 | 30,119 | |||||||||||||||||||
Income (loss) before income taxes | 1,542 | (2,347 | ) | 3,741 | 1,626 | (1,668 | ) | 2,894 | |||||||||||||||||
Provision (benefit) for income taxes | (46 | ) | (839 | ) | 1,313 | 460 | — | 888 | |||||||||||||||||
Net income (loss) | 1,588 | (1,508 | ) | 2,428 | 1,166 | (1,668 | ) | 2,006 | |||||||||||||||||
Net income attributable to noncontrolling interests | — | — | 62 | 339 | — | 401 | |||||||||||||||||||
Net income (loss) attributable to HCA Holdings, Inc. | $ | 1,588 | $ | (1,508 | ) | $ | 2,366 | $ | 827 | $ | (1,668 | ) | $ | 1,605 | |||||||||||
Comprehensive income (loss) attributable to HCA Holdings, Inc. | $ | 1,588 | $ | (1,526 | ) | $ | 2,339 | $ | 855 | $ | (1,668 | ) | $ | 1,588 | |||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT | |||||||||||||||||||||||||
FOR THE YEAR ENDED DECEMBER 31, 2011 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Revenues before provision for doubtful accounts | $ | — | $ | — | $ | 18,126 | $ | 14,380 | $ | — | $ | 32,506 | |||||||||||||
Provision for doubtful accounts | — | — | 1,644 | 1,180 | — | 2,824 | |||||||||||||||||||
Revenues | — | — | 16,482 | 13,200 | — | 29,682 | |||||||||||||||||||
Salaries and benefits | — | — | 7,584 | 5,856 | — | 13,440 | |||||||||||||||||||
Supplies | — | — | 2,851 | 2,328 | — | 5,179 | |||||||||||||||||||
Other operating expenses | — | 4 | 2,741 | 2,725 | — | 5,470 | |||||||||||||||||||
Electronic health record incentive income | — | — | (126 | ) | (84 | ) | — | (210 | ) | ||||||||||||||||
Equity in earnings of affiliates | (2,531 | ) | — | (86 | ) | (172 | ) | 2,531 | (258 | ) | |||||||||||||||
Depreciation and amortization | — | — | 777 | 688 | — | 1,465 | |||||||||||||||||||
Interest expense | 120 | 2,390 | (342 | ) | (131 | ) | — | 2,037 | |||||||||||||||||
Gains on sales of facilities | — | — | (127 | ) | (15 | ) | — | (142 | ) | ||||||||||||||||
Gain on acquisition of controlling interest in equity investment | — | — | — | (1,522 | ) | — | (1,522 | ) | |||||||||||||||||
Losses on retirement of debt | — | 481 | — | — | — | 481 | |||||||||||||||||||
Termination of management agreement | — | 181 | — | — | — | 181 | |||||||||||||||||||
Management fees | — | — | (491 | ) | 491 | — | — | ||||||||||||||||||
(2,411 | ) | 3,056 | 12,781 | 10,164 | 2,531 | 26,121 | |||||||||||||||||||
Income (loss) before income taxes | 2,411 | (3,056 | ) | 3,701 | 3,036 | (2,531 | ) | 3,561 | |||||||||||||||||
Provision (benefit) for income taxes | (42 | ) | (1,068 | ) | 1,271 | 558 | — | 719 | |||||||||||||||||
Net income (loss) | 2,453 | (1,988 | ) | 2,430 | 2,478 | (2,531 | ) | 2,842 | |||||||||||||||||
Net income attributable to noncontrolling interests | — | — | 63 | 314 | — | 377 | |||||||||||||||||||
Net income (loss) attributable to HCA Holdings, Inc. | $ | 2,453 | $ | (1,988 | ) | $ | 2,367 | $ | 2,164 | $ | (2,531 | ) | $ | 2,465 | |||||||||||
Comprehensive income (loss) attributable to HCA Holdings, Inc. | $ | 2,453 | $ | (1,969 | ) | $ | 2,341 | $ | 2,159 | $ | (2,531 | ) | $ | 2,453 | |||||||||||
Schedule of Condensed Consolidating Balance Sheet | ' | ||||||||||||||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING BALANCE SHEET | |||||||||||||||||||||||||
31-Dec-13 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
ASSETS | |||||||||||||||||||||||||
Current assets: | |||||||||||||||||||||||||
Cash and cash equivalents | $ | — | $ | — | $ | 112 | $ | 302 | $ | — | $ | 414 | |||||||||||||
Accounts receivable, net | — | — | 2,565 | 2,643 | — | 5,208 | |||||||||||||||||||
Inventories | — | — | 692 | 487 | — | 1,179 | |||||||||||||||||||
Deferred income taxes | 489 | — | — | — | — | 489 | |||||||||||||||||||
Other | — | — | 301 | 446 | — | 747 | |||||||||||||||||||
489 | — | 3,670 | 3,878 | — | 8,037 | ||||||||||||||||||||
Property and equipment, net | — | — | 7,504 | 6,115 | — | 13,619 | |||||||||||||||||||
Investments of insurance subsidiaries | — | — | — | 448 | — | 448 | |||||||||||||||||||
Investments in and advances to affiliates | 20,356 | — | 13 | 108 | (20,356 | ) | 121 | ||||||||||||||||||
Goodwill and other intangible assets | — | — | 1,695 | 4,208 | — | 5,903 | |||||||||||||||||||
Deferred loan costs | 30 | 207 | — | — | — | 237 | |||||||||||||||||||
Other | 250 | — | 48 | 168 | — | 466 | |||||||||||||||||||
$ | 21,125 | $ | 207 | $ | 12,930 | $ | 14,925 | $ | (20,356 | ) | $ | 28,831 | |||||||||||||
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY | |||||||||||||||||||||||||
Current liabilities: | |||||||||||||||||||||||||
Accounts payable | $ | 1 | $ | — | $ | 1,169 | $ | 633 | $ | — | $ | 1,803 | |||||||||||||
Accrued salaries | — | — | 694 | 499 | — | 1,193 | |||||||||||||||||||
Other accrued expenses | 272 | 353 | 464 | 824 | — | 1,913 | |||||||||||||||||||
Long-term debt due within one year | — | 702 | 45 | 39 | — | 786 | |||||||||||||||||||
273 | 1,055 | 2,372 | 1,995 | — | 5,695 | ||||||||||||||||||||
Long-term debt | 2,525 | 24,701 | 181 | 183 | — | 27,590 | |||||||||||||||||||
Intercompany balances | 26,107 | (10,513 | ) | (19,428 | ) | 3,834 | — | — | |||||||||||||||||
Professional liability risks | — | — | — | 949 | — | 949 | |||||||||||||||||||
Income taxes and other liabilities | 490 | 296 | 521 | 218 | — | 1,525 | |||||||||||||||||||
29,395 | 15,539 | (16,354 | ) | 7,179 | — | 35,759 | |||||||||||||||||||
Stockholders’ (deficit) equity attributable to HCA Holdings, Inc. | (8,270 | ) | (15,332 | ) | 29,185 | 6,503 | (20,356 | ) | (8,270 | ) | |||||||||||||||
Noncontrolling interests | — | — | 99 | 1,243 | — | 1,342 | |||||||||||||||||||
(8,270 | ) | (15,332 | ) | 29,284 | 7,746 | (20,356 | ) | (6,928 | ) | ||||||||||||||||
$ | 21,125 | $ | 207 | $ | 12,930 | $ | 14,925 | $ | (20,356 | ) | $ | 28,831 | |||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING BALANCE SHEET | |||||||||||||||||||||||||
31-Dec-12 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
ASSETS | |||||||||||||||||||||||||
Current assets: | |||||||||||||||||||||||||
Cash and cash equivalents | $ | 22 | $ | — | $ | 383 | $ | 300 | $ | — | $ | 705 | |||||||||||||
Accounts receivable, net | — | — | 2,448 | 2,224 | — | 4,672 | |||||||||||||||||||
Inventories | — | — | 629 | 457 | — | 1,086 | |||||||||||||||||||
Deferred income taxes | 385 | — | — | — | — | 385 | |||||||||||||||||||
Other | 122 | — | 342 | 451 | — | 915 | |||||||||||||||||||
529 | — | 3,802 | 3,432 | — | 7,763 | ||||||||||||||||||||
Property and equipment, net | — | — | 7,417 | 5,768 | — | 13,185 | |||||||||||||||||||
Investments of insurance subsidiaries | — | — | — | 515 | — | 515 | |||||||||||||||||||
Investments in and advances to affiliates | 18,481 | — | 16 | 88 | (18,481 | ) | 104 | ||||||||||||||||||
Goodwill and other intangible assets | — | — | 1,697 | 3,842 | — | 5,539 | |||||||||||||||||||
Deferred loan costs | 32 | 258 | — | — | — | 290 | |||||||||||||||||||
Other | 469 | — | 31 | 179 | — | 679 | |||||||||||||||||||
$ | 19,511 | $ | 258 | $ | 12,963 | $ | 13,824 | $ | (18,481 | ) | $ | 28,075 | |||||||||||||
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY | |||||||||||||||||||||||||
Current liabilities: | |||||||||||||||||||||||||
Accounts payable | $ | — | $ | — | $ | 1,203 | $ | 565 | $ | — | $ | 1,768 | |||||||||||||
Accrued salaries | — | — | 638 | 482 | — | 1,120 | |||||||||||||||||||
Other accrued expenses | 30 | 567 | 464 | 788 | — | 1,849 | |||||||||||||||||||
Long-term debt due within one year | — | 1,360 | 39 | 36 | — | 1,435 | |||||||||||||||||||
30 | 1,927 | 2,344 | 1,871 | — | 6,172 | ||||||||||||||||||||
Long-term debt | 2,525 | 24,304 | 173 | 493 | — | 27,495 | |||||||||||||||||||
Intercompany balances | 26,131 | (12,407 | ) | (17,130 | ) | 3,406 | — | — | |||||||||||||||||
Professional liability risks | — | — | — | 973 | — | 973 | |||||||||||||||||||
Income taxes and other liabilities | 485 | 442 | 629 | 220 | — | 1,776 | |||||||||||||||||||
29,171 | 14,266 | (13,984 | ) | 6,963 | — | 36,416 | |||||||||||||||||||
Stockholders’ (deficit) equity attributable to HCA Holdings, Inc. | (9,660 | ) | (14,008 | ) | 26,847 | 5,642 | (18,481 | ) | (9,660 | ) | |||||||||||||||
Noncontrolling interests | — | — | 100 | 1,219 | — | 1,319 | |||||||||||||||||||
(9,660 | ) | (14,008 | ) | 26,947 | 6,861 | (18,481 | ) | (8,341 | ) | ||||||||||||||||
$ | 19,511 | $ | 258 | $ | 12,963 | $ | 13,824 | $ | (18,481 | ) | $ | 28,075 | |||||||||||||
Schedule of Condensed Consolidating Statement of Cash Flows | ' | ||||||||||||||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS | |||||||||||||||||||||||||
FOR THE YEAR ENDED DECEMBER 31, 2013 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Cash flows from operating activities: | |||||||||||||||||||||||||
Net income (loss) | $ | 1,756 | $ | (1,408 | ) | $ | 2,299 | $ | 1,224 | $ | (1,875 | ) | $ | 1,996 | |||||||||||
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||||||||||||||||
Change in operating assets and liabilities | (11 | ) | 17 | (2,320 | ) | (1,958 | ) | — | (4,272 | ) | |||||||||||||||
Provision for doubtful accounts | — | — | 2,262 | 1,596 | — | 3,858 | |||||||||||||||||||
Depreciation and amortization | — | — | 855 | 898 | — | 1,753 | |||||||||||||||||||
Income taxes | 143 | — | — | — | — | 143 | |||||||||||||||||||
Losses (gains) on sales of facilities | — | — | 20 | (10 | ) | — | 10 | ||||||||||||||||||
Loss on retirement of debt | — | 17 | — | — | — | 17 | |||||||||||||||||||
Amortization of deferred loan costs | 3 | 52 | — | — | — | 55 | |||||||||||||||||||
Share-based compensation | 113 | — | — | — | — | 113 | |||||||||||||||||||
Equity in earnings of affiliates | (1,875 | ) | — | — | — | 1,875 | — | ||||||||||||||||||
Other | — | 9 | 2 | (4 | ) | — | 7 | ||||||||||||||||||
Net cash provided by (used in) operating activities | 129 | (1,313 | ) | 3,118 | 1,746 | — | 3,680 | ||||||||||||||||||
Cash flows from investing activities: | |||||||||||||||||||||||||
Purchase of property and equipment | — | — | (921 | ) | (1,022 | ) | — | (1,943 | ) | ||||||||||||||||
Acquisition of hospitals and health care entities | — | — | — | (481 | ) | — | (481 | ) | |||||||||||||||||
Disposal of hospitals and health care entities | — | — | 17 | 16 | — | 33 | |||||||||||||||||||
Change in investments | — | — | (16 | ) | 52 | — | 36 | ||||||||||||||||||
Other | — | — | — | 9 | — | 9 | |||||||||||||||||||
Net cash used in investing activities | — | — | (920 | ) | (1,426 | ) | — | (2,346 | ) | ||||||||||||||||
Cash flows from financing activities: | |||||||||||||||||||||||||
Net change in revolving bank credit facilities | — | 970 | — | — | — | 970 | |||||||||||||||||||
Repayment of long-term debt | — | (1,254 | ) | (34 | ) | (374 | ) | — | (1,662 | ) | |||||||||||||||
Distributions to noncontrolling interests | — | — | (71 | ) | (364 | ) | — | (435 | ) | ||||||||||||||||
Payment of debt issuance costs | — | (5 | ) | — | — | — | (5 | ) | |||||||||||||||||
Repurchase of common stock | (500 | ) | — | — | — | — | (500 | ) | |||||||||||||||||
Distributions to stockholders | (16 | ) | — | — | — | — | (16 | ) | |||||||||||||||||
Income tax benefits | 113 | — | — | — | — | 113 | |||||||||||||||||||
Changes in intercompany balances with affiliates, net | 342 | 1,602 | (2,364 | ) | 420 | — | — | ||||||||||||||||||
Other | (90 | ) | — | — | — | — | (90 | ) | |||||||||||||||||
Net cash (used in) provided by financing activities | (151 | ) | 1,313 | (2,469 | ) | (318 | ) | — | (1,625 | ) | |||||||||||||||
Change in cash and cash equivalents | (22 | ) | — | (271 | ) | 2 | — | (291 | ) | ||||||||||||||||
Cash and cash equivalents at beginning of period | 22 | — | 383 | 300 | — | 705 | |||||||||||||||||||
Cash and cash equivalents at end of period | $ | — | $ | — | $ | 112 | $ | 302 | $ | — | $ | 414 | |||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS | |||||||||||||||||||||||||
FOR THE YEAR ENDED DECEMBER 31, 2012 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Cash flows from operating activities: | |||||||||||||||||||||||||
Net income (loss) | $ | 1,588 | $ | (1,508 | ) | $ | 2,428 | $ | 1,166 | $ | (1,668 | ) | $ | 2,006 | |||||||||||
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||||||||||||||||
Change in operating assets and liabilities | 57 | (28 | ) | (1,927 | ) | (1,765 | ) | — | (3,663 | ) | |||||||||||||||
Provision for doubtful accounts | — | — | 2,144 | 1,626 | — | 3,770 | |||||||||||||||||||
Depreciation and amortization | — | — | 821 | 858 | — | 1,679 | |||||||||||||||||||
Income taxes | 96 | — | — | — | — | 96 | |||||||||||||||||||
Losses (gains) on sales of facilities | — | — | 3 | (18 | ) | — | (15 | ) | |||||||||||||||||
Legal claim costs | — | 175 | — | — | — | 175 | |||||||||||||||||||
Amortization of deferred loan costs | 2 | 60 | — | — | — | 62 | |||||||||||||||||||
Share-based compensation | 56 | — | — | — | — | 56 | |||||||||||||||||||
Equity in earnings of affiliates | (1,668 | ) | — | — | — | 1,668 | — | ||||||||||||||||||
Other | — | 14 | (1 | ) | (4 | ) | — | 9 | |||||||||||||||||
Net cash provided by (used in) operating activities | 131 | (1,287 | ) | 3,468 | 1,863 | — | 4,175 | ||||||||||||||||||
Cash flows from investing activities: | |||||||||||||||||||||||||
Purchase of property and equipment | — | — | (1,039 | ) | (823 | ) | — | (1,862 | ) | ||||||||||||||||
Acquisition of hospitals and health care entities | — | — | (110 | ) | (148 | ) | — | (258 | ) | ||||||||||||||||
Disposal of hospitals and health care entities | — | — | 2 | 28 | — | 30 | |||||||||||||||||||
Change in investments | — | — | (11 | ) | 27 | — | 16 | ||||||||||||||||||
Other | — | — | (2 | ) | 13 | — | 11 | ||||||||||||||||||
Net cash used in investing activities | — | — | (1,160 | ) | (903 | ) | — | (2,063 | ) | ||||||||||||||||
Cash flows from financing activities: | |||||||||||||||||||||||||
Issuances of long-term debt | 1,000 | 3,850 | — | — | — | 4,850 | |||||||||||||||||||
Net change in revolving bank credit facilities | — | (685 | ) | — | — | — | (685 | ) | |||||||||||||||||
Repayment of long-term debt | — | (2,309 | ) | (20 | ) | (112 | ) | — | (2,441 | ) | |||||||||||||||
Distributions to noncontrolling interests | — | — | (60 | ) | (341 | ) | — | (401 | ) | ||||||||||||||||
Payment of debt issuance costs | (12 | ) | (50 | ) | — | — | — | (62 | ) | ||||||||||||||||
Distributions to stockholders | (3,148 | ) | — | — | — | — | (3,148 | ) | |||||||||||||||||
Income tax benefits | 174 | — | — | — | — | 174 | |||||||||||||||||||
Changes in intercompany balances with affiliates, net | 1,938 | 481 | (1,960 | ) | (459 | ) | — | — | |||||||||||||||||
Other | (61 | ) | — | — | (6 | ) | — | (67 | ) | ||||||||||||||||
Net cash (used in) provided by financing activities | (109 | ) | 1,287 | (2,040 | ) | (918 | ) | — | (1,780 | ) | |||||||||||||||
Change in cash and cash equivalents | 22 | — | 268 | 42 | — | 332 | |||||||||||||||||||
Cash and cash equivalents at beginning of period | — | — | 115 | 258 | — | 373 | |||||||||||||||||||
Cash and cash equivalents at end of period | $ | 22 | $ | — | $ | 383 | $ | 300 | $ | — | $ | 705 | |||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS | |||||||||||||||||||||||||
FOR THE YEAR ENDED DECEMBER 31, 2011 | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
HCA | HCA Inc. | Subsidiary | Subsidiary | Eliminations | Condensed | ||||||||||||||||||||
Holdings, Inc. | Issuer | Guarantors | Non- | Consolidated | |||||||||||||||||||||
