Document and Entity Information
Document and Entity Information - shares | 9 Months Ended | |
Sep. 30, 2017 | Oct. 31, 2017 | |
Document And Entity Information [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Sep. 30, 2017 | |
Document Fiscal Year Focus | 2,017 | |
Document Fiscal Period Focus | Q3 | |
Trading Symbol | HCA | |
Entity Registrant Name | HCA HEALTHCARE, INC. | |
Entity Central Index Key | 860,730 | |
Current Fiscal Year End Date | --12-31 | |
Entity Filer Category | Large Accelerated Filer | |
Entity Common Stock, Shares Outstanding | 354,052,500 |
Condensed Consolidated Income S
Condensed Consolidated Income Statements (Unaudited) - USD ($) shares in Thousands, $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2017 | Sep. 30, 2016 | Sep. 30, 2017 | Sep. 30, 2016 | |
Income Statement [Abstract] | ||||
Revenues before provision for doubtful accounts | $ 11,967 | $ 11,110 | $ 35,156 | $ 33,241 |
Provision for doubtful accounts | 1,271 | 840 | 3,104 | 2,392 |
Revenues | 10,696 | 10,270 | 32,052 | 30,849 |
Salaries and benefits | 5,081 | 4,740 | 14,878 | 14,133 |
Supplies | 1,777 | 1,699 | 5,369 | 5,131 |
Other operating expenses | 2,075 | 1,896 | 5,970 | 5,617 |
Equity in earnings of affiliates | (13) | (22) | (36) | (44) |
Depreciation and amortization | 539 | 495 | 1,581 | 1,463 |
Interest expense | 427 | 432 | 1,257 | 1,275 |
Gains on sales of facilities | (7) | (3) | (10) | (8) |
Losses on retirement of debt | 39 | 4 | 39 | 4 |
Legal claim costs | 11 | 33 | ||
Total expenses including equity in earnings of affiliates | 9,918 | 9,252 | 29,048 | 27,604 |
Income before income taxes | 778 | 1,018 | 3,004 | 3,245 |
Provision for income taxes | 248 | 273 | 902 | 898 |
Net income | 530 | 745 | 2,102 | 2,347 |
Net income attributable to noncontrolling interests | 104 | 127 | 360 | 377 |
Net income attributable to HCA Healthcare, Inc. | $ 426 | $ 618 | $ 1,742 | $ 1,970 |
Per share data: | ||||
Basic earnings per share | $ 1.18 | $ 1.63 | $ 4.77 | $ 5.09 |
Diluted earnings per share | $ 1.15 | $ 1.59 | $ 4.64 | $ 4.93 |
Shares used in earnings per share calculations (in millions): | ||||
Basic | 360,170 | 378,199 | 365,398 | 386,968 |
Diluted | 369,834 | 389,592 | 375,013 | 399,577 |
Condensed Consolidated Comprehe
Condensed Consolidated Comprehensive Income Statements (Unaudited) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2017 | Sep. 30, 2016 | Sep. 30, 2017 | Sep. 30, 2016 | |
Statement of Comprehensive Income [Abstract] | ||||
Net income | $ 530 | $ 745 | $ 2,102 | $ 2,347 |
Other comprehensive income (loss) before taxes: | ||||
Foreign currency translation | 32 | (40) | 87 | (169) |
Unrealized gains (losses) on available-for-sale securities | (2) | 5 | 3 | |
Defined benefit plans | 0 | 0 | 0 | 0 |
Pension costs included in salaries and benefits | 5 | 4 | 14 | 13 |
Total defined benefit plans | 5 | 4 | 14 | 13 |
Change in fair value of derivative financial instruments | (1) | 13 | (9) | (57) |
Interest costs included in interest expense | 4 | 28 | 17 | 84 |
Total change in fair value of derivative financial instruments | 3 | 41 | 8 | 27 |
Other comprehensive income (loss) before taxes | 40 | 3 | 114 | (126) |
Income taxes (benefits) related to other comprehensive income items | 15 | 44 | (50) | |
Other comprehensive income (loss) | 25 | 3 | 70 | (76) |
Comprehensive income | 555 | 748 | 2,172 | 2,271 |
Comprehensive income attributable to noncontrolling interests | 104 | 127 | 360 | 377 |
Comprehensive income attributable to HCA Healthcare, Inc. | $ 451 | $ 621 | $ 1,812 | $ 1,894 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Millions | Sep. 30, 2017 | Dec. 31, 2016 |
Current assets: | ||
Cash and cash equivalents | $ 718 | $ 646 |
Accounts receivable, less allowance for doubtful accounts of $5,416 and $4,988 | 5,980 | 5,826 |
Inventories | 1,546 | 1,503 |
Other | 1,204 | 1,111 |
Total current assets | 9,448 | 9,086 |
Property and equipment, at cost | 39,262 | 37,055 |