Issuer | Guarantors | ||||||||||||||||||||||||
Cash flows from operating activities: | |||||||||||||||||||||||||
Net income (loss) | $ | 2,453 | $ | (1,988 | ) | $ | 2,430 | $ | 2,478 | $ | (2,531 | ) | $ | 2,842 | |||||||||||
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||||||||||||||||
Change in operating assets and liabilities | 6 | 71 | (1,755 | ) | (1,275 | ) | — | (2,953 | ) | ||||||||||||||||
Provision for doubtful accounts | — | — | 1,644 | 1,180 | — | 2,824 | |||||||||||||||||||
Depreciation and amortization | — | — | 777 | 688 | — | 1,465 | |||||||||||||||||||
Income taxes | 912 | — | — | — | — | 912 | |||||||||||||||||||
Gains on sales of facilities | — | — | (127 | ) | (15 | ) | — | (142 | ) | ||||||||||||||||
Gain on acquisition of controlling interest in equity investment | — | — | — | (1,522 | ) | — | (1,522 | ) | |||||||||||||||||
Losses on retirement of debt | — | 481 | — | — | — | 481 | |||||||||||||||||||
Amortization of deferred loan costs | — | 70 | — | — | — | 70 | |||||||||||||||||||
Share-based compensation | 26 | — | — | — | — | 26 | |||||||||||||||||||
Pay-in-kind interest | — | (78 | ) | — | — | — | (78 | ) | |||||||||||||||||
Equity in earnings of affiliates | (2,531 | ) | — | — | — | 2,531 | — | ||||||||||||||||||
Other | — | 9 | — | (1 | ) | — | 8 | ||||||||||||||||||
Net cash provided by (used in) operating activities | 866 | (1,435 | ) | 2,969 | 1,533 | — | 3,933 | ||||||||||||||||||
Cash flows from investing activities: | |||||||||||||||||||||||||
Purchase of property and equipment | — | — | (910 | ) | (769 | ) | — | (1,679 | ) | ||||||||||||||||
Acquisition of hospitals and health care entities | — | — | (142 | ) | (1,540 | ) | — | (1,682 | ) | ||||||||||||||||
Disposal of hospitals and health care entities | — | — | 200 | 81 | — | 281 | |||||||||||||||||||
Change in investments | — | — | 34 | 46 | — | 80 | |||||||||||||||||||
Other | — | — | — | 5 | — | 5 | |||||||||||||||||||
Net cash used in investing activities | — | — | (818 | ) | (2,177 | ) | — | (2,995 | ) | ||||||||||||||||
Cash flows from financing activities: | |||||||||||||||||||||||||
Issuances of long-term debt | — | 5,500 | — | — | — | 5,500 | |||||||||||||||||||
Net change in revolving bank credit facilities | — | (449 | ) | — | — | — | (449 | ) | |||||||||||||||||
Repayment of long-term debt | — | (6,577 | ) | (17 | ) | (46 | ) | — | (6,640 | ) | |||||||||||||||
Distributions to noncontrolling interests | — | — | (77 | ) | (301 | ) | — | (378 | ) | ||||||||||||||||
Payment of debt issuance costs | — | (92 | ) | — | — | — | (92 | ) | |||||||||||||||||
Issuance of common stock | 2,506 | — | — | — | — | 2,506 | |||||||||||||||||||
Repurchase of common stock | (1,503 | ) | — | — | — | — | (1,503 | ) | |||||||||||||||||
Distributions to stockholders | (31 | ) | — | — | — | — | (31 | ) | |||||||||||||||||
Income tax benefits | 63 | — | — | — | — | 63 | |||||||||||||||||||
Changes in intercompany balances with affiliates, net | (1,918 | ) | 3,053 | (2,098 | ) | 963 | — | — | |||||||||||||||||
Other | 11 | — | — | 37 | — | 48 | |||||||||||||||||||
Net cash provided by (used in) financing activities | (872 | ) | 1,435 | (2,192 | ) | 653 | — | (976 | ) | ||||||||||||||||
Change in cash and cash equivalents | (6 | ) | — | (41 | ) | 9 | — | (38 | ) | ||||||||||||||||
Cash and cash equivalents at beginning of period | 6 | — | 156 | 249 | — | 411 | |||||||||||||||||||
Cash and cash equivalents at end of period | $ | — | $ | — | $ | 115 | $ | 258 | $ | — | $ | 373 | |||||||||||||
Schedule of Consolidated Statements of Stockholder's Deficit | ' | ||||||||||||||||||||||||
The Hospital Company Consolidated Statements of Stockholder’s Deficit presentation for the years ended December 31, 2013, 2012 and 2011 are as follows (dollars in millions): | |||||||||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||||||||
Presentation in HCA Holdings, Inc. Consolidated Statements of Stockholders’ Deficit: | |||||||||||||||||||||||||
Share-based benefit plans | $ | 139 | $ | 169 | $ | 35 | |||||||||||||||||||
Reclassification of certain equity securities with contingent redemption rights | — | — | 141 | ||||||||||||||||||||||
Other | (6 | ) | (17 | ) | 36 | ||||||||||||||||||||
Presentation in Healthtrust, Inc. — The Hospital Company Consolidated Statements of Stockholder’s Deficit: | |||||||||||||||||||||||||
Distributions from HCA Holdings, Inc., net of contributions to HCA Holdings, Inc. | $ | 133 | $ | 152 | $ | 212 | |||||||||||||||||||
Schedule of Quarterly Consolidated Financial Information | ' | ||||||||||||||||||||||||
HCA HOLDINGS, INC. | |||||||||||||||||||||||||
QUARTERLY CONSOLIDATED FINANCIAL INFORMATION | |||||||||||||||||||||||||
(UNAUDITED) | |||||||||||||||||||||||||
(Dollars in millions) | |||||||||||||||||||||||||
2013 | |||||||||||||||||||||||||
First | Second | Third | Fourth | ||||||||||||||||||||||
Revenues | $ | 8,440 | $ | 8,450 | $ | 8,456 | $ | 8,836 | |||||||||||||||||
Net income | $ | 438 | (a) | $ | 537 | (b) | $ | 467 | (c) | $ | 554 | (d) | |||||||||||||
Net income attributable to HCA Holdings, Inc. | $ | 344 | (a) | $ | 423 | (b) | $ | 365 | (c) | $ | 424 | (d) | |||||||||||||
Basic earnings per share | $ | 0.77 | $ | 0.95 | $ | 0.82 | $ | 0.96 | |||||||||||||||||
Diluted earnings per share | $ | 0.74 | $ | 0.91 | $ | 0.79 | $ | 0.92 | |||||||||||||||||
2012 | |||||||||||||||||||||||||
First | Second | Third | Fourth | ||||||||||||||||||||||
Revenues | $ | 8,405 | $ | 8,112 | $ | 8,062 | $ | 8,434 | |||||||||||||||||
Net income | $ | 639 | (e) | $ | 485 | (f) | $ | 455 | (g) | $ | 427 | (h) | |||||||||||||
Net income attributable to HCA Holdings, Inc. | $ | 540 | (e) | $ | 391 | (f) | $ | 360 | (g) | $ | 314 | (h) | |||||||||||||
Basic earnings per share | $ | 1.23 | $ | 0.89 | $ | 0.82 | $ | 0.71 | |||||||||||||||||
Diluted earnings per share | $ | 1.18 | $ | 0.85 | $ | 0.78 | $ | 0.68 | |||||||||||||||||
(a) | First quarter results include $11 million of losses on sales of facilities (See NOTE 3 of the notes to consolidated financial statements) and $11 million of loss on retirement of debt (See NOTE 9 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(b) | Second quarter results include $3 million of gains on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(c) | Third quarter results include $1 million of losses on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(d) | Fourth quarter results include $2 million of gains on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(e) | First quarter results include $1 million of losses on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(f) | Second quarter results include $1 million of losses on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(g) | Third quarter results include $5 million of gains on sales of facilities (See NOTE 3 of the notes to consolidated financial statements). | ||||||||||||||||||||||||
(h) | Fourth quarter results include $6 million of gains on sales of facilities (See NOTE 3 of the notes to consolidated financial statements) and $110 million of legal claim costs (See NOTE 10 of the notes to consolidated financial statements). |
Accounting_Policies_Additional
Accounting Policies - Additional Information (Detail) (USD $) | 1 Months Ended | 12 Months Ended | 168 Months Ended | |||
In Millions, except Share data, unless otherwise specified | Mar. 31, 2011 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2013 | Nov. 22, 2010 |
State | State | |||||
Surgery_Center | Surgery_Center | |||||
Hospital | Hospital | |||||
Summary Of Significant Accounting Policies [Line Items] | ' | ' | ' | ' | ' | ' |
Ownership percentage held by parent | ' | ' | ' | ' | ' | 100.00% |
Initial public offering of shares common stock | 87,719,300 | ' | ' | ' | ' | ' |
Number of owned and operated hospitals | ' | 165 | ' | ' | 165 | ' |
Number of freestanding surgery centers | ' | 115 | ' | ' | 115 | ' |
Number of facilities locations | ' | 20 | ' | ' | 20 | ' |
General and administrative expense | ' | $287 | $248 | $228 | ' | ' |
Adjustments to estimated reimbursement filed during respective year | ' | 41 | 50 | 40 | ' | ' |
Adjustments to estimated reimbursement filed during previous years | ' | 68 | 242 | 30 | ' | ' |
Revenue related to operations in previous year | ' | 46 | ' | ' | ' | ' |
Percentage of the sum of revenues, uninsured discounts and charity care | ' | 31.30% | 29.50% | 27.40% | ' | ' |
Outstanding checks unpresented for payment | ' | 461 | 437 | ' | 461 | ' |
Allowance for doubtful accounts percentage of accounts receivable | ' | 93.00% | 93.00% | ' | ' | ' |
Allowance for doubtful accounts | ' | 5,488 | 4,846 | ' | 5,488 | ' |
Days revenues in accounts receivable | ' | '54 days | '51 days | '52 days | ' | ' |
Depreciation expense | ' | 1,733 | 1,673 | 1,461 | ' | ' |
Goodwill impairments | ' | 0 | 0 | 0 | 102 | ' |
Goodwill increased related to acquisitions | ' | 265 | 288 | ' | ' | ' |
Goodwill decrease related to facility sales | ' | 1 | 3 | ' | ' | ' |
Goodwill increase (decrease) related to foreign currency translation and other adjustments | ' | -13 | 3 | ' | ' | ' |
Acquired identifiable intangible assets | ' | 113 | ' | ' | ' | ' |
Deferred loan costs | ' | 542 | 571 | ' | 542 | ' |
Deferred loan costs, accumulated amortization | ' | 305 | 281 | ' | 305 | ' |
Amortization of deferred loan costs | ' | 55 | 62 | 70 | ' | ' |
Physician recruiting liability amounts | ' | 15 | 15 | ' | 15 | ' |
Maximum amount pay under effective minimum revenue guarantees | ' | 39 | ' | ' | 39 | ' |
Reserves for professional liability risks | ' | 1,279 | 1,297 | ' | 1,279 | ' |
Current portion of professional liability risks reserves | ' | 331 | 324 | ' | 331 | ' |
Provisions for losses related to professional liability risks | ' | 314 | 331 | 244 | ' | ' |
Reserves for professional liability risks cover individual claims | ' | 2,600 | 2,700 | ' | 2,600 | ' |
Net payments of professional and general liability claims | ' | 307 | 335 | ' | ' | ' |
Insurance subsidiary ownership percentage | ' | 100.00% | ' | ' | 100.00% | ' |
Self-insured retention amount per occurrence | ' | 5 | ' | ' | ' | ' |
Maximum amount losses per occurrence | ' | 50 | ' | ' | ' | ' |
Reinsurance for professional liability risks retention level of amount per occurrence | ' | 15 | ' | ' | ' | ' |
Amounts receivable under reinsurance contracts recorded in other assets | ' | 19 | 17 | ' | 19 | ' |
Amounts receivable under reinsurance contracts recorded in other current assets | ' | 5 | 32 | ' | 5 | ' |
Electronic health record incentive income | ' | 216 | 336 | 210 | ' | ' |
Incentive income, Medicaid | ' | 33 | 84 | 87 | ' | ' |
Incentive income, Medicare | ' | 183 | 252 | 123 | ' | ' |
Electronic health record deferred incentive income | ' | 78 | 113 | ' | 78 | ' |
Investor final fee upon completion of initial public offering of common stock | 181 | ' | ' | ' | ' | ' |
Percentage of fee | 1.00% | ' | ' | ' | ' | ' |
Investors fee related to the initial public offering of common stock, recorded as cost of stock offering | 26 | ' | ' | ' | ' | ' |
Rural Floor Provision Settlement Effect [Member] | ' | ' | ' | ' | ' | ' |
Summary Of Significant Accounting Policies [Line Items] | ' | ' | ' | ' | ' | ' |
Adjustments to Medicare revenues | ' | 271 | ' | ' | ' | ' |
Implementation of Revised Supplemental Security Income Ratios [Member] | ' | ' | ' | ' | ' | ' |
Summary Of Significant Accounting Policies [Line Items] | ' | ' | ' | ' | ' | ' |
Adjustments to Medicare revenues | ' | 75 | ' | ' | ' | ' |
HealthONE [Member] | ' | ' | ' | ' | ' | ' |
Summary Of Significant Accounting Policies [Line Items] | ' | ' | ' | ' | ' | ' |
Other intangible assets | ' | ' | $0 | $269 | ' | ' |
IPO [Member] | ' | ' | ' | ' | ' | ' |
Summary Of Significant Accounting Policies [Line Items] | ' | ' | ' | ' | ' | ' |
Initial public offering of shares common stock | 87,719,300 | ' | ' | ' | ' | ' |
Maximum [Member] | ' | ' | ' | ' | ' | ' |
Summary Of Significant Accounting Policies [Line Items] | ' | ' | ' | ' | ' | ' |
Percentage of income of federal poverty level eligible for charity care | ' | 200.00% | ' | ' | ' | ' |
Finite lived intangible asset useful life | ' | '15 years | ' | ' | ' | ' |
Maximum [Member] | Building and Improvements [Member] | ' | ' | ' | ' | ' | ' |
Summary Of Significant Accounting Policies [Line Items] | ' | ' | ' | ' | ' | ' |
Estimated useful lives in years | ' | '40 years | ' | ' | ' | ' |
Maximum [Member] | Equipment [Member] | ' | ' | ' | ' | ' | ' |
Summary Of Significant Accounting Policies [Line Items] | ' | ' | ' | ' | ' | ' |
Estimated useful lives in years | ' | '10 years | ' | ' | ' | ' |
Minimum [Member] | ' | ' | ' | ' | ' | ' |
Summary Of Significant Accounting Policies [Line Items] | ' | ' | ' | ' | ' | ' |
Finite lived intangible asset useful life | ' | '3 years | ' | ' | ' | ' |
Minimum [Member] | Building and Improvements [Member] | ' | ' | ' | ' | ' | ' |
Summary Of Significant Accounting Policies [Line Items] | ' | ' | ' | ' | ' | ' |
Estimated useful lives in years | ' | '10 years | ' | ' | ' | ' |
Minimum [Member] | Equipment [Member] | ' | ' | ' | ' | ' | ' |
Summary Of Significant Accounting Policies [Line Items] | ' | ' | ' | ' | ' | ' |
Estimated useful lives in years | ' | '4 years | ' | ' | ' | ' |
Accounting_Policies_Schedule_o
Accounting Policies - Schedule of Revenues from Third Party Payers and Uninsured (Detail) (USD $) | 3 Months Ended | 12 Months Ended | |||||||||
In Millions, unless otherwise specified | Dec. 31, 2013 | Sep. 30, 2013 | Jun. 30, 2013 | Mar. 31, 2013 | Dec. 31, 2012 | Sep. 30, 2012 | Jun. 30, 2012 | Mar. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues from third party payers | ' | ' | ' | ' | ' | ' | ' | ' | $34,109 | $33,272 | $29,846 |
Uninsured | ' | ' | ' | ' | ' | ' | ' | ' | 2,677 | 2,580 | 1,846 |
Other | ' | ' | ' | ' | ' | ' | ' | ' | 1,254 | 931 | 814 |
Revenues before provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | 38,040 | 36,783 | 32,506 |
Provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | -3,858 | -3,770 | -2,824 |
Revenues | 8,836 | 8,456 | 8,450 | 8,440 | 8,434 | 8,062 | 8,112 | 8,405 | 34,182 | 33,013 | 29,682 |
Revenues from third party payers, ratio | ' | ' | ' | ' | ' | ' | ' | ' | 99.80% | 100.70% | 100.60% |
Uninsured Ratio | ' | ' | ' | ' | ' | ' | ' | ' | 7.80% | 7.80% | 6.20% |
Other Ratio | ' | ' | ' | ' | ' | ' | ' | ' | 3.70% | 2.80% | 2.70% |
Revenues before provision for doubtful accounts, ratio | ' | ' | ' | ' | ' | ' | ' | ' | 111.30% | 111.30% | 109.50% |
Provision for doubtful accounts Ratio | ' | ' | ' | ' | ' | ' | ' | ' | -11.30% | -11.30% | -9.50% |
Revenues ratio from third party payers | ' | ' | ' | ' | ' | ' | ' | ' | 100.00% | 100.00% | 100.00% |
Medicare [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues from third party payers | ' | ' | ' | ' | ' | ' | ' | ' | 7,951 | 8,292 | 7,653 |
Revenues from third party payers, ratio | ' | ' | ' | ' | ' | ' | ' | ' | 23.30% | 25.10% | 25.80% |
Managed Medicare [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues from third party payers | ' | ' | ' | ' | ' | ' | ' | ' | 3,279 | 2,954 | 2,442 |
Revenues from third party payers, ratio | ' | ' | ' | ' | ' | ' | ' | ' | 9.60% | 8.90% | 8.20% |
Medicaid [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues from third party payers | ' | ' | ' | ' | ' | ' | ' | ' | 1,480 | 1,464 | 1,845 |
Revenues from third party payers, ratio | ' | ' | ' | ' | ' | ' | ' | ' | 4.30% | 4.40% | 6.20% |
Managed Medicaid [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues from third party payers | ' | ' | ' | ' | ' | ' | ' | ' | 1,570 | 1,504 | 1,265 |
Revenues from third party payers, ratio | ' | ' | ' | ' | ' | ' | ' | ' | 4.60% | 4.60% | 4.30% |
Managed Care and Other Insurers [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues from third party payers | ' | ' | ' | ' | ' | ' | ' | ' | 18,654 | 17,998 | 15,703 |
Revenues from third party payers, ratio | ' | ' | ' | ' | ' | ' | ' | ' | 54.60% | 54.50% | 52.90% |
International (Managed Care and Other Insurers) [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenue Recognition, Multiple-deliverable Arrangements [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues from third party payers | ' | ' | ' | ' | ' | ' | ' | ' | $1,175 | $1,060 | $938 |
Revenues from third party payers, ratio | ' | ' | ' | ' | ' | ' | ' | ' | 3.40% | 3.20% | 3.20% |
Accounting_Policies_Schedule_o1
Accounting Policies - Schedule of Revenue Deductions Related to Uninsured Accounts (Detail) (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Regulatory Assets [Abstract] | ' | ' | ' |
Charity care | $3,497 | $3,093 | $2,683 |
Uninsured discounts | 8,210 | 6,978 | 5,707 |
Provision for doubtful accounts | 3,858 | 3,770 | 2,824 |
Total uncompensated care | $15,565 | $13,841 | $11,214 |
Charity care, ratio | 22.00% | 22.00% | 24.00% |
Uninsured discounts, ratio | 53.00% | 51.00% | 51.00% |
Provision for doubtful accounts, ratio | 25.00% | 27.00% | 25.00% |
Total uncompensated care, ratio | 100.00% | 100.00% | 100.00% |
Accounting_Policies_Schedule_o2
Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Accounting Policies [Abstract] | ' | ' | ' |
Gross patient charges | $181,141 | $165,614 | $141,516 |
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | 29,606 | 28,533 | 25,554 |
Cost-to-charges ratio | 16.30% | 17.20% | 18.10% |
Total uncompensated care | 15,565 | 13,841 | 11,214 |
Estimated cost of total uncompensated care | $2,537 | $2,381 | $2,030 |
ShareBased_Compensation_Additi
Share-Based Compensation - Additional Information (Detail) (USD $) | 12 Months Ended | ||
Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ' | ' | ' |
Weighted Average Fair Value of Stock Options Granted | $16.68 | $13.16 | $8.53 |
Total Intrinsic Value of Stock Options | $334,000,000 | ' | ' |
Unrecognized Compensation Cost Related to Nonvested Awards | 104,000,000 | ' | ' |
Value of distribution per share | ' | $6.50 | ' |
Value of distribution | ' | 3,142,000,000 | ' |
Reduction of non vested stock options on exercise price of share-based awards | ' | $6.50 | ' |
Share Based Compensation Nonvested Distribution Declared | 0 | ' | 0 |
Restricted Stock Units [Member] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ' | ' | ' |
Unrecognized Compensation Cost Related to Nonvested Awards | $185,000,000 | ' | ' |
Restricted Stock Units [Member] | 2006 Stock Incentive Plan [Member] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ' | ' | ' |
Granted, Stock Options | 4,858,800 | 4,647,400 | ' |
Stock Appreciation Rights (SARs) [Member] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ' | ' | ' |
Granted, Stock Options | 4,864,000 | 6,348,000 | ' |
Vested, Stock Options | 25,088,200 | ' | ' |
Shares Available for Future Grants | 32,269,100 | ' | ' |
ShareBased_Compensation_Schedu
Share-Based Compensation - Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models (Detail) | 12 Months Ended | ||
Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | ' | ' | ' |
Risk-free interest rate | 1.20% | 1.18% | 0.89% |
Expected volatility | 45.00% | 50.00% | 41.00% |
Expected life, in years | '6 years 3 months | '6 years 3 months | '5 years |
Expected dividend yield | ' | ' | ' |
ShareBased_Compensation_Schedu1
Share-Based Compensation - Schedule of Stock Option Activity (Detail) (USD $) | 12 Months Ended | ||
In Millions, except Share data, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ' | ' | ' |
Stock Options outstanding, Weighted Average Exercise Price, Beginning Balance | $11.56 | $9.26 | $8.58 |
Granted, Weighted Average Exercise Price | $37.49 | $27.03 | $23.35 |
Exercised, Weighted Average Exercise Price | $8.49 | $7.60 | $6.31 |
Cancelled, Weighted Average Exercise Price | $25.50 | $9.49 | $5.88 |
Stock Options outstanding, Weighted Average Exercise Price, Ending Balance | $15.82 | $11.56 | $9.26 |
Options exercisable, Weighted Average Exercise Price | $10.55 | ' | ' |
Options outstanding, Weighted Average Remaining Contractual Term | '5 years 4 months 24 days | ' | ' |
Options exercisable, Weighted Average Remaining Contractual Term | '4 years 1 month 6 days | ' | ' |
Options outstanding, Aggregate Intrinsic Value | $1,122 | ' | ' |
Options exercisable, Aggregate Intrinsic Value | $947 | ' | ' |
Time Based Stock Options and SARs [Member] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ' | ' | ' |
Stock Options Outstanding, Beginning Balance | 19,191,000 | 21,739,000 | 24,517,000 |
Granted, Stock Options | 2,432,000 | 3,174,000 | 644,000 |
Exercised, Stock Options | -4,498,000 | -5,530,000 | -3,312,000 |
Cancelled, Stock Options | -316,000 | -192,000 | -110,000 |
Stock Options Outstanding, Ending Balance | 16,809,000 | 19,191,000 | 21,739,000 |
Stock Options Exercisable, Ending Balance | 11,960,000 | ' | ' |
Performance Stock Options and SARs [Member] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ' | ' | ' |
Stock Options Outstanding, Beginning Balance | 22,051,000 | 24,573,000 | 26,009,000 |
Granted, Stock Options | 2,432,000 | 3,174,000 | 644,000 |
Exercised, Stock Options | -5,843,000 | -5,128,000 | -1,732,000 |
Cancelled, Stock Options | -263,000 | -568,000 | -348,000 |
Stock Options Outstanding, Ending Balance | 18,377,000 | 22,051,000 | 24,573,000 |
Stock Options Exercisable, Ending Balance | 13,527,000 | ' | ' |
Total Stock Options and Stock SARs [Member] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ' | ' | ' |
Stock Options Outstanding, Beginning Balance | 41,242,000 | 46,312,000 | 50,526,000 |
Granted, Stock Options | 4,864,000 | 6,348,000 | 1,288,000 |
Exercised, Stock Options | -10,341,000 | -10,658,000 | -5,044,000 |
Cancelled, Stock Options | -579,000 | -760,000 | -458,000 |
Stock Options Outstanding, Ending Balance | 35,186,000 | 41,242,000 | 46,312,000 |
Stock Options Exercisable, Ending Balance | 25,487,000 | ' | ' |
ShareBased_Compensation_Schedu2
Share-Based Compensation - Schedule of Restricted Stock Units Activity (Detail) (USD $) | 12 Months Ended | ||||||||
In Thousands, except Per Share data, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2012 | Dec. 31, 2011 |
Time Based Stock Options and SARs [Member] | Performance Based Stock Options and RSUs [Member] | Restricted Stock Units [Member] | Restricted Stock Units [Member] | Restricted Stock Units [Member] | Restricted Stock Units [Member] | Restricted Stock Units [Member] | Restricted Stock Units [Member] | ||
Time Based Stock Options and SARs [Member] | Time Based Stock Options and SARs [Member] | Performance Based Stock Options and RSUs [Member] | Performance Based Stock Options and RSUs [Member] | ||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' |
RSUs Outstanding, Beginning Balance | ' | ' | ' | 80 | ' | 80 | ' | ' | ' |
RSUs Outstanding, Granted | 4,859 | 3,305 | 1,554 | 4,647 | 80 | 3,162 | 80 | 1,485 | ' |
RSUs Outstanding, Vested | -1,183 | -831 | -352 | -4 | ' | -4 | ' | ' | ' |
RSUs Outstanding, Cancelled | -662 | -449 | -213 | -239 | ' | -164 | ' | -75 | ' |
RSUs Outstanding, Ending Balance | 7,498 | 5,099 | 2,399 | 4,484 | 80 | 3,074 | 80 | 1,410 | ' |
Weighted Average Grant Date Fair Value, RSUs, Beginning balance | ' | ' | ' | $30 | ' | ' | ' | ' | ' |
Weighted Average Grant Date Fair Value, RSUs, Granted | $37.43 | ' | ' | $26.98 | $30 | ' | ' | ' | ' |
Weighted Average Grant Date Fair Value, RSUs, Vested | $27.30 | ' | ' | $30 | ' | ' | ' | ' | ' |
Weighted Average Grant Date Fair Value, RSUs, Cancelled | $31.91 | ' | ' | $26.99 | ' | ' | ' | ' | ' |
Weighted Average Grant Date Fair Value, RSUs, Ending balance | $33.30 | ' | ' | $27.03 | $30 | ' | ' | ' | ' |
Acquisitions_and_Dispositions_1
Acquisitions and Dispositions - Additional Information (Detail) (USD $) | 3 Months Ended | 12 Months Ended | 2 Months Ended | 12 Months Ended | 12 Months Ended | 12 Months Ended | |||||||||||||||||||||||||||||
In Millions, unless otherwise specified | Dec. 31, 2013 | Sep. 30, 2013 | Jun. 30, 2013 | Mar. 31, 2013 | Dec. 31, 2012 | Sep. 30, 2012 | Jun. 30, 2012 | Mar. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2011 | Dec. 31, 2012 | Oct. 31, 2011 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2013 | Dec. 31, 2011 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2012 |
American Group [Member] | American Group [Member] | American Group [Member] | National Group [Member] | National Group [Member] | National Group [Member] | HealthONE [Member] | HealthONE [Member] | HealthONE [Member] | HealthONE [Member] | HealthONE [Member] | Outsource Group [Member] | Hospitals [Member] | Hospitals [Member] | Hospitals [Member] | Hospitals [Member] | Hospitals [Member] | Other Healthcare Entity [Member] | Other Healthcare Entity [Member] | Other Healthcare Entity [Member] | Other [Member] | Other [Member] | Other [Member] | Real Estate [Member] | ||||||||||||
Hospitals [Member] | Freestanding Surgery Centers [Member] | American Group [Member] | National Group [Member] | Hospital | |||||||||||||||||||||||||||||||
Hospital | Hospital | ||||||||||||||||||||||||||||||||||
Business Acquisition [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Equity interest, ownership percentage by parent | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 40.00% | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Purchase price of acquisition | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | $1,450 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Number of acquired businesses | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 7 | 12 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Fair value of identifiable net assets of acquired entities | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,261 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 265 | 232 | 68 | ' |
Gain on acquisition of business | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,522 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Increase in noncontrolling interests on business acquisition | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 30 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Decrease in property and equipment on business acquisition | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 26 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Increase in goodwill on business acquisition | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 56 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Expected tax deductible on the amount of goodwill related to acquisition | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 981 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues | 8,836 | 8,456 | 8,450 | 8,440 | 8,434 | 8,062 | 8,112 | 8,405 | 34,182 | 33,013 | 29,682 | 16,487 | 16,115 | 13,714 | 15,968 | 15,505 | 14,741 | 347 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Net income | 424 | 365 | 423 | 344 | 314 | 360 | 391 | 540 | 1,556 | 1,605 | 2,465 | ' | ' | ' | ' | ' | ' | 15 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Cash paid for acquisition | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 277 | 146 | 58 | 136 | ' | ' | 57 | 200 | 96 | ' | ' | ' | ' |
Payment to acquire goodwill | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,317 | ' | ' | ' | ' | 183 | 58 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Payment to acquire intangible assets | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 113 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Number of hospitals acquired | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3 | ' | ' | ' | ' | ' | ' |
Liability assumed on acquisition | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 33 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Pretax gain (loss) on sales of business | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | -10 | 142 | ' | ' | ' | ' | ' | ' | 15 |
Proceeds from sale of business | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 33 | 281 | ' | ' | ' | ' | ' | ' | 30 |
Gain (loss) on sale of business after tax | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ($7) | $80 | ' | ' | ' | ' | ' | ' | $9 |
Acquisitions_and_Dispositions_2
Acquisitions and Dispositions - Schedule of Allocation of Purchase Price, Including Assumed Liabilities (Detail) (HealthONE [Member], USD $) | Dec. 31, 2012 | Dec. 31, 2011 |
In Millions, unless otherwise specified | ||
HealthONE [Member] | ' | ' |
Current assets | ' | $400 |
Property and equipment | ' | 1,014 |
Identifiable intangible asset (trade name) | 0 | 269 |
Goodwill | ' | 2,317 |
Other assets | ' | 7 |
Liabilities | ' | 152 |
Noncontrolling interests | ' | $123 |
Acquisitions_and_Dispositions_3
Acquisitions and Dispositions - Schedule of Pro Forma Summary of Operations (Detail) (USD $) | 12 Months Ended |
In Millions, unless otherwise specified | Dec. 31, 2011 |
Business Combinations [Abstract] | ' |
Pro forma revenues | $31,383 |
Pro forma net income attributable to HCA Holdings, Inc. | $2,507 |
Income_Taxes_Schedule_of_Provi
Income Taxes - Schedule of Provision for Income Taxes (Detail) (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Income Tax Disclosure [Abstract] | ' | ' | ' |
Current, Federal | $827 | $604 | ($119) |
Current, State | 86 | 58 | -12 |
Current, Foreign | 44 | 43 | 44 |
Deferred, Federal | -53 | 167 | 714 |
Deferred, State | 20 | -8 | 71 |
Deferred, Foreign | 26 | 24 | 21 |
Provision for income taxes | $950 | $888 | $719 |
Income_Taxes_Additional_Inform
Income Taxes - Additional Information (Detail) (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Income Tax Contingency [Line Items] | ' | ' | ' |
Reductions in interest related to taxing authority examinations | $4 | $53 | $100 |
Reductions in interest related to taxing authority examinations, net of tax | 3 | 33 | 63 |
Income before income taxes, Foreign | 187 | 178 | 173 |
State net operating loss carryforwards | 17 | ' | ' |
Liability for unrecognized tax benefits | 462 | 426 | ' |
Unrecognized tax benefits, accrued interest | 30 | 14 | ' |
Deferred tax assets, reductions | 13 | 13 | ' |
Unrecognized tax benefits that would impact effective tax rate | $160 | $125 | ' |
State and Local Jurisdiction [Member] | Minimum [Member] | ' | ' | ' |
Income Tax Contingency [Line Items] | ' | ' | ' |
Net operating loss carryforwards, expiration date | '2014 | ' | ' |
State and Local Jurisdiction [Member] | Maximum [Member] | ' | ' | ' |
Income Tax Contingency [Line Items] | ' | ' | ' |
Net operating loss carryforwards, expiration date | '2033 | ' | ' |
Income_Taxes_Schedule_of_Recon
Income Taxes - Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate (Detail) | 12 Months Ended | ||
Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | |
Income Tax Disclosure [Abstract] | ' | ' | ' |
Federal statutory rate | 35.00% | 35.00% | 35.00% |
State income taxes, net of federal tax benefit | 2.30% | 2.20% | 2.00% |