Accumulated depreciation | (21,933) | (20,703) |
Property and equipment, net | 17,329 | 16,352 |
Investments of insurance subsidiaries | 368 | 336 |
Investments in and advances to affiliates | 201 | 206 |
Goodwill and other intangible assets | 7,357 | 6,704 |
Other | 1,028 | 1,074 |
Total assets | 35,731 | 33,758 |
Current liabilities: | ||
Accounts payable | 2,314 | 2,318 |
Accrued salaries | 1,312 | 1,265 |
Other accrued expenses | 1,783 | 2,035 |
Long-term debt due within one year | 202 | 216 |
Total current liabilities | 5,611 | 5,834 |
Long-term debt, less net debt issuance costs of $171 and $170 | 32,751 | 31,160 |
Professional liability risks | 1,179 | 1,148 |
Income taxes and other liabilities | 1,256 | 1,249 |
Stockholders' deficit: | ||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 356,979,800 shares in 2017 and 370,535,900 shares in 2016 | 4 | 4 |
Accumulated other comprehensive loss | (268) | (338) |
Retained deficit | (6,516) | (6,968) |
Stockholders' deficit attributable to HCA Healthcare, Inc. | (6,780) | (7,302) |
Noncontrolling interests | 1,714 | 1,669 |
Total stockholders' deficit | (5,066) | (5,633) |
Total liabilities and stockholders' deficit | $ 35,731 | $ 33,758 |
Condensed Consolidated Balance5
Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - USD ($) $ in Millions | Sep. 30, 2017 | Dec. 31, 2016 |
Statement of Financial Position [Abstract] | ||
Allowance for Accounts receivable | $ 5,416 | $ 4,988 |
Debt issuance cost | $ 171 | $ 170 |
Common stock, par value | $ 0.01 | $ 0.01 |
Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 |
Common stock, shares outstanding | 356,979,800 | 370,535,900 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Millions | 9 Months Ended | |
Sep. 30, 2017 | Sep. 30, 2016 | |
Cash flows from operating activities: | ||
Net income | $ 2,102 | $ 2,347 |
Increase (decrease) in cash from operating assets and liabilities: | ||
Accounts receivable | (3,174) | (2,044) |
Provision for doubtful accounts | 3,104 | 2,392 |
Accounts receivable, net | (70) | 348 |
Inventories and other assets | (50) | (161) |
Accounts payable and accrued expenses | (169) | (341) |
Depreciation and amortization | 1,581 | 1,463 |
Income taxes | (9) | 8 |
Gains on sales of facilities | (10) | (8) |
Losses on retirement of debt | 39 | 4 |
Legal claim costs | 33 | |
Amortization of debt issuance costs | 23 | 26 |
Share-based compensation | 195 | 196 |
Other | 60 | 39 |
Net cash provided by (used in) operating activities | 3,692 | 3,954 |
Cash flows from investing activities: | ||
Purchase of property and equipment | (2,033) | (1,884) |
Acquisition of hospitals and health care entities | (1,142) | (468) |
Disposal of hospitals and health care entities | 24 | 23 |
Change in investments | (15) | 78 |
Other | (6) | 17 |
Net cash used in investing activities | (3,172) | (2,234) |
Cash flows from financing activities: | ||
Issuances of long-term debt | 1,502 | 5,400 |
Net change in revolving bank credit facilities | 650 | (70) |
Repayment of long-term debt | (700) | (4,424) |
Distributions to noncontrolling interests | (363) | (342) |
Payment of debt issuance costs | (25) | (40) |
Repurchases of common stock | (1,475) | (2,213) |
Other | (37) | (95) |
Net cash (used in) provided by financing activities | (448) | (1,784) |
Change in cash and cash equivalents | 72 | (64) |
Cash and cash equivalents at beginning of period | 646 | 741 |
Cash and cash equivalents at end of period | 718 | 677 |
Interest payments | 1,383 | 1,339 |
Income tax payments, net | $ 911 | $ 890 |
Basis of Presentation and Signi
Basis of Presentation and Significant Accounting Policies | 9 Months Ended |
Sep. 30, 2017 | |
Accounting Policies [Abstract] | |