Change in liability for uncertain tax positions | 0.50% | ' | 1.00% |
Nontaxable gain on acquisition of controlling interest in equity investment | ' | ' | -13.80% |
Tax exempt interest income | -0.20% | -0.20% | -0.20% |
Other items, net | 0.30% | -1.40% | -1.40% |
Effective income tax rate on income applicable to HCA Holdings, Inc. | 37.90% | 35.60% | 22.60% |
Income attributable to noncontrolling interests from consolidated partnerships | -5.70% | -4.90% | -2.40% |
Effective income tax rate on income before income taxes | 32.20% | 30.70% | 20.20% |
Income_Taxes_Schedule_of_Defer
Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Millions, unless otherwise specified | ||
Income Tax Disclosure [Abstract] | ' | ' |
Depreciation and fixed asset basis differences, Assets | ' | ' |
Allowances for professional liability and other risks, Assets | 365 | 355 |
Accounts receivable, Assets | 423 | 405 |
Compensation, Assets | 240 | 237 |
Other, Assets | 638 | 744 |
Deferred tax assets | 1,666 | 1,741 |
Depreciation and fixed asset basis differences, Liabilities | 229 | 292 |
Allowances for professional liability and other risks, Liabilities | ' | ' |
Accounts receivable, Liabilities | ' | ' |
Compensation, Liabilities | ' | ' |
Other, Liabilities | 698 | 595 |
Deferred tax liabilities | $927 | $887 |
Income_Taxes_Schedule_of_Activ
Income Taxes - Schedule of Activity Related to Unrecognized Tax Benefits (Detail) (USD $) | 12 Months Ended | |
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 |
Income Tax Disclosure [Abstract] | ' | ' |
Beginning Balance | $425 | $445 |
Additions based on tax positions related to the current year | 21 | 16 |
Additions for tax positions of prior years | 25 | 92 |
Reductions for tax positions of prior years | -18 | -19 |
Settlements | -5 | -103 |
Lapse of applicable statutes of limitations | -3 | -6 |
Ending Balance | $445 | $425 |
Earnings_Per_Share_Additional_
Earnings Per Share - Additional Information (Detail) | 1 Months Ended | |
Nov. 30, 2013 | Sep. 30, 2011 | |
Earnings Per Share [Abstract] | ' | ' |
Common stock repurchased | 10,656,436 | 80,771,143 |
Earnings_Per_Share_Schedule_of
Earnings Per Share - Schedule of Computations of Basic and Diluted Earnings Per Share (Detail) (USD $) | 3 Months Ended | 12 Months Ended | |||||||||
In Millions, except Share data in Thousands, unless otherwise specified | Dec. 31, 2013 | Sep. 30, 2013 | Jun. 30, 2013 | Mar. 31, 2013 | Dec. 31, 2012 | Sep. 30, 2012 | Jun. 30, 2012 | Mar. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Earnings Per Share [Abstract] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Net income attributable to HCA Holdings, Inc | $424 | $365 | $423 | $344 | $314 | $360 | $391 | $540 | $1,556 | $1,605 | $2,465 |
Weighted average common shares outstanding | ' | ' | ' | ' | ' | ' | ' | ' | 445,066 | 440,178 | 476,609 |
Effect of dilutive incremental shares | ' | ' | ' | ' | ' | ' | ' | ' | 16,847 | 19,225 | 19,334 |
Shares used for diluted earnings per share | ' | ' | ' | ' | ' | ' | ' | ' | 461,913 | 459,403 | 495,943 |
Basic earnings per share | $0.96 | $0.82 | $0.95 | $0.77 | $0.71 | $0.82 | $0.89 | $1.23 | $3.50 | $3.65 | $5.17 |
Diluted earnings per share | $0.92 | $0.79 | $0.91 | $0.74 | $0.68 | $0.78 | $0.85 | $1.18 | $3.37 | $3.49 | $4.97 |
Investments_of_Insurance_Subsi2
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Millions, unless otherwise specified | ||
Schedule of Trading Securities and Other Trading Assets [Line Items] | ' | ' |
Amortized Cost | $500 | $552 |
Unrealized Amounts, Gains | 13 | 24 |
Unrealized Amounts, Losses | -3 | -6 |
Fair Value | 510 | 570 |
Amounts classified as current assets | -62 | -55 |
Investment carrying value | 448 | 515 |
Debt Securities [Member] | ' | ' |
Schedule of Trading Securities and Other Trading Assets [Line Items] | ' | ' |
Amortized Cost | 498 | 550 |
Unrealized Amounts, Gains | 11 | 23 |
Unrealized Amounts, Losses | -3 | -6 |
Fair Value | 506 | 567 |
Debt Securities [Member] | States and Municipalities [Member] | ' | ' |
Schedule of Trading Securities and Other Trading Assets [Line Items] | ' | ' |
Amortized Cost | 385 | 395 |
Unrealized Amounts, Gains | 11 | 23 |
Unrealized Amounts, Losses | -3 | ' |
Fair Value | 393 | 418 |
Debt Securities [Member] | Auction Rate Securities [Member] | ' | ' |
Schedule of Trading Securities and Other Trading Assets [Line Items] | ' | ' |
Amortized Cost | 7 | 74 |
Unrealized Amounts, Gains | ' | ' |
Unrealized Amounts, Losses | ' | -6 |
Fair Value | 7 | 68 |
Debt Securities [Member] | Asset-Backed Securities [Member] | ' | ' |
Schedule of Trading Securities and Other Trading Assets [Line Items] | ' | ' |
Amortized Cost | 12 | 14 |
Unrealized Amounts, Gains | ' | ' |
Unrealized Amounts, Losses | ' | ' |
Fair Value | 12 | 14 |
Debt Securities [Member] | Money Market Funds [Member] | ' | ' |
Schedule of Trading Securities and Other Trading Assets [Line Items] | ' | ' |
Amortized Cost | 94 | 67 |
Unrealized Amounts, Gains | ' | ' |
Unrealized Amounts, Losses | ' | ' |
Fair Value | 94 | 67 |
Equity Securities [Member] | ' | ' |
Schedule of Trading Securities and Other Trading Assets [Line Items] | ' | ' |
Amortized Cost | 2 | 2 |
Unrealized Amounts, Gains | 2 | 1 |
Unrealized Amounts, Losses | ' | ' |
Fair Value | $4 | $3 |
Investments_of_Insurance_Subsi3
Investments of Insurance Subsidiaries - Additional Information (Detail) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Millions, unless otherwise specified | ||
Amortized Cost And Fair Value Debt Securities [Abstract] | ' | ' |
Investments subject to restrictions | $1 | $9 |
Available for sale securities expected maturity of debt securities | '3 years 9 months 18 days | ' |
Available for sale securities average scheduled maturity | '5 years 4 months 24 days | ' |
Investments_of_Insurance_Subsi4
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Millions, unless otherwise specified | ||
Schedule of Available-for-sale Securities [Line Items] | ' | ' |
Due in one year or less, Amortized Cost | $110 | ' |
Due after one year through five years, Amortized Cost | 180 | ' |
Due after five years through ten years, Amortized Cost | 100 | ' |
Due after ten years, Amortized Cost | 89 | ' |
Amortized Cost, Total | 479 | ' |
Amortized Cost | 498 | ' |
Due in one year or less, Fair Value | 110 | ' |
Fair Value | 510 | 570 |
Due after one year through five years, Fair Value | 186 | ' |
Due after five years through ten years, Fair Value | 102 | ' |
Due after ten years, Fair Value | 89 | ' |
Fair Value, Total | 487 | ' |
Fair Value | 506 | ' |
Auction Rate Securities [Member] | ' | ' |
Schedule of Available-for-sale Securities [Line Items] | ' | ' |
Amortized Cost | 7 | ' |
Fair Value | 7 | ' |
Asset-Backed Securities [Member] | ' | ' |
Schedule of Available-for-sale Securities [Line Items] | ' | ' |
Amortized Cost | 12 | ' |
Fair Value | $12 | ' |
Financial_Instruments_Schedule
Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) (Pay-Fixed Interest Rate Swaps [Member], USD $) | 12 Months Ended |
In Millions, unless otherwise specified | Dec. 31, 2013 |
Maturity Date, 2014 [Member] | ' |
Derivative Instruments, Gain (Loss) [Line Items] | ' |
Notional Amount | $500 |
Fair Value | -5 |
Pay-fixed interest rate swaps | 31-Dec-14 |
Maturity Date, 2016 [Member] | ' |
Derivative Instruments, Gain (Loss) [Line Items] | ' |
Notional Amount | 3,000 |
Fair Value | -248 |
Pay-fixed interest rate swaps | 31-Dec-16 |
Maturity Date, 2017 [Member] | ' |
Derivative Instruments, Gain (Loss) [Line Items] | ' |
Notional Amount | 1,000 |
Fair Value | ($42) |
Pay-fixed interest rate swaps | 31-Dec-17 |
Financial_Instruments_Addition
Financial Instruments - Additional Information (Detail) (USD $) | 12 Months Ended |
In Millions, unless otherwise specified | Dec. 31, 2013 |
Offsetting [Abstract] | ' |
Estimated amount reclassified from other comprehensive income to interest expense | $127 |
Estimated termination value if there is breach of provision related to derivative agreement | $308 |
Financial_Instruments_Effect_o
Financial Instruments - Effect of Interest Rate and Cross Currency Swaps on Results of Operations (Detail) (USD $) | 12 Months Ended |
In Millions, unless otherwise specified | Dec. 31, 2013 |
Cross Currency Swap (Income Taxes and Other Liabilities) [Member] | Other Operating Expenses [Member] | ' |
Derivative Instruments, Gain (Loss) [Line Items] | ' |
Amount of Gain Recognized in Operations on Derivatives | $13 |
Interest Rate Swaps [Member] | ' |
Derivative Instruments, Gain (Loss) [Line Items] | ' |
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | 2 |
Interest Rate Swaps [Member] | Interest Expense [Member] | ' |
Derivative Instruments, Gain (Loss) [Line Items] | ' |
Amount of Loss Reclassified from Accumulated OCI into Operations | $131 |
Financial_Instruments_Effect_o1
Financial Instruments - Effect of Interest Rate and Cross Currency Swaps on Results of Operations (Parenthetical) (Detail) (Other Operating Expenses [Member], Cross Currency Swap (Income Taxes and Other Liabilities) [Member]) | 12 Months Ended |
Dec. 31, 2013 | |
Other Operating Expenses [Member] | Cross Currency Swap (Income Taxes and Other Liabilities) [Member] | ' |
Derivative Instruments, Gain (Loss) [Line Items] | ' |
Maturity Date for Derivatives Hedging Instrument | '2013-11 |
Assets_and_Liabilities_Measure2
Assets and Liabilities Measured at Fair Value - Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis (Detail) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Millions, unless otherwise specified | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | $510 | $570 |
Less amounts classified as current assets | -62 | -55 |
Investments of insurance subsidiaries, noncurrent | 448 | 515 |
Interest Rate Swaps [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Liabilities, Fair Value | 295 | 429 |
Cross Currency Swap (Income Taxes and Other Liabilities) [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Liabilities, Fair Value | ' | 13 |
Debt Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 506 | 567 |
Debt Securities [Member] | States and Municipalities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 393 | 418 |
Debt Securities [Member] | Auction Rate Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 7 | 68 |
Debt Securities [Member] | Asset-Backed Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 12 | 14 |
Debt Securities [Member] | Money Market Funds [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 94 | 67 |
Equity Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 4 | 3 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 97 | 68 |
Less amounts classified as current assets | -62 | -55 |
Investments of insurance subsidiaries, noncurrent | 35 | 13 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Interest Rate Swaps [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Liabilities, Fair Value | ' | ' |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Debt Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 94 | 67 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Debt Securities [Member] | States and Municipalities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | ' | ' |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Debt Securities [Member] | Auction Rate Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | ' | ' |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Debt Securities [Member] | Asset-Backed Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | ' | ' |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Debt Securities [Member] | Money Market Funds [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 94 | 67 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Equity Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 3 | 1 |
Significant Other Observable Inputs (Level 2) [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 405 | 432 |
Less amounts classified as current assets | ' | ' |
Investments of insurance subsidiaries, noncurrent | 405 | 432 |
Significant Other Observable Inputs (Level 2) [Member] | Interest Rate Swaps [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Liabilities, Fair Value | 295 | 429 |
Significant Other Observable Inputs (Level 2) [Member] | Cross Currency Swap (Income Taxes and Other Liabilities) [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Liabilities, Fair Value | ' | 13 |
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 405 | 432 |
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member] | States and Municipalities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 393 | 418 |
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member] | Auction Rate Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | ' | ' |
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member] | Asset-Backed Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 12 | 14 |
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member] | Money Market Funds [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | ' | ' |
Significant Other Observable Inputs (Level 2) [Member] | Equity Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | ' | ' |
Significant Unobservable Inputs (Level 3) [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 8 | 70 |
Less amounts classified as current assets | ' | ' |
Investments of insurance subsidiaries, noncurrent | 8 | 70 |
Significant Unobservable Inputs (Level 3) [Member] | Interest Rate Swaps [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Liabilities, Fair Value | ' | ' |
Significant Unobservable Inputs (Level 3) [Member] | Debt Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 7 | 68 |
Significant Unobservable Inputs (Level 3) [Member] | Debt Securities [Member] | States and Municipalities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | ' | ' |
Significant Unobservable Inputs (Level 3) [Member] | Debt Securities [Member] | Auction Rate Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | 7 | 68 |
Significant Unobservable Inputs (Level 3) [Member] | Debt Securities [Member] | Asset-Backed Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | ' | ' |
Significant Unobservable Inputs (Level 3) [Member] | Debt Securities [Member] | Money Market Funds [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | ' | ' |
Significant Unobservable Inputs (Level 3) [Member] | Equity Securities [Member] | ' | ' |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ' | ' |
Assets, Fair Value | $1 | $2 |
Assets_and_Liabilities_Measure3
Assets and Liabilities Measured at Fair Value - Schedule Related to Auction Rate and Equity Securities Investments of Insurance Subsidiaries at Fair Value (Detail) (USD $) | 12 Months Ended |
In Millions, unless otherwise specified | Dec. 31, 2013 |
Fair Value Disclosures [Abstract] | ' |
Asset, Beginning Balance | $70 |
Unrealized gains included in other comprehensive income | 6 |
Settlements | -68 |
Asset, Ending Balance | $8 |
Assets_and_Liabilities_Measure4
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Millions, unless otherwise specified | ||
Fair Value Disclosures [Abstract] | ' | ' |
Estimated fair value of long-term debt | $29,603 | $30,781 |
Carrying amounts of long-term debt | $28,376 | $28,930 |
LongTerm_Debt_Schedule_of_Long
Long-Term Debt - Schedule of Long-Term Debt (Detail) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Millions, unless otherwise specified | ||