Basis of Presentation and Significant Accounting Policies | NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES Reporting Entity HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At September 30, 2017, these affiliates owned and operated 177 hospitals, 119 freestanding surgery centers and provided extensive outpatient and ancillary services. HCA Healthcare, 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 Healthcare, Inc. and its affiliates. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q Regulation S-X. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $91 million and $94 million for the quarters ended September 30, 2017 and 2016, respectively, and $273 million and $272 million for the nine months ended September 30, 2017 and 2016, respectively. Operating results for the quarter and nine months ended September 30, 2017 are not necessarily indicative of the results that may be expected for the year ending December 31, 2017. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K Revenues Revenues are recorded during the period the health care services are provided, based upon the estimated amounts due from the patients and third-party payers. Third-party payers include federal and state agencies (under the Medicare and Medicaid programs), managed care health plans and commercial insurance companies (including plans offered through the health insurance exchanges), and employers. Estimates of contractual allowances under managed care health plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured 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 uninsured accounts to record net self-pay Quarter 2017 Ratio 2016 Ratio Medicare $ 2,354 22.0 % $ 2,158 21.0 % Managed Medicare 1,156 10.8 1,068 10.4 Medicaid 362 3.4 405 3.9 Managed Medicaid 582 5.4 611 6.0 Managed care and other insurers 6,039 56.4 5,863 57.1 International (managed care and other insurers) 276 2.6 285 2.8 10,769 100.6 10,390 101.2 Uninsured 849 7.9 336 3.3 Other 349 3.3 384 3.7 Revenues before provision for doubtful accounts 11,967 111.8 11,110 108.2 Provision for doubtful accounts (1,271 ) (11.8 ) (840 ) (8.2 ) Revenues $ 10,696 100.0 % $ 10,270 100.0 % Nine Months 2017 Ratio 2016 Ratio Medicare $ 7,080 22.1 % $ 6,641 21.5 % Managed Medicare 3,546 11.1 3,250 10.5 Medicaid 1,188 3.7 1,248 4.0 Managed Medicaid 1,798 5.6 1,816 5.9 Managed care and other insurers 18,071 56.4 17,324 56.2 International (managed care and other insurers) 814 2.5 926 3.0 32,497 101.4 31,205 101.1 Uninsured 1,593 5.0 750 2.4 Other 1,066 3.3 1,286 4.2 Revenues before provision for doubtful accounts 35,156 109.7 33,241 107.7 Provision for doubtful accounts (3,104 ) (9.7 ) (2,392 ) (7.7 ) Revenues $ 32,052 100.0 % $ 30,849 100.0 % Recent Pronouncements In May 2014, the Financial Accounting Standards Board (“FASB”) and the International Accounting Standards Board issued a final, converged, principles-based standard on revenue recognition. Companies across all industries will use a five-step model to recognize revenue from customer contracts. The new standard, which replaces nearly all existing revenue recognition guidance, will require significant management judgments and change the way many companies recognize revenue in their financial statements. In July 2015, the FASB decided to defer the effective date of the new revenue standard by one year to annual and interim periods beginning after December 15, 2017 for public entities and permit entities to adopt one year earlier if they choose. The FASB decided, based on its outreach to various stakeholders and continuing amendments to the new revenue standard, that a deferral was necessary to provide adequate time to effectively implement the new standard. We are continuing to evaluate the effects the adoption of this standard will have on our financial statements and financial disclosures. We believe the most significant impact will be to the presentation of our income statement where the provision for doubtful accounts will be recorded as a direct reduction to revenues and will not be presented as a separate line item. We expect to adopt the new standard using the full retrospective application, and we do not currently believe the adoption will have a significant impact on our recognition of net revenues or related disclosures for any period. In February 2016, the FASB issued Accounting Standards Update 2016-02, Leases 2016-02”), 2016-02 2016-02’s 2016-02 right-of-use Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Acquisitions and Dispositions