Debt Instrument [Line Items] | ' | ' |
First lien debt | $18,181 | $17,539 |
Total debt (average life of 6.3 years, rates averaging 6.3%) | 28,376 | 28,930 |
Less amounts due within one year | 786 | 1,435 |
Long-term debt | 27,590 | 27,495 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Long-term line of credit | 2,440 | 1,470 |
Senior Secured Revolving Credit Facility [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Long-term line of credit | ' | ' |
Senior Secured Term Loan Facilities [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Term loans | 5,598 | 5,958 |
Senior Secured First Lien Notes [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Senior secured first lien notes | 9,695 | 9,688 |
Other Senior Secured Debt [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Other senior secured debt (effective interest rate of 6.8%) | 448 | 423 |
Senior Secured Second Lien Notes [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Senior secured second lien notes | ' | 197 |
Senior Unsecured Notes [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Senior unsecured notes | $10,195 | $11,194 |
LongTerm_Debt_Schedule_of_Long1
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | Dec. 31, 2013 |
Debt Instrument [Line Items] | ' |
Total debt average term | '6 years 3 months 18 days |
Total debt average rate | 6.30% |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ' |
Debt Instrument [Line Items] | ' |
Effective interest rate | 1.70% |
Senior Secured Term Loan Facilities [Member] | ' |
Debt Instrument [Line Items] | ' |
Effective interest rate | 5.30% |
Senior Secured First Lien Notes [Member] | ' |
Debt Instrument [Line Items] | ' |
Effective interest rate | 7.10% |
Other Senior Secured Debt [Member] | ' |
Debt Instrument [Line Items] | ' |
Effective interest rate | 6.80% |
Senior Unsecured Notes [Member] | ' |
Debt Instrument [Line Items] | ' |
Effective interest rate | 7.20% |
LongTerm_Debt_Additional_Infor
Long-Term Debt - Additional Information (Detail) (USD $) | 1 Months Ended | 3 Months Ended | 12 Months Ended | 12 Months Ended | 1 Months Ended | 12 Months Ended | 12 Months Ended | 12 Months Ended | 12 Months Ended | 12 Months Ended | 12 Months Ended | 12 Months Ended | |||||||||||||||||||||||||||||||||
Mar. 31, 2013 | Mar. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Oct. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Mar. 31, 2013 | Nov. 30, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Feb. 29, 2012 | Dec. 31, 2013 | Oct. 31, 2012 | Dec. 31, 2013 | Oct. 31, 2012 | Dec. 31, 2013 | Oct. 31, 2012 | Oct. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 06, 2012 | Nov. 23, 2010 | Dec. 31, 2013 | |
Maximum [Member] | Minimum [Member] | Interest Rate Swaps [Member] | Senior Secured Second Lien Notes Due 2017 [Member] | Senior Secured Term Loan Facilities [Member] | Federal Fund Rate [Member] | Senior Secured First Lien Notes Due 2022 [Member] | Senior Secured First Lien Notes Due 2022 [Member] | Senior Secured Revolving Credit Facility Maturing on November 17, 2015 [Member] | Senior Secured Revolving Credit Facility Maturing on November 17, 2015 [Member] | Senior Secured Revolving Credit Facility Maturing on November 17, 2016 [Member] | Senior Secured Revolving Credit Facility Maturing on November 17, 2016 [Member] | Senior Secured First Lien Notes Due 2023 [Member] | Senior Secured First Lien Notes Due 2023 [Member] | Senior Unsecured Notes Due 2023 [Member] | Asset-Based Revolving Credit Facility Maturing on September 30, 2016 [Member] | Senior Secured Term Loan A-2 Facility Maturing on May 2, 2016 [Member] | Senior Secured Term Loan A-3 Facility Maturing on February 2, 2016 [Member] | Senior Secured Term Loan B-3 Facility Maturing on May 1, 2018 [Member] | Senior Secured Term Loan B-2 Facility Maturing on March 31, 2017 [Member] | Senior Secured First Lien Notes Due 2019 [Member] | Senior Secured First Lien Notes Due 2020 [Member] | Senior Secured First Lien Notes Due 2020 [Member] | Senior Secured First Lien Notes Due 2020 [Member] | Senior secured first lien indebtedness [Member] | Maturities Ranging Two Thousand Fourteen To Two Thousand Thirty Three [Member] | Maturities Ranging Two Thousand Fourteen To Two Thousand Thirty Three [Member] | Maturities Ranging Two Thousand Fourteen To Two Thousand Thirty Three [Member] | Maturities Ranging 2014 To 2025 [Member] | Maturities Ranging 2014 To 2025 [Member] | Maturities Ranging 2014 To 2025 [Member] | Maturities Ranging 2015 To 2095 [Member] | Maturities Ranging 2015 To 2095 [Member] | Maturities Ranging 2015 To 2095 [Member] | Senior Unsecured Notes Due 2021 [Member] | Senior Unsecured Notes Due 2021 [Member] | Senior Unsecured Notes Due 2021 [Member] | Senior Unsecured Notes Due 2021 [Member] | Senior Unsecured Notes Unamortized Debt Discounts [Member] | |||||||
Maximum [Member] | Minimum [Member] | Maximum [Member] | Minimum [Member] | Maximum [Member] | Minimum [Member] | Maximum [Member] | Minimum [Member] | ||||||||||||||||||||||||||||||||||||||
Debt Instrument [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Redemption of aggregate principal amount | ' | ' | ' | ' | ' | ' | ' | ' | ' | $201,000,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Debt instrument, stated interest | ' | ' | ' | ' | ' | ' | ' | ' | ' | 9.88% | ' | ' | 5.88% | 5.88% | ' | ' | ' | ' | 4.75% | 4.75% | 5.88% | ' | ' | ' | ' | ' | 8.50% | 7.25% | 7.88% | 6.50% | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 6.25% | 6.25% | 7.75% | ' |
Percentage of redemption of principal amount | ' | ' | ' | ' | ' | ' | ' | ' | ' | 104.94% | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Pretax loss on retirement of debt | -17,000,000 | -11,000,000 | -17,000,000 | ' | -481,000,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Loan facility amount matured | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 329,000,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Debt instrument, principal amount | ' | ' | ' | ' | ' | 2,500,000,000 | ' | ' | ' | ' | ' | ' | 1,350,000,000 | 1,350,000,000 | ' | ' | ' | ' | 1,250,000,000 | 1,250,000,000 | 1,250,000,000 | ' | ' | ' | ' | ' | 1,500,000,000 | 1,400,000,000 | 1,250,000,000 | 3,000,000,000 | ' | 6,541,000,000 | ' | ' | 246,000,000 | ' | ' | ' | ' | ' | 1,000,000,000 | 1,000,000,000 | 1,000,000,000 | 1,525,000,000 | ' |
Long-term line of credit | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,000,000,000 | 2,000,000,000 | 2,000,000,000 | ' | ' | ' | 2,500,000,000 | 512,000,000 | 724,000,000 | 2,367,000,000 | 1,995,000,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Debt instrument maturity date | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 17-Nov-15 | ' | 17-Nov-16 | ' | ' | ' | ' | 30-Sep-16 | 2-May-16 | 2-Feb-16 | 1-May-18 | 31-Mar-17 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Percentage of senior secured credit facility over eligible accounts receivable | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 85.00% | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Line of credit outstanding | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 0 | ' | ' | ' | ' | 2,440,000,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Debt instrument basis spread | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 0.50% | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Debt instrument, unamortized discount | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 55,000,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3,000,000 |
Capital leases and other secured debt | ' | ' | 448,000,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Notional amount, total | ' | ' | ' | ' | ' | ' | ' | ' | 4,500,000,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Debentures, principal amount | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 886,000,000 | ' | ' | ' | ' | ' | ' | ' |
Senior unsecured notes | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,525,000,000 | ' | ' | ' | ' |
Debt instrument, maturities range | ' | ' | ' | ' | ' | ' | '2018 | '2015 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | '2033 | '2014 | ' | '2025 | '2014 | ' | '2095 | '2015 | ' | ' | ' | ' | ' |
Maturity of long-term debt in 2015 | ' | ' | 1,065,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Maturity of long-term debt in 2016 | ' | ' | 2,282,000,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Maturity of long-term debt in 2017 | ' | ' | 2,028,000,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Maturity of long-term debt in 2018 | ' | ' | $2,803,000,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Contingencies_and_Legal_Claim_1
Contingencies and Legal Claim Costs - Additional Information (Detail) (USD $) | 0 Months Ended | 3 Months Ended | 12 Months Ended | 0 Months Ended | 12 Months Ended | ||
In Millions, unless otherwise specified | Oct. 28, 2011 | Dec. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2003 | Jan. 24, 2013 | Dec. 31, 2013 | Jul. 31, 2012 |
Cases | Hospital | Pending Litigation [Member] | Pending Litigation [Member] | FLORIDA [Member] | |||
Health Care Foundation of Greater Kansas City [Member] | Health Care Foundation of Greater Kansas City [Member] | Hospital | |||||
Schedule Of Activities Related To Claims Filed [Line Items] | ' | ' | ' | ' | ' | ' | ' |
Number of owned and operated hospitals reviewed | ' | ' | 95 | ' | ' | ' | 8 |
Number of claims filed | 3 | ' | ' | ' | ' | ' | ' |
Capital commitments in connection with purchase of hospitals | ' | ' | ' | $450 | ' | ' | ' |
Legal claim costs | ' | 175 | ' | ' | ' | ' | ' |
Judgment award by the court | ' | ' | ' | ' | 162 | ' | ' |
Period of agreed capital commitments | ' | ' | '5 years | ' | ' | ' | ' |
Number of year under court-supervisor accounting for expenditures following the purchase | ' | ' | '10 years | ' | ' | ' | ' |
Plaintiff attorneys fees award | ' | ' | ' | ' | ' | $12 | ' |
Leases_Schedule_of_Commitments
Leases - Schedule of Commitments Relating to Noncancellable Operating Leases (Detail) (USD $) | Dec. 31, 2013 |
In Millions, unless otherwise specified | |
Leases [Abstract] | ' |
2014 | $293 |
2015 | 267 |
2016 | 215 |
2017 | 175 |
2018 | 132 |
Thereafter | 740 |
Operating leases future minimum payments due, gross | 1,822 |
Less sublease income | -30 |
Commitments relating to noncancellable operating leases | $1,792 |
Capital_Stock_Additional_Infor
Capital Stock - Additional Information (Detail) (USD $) | 1 Months Ended | 12 Months Ended | ||||
Nov. 30, 2013 | Sep. 30, 2011 | Mar. 31, 2011 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | |
Capital Stock [Line Items] | ' | ' | ' | ' | ' | ' |
Common stock, shares authorized | ' | ' | ' | 1,800,000,000 | 1,800,000,000 | ' |
Initial public offering of shares common stock | ' | ' | 87,719,300 | ' | ' | ' |
Initial public offering of shares of common stock, price per share | ' | ' | $30 | ' | ' | ' |
Proceeds from issuance of initial public offering | ' | ' | $2,506,000,000 | ' | ' | ' |
Repurchase of common stock | 10,656,436 | 80,771,143 | ' | ' | ' | ' |
Repurchase of common stock, per share | $46.92 | $18.61 | ' | ' | ' | ' |
Shares repurchased as percentage of total shares outstanding | ' | 15.60% | ' | ' | ' | ' |
Value of distribution per share | ' | ' | ' | ' | $6.50 | ' |
Value of distribution | ' | ' | ' | ' | 3,142,000,000 | ' |
Reduction of non vested stock options on exercise price of share-based awards | ' | ' | ' | ' | $6.50 | ' |
Share Based Compensation Nonvested Distribution Declared | ' | ' | ' | $0 | ' | $0 |
Minimum [Member] | ' | ' | ' | ' | ' | ' |
Capital Stock [Line Items] | ' | ' | ' | ' | ' | ' |
Number of directors as per the amended and restated by-laws | ' | ' | ' | 3 | ' | ' |
Employee_Benefit_Plans_Additio
Employee Benefit Plans - Additional Information (Detail) (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Defined Contribution Benefit Plans [Member] | ' | ' | ' |
Defined Benefit Plan Disclosure [Line Items] | ' | ' | ' |
Cost of defined benefit plans | $374 | $371 | $322 |
Restoration Plan [Member] | ' | ' | ' |
Defined Benefit Plan Disclosure [Line Items] | ' | ' | ' |
Number of hours of service required to qualify for the plan | '1,000 or more hours | ' | ' |
Noncontributory and nonqualified plan, benefit expense | 29 | 20 | 25 |
Noncontributory and nonqualified plan, accrued benefits liabilities | 137 | 120 | ' |
Supplemental Executive Retirement Plan [Member] | ' | ' | ' |
Defined Benefit Plan Disclosure [Line Items] | ' | ' | ' |
Defined benefit plan cost | 43 | 51 | 33 |
Defined benefit plan obligation | 214 | 242 | ' |
Defined Benefit Pension Plans [Member] | ' | ' | ' |
Defined Benefit Plan Disclosure [Line Items] | ' | ' | ' |
Defined benefit plan cost | 37 | 49 | 39 |
Defined benefit plan obligation | $81 | $196 | ' |
Subsequent to March 31, 2008 [Member] | Defined Contribution Benefit Plans [Member] | ' | ' | ' |
Defined Benefit Plan Disclosure [Line Items] | ' | ' | ' |
Percentage of employer contribution to match participant contribution in defined contribution plan, net | 100.00% | ' | ' |
Subsequent to March 31, 2008 [Member] | Defined Contribution Benefit Plans [Member] | Minimum [Member] | ' | ' | ' |
Defined Benefit Plan Disclosure [Line Items] | ' | ' | ' |
Percentage of employer contribution to match participant contribution in defined contribution plan | 3.00% | ' | ' |
Subsequent to March 31, 2008 [Member] | Defined Contribution Benefit Plans [Member] | Maximum [Member] | ' | ' | ' |
Defined Benefit Plan Disclosure [Line Items] | ' | ' | ' |
Percentage of employer contribution to match participant contribution in defined contribution plan | 9.00% | ' | ' |
Segment_and_Geographic_Informa2
Segment and Geographic Information - Additional Information (Detail) | 12 Months Ended |
Dec. 31, 2013 | |
Hospital | |
Segment Reporting Information [Line Items] | ' |
Number of geographically organized groups | 2 |
Number of owned and operated hospitals | 165 |
Reorganization Group [Member] | National Group [Member] | ' |
Segment Reporting Information [Line Items] | ' |
Number of owned and operated hospitals | 82 |
Reorganization Group [Member] | American Group [Member] | ' |
Segment Reporting Information [Line Items] | ' |
Number of owned and operated hospitals | 77 |
Reorganization Group [Member] | Corporate and Other [Member] | ' |
Segment Reporting Information [Line Items] | ' |
Number of owned and operated hospitals | 6 |
Segment_and_Geographic_Informa3
Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization and Assets (Detail) (USD $) | 1 Months Ended | 3 Months Ended | 12 Months Ended | |||||||||
In Millions, unless otherwise specified | Mar. 31, 2013 | Dec. 31, 2013 | Sep. 30, 2013 | Jun. 30, 2013 | Mar. 31, 2013 | Dec. 31, 2012 | Sep. 30, 2012 | Jun. 30, 2012 | Mar. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Segment Reporting Information [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues | ' | $8,836 | $8,456 | $8,450 | $8,440 | $8,434 | $8,062 | $8,112 | $8,405 | $34,182 | $33,013 | $29,682 |
Equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | -29 | -36 | -258 |
Adjusted segment EBITDA | ' | ' | ' | ' | ' | ' | ' | ' | ' | 6,574 | 6,531 | 6,061 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,753 | 1,679 | 1,465 |
Adjusted segment EBITDA | ' | ' | ' | ' | ' | ' | ' | ' | ' | 6,574 | 6,531 | 6,061 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,753 | 1,679 | 1,465 |
Interest expense | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,848 | 1,798 | 2,037 |
Losses (gains) on sales of facilities | ' | -2 | 1 | -3 | 11 | -6 | -5 | 1 | 1 | 10 | -15 | -142 |
Losses on retirement of debt | 17 | ' | ' | ' | 11 | ' | ' | ' | ' | 17 | ' | 481 |
Legal claim costs | ' | ' | ' | ' | ' | 110 | ' | ' | ' | ' | 175 | ' |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,522 |
Termination of management agreement | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 181 |
Income before income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,946 | 2,894 | 3,561 |
Assets | ' | 28,831 | ' | ' | ' | 28,075 | ' | ' | ' | 28,831 | 28,075 | ' |
Goodwill and other intangible assets, Beginning Balance | ' | ' | ' | ' | 5,539 | ' | ' | ' | ' | 5,539 | ' | ' |
Goodwill and other intangible assets, Acquisitions | ' | ' | ' | ' | ' | ' | ' | ' | ' | 378 | ' | ' |
Goodwill and other intangible assets, Dispositions | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1 | ' | ' |
Goodwill and other intangible assets, Foreign currency translation and other | ' | ' | ' | ' | ' | ' | ' | ' | ' | -13 | 3 | ' |
Goodwill and other intangible assets, Ending Balance | ' | 5,903 | ' | ' | ' | 5,539 | ' | ' | ' | 5,903 | 5,539 | ' |
National Group [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Segment Reporting Information [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues | ' | ' | ' | ' | ' | ' | ' | ' | ' | 15,968 | 15,505 | 14,741 |
Equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | -9 | -9 | -7 |
Adjusted segment EBITDA | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3,301 | 3,325 | 3,052 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 718 | 694 | 639 |
Adjusted segment EBITDA | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3,301 | 3,325 | 3,052 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 718 | 694 | 639 |
Assets | ' | 10,206 | ' | ' | ' | 9,451 | ' | ' | ' | 10,206 | 9,451 | ' |
Goodwill and other intangible assets, Beginning Balance | ' | ' | ' | ' | 1,035 | ' | ' | ' | ' | 1,035 | ' | ' |
Goodwill and other intangible assets, Acquisitions | ' | ' | ' | ' | ' | ' | ' | ' | ' | 68 | ' | ' |
Goodwill and other intangible assets, Dispositions | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Goodwill and other intangible assets, Foreign currency translation and other | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1 | ' | ' |
Goodwill and other intangible assets, Ending Balance | ' | 1,104 | ' | ' | ' | 1,035 | ' | ' | ' | 1,104 | 1,035 | ' |
American Group [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Segment Reporting Information [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues | ' | ' | ' | ' | ' | ' | ' | ' | ' | 16,487 | 16,115 | 13,714 |
Equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | -24 | -28 | -251 |
Adjusted segment EBITDA | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3,662 | 3,575 | 3,141 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 835 | 816 | 680 |
Adjusted segment EBITDA | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3,662 | 3,575 | 3,141 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 835 | 816 | 680 |
Assets | ' | 13,911 | ' | ' | ' | 13,744 | ' | ' | ' | 13,911 | 13,744 | ' |
Goodwill and other intangible assets, Beginning Balance | ' | ' | ' | ' | 4,189 | ' | ' | ' | ' | 4,189 | ' | ' |
Goodwill and other intangible assets, Acquisitions | ' | ' | ' | ' | ' | ' | ' | ' | ' | 13 | ' | ' |
Goodwill and other intangible assets, Dispositions | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1 | ' | ' |
Goodwill and other intangible assets, Foreign currency translation and other | ' | ' | ' | ' | ' | ' | ' | ' | ' | -11 | ' | ' |
Goodwill and other intangible assets, Ending Balance | ' | 4,190 | ' | ' | ' | 4,189 | ' | ' | ' | 4,190 | 4,189 | ' |
Corporate and Other [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Segment Reporting Information [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,727 | 1,393 | 1,227 |
Equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | 4 | 1 | ' |
Adjusted segment EBITDA | ' | ' | ' | ' | ' | ' | ' | ' | ' | -389 | -369 | -132 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 200 | 169 | 146 |
Adjusted segment EBITDA | ' | ' | ' | ' | ' | ' | ' | ' | ' | -389 | -369 | -132 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 200 | 169 | 146 |
Assets | ' | 4,714 | ' | ' | ' | 4,880 | ' | ' | ' | 4,714 | 4,880 | ' |
Goodwill and other intangible assets, Beginning Balance | ' | ' | ' | ' | 315 | ' | ' | ' | ' | 315 | ' | ' |
Goodwill and other intangible assets, Acquisitions | ' | ' | ' | ' | ' | ' | ' | ' | ' | 297 | ' | ' |
Goodwill and other intangible assets, Dispositions | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Goodwill and other intangible assets, Foreign currency translation and other | ' | ' | ' | ' | ' | ' | ' | ' | ' | -3 | ' | ' |
Goodwill and other intangible assets, Ending Balance | ' | $609 | ' | ' | ' | $315 | ' | ' | ' | $609 | $315 | ' |
Other_Comprehensive_Loss_Compo
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Equity [Abstract] | ' | ' | ' |
Unrealized gains on available-for-sale securities, beginning balance | $11 | $7 | $6 |
Unrealized gains on available-for-sale securities, net of income taxes | -4 | 4 | 1 |
Unrealized gains on available-for-sale securities, ending balance | 7 | 11 | 7 |
Foreign currency translation adjustments, beginning balance | -1 | -25 | -19 |
Foreign currency translation adjustments | 12 | 24 | -6 |
Foreign currency translation adjustments, ending balance | 11 | -1 | -25 |
Defined benefit plans, beginning balance | -196 | -169 | -143 |
Defined benefit plans | 84 | -56 | -42 |
Defined benefit plans, (income) expense reclassified into operations from other comprehensive income | 24 | 29 | 16 |
Defined benefit plans, ending balance | -88 | -196 | -169 |
Change in fair value of derivative instruments, beginning balance | -271 | -253 | -272 |
Change in fair value of derivative instruments | 2 | -96 | -197 |
Change in fair value of derivatives instruments, (income) expense reclassified into operations from other comprehensive income | 82 | 78 | 216 |
Change in fair value of derivative instruments, ending balance | -187 | -271 | -253 |
Accumulated other comprehensive income (loss), net of tax, beginning balance | -457 | -440 | -428 |
Unrealized gains on available-for-sale securities, net of income taxes | -4 | 4 | 1 |
Foreign currency translation adjustments | 12 | 24 | -6 |
Defined benefit plans | 84 | -56 | -42 |
Change in fair value of derivative instruments, net of income tax benefit | 2 | -96 | -197 |
Expense reclassified into operations from other comprehensive income, Total | 106 | 107 | 232 |
Accumulated other comprehensive income (loss), net of tax, Ending balance | ($257) | ($457) | ($440) |
Other_Comprehensive_Loss_Compo1
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Equity [Abstract] | ' | ' | ' |
Unrealized gains on available-for-sale securities, tax portion | ($3) | $2 | $1 |
Foreign currency translation adjustments, income (taxes) | 6 | 13 | -3 |
Defined benefit plans, income tax benefit | -50 | 33 | 25 |
Change in fair value of derivative instruments, income tax benefit | 1 | -55 | -114 |
Defined benefit plans, Expense reclassified into operations from other comprehensive income, Income tax benefits | 14 | 17 | 9 |
Change in fair value of derivative instruments, Expense reclassified into operations from other comprehensive income, Income tax benefits | $49 | $44 | $125 |
Accrued_Expenses_and_Allowance2
Accrued Expenses and Allowance for Doubtful Accounts - Summary of Other Accrued Expenses (Detail) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Millions, unless otherwise specified | ||
Payables And Accruals [Abstract] | ' | ' |
Professional liability risks | $331 | $324 |
Interest | 392 | 409 |
Taxes other than income | 252 | 235 |
Legal claim costs | 189 | 175 |
Other | 749 | 706 |
Other accrued expenses | $1,913 | $1,849 |
Accrued_Expenses_and_Allowance3
Accrued Expenses and Allowance for Doubtful Accounts - Summary of Allowance of Doubtful Accounts (Detail) (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Payables And Accruals [Abstract] | ' | ' | ' |
Balance at Beginning of Year | $4,846 | $4,106 | $3,939 |
Provision for doubtful accounts | 3,858 | 3,770 | 2,824 |
Accounts Written off, Net of Recoveries | -3,216 | -3,030 | -2,657 |
Balance at End of Year | $5,488 | $4,846 | $4,106 |
Supplemental_Condensed_Consoli2
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Additional Information (Detail) (USD $) | Oct. 31, 2012 | Nov. 22, 2010 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 06, 2012 | Nov. 23, 2010 |
In Millions, unless otherwise specified | Senior Unsecured Notes Due 2021 [Member] | Senior Unsecured Notes Due 2021 [Member] | Senior Unsecured Notes Due 2021 [Member] | Senior Unsecured Notes Due 2021 [Member] | ||
Supplemental Condensed Consolidating Financial Information [Line Items] | ' | ' | ' | ' | ' | ' |
Debt instrument, principal amount | $2,500 | ' | $1,000 | $1,000 | $1,000 | $1,525 |
Debt instrument, stated interest | ' | ' | ' | 6.25% | 6.25% | 7.75% |
Ownership percentage held by parent | ' | 100.00% | ' | ' | ' | ' |
Supplemental_Condensed_Consoli3
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Comprehensive Income Statement (Detail) (USD $) | 1 Months Ended | 3 Months Ended | 12 Months Ended | |||||||||
In Millions, unless otherwise specified | Mar. 31, 2013 | Dec. 31, 2013 | Sep. 30, 2013 | Jun. 30, 2013 | Mar. 31, 2013 | Dec. 31, 2012 | Sep. 30, 2012 | Jun. 30, 2012 | Mar. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Supplemental Condensed Consolidating Financial Information [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues before provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | $38,040 | $36,783 | $32,506 |
Provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3,858 | 3,770 | 2,824 |
Revenues | ' | 8,836 | 8,456 | 8,450 | 8,440 | 8,434 | 8,062 | 8,112 | 8,405 | 34,182 | 33,013 | 29,682 |
Salaries and benefits | ' | ' | ' | ' | ' | ' | ' | ' | ' | 15,646 | 15,089 | 13,440 |
Supplies | ' | ' | ' | ' | ' | ' | ' | ' | ' | 5,970 | 5,717 | 5,179 |
Other operating expenses | ' | ' | ' | ' | ' | ' | ' | ' | ' | 6,237 | 6,048 | 5,470 |
Electronic health record incentive income | ' | ' | ' | ' | ' | ' | ' | ' | ' | -216 | -336 | -210 |
Equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | -29 | -36 | -258 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,753 | 1,679 | 1,465 |
Interest expense | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,848 | 1,798 | 2,037 |
Losses (gains) on sales of facilities | ' | -2 | 1 | -3 | 11 | -6 | -5 | 1 | 1 | 10 | -15 | -142 |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,522 |
Legal claim costs | ' | ' | ' | ' | ' | 110 | ' | ' | ' | ' | 175 | ' |
Loss on retirement of debt | 17 | ' | ' | ' | 11 | ' | ' | ' | ' | 17 | ' | 481 |
Termination of management agreement | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 181 |
Management fees | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Total expenses including equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | 31,236 | 30,119 | 26,121 |
Income (loss) before income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,946 | 2,894 | 3,561 |
Provision (benefit) for income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | 950 | 888 | 719 |
Net income (loss) | ' | 554 | 467 | 537 | 438 | 427 | 455 | 485 | 639 | 1,996 | 2,006 | 2,842 |
Net income attributable to noncontrolling interests | ' | ' | ' | ' | ' | ' | ' | ' | ' | 440 | 401 | 377 |
Net income (loss) attributable to HCA Holdings, Inc. | ' | 424 | 365 | 423 | 344 | 314 | 360 | 391 | 540 | 1,556 | 1,605 | 2,465 |
Comprehensive income (loss) attributable to HCA Holdings, Inc. | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,756 | 1,588 | 2,453 |
HCA Holdings, Inc. Issuer [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Supplemental Condensed Consolidating Financial Information [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues before provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Salaries and benefits | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Supplies | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Other operating expenses | ' | ' | ' | ' | ' | ' | ' | ' | ' | 8 | 3 | ' |
Electronic health record incentive income | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,875 | -1,668 | -2,531 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Interest expense | ' | ' | ' | ' | ' | ' | ' | ' | ' | 184 | 123 | 120 |
Losses (gains) on sales of facilities | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Legal claim costs | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Loss on retirement of debt | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Termination of management agreement | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Management fees | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Total expenses including equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,683 | -1,542 | -2,411 |
Income (loss) before income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,683 | 1,542 | 2,411 |
Provision (benefit) for income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | -73 | -46 | -42 |
Net income (loss) | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,756 | 1,588 | 2,453 |
Net income attributable to noncontrolling interests | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Net income (loss) attributable to HCA Holdings, Inc. | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,756 | 1,588 | 2,453 |
Comprehensive income (loss) attributable to HCA Holdings, Inc. | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,756 | 1,588 | 2,453 |
HCA Inc. Issuer [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Supplemental Condensed Consolidating Financial Information [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues before provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Salaries and benefits | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Supplies | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Other operating expenses | ' | ' | ' | ' | ' | ' | ' | ' | ' | -2 | 5 | 4 |
Electronic health record incentive income | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Interest expense | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,253 | 2,167 | 2,390 |
Losses (gains) on sales of facilities | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Legal claim costs | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 175 | ' |
Loss on retirement of debt | ' | ' | ' | ' | ' | ' | ' | ' | ' | 17 | ' | 481 |
Termination of management agreement | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 181 |
Management fees | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Total expenses including equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,268 | 2,347 | 3,056 |
Income (loss) before income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | -2,268 | -2,347 | -3,056 |
Provision (benefit) for income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | -860 | -839 | -1,068 |
Net income (loss) | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,408 | -1,508 | -1,988 |