Acquisitions and Dispositions | 9 Months Ended |
Sep. 30, 2017 | |
Business Combinations [Abstract] | |
Acquisitions and Dispositions | NOTE 2 — ACQUISITIONS AND DISPOSITIONS During the nine months ended September 30, 2017, we paid $1.000 billion to acquire seven hospital facilities (one of the acquired hospital facilities has an effective acquisition date of October 1, 2017) and $142 million to acquire other nonhospital health care entities. During the nine months ended September 30, 2016, we paid $343 million to acquire three hospital facilities and $125 million to acquire other nonhospital health care entities. During the nine months ended September 30, 2017, we received proceeds of $24 million and recognized a net pretax gain of $10 million related to sales of real estate and other investments. During the nine months ended September 30, 2016, we received proceeds of $23 million and recognized a net pretax gain of $8 million related to sales of real estate and other investments. |
Income Taxes
Income Taxes | 9 Months Ended |
Sep. 30, 2017 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | NOTE 3 — INCOME TAXES Our liability for unrecognized tax benefits was $429 million, including accrued interest of $40 million, as of September 30, 2017 ($418 million and $45 million, respectively, as of December 31, 2016). Unrecognized tax benefits of $136 million ($137 million as of December 31, 2016) would affect the effective rate, if recognized. Our provision for income taxes for the quarters ended September 30, 2017 and 2016, included tax benefits of $4 million and $11 million, respectively, and for the nine months ended September 30, 2017 and 2016, included tax benefits of $80 million and $129 million, respectively, related to the settlement of employee equity awards. Our provision for income taxes for the quarter and nine months ended September 30, 2017 also included $4 million and $16 million, respectively, of reductions in interest expense (net of tax). We also reduced our provision for income taxes for the quarter and nine months ended September 30, 2016 by $51 million, including interest of $17 million (net of tax) primarily related to the completion of IRS examinations which resolved all outstanding federal tax issues for our 2011 and 2012 tax years. We are subject to examination by federal, state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change. |
Earnings Per Share
Earnings Per Share | 9 Months Ended |
Sep. 30, 2017 | |
Earnings Per Share [Abstract] | |
Earnings Per Share | NOTE 4 — EARNINGS PER SHARE We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards and potential shares, computed using the treasury stock method. The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2017 and 2016 (dollars and shares in millions, except per share amounts): Quarter Nine months 2017 2016 2017 2016 Net income attributable to HCA Healthcare, Inc. $ 426 $ 618 $ 1,742 $ 1,970 Weighted average common shares outstanding 360.170 378.199 365.398 386.968 Effect of dilutive incremental shares 9.664 11.393 9.615 12.609 Shares used for diluted earnings per share 369.834 389.592 375.013 399.577 Earnings per share: Basic earnings per share $ 1.18 $ 1.63 $ 4.77 $ 5.09 Diluted earnings per share $ 1.15 $ 1.59 $ 4.64 $ 4.93 |
Investments of Insurance Subsid
Investments of Insurance Subsidiaries | 9 Months Ended |