Net income attributable to noncontrolling interests | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Net income (loss) attributable to HCA Holdings, Inc. | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,408 | -1,508 | -1,988 |
Comprehensive income (loss) attributable to HCA Holdings, Inc. | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,324 | -1,526 | -1,969 |
Subsidiary Guarantors [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Supplemental Condensed Consolidating Financial Information [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues before provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | 20,042 | 19,415 | 18,126 |
Provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,262 | 2,144 | 1,644 |
Revenues | ' | ' | ' | ' | ' | ' | ' | ' | ' | 17,780 | 17,271 | 16,482 |
Salaries and benefits | ' | ' | ' | ' | ' | ' | ' | ' | ' | 8,387 | 7,959 | 7,584 |
Supplies | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3,158 | 2,995 | 2,851 |
Other operating expenses | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,998 | 3,013 | 2,741 |
Electronic health record incentive income | ' | ' | ' | ' | ' | ' | ' | ' | ' | -142 | -219 | -126 |
Equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | -2 | -5 | -86 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 855 | 821 | 777 |
Interest expense | ' | ' | ' | ' | ' | ' | ' | ' | ' | -523 | -468 | -342 |
Losses (gains) on sales of facilities | ' | ' | ' | ' | ' | ' | ' | ' | ' | 20 | 3 | -127 |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Legal claim costs | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Loss on retirement of debt | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Termination of management agreement | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Management fees | ' | ' | ' | ' | ' | ' | ' | ' | ' | -632 | -569 | -491 |
Total expenses including equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | 14,119 | 13,530 | 12,781 |
Income (loss) before income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3,661 | 3,741 | 3,701 |
Provision (benefit) for income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,362 | 1,313 | 1,271 |
Net income (loss) | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,299 | 2,428 | 2,430 |
Net income attributable to noncontrolling interests | ' | ' | ' | ' | ' | ' | ' | ' | ' | 69 | 62 | 63 |
Net income (loss) attributable to HCA Holdings, Inc. | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,230 | 2,366 | 2,367 |
Comprehensive income (loss) attributable to HCA Holdings, Inc. | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,338 | 2,339 | 2,341 |
Subsidiary Non-Guarantors [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Supplemental Condensed Consolidating Financial Information [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues before provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | 17,998 | 17,368 | 14,380 |
Provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,596 | 1,626 | 1,180 |
Revenues | ' | ' | ' | ' | ' | ' | ' | ' | ' | 16,402 | 15,742 | 13,200 |
Salaries and benefits | ' | ' | ' | ' | ' | ' | ' | ' | ' | 7,259 | 7,130 | 5,856 |
Supplies | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,812 | 2,722 | 2,328 |
Other operating expenses | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3,233 | 3,027 | 2,725 |
Electronic health record incentive income | ' | ' | ' | ' | ' | ' | ' | ' | ' | -74 | -117 | -84 |
Equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | -27 | -31 | -172 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | 898 | 858 | 688 |
Interest expense | ' | ' | ' | ' | ' | ' | ' | ' | ' | -66 | -24 | -131 |
Losses (gains) on sales of facilities | ' | ' | ' | ' | ' | ' | ' | ' | ' | -10 | -18 | -15 |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,522 |
Legal claim costs | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Loss on retirement of debt | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Termination of management agreement | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Management fees | ' | ' | ' | ' | ' | ' | ' | ' | ' | 632 | 569 | 491 |
Total expenses including equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | 14,657 | 14,116 | 10,164 |
Income (loss) before income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,745 | 1,626 | 3,036 |
Provision (benefit) for income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | 521 | 460 | 558 |
Net income (loss) | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,224 | 1,166 | 2,478 |
Net income attributable to noncontrolling interests | ' | ' | ' | ' | ' | ' | ' | ' | ' | 371 | 339 | 314 |
Net income (loss) attributable to HCA Holdings, Inc. | ' | ' | ' | ' | ' | ' | ' | ' | ' | 853 | 827 | 2,164 |
Comprehensive income (loss) attributable to HCA Holdings, Inc. | ' | ' | ' | ' | ' | ' | ' | ' | ' | 861 | 855 | 2,159 |
Eliminations [Member] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Supplemental Condensed Consolidating Financial Information [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues before provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Provision for doubtful accounts | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Salaries and benefits | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Supplies | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Other operating expenses | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Electronic health record incentive income | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,875 | 1,668 | 2,531 |
Depreciation and amortization | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Interest expense | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Losses (gains) on sales of facilities | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Legal claim costs | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Loss on retirement of debt | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Termination of management agreement | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Management fees | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Total expenses including equity in earnings of affiliates | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,875 | 1,668 | 2,531 |
Income (loss) before income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,875 | -1,668 | -2,531 |
Provision (benefit) for income taxes | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Net income (loss) | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,875 | -1,668 | -2,531 |
Net income attributable to noncontrolling interests | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Net income (loss) attributable to HCA Holdings, Inc. | ' | ' | ' | ' | ' | ' | ' | ' | ' | -1,875 | -1,668 | -2,531 |
Comprehensive income (loss) attributable to HCA Holdings, Inc. | ' | ' | ' | ' | ' | ' | ' | ' | ' | ($1,875) | ($1,668) | ($2,531) |
Supplemental_Condensed_Consoli4
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Balance Sheet (Detail) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2010 |
In Millions, unless otherwise specified | ||||
Current assets: | ' | ' | ' | ' |
Cash and cash equivalents | $414 | $705 | $373 | $411 |
Accounts receivable, net | 5,208 | 4,672 | ' | ' |
Inventories | 1,179 | 1,086 | ' | ' |
Deferred income taxes | 489 | 385 | ' | ' |
Other | 747 | 915 | ' | ' |
Total current assets | 8,037 | 7,763 | ' | ' |
Property and equipment, net | 13,619 | 13,185 | ' | ' |
Investments of insurance subsidiaries | 448 | 515 | ' | ' |
Investments in and advances to affiliates | 121 | 104 | ' | ' |
Goodwill and other intangible assets | 5,903 | 5,539 | ' | ' |
Deferred loan costs | 237 | 290 | ' | ' |
Other | 466 | 679 | ' | ' |
Total assets | 28,831 | 28,075 | ' | ' |
Current liabilities: | ' | ' | ' | ' |
Accounts payable | 1,803 | 1,768 | ' | ' |
Accrued salaries | 1,193 | 1,120 | ' | ' |
Other accrued expenses | 1,913 | 1,849 | ' | ' |
Long-term debt due within one year | 786 | 1,435 | ' | ' |
Total current liabilities | 5,695 | 6,172 | ' | ' |
Long-term debt | 27,590 | 27,495 | ' | ' |
Intercompany balances | ' | ' | ' | ' |
Professional liability risks | 949 | 973 | ' | ' |
Income taxes and other liabilities | 1,525 | 1,776 | ' | ' |
Total liabilities | 35,759 | 36,416 | ' | ' |
Stockholders' (deficit) equity attributable to HCA Holdings, Inc. | -8,270 | -9,660 | ' | ' |
Noncontrolling interests | 1,342 | 1,319 | ' | ' |
Total stockholders' deficit | -6,928 | -8,341 | -7,014 | -10,794 |
Total liabilities and stockholders' deficit | 28,831 | 28,075 | ' | ' |
HCA Holdings, Inc. Issuer [Member] | ' | ' | ' | ' |
Current assets: | ' | ' | ' | ' |
Cash and cash equivalents | ' | 22 | ' | 6 |
Accounts receivable, net | ' | ' | ' | ' |
Inventories | ' | ' | ' | ' |
Deferred income taxes | 489 | 385 | ' | ' |
Other | ' | 122 | ' | ' |
Total current assets | 489 | 529 | ' | ' |
Property and equipment, net | ' | ' | ' | ' |
Investments of insurance subsidiaries | ' | ' | ' | ' |
Investments in and advances to affiliates | 20,356 | 18,481 | ' | ' |
Goodwill and other intangible assets | ' | ' | ' | ' |
Deferred loan costs | 30 | 32 | ' | ' |
Other | 250 | 469 | ' | ' |
Total assets | 21,125 | 19,511 | ' | ' |
Current liabilities: | ' | ' | ' | ' |
Accounts payable | 1 | ' | ' | ' |
Accrued salaries | ' | ' | ' | ' |
Other accrued expenses | 272 | 30 | ' | ' |
Long-term debt due within one year | ' | ' | ' | ' |
Total current liabilities | 273 | 30 | ' | ' |
Long-term debt | 2,525 | 2,525 | ' | ' |
Intercompany balances | 26,107 | 26,131 | ' | ' |
Professional liability risks | ' | ' | ' | ' |
Income taxes and other liabilities | 490 | 485 | ' | ' |
Total liabilities | 29,395 | 29,171 | ' | ' |
Stockholders' (deficit) equity attributable to HCA Holdings, Inc. | -8,270 | -9,660 | ' | ' |
Noncontrolling interests | ' | ' | ' | ' |
Total stockholders' deficit | -8,270 | -9,660 | ' | ' |
Total liabilities and stockholders' deficit | 21,125 | 19,511 | ' | ' |
HCA Inc. Issuer [Member] | ' | ' | ' | ' |
Current assets: | ' | ' | ' | ' |
Cash and cash equivalents | ' | ' | ' | ' |
Accounts receivable, net | ' | ' | ' | ' |
Inventories | ' | ' | ' | ' |
Deferred income taxes | ' | ' | ' | ' |
Other | ' | ' | ' | ' |
Total current assets | ' | ' | ' | ' |
Property and equipment, net | ' | ' | ' | ' |
Investments of insurance subsidiaries | ' | ' | ' | ' |
Investments in and advances to affiliates | ' | ' | ' | ' |
Goodwill and other intangible assets | ' | ' | ' | ' |
Deferred loan costs | 207 | 258 | ' | ' |
Other | ' | ' | ' | ' |
Total assets | 207 | 258 | ' | ' |
Current liabilities: | ' | ' | ' | ' |
Accounts payable | ' | ' | ' | ' |
Accrued salaries | ' | ' | ' | ' |
Other accrued expenses | 353 | 567 | ' | ' |
Long-term debt due within one year | 702 | 1,360 | ' | ' |
Total current liabilities | 1,055 | 1,927 | ' | ' |
Long-term debt | 24,701 | 24,304 | ' | ' |
Intercompany balances | -10,513 | -12,407 | ' | ' |
Professional liability risks | ' | ' | ' | ' |
Income taxes and other liabilities | 296 | 442 | ' | ' |
Total liabilities | 15,539 | 14,266 | ' | ' |
Stockholders' (deficit) equity attributable to HCA Holdings, Inc. | -15,332 | -14,008 | ' | ' |
Noncontrolling interests | ' | ' | ' | ' |
Total stockholders' deficit | -15,332 | -14,008 | ' | ' |
Total liabilities and stockholders' deficit | 207 | 258 | ' | ' |
Subsidiary Guarantors [Member] | ' | ' | ' | ' |
Current assets: | ' | ' | ' | ' |
Cash and cash equivalents | 112 | 383 | 115 | 156 |
Accounts receivable, net | 2,565 | 2,448 | ' | ' |
Inventories | 692 | 629 | ' | ' |
Deferred income taxes | ' | ' | ' | ' |
Other | 301 | 342 | ' | ' |
Total current assets | 3,670 | 3,802 | ' | ' |
Property and equipment, net | 7,504 | 7,417 | ' | ' |
Investments of insurance subsidiaries | ' | ' | ' | ' |
Investments in and advances to affiliates | 13 | 16 | ' | ' |
Goodwill and other intangible assets | 1,695 | 1,697 | ' | ' |
Deferred loan costs | ' | ' | ' | ' |
Other | 48 | 31 | ' | ' |
Total assets | 12,930 | 12,963 | ' | ' |
Current liabilities: | ' | ' | ' | ' |
Accounts payable | 1,169 | 1,203 | ' | ' |
Accrued salaries | 694 | 638 | ' | ' |
Other accrued expenses | 464 | 464 | ' | ' |
Long-term debt due within one year | 45 | 39 | ' | ' |
Total current liabilities | 2,372 | 2,344 | ' | ' |
Long-term debt | 181 | 173 | ' | ' |
Intercompany balances | -19,428 | -17,130 | ' | ' |
Professional liability risks | ' | ' | ' | ' |
Income taxes and other liabilities | 521 | 629 | ' | ' |
Total liabilities | -16,354 | -13,984 | ' | ' |
Stockholders' (deficit) equity attributable to HCA Holdings, Inc. | 29,185 | 26,847 | ' | ' |
Noncontrolling interests | 99 | 100 | ' | ' |
Total stockholders' deficit | 29,284 | 26,947 | ' | ' |
Total liabilities and stockholders' deficit | 12,930 | 12,963 | ' | ' |
Subsidiary Non-Guarantors [Member] | ' | ' | ' | ' |
Current assets: | ' | ' | ' | ' |
Cash and cash equivalents | 302 | 300 | 258 | 249 |
Accounts receivable, net | 2,643 | 2,224 | ' | ' |
Inventories | 487 | 457 | ' | ' |
Deferred income taxes | ' | ' | ' | ' |
Other | 446 | 451 | ' | ' |
Total current assets | 3,878 | 3,432 | ' | ' |
Property and equipment, net | 6,115 | 5,768 | ' | ' |
Investments of insurance subsidiaries | 448 | 515 | ' | ' |
Investments in and advances to affiliates | 108 | 88 | ' | ' |
Goodwill and other intangible assets | 4,208 | 3,842 | ' | ' |
Deferred loan costs | ' | ' | ' | ' |
Other | 168 | 179 | ' | ' |
Total assets | 14,925 | 13,824 | ' | ' |
Current liabilities: | ' | ' | ' | ' |
Accounts payable | 633 | 565 | ' | ' |
Accrued salaries | 499 | 482 | ' | ' |
Other accrued expenses | 824 | 788 | ' | ' |
Long-term debt due within one year | 39 | 36 | ' | ' |
Total current liabilities | 1,995 | 1,871 | ' | ' |
Long-term debt | 183 | 493 | ' | ' |
Intercompany balances | 3,834 | 3,406 | ' | ' |
Professional liability risks | 949 | 973 | ' | ' |
Income taxes and other liabilities | 218 | 220 | ' | ' |
Total liabilities | 7,179 | 6,963 | ' | ' |
Stockholders' (deficit) equity attributable to HCA Holdings, Inc. | 6,503 | 5,642 | ' | ' |
Noncontrolling interests | 1,243 | 1,219 | ' | ' |
Total stockholders' deficit | 7,746 | 6,861 | ' | ' |
Total liabilities and stockholders' deficit | 14,925 | 13,824 | ' | ' |
Eliminations [Member] | ' | ' | ' | ' |
Current assets: | ' | ' | ' | ' |
Cash and cash equivalents | ' | ' | ' | ' |
Accounts receivable, net | ' | ' | ' | ' |
Inventories | ' | ' | ' | ' |
Deferred income taxes | ' | ' | ' | ' |
Other | ' | ' | ' | ' |
Total current assets | ' | ' | ' | ' |
Property and equipment, net | ' | ' | ' | ' |
Investments of insurance subsidiaries | ' | ' | ' | ' |
Investments in and advances to affiliates | -20,356 | -18,481 | ' | ' |
Goodwill and other intangible assets | ' | ' | ' | ' |
Deferred loan costs | ' | ' | ' | ' |
Other | ' | ' | ' | ' |
Total assets | -20,356 | -18,481 | ' | ' |
Current liabilities: | ' | ' | ' | ' |
Accounts payable | ' | ' | ' | ' |
Accrued salaries | ' | ' | ' | ' |
Other accrued expenses | ' | ' | ' | ' |
Long-term debt due within one year | ' | ' | ' | ' |
Total current liabilities | ' | ' | ' | ' |
Long-term debt | ' | ' | ' | ' |
Intercompany balances | ' | ' | ' | ' |
Professional liability risks | ' | ' | ' | ' |
Income taxes and other liabilities | ' | ' | ' | ' |
Total liabilities | ' | ' | ' | ' |