Sep. 30, 2017 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments of Insurance Subsidiaries | NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES A summary of our insurance subsidiaries’ investments at September 30, 2017 and December 31, 2016 follows (dollars in millions): September 30, 2017 Amortized Unrealized Fair Gains Losses Debt securities: States and municipalities $ 352 $14 $— $ 366 Money market funds 52 — — 52 404 14 — 418 Equity securities 1 2 — 3 $ 405 $16 $— 421 Amounts classified as current assets (53 ) Investment carrying value $ 368 December 31, 2016 Amortized Unrealized Fair Gains Losses Debt securities: States and municipalities $ 345 $9 $(1) $ 353 Money market funds 28 — — 28 373 9 (1) 381 Equity securities 1 3 — 4 $ 374 $12 $(1) 385 Amounts classified as current assets (49 ) Investment carrying value $ 336 At September 30, 2017 and December 31, 2016, the investments of our insurance subsidiaries were classified as “available-for-sale.” Scheduled maturities of investments in debt securities at September 30, 2017 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 100 $ 100 Due after one year through five years 76 80 Due after five years through ten years 178 187 Due after ten years 50 51 $ 404 $ 418 The average expected maturity of the investments in debt securities at September 30, 2017 was 4.0 years, compared to the average scheduled maturity of 5.5 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 | 9 Months Ended |
Sep. 30, 2017 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Financial Instruments | NOTE 6 — FINANCIAL INSTRUMENTS Interest Rate Swap Agreements We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between two parties based on common notional principal amounts and maturity dates. Pay-fixed The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at September 30, 2017 (dollars in millions): Notional Maturity Date Fair Pay-fixed $ 1,000 December 2017 $ (3 ) Pay-fixed 2,000 December 2021 30 During the next 12 months, we estimate $3 million will be reclassified from other comprehensive income (“OCI”) to interest expense. Derivatives — Results of Operations The following table presents the effect of our interest rate swaps on our results of operations for the nine months ended September 30, 2017 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Loss Location of Loss Amount of Loss Interest rate swaps $ 6 Interest expense $ 17 |
Assets and Liabilities Measured
Assets and Liabilities Measured at Fair Value | 9 Months Ended |
Sep. 30, 2017 | |
Fair Value Disclosures [Abstract] | |
Assets and Liabilities Measured at Fair Value | NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE Accounting Standards Codification 820, Fair Value Measurements and Disclosures Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment. Cash Traded Investments Our cash traded investments are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. 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 the consideration of market factors and management’s judgment. Derivative Financial Instruments We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments. Although we determined the majority of the inputs used to value our derivatives fall within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with our derivatives utilize Level 3 inputs, such as estimates of current credit spreads to evaluate the likelihood of default by us and our counterparties. We assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions, and at September 30, 2017 and December 31, 2016, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives. The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of September 30, 2017 and December 31, 2016, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): September 30, 2017 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities: States and municipalities $ 366 $ — $ 366 $ — Money market funds 52 52 — — 418 52 366 — Equity securities 3 3 — — Investments of insurance subsidiaries 421 55 366 — Less amounts classified as current assets (53 ) (52 ) (1 ) — $ 368 $ 3 $ 365 $ — Interest rate swaps (Other) $ 30 $ — $ 30 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 