Stockholders' (deficit) equity attributable to HCA Holdings, Inc. | -20,356 | -18,481 | ' | ' |
Noncontrolling interests | ' | ' | ' | ' |
Total stockholders' deficit | -20,356 | -18,481 | ' | ' |
Total liabilities and stockholders' deficit | ($20,356) | ($18,481) | ' | ' |
Supplemental_Condensed_Consoli5
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Statement of Cash Flows (Detail) (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Cash flows from operating activities: | ' | ' | ' |
Net income (loss) | $1,996 | $2,006 | $2,842 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ' | ' | ' |
Change in operating assets and liabilities | -4,272 | -3,663 | -2,953 |
Provision for doubtful accounts | 3,858 | 3,770 | 2,824 |
Depreciation and amortization | 1,753 | 1,679 | 1,465 |
Income taxes | 143 | 96 | 912 |
Gains on sales of facilities | 10 | -15 | -142 |
Gain on acquisition of controlling interest in equity investment | ' | ' | -1,522 |
Legal claim costs | ' | 175 | ' |
Loss on retirement of debt | 17 | ' | 481 |
Amortization of deferred loan costs | 55 | 62 | 70 |
Share-based compensation | 113 | 56 | 26 |
Pay-in-kind interest | ' | ' | -78 |
Equity in earnings of affiliates | -29 | -36 | -258 |
Other | 7 | 9 | 8 |
Net cash provided by (used in) operating activities | 3,680 | 4,175 | 3,933 |
Cash flows from investing activities: | ' | ' | ' |
Purchase of property and equipment | -1,943 | -1,862 | -1,679 |
Acquisition of hospitals and health care entities | -481 | -258 | -1,682 |
Disposal of hospitals and health care entities | 33 | 30 | 281 |
Change in investments | 36 | 16 | 80 |
Other | 9 | 11 | 5 |
Net cash used in investing activities | -2,346 | -2,063 | -2,995 |
Cash flows from financing activities: | ' | ' | ' |
Issuances of long-term debt | ' | 4,850 | 5,500 |
Net change in revolving bank credit facilities | 970 | -685 | -449 |
Repayment of long-term debt | -1,662 | -2,441 | -6,640 |
Distributions to noncontrolling interests | -435 | -401 | -378 |
Payment of debt issuance costs | -5 | -62 | -92 |
Issuance of common stock | ' | ' | 2,506 |
Repurchase of common stock | -500 | ' | -1,503 |
Distributions to stockholders | -16 | -3,148 | -31 |
Income tax benefits | 113 | 174 | 63 |
Changes in intercompany balances with affiliates, net | ' | ' | ' |
Other | -90 | -67 | 48 |
Net cash (used in) provided by financing activities | -1,625 | -1,780 | -976 |
Change in cash and cash equivalents | -291 | 332 | -38 |
Cash and cash equivalents at beginning of period | 705 | 373 | 411 |
Cash and cash equivalents at end of period | 414 | 705 | 373 |
HCA Holdings, Inc. Issuer [Member] | ' | ' | ' |
Cash flows from operating activities: | ' | ' | ' |
Net income (loss) | 1,756 | 1,588 | 2,453 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ' | ' | ' |
Change in operating assets and liabilities | -11 | 57 | 6 |
Provision for doubtful accounts | ' | ' | ' |
Depreciation and amortization | ' | ' | ' |
Income taxes | 143 | 96 | 912 |
Gains on sales of facilities | ' | ' | ' |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' |
Legal claim costs | ' | ' | ' |
Loss on retirement of debt | ' | ' | ' |
Amortization of deferred loan costs | 3 | 2 | ' |
Share-based compensation | 113 | 56 | 26 |
Pay-in-kind interest | ' | ' | ' |
Equity in earnings of affiliates | -1,875 | -1,668 | -2,531 |
Other | ' | ' | ' |
Net cash provided by (used in) operating activities | 129 | 131 | 866 |
Cash flows from investing activities: | ' | ' | ' |
Purchase of property and equipment | ' | ' | ' |
Acquisition of hospitals and health care entities | ' | ' | ' |
Disposal of hospitals and health care entities | ' | ' | ' |
Change in investments | ' | ' | ' |
Other | ' | ' | ' |
Net cash used in investing activities | ' | ' | ' |
Cash flows from financing activities: | ' | ' | ' |
Issuances of long-term debt | ' | 1,000 | ' |
Net change in revolving bank credit facilities | ' | ' | ' |
Repayment of long-term debt | ' | ' | ' |
Distributions to noncontrolling interests | ' | ' | ' |
Payment of debt issuance costs | ' | -12 | ' |
Issuance of common stock | ' | ' | 2,506 |
Repurchase of common stock | -500 | ' | -1,503 |
Distributions to stockholders | -16 | -3,148 | -31 |
Income tax benefits | 113 | 174 | 63 |
Changes in intercompany balances with affiliates, net | 342 | 1,938 | -1,918 |
Other | -90 | -61 | 11 |
Net cash (used in) provided by financing activities | -151 | -109 | -872 |
Change in cash and cash equivalents | -22 | 22 | -6 |
Cash and cash equivalents at beginning of period | 22 | ' | 6 |
Cash and cash equivalents at end of period | ' | 22 | ' |
HCA Inc. Issuer [Member] | ' | ' | ' |
Cash flows from operating activities: | ' | ' | ' |
Net income (loss) | -1,408 | -1,508 | -1,988 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ' | ' | ' |
Change in operating assets and liabilities | 17 | -28 | 71 |
Provision for doubtful accounts | ' | ' | ' |
Depreciation and amortization | ' | ' | ' |
Income taxes | ' | ' | ' |
Gains on sales of facilities | ' | ' | ' |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' |
Legal claim costs | ' | 175 | ' |
Loss on retirement of debt | 17 | ' | 481 |
Amortization of deferred loan costs | 52 | 60 | 70 |
Share-based compensation | ' | ' | ' |
Pay-in-kind interest | ' | ' | -78 |
Equity in earnings of affiliates | ' | ' | ' |
Other | 9 | 14 | 9 |
Net cash provided by (used in) operating activities | -1,313 | -1,287 | -1,435 |
Cash flows from investing activities: | ' | ' | ' |
Purchase of property and equipment | ' | ' | ' |
Acquisition of hospitals and health care entities | ' | ' | ' |
Disposal of hospitals and health care entities | ' | ' | ' |
Change in investments | ' | ' | ' |
Other | ' | ' | ' |
Net cash used in investing activities | ' | ' | ' |
Cash flows from financing activities: | ' | ' | ' |
Issuances of long-term debt | ' | 3,850 | 5,500 |
Net change in revolving bank credit facilities | 970 | -685 | -449 |
Repayment of long-term debt | -1,254 | -2,309 | -6,577 |
Distributions to noncontrolling interests | ' | ' | ' |
Payment of debt issuance costs | -5 | -50 | -92 |
Issuance of common stock | ' | ' | ' |
Repurchase of common stock | ' | ' | ' |
Distributions to stockholders | ' | ' | ' |
Income tax benefits | ' | ' | ' |
Changes in intercompany balances with affiliates, net | 1,602 | 481 | 3,053 |
Other | ' | ' | ' |
Net cash (used in) provided by financing activities | 1,313 | 1,287 | 1,435 |
Change in cash and cash equivalents | ' | ' | ' |
Cash and cash equivalents at beginning of period | ' | ' | ' |
Cash and cash equivalents at end of period | ' | ' | ' |
Subsidiary Guarantors [Member] | ' | ' | ' |
Cash flows from operating activities: | ' | ' | ' |
Net income (loss) | 2,299 | 2,428 | 2,430 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ' | ' | ' |
Change in operating assets and liabilities | -2,320 | -1,927 | -1,755 |
Provision for doubtful accounts | 2,262 | 2,144 | 1,644 |
Depreciation and amortization | 855 | 821 | 777 |
Income taxes | ' | ' | ' |
Gains on sales of facilities | 20 | 3 | -127 |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' |
Legal claim costs | ' | ' | ' |
Loss on retirement of debt | ' | ' | ' |
Amortization of deferred loan costs | ' | ' | ' |
Share-based compensation | ' | ' | ' |
Pay-in-kind interest | ' | ' | ' |
Equity in earnings of affiliates | -2 | -5 | -86 |
Other | 2 | -1 | ' |
Net cash provided by (used in) operating activities | 3,118 | 3,468 | 2,969 |
Cash flows from investing activities: | ' | ' | ' |
Purchase of property and equipment | -921 | -1,039 | -910 |
Acquisition of hospitals and health care entities | ' | -110 | -142 |
Disposal of hospitals and health care entities | 17 | 2 | 200 |
Change in investments | -16 | -11 | 34 |
Other | ' | -2 | ' |
Net cash used in investing activities | -920 | -1,160 | -818 |
Cash flows from financing activities: | ' | ' | ' |
Issuances of long-term debt | ' | ' | ' |
Net change in revolving bank credit facilities | ' | ' | ' |
Repayment of long-term debt | -34 | -20 | -17 |
Distributions to noncontrolling interests | -71 | -60 | -77 |
Payment of debt issuance costs | ' | ' | ' |
Issuance of common stock | ' | ' | ' |
Repurchase of common stock | ' | ' | ' |
Distributions to stockholders | ' | ' | ' |
Income tax benefits | ' | ' | ' |
Changes in intercompany balances with affiliates, net | -2,364 | -1,960 | -2,098 |
Other | ' | ' | ' |
Net cash (used in) provided by financing activities | -2,469 | -2,040 | -2,192 |
Change in cash and cash equivalents | -271 | 268 | -41 |
Cash and cash equivalents at beginning of period | 383 | 115 | 156 |
Cash and cash equivalents at end of period | 112 | 383 | 115 |
Subsidiary Non-Guarantors [Member] | ' | ' | ' |
Cash flows from operating activities: | ' | ' | ' |
Net income (loss) | 1,224 | 1,166 | 2,478 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ' | ' | ' |
Change in operating assets and liabilities | -1,958 | -1,765 | -1,275 |
Provision for doubtful accounts | 1,596 | 1,626 | 1,180 |
Depreciation and amortization | 898 | 858 | 688 |
Income taxes | ' | ' | ' |
Gains on sales of facilities | -10 | -18 | -15 |
Gain on acquisition of controlling interest in equity investment | ' | ' | -1,522 |
Legal claim costs | ' | ' | ' |
Loss on retirement of debt | ' | ' | ' |
Amortization of deferred loan costs | ' | ' | ' |
Share-based compensation | ' | ' | ' |
Pay-in-kind interest | ' | ' | ' |
Equity in earnings of affiliates | -27 | -31 | -172 |
Other | -4 | -4 | -1 |
Net cash provided by (used in) operating activities | 1,746 | 1,863 | 1,533 |
Cash flows from investing activities: | ' | ' | ' |
Purchase of property and equipment | -1,022 | -823 | -769 |
Acquisition of hospitals and health care entities | -481 | -148 | -1,540 |
Disposal of hospitals and health care entities | 16 | 28 | 81 |
Change in investments | 52 | 27 | 46 |
Other | 9 | 13 | 5 |
Net cash used in investing activities | -1,426 | -903 | -2,177 |
Cash flows from financing activities: | ' | ' | ' |
Issuances of long-term debt | ' | ' | ' |
Net change in revolving bank credit facilities | ' | ' | ' |
Repayment of long-term debt | -374 | -112 | -46 |
Distributions to noncontrolling interests | -364 | -341 | -301 |
Payment of debt issuance costs | ' | ' | ' |
Issuance of common stock | ' | ' | ' |
Repurchase of common stock | ' | ' | ' |
Distributions to stockholders | ' | ' | ' |
Income tax benefits | ' | ' | ' |
Changes in intercompany balances with affiliates, net | 420 | -459 | 963 |
Other | ' | -6 | 37 |
Net cash (used in) provided by financing activities | -318 | -918 | 653 |
Change in cash and cash equivalents | 2 | 42 | 9 |
Cash and cash equivalents at beginning of period | 300 | 258 | 249 |
Cash and cash equivalents at end of period | 302 | 300 | 258 |
Eliminations [Member] | ' | ' | ' |
Cash flows from operating activities: | ' | ' | ' |
Net income (loss) | -1,875 | -1,668 | -2,531 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ' | ' | ' |
Change in operating assets and liabilities | ' | ' | ' |
Provision for doubtful accounts | ' | ' | ' |
Depreciation and amortization | ' | ' | ' |
Income taxes | ' | ' | ' |
Gains on sales of facilities | ' | ' | ' |
Gain on acquisition of controlling interest in equity investment | ' | ' | ' |
Legal claim costs | ' | ' | ' |
Loss on retirement of debt | ' | ' | ' |
Amortization of deferred loan costs | ' | ' | ' |
Share-based compensation | ' | ' | ' |
Pay-in-kind interest | ' | ' | ' |
Equity in earnings of affiliates | 1,875 | 1,668 | 2,531 |
Other | ' | ' | ' |
Net cash provided by (used in) operating activities | ' | ' | ' |
Cash flows from investing activities: | ' | ' | ' |
Purchase of property and equipment | ' | ' | ' |
Acquisition of hospitals and health care entities | ' | ' | ' |
Disposal of hospitals and health care entities | ' | ' | ' |
Change in investments | ' | ' | ' |
Other | ' | ' | ' |
Net cash used in investing activities | ' | ' | ' |
Cash flows from financing activities: | ' | ' | ' |
Issuances of long-term debt | ' | ' | ' |
Net change in revolving bank credit facilities | ' | ' | ' |
Repayment of long-term debt | ' | ' | ' |
Distributions to noncontrolling interests | ' | ' | ' |
Payment of debt issuance costs | ' | ' | ' |
Issuance of common stock | ' | ' | ' |
Repurchase of common stock | ' | ' | ' |
Distributions to stockholders | ' | ' | ' |
Income tax benefits | ' | ' | ' |
Changes in intercompany balances with affiliates, net | ' | ' | ' |
Other | ' | ' | ' |
Net cash (used in) provided by financing activities | ' | ' | ' |
Change in cash and cash equivalents | ' | ' | ' |
Cash and cash equivalents at beginning of period | ' | ' | ' |
Cash and cash equivalents at end of period | ' | ' | ' |
Supplemental_Condensed_Consoli6
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Consolidated Statements of Stockholder's Deficit (Detail) (USD $) | 12 Months Ended | ||
In Millions, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Share-based benefit plans | $139 | $169 | $35 |
Reclassification of certain equity securities with contingent redemption rights | ' | ' | 141 |
Other | -13 | -28 | -56 |
Healthtrust, Inc. [Member] | ' | ' | ' |
Share-based benefit plans | 139 | 169 | 35 |
Reclassification of certain equity securities with contingent redemption rights | ' | ' | 141 |
Other | -6 | -17 | 36 |
Distributions from HCA Holdings, Inc., net of contributions to HCA Holdings, Inc. | $133 | $152 | $212 |
Supplemental_Condensed_Consoli7
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Quarterly Consolidated Financial Information (Detail) (USD $) | 3 Months Ended | 12 Months Ended | |||||||||
In Millions, except Per Share data, unless otherwise specified | Dec. 31, 2013 | Sep. 30, 2013 | Jun. 30, 2013 | Mar. 31, 2013 | Dec. 31, 2012 | Sep. 30, 2012 | Jun. 30, 2012 | Mar. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Stockholders Equity Excluding Portion Attributable To Subsidiaries Noncontrolling Interest [Abstract] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Revenues | $8,836 | $8,456 | $8,450 | $8,440 | $8,434 | $8,062 | $8,112 | $8,405 | $34,182 | $33,013 | $29,682 |
Net income | 554 | 467 | 537 | 438 | 427 | 455 | 485 | 639 | 1,996 | 2,006 | 2,842 |
Net income attributable to HCA Holdings, Inc. | $424 | $365 | $423 | $344 | $314 | $360 | $391 | $540 | $1,556 | $1,605 | $2,465 |
Basic earnings per share | $0.96 | $0.82 | $0.95 | $0.77 | $0.71 | $0.82 | $0.89 | $1.23 | $3.50 | $3.65 | $5.17 |
Diluted earnings per share | $0.92 | $0.79 | $0.91 | $0.74 | $0.68 | $0.78 | $0.85 | $1.18 | $3.37 | $3.49 | $4.97 |
Supplemental_Condensed_Consoli8
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Quarterly Consolidated Financial Information (Parenthetical) (Detail) (USD $) | 1 Months Ended | 3 Months Ended | 12 Months Ended | |||||||||
In Millions, unless otherwise specified | Mar. 31, 2013 | Dec. 31, 2013 | Sep. 30, 2013 | Jun. 30, 2013 | Mar. 31, 2013 | Dec. 31, 2012 | Sep. 30, 2012 | Jun. 30, 2012 | Mar. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Stockholders Equity Excluding Portion Attributable To Subsidiaries Noncontrolling Interest [Abstract] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Losses (gains) on sales of facilities | ' | $2 | ($1) | $3 | ($11) | $6 | $5 | ($1) | ($1) | ($10) | $15 | $142 |
Losses on retirement of debt | -17 | ' | ' | ' | -11 | ' | ' | ' | ' | -17 | ' | -481 |
Legal claim costs | ' | ' | ' | ' | ' | $110 | ' | ' | ' | ' | $175 | ' |