3 $ — $ 3 $ — December 31, 2016 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities: States and municipalities $ 353 $ — $ 347 $ 6 Money market funds 28 28 — — 381 28 347 6 Equity securities 4 4 — — Investments of insurance subsidiaries 385 32 347 6 Less amounts classified as current assets (49 ) (28 ) (21 ) — $ 336 $ 4 $ 326 $ 6 Interest rate swaps (Other) $ 31 $ — $ 31 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 12 $ — $ 12 $ — The $6 million reduction in the Level 3 investments of our insurance subsidiaries resulted from settlements. The estimated fair value of our long-term debt was $34.998 billion and $32.833 billion at September 30, 2017 and December 31, 2016, respectively, compared to carrying amounts, excluding net debt issuance costs, aggregating $33.124 billion and $31.546 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. |
Long-Term Debt
Long-Term Debt | 9 Months Ended |
Sep. 30, 2017 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | NOTE 8 — LONG-TERM DEBT A summary of long-term debt at September 30, 2017 and December 31, 2016, including related interest rates at September 30, 2017, follows (dollars in millions): September 30, December 31, Senior secured asset-based revolving credit facility (effective interest rate of 2.7%) $ 3,570 $ 2,920 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 3.6%) 3,915 3,981 Senior secured notes (effective interest rate of 5.4%) 15,300 13,800 Other senior secured debt (effective interest rate of 5.8%) 587 593 Senior secured debt 23,372 21,294 Senior unsecured notes (effective interest rate of 6.4%) 9,752 10,252 Net debt issuance costs (171 ) (170 ) Total debt (average life of 7.1 years, rates averaging 5.2%) 32,953 31,376 Less amounts due within one year 202 216 $ 32,751 $ 31,160 2017 Activity During June 2017, we issued $1.500 billion aggregate principal amount of 5.500% senior secured notes due 2047. We used the net proceeds for general corporate purposes, including funding the purchase of certain hospital acquisitions, and the redemption, during July 2017, of all $500 million aggregate principal amount of our existing 8.000% senior notes maturing in October 2018. The pretax loss on retirement of debt was $39 million. During June 2017, we amended our senior secured revolving credit facilities by (i) increasing the commitments under the senior secured asset-based revolving credit facility to $3.750 billion, (ii) extending the maturity date of the revolving credit commitments to June 28, 2022, (iii) amending the incremental facility provisions to permit the incurrence of additional incremental credit facilities in an aggregate principal amount of $1.5 billion and (iv) providing that the commitment fee for unutilized commitments under the senior secured asset-based revolving credit facility shall be 0.250% per annum. |
Contingencies
Contingencies | 9 Months Ended |
Sep. 30, 2017 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | NOTE 9 — CONTINGENCIES We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity. Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act, private parties have the right to bring qui tam |
Capital Structure
Capital Structure | 9 Months Ended |
Sep. 30, 2017 | |
Text Block [Abstract] | |
Capital Structure | NOTE 10 — CAPITAL STRUCTURE The changes in stockholders’ deficit, including changes in stockholders’ deficit attributable to HCA Healthcare, Inc. and changes in equity attributable to noncontrolling interests, are as follows (dollars and shares in millions): Equity (Deficit) Attributable to HCA Healthcare, Inc. Equity Total Common Stock Capital in Accumulated Retained Shares Par Value Balances at December 31, 2016 370.536 $ 4 $ — $ (338 ) $ (6,968 ) $ 1,669 $ (5,633 ) Comprehensive income — — — 70 1,742 360 2,172 Repurchase of common stock (17.847 ) — (185 ) — (1,290 ) — (1,475 ) Distributions — — — — — (363 ) (363 ) Share-based benefit plans 4.291 — 188 — — — 188 Other — — (3 ) — — 48 45 Balances at September 30, 2017 356.980 $ 4 $ — $ (268 ) $ (6,516 ) $ 1,714 $ (5,066 ) During the nine months ended September 30, 2017, we repurchased 17.847 million shares of our common stock at an average price of $82.62 per share through market purchases pursuant to the $2.0 billion share repurchase program authorized during November 2016. At September 30, 2017, we had $379 million of repurchase authorization available under the November 2016 authorization. During October 2017, our board of directors authorized a share repurchase program for up to $2 billion of our outstanding common stock. The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized for-Sale Foreign Defined Change Total Balances at December 31, 2016 $ 7 $ (211 ) $ (146 ) $ 12 $ (338 ) Unrealized gains on available-for-sale 3 — — — 3 Foreign currency translation adjustments, net of $34 of income taxes — 53 — — 53 Change in fair value of derivative instruments, net of $3 income tax benefits — — — (6 ) (6 ) Expense reclassified into operations from other comprehensive income, net of $5 and $6, respectively, income tax benefits — — 9 11 20 Balances at September 30, 2017 $ 10 $ (158 ) $ (137 ) $ 17 $ (268 ) |
Segment and Geographic Informat
Segment and Geographic Information | 9 Months Ended |
Sep. 30, 2017 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION We operate in one line of business, which is operating hospitals and related health care entities. We operate in two geographically organized groups: the National and American Groups. The National Group includes 86 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, South Carolina, Utah and Virginia, and the American Group includes 85 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, gains on sales of facilities, losses on retirement of debt, legal claim costs, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2017 and 2016 are summarized in the following table (dollars in millions): Quarter Nine months 2017 2016 2017 2016 Revenues: National Group $ 5,036 $ 4,882 $ 15,344 $ 14,780 American Group 5,180 4,908 15,268 14,554 Corporate and other 480 480 1,440 1,515 $ 10,696 $ 10,270 $ 32,052 $ 30,849 Equity in earnings of affiliates: National Group $ (8 ) $ (13 ) $ (17 ) $ (17 ) American Group (9 ) (9 ) (27 ) (26 ) Corporate and other 4 — 8 (1 ) $ (13 ) $ (22 ) $ (36 ) $ (44 ) Adjusted segment EBITDA: National Group $ 975 $ 1,073 $ 3,268 $ 3,342 American Group 930 1,016 2,977 3,002 Corporate and other (129 ) (132 ) (374 ) (332 ) $ 1,776 $ 1,957 $ 5,871 $ 6,012 Depreciation and amortization: National Group $ 219 $ 204 $ 650 $ 602 American Group 251 231 727 675 Corporate and other 69 60 204 186 $ 539 $ 495 $ 1,581 $ 1,463 Adjusted segment EBITDA $ 1,776 $ 1,957 $ 5,871 $ 6,012 Depreciation and amortization 539 495 1,581 1,463 Interest expense 427 432 1,257 1,275 Gains on sales of facilities (7 ) (3 ) (10 ) (8 ) Losses on retirement of debt 39 4 39 4 Legal claim costs — 11 — 33 Income before income taxes $ 778 $ 1,018 $ 3,004 $ 3,245 |
Supplemental Condensed Consolid
Supplemental Condensed Consolidating Financial Information | 9 Months Ended |
Sep. 30, 2017 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Supplemental Condensed Consolidating Financial Information | NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION During December 2012, HCA Healthcare, Inc. issued $1.000 billion aggregate principal amount of 6.250% senior unsecured notes due 2021. These notes are senior unsecured obligations and are not guaranteed by any of our subsidiaries. HCA Inc., a direct wholly-owned subsidiary of HCA Healthcare, Inc., is the obligor under a significant portion of our other indebtedness, including our senior secured credit facilities, senior secured notes and senior unsecured notes (other than the senior unsecured notes issued by HCA Healthcare, Inc.). The senior secured notes and senior unsecured notes issued by HCA Inc. are fully and unconditionally guaranteed by HCA Healthcare, Inc. The senior secured credit facilities and senior secured notes are fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, 100% owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our senior secured asset-based revolving credit facility). Our summarized condensed consolidating comprehensive income statements for the quarters and nine months ended September 30, 2017 and 2016, condensed consolidating balance sheets at September 30, 2017 and December 31, 2016 and condensed consolidating statements of cash flows for the nine months ended September 30, 2017 and 2016, segregating HCA Healthcare, Inc. issuer, HCA Inc. issuer, the subsidiary guarantors, the subsidiary non-guarantors HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE QUARTER ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 5,897 $ 6,070 $ — $ 11,967 Provision for doubtful accounts — — 636 635 — 1,271 Revenues — — 5,261 5,435 — 10,696 Salaries and benefits — — 2,427 2,654 — 5,081 Supplies — — 889 888 — 1,777 Other operating expenses — — 963 1,112 — 2,075 Equity in earnings of affiliates (436 ) — (1 ) (12 ) 436 (13 ) Depreciation and amortization — — 249 290 — 539 Interest expense 16 792 (318 ) (63 ) — 427 Gains on sales of facilities — — (4 ) (3 ) — (7 ) Losses on retirement of debt — 39 — — — 39 Management fees — — (215 ) 215 — — (420 ) 831 3,990 5,081 436 9,918 Income (loss) before income taxes 420 (831 ) 1,271 354 (436 ) 778 Provision (benefit) for income taxes (6 ) (307 ) 460 101 — 248 Net income (loss) 426 (524 ) 811 253 (436 ) 530 Net income attributable to noncontrolling interests — — 24 80 — 104 Net income (loss) attributable to HCA Healthcare, Inc. $ 426 $ (524 ) $ 787 $ 173 $ (436 ) $ 426 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 451 $ (522 ) $ 790 $ 193 $ (461 ) $ 451 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE QUARTER ENDED SEPTEMBER 30, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 5,591 $ 5,519 $ — $ 11,110 Provision for doubtful accounts — — 391 449 — 840 Revenues — — 5,200 5,070 — 10,270 Salaries and benefits — — 2,373 2,367 — 4,740 Supplies — — 888 811 — 1,699 Other operating expenses 1 — 904 991 — 1,896 Equity in earnings of affiliates (573 ) — (1 ) (21 ) 573 (22 ) Depreciation and amortization — — 242 253 — 495 Interest expense 16 711 (235 ) (60 ) — 432 Gains on sales of facilities — — — (3 ) — (3 ) Losses on retirement of debt — 4 — — — 4 Legal claim costs — 11 — — — 11 Management fees — — (206 ) 206 — — (556 ) 726 3,965 4,544 573 9,252 Income (loss) before income taxes 556 (726 ) 1,235 526 (573 ) 1,018 Provision (benefit) for income taxes (62 ) (268 ) 447 156 — 273 Net income (loss) 618 (458 ) 788 370 (573 ) 745 Net income attributable to noncontrolling interests — — 24 103 — 127 Net income (loss) attributable to HCA Healthcare, Inc. $ 618 $ (458 ) $ 764 $ 267 $ (573 ) $ 618 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 621 $ (432 ) $ 766 $ 242 $ (576 ) $ 621 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 17,799 17,357 $ — $ 35,156 Provision for doubtful accounts — — 1,648 1,456 — 3,104 Revenues — — 16,151 15,901 — 32,052 Salaries and benefits — — 7,330 7,548 — 14,878 Supplies — — 2,771 2,598 — 5,369 Other operating expenses 5 — 2,841 3,124 — 5,970 Equity in earnings of affiliates (1,702 ) — (3 ) (33 ) 1,702 (36 ) Depreciation and amortization — — 748 833 — 1,581 Interest expense 48 2,280 (878 ) (193 ) — 1,257 Gains on sales of facilities — — (5 ) (5 ) — (10 ) Losses on retirement of debt — 39 — — — 39 Management fees — — (637 ) 637 — — (1,649 ) 2,319 12,167 14,509 1,702 29,048 Income (loss) before income taxes 1,649 (2,319 ) 3,984 1,392 (1,702 ) 3,004 Provision (benefit) for income taxes (93 ) (856 ) 1,443 408 — 902 Net income (loss) 1,742 (1,463 ) 2,541 984 (1,702 ) 2,102 Net income attributable to noncontrolling interests — — 74 286 — 360 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,742 $ (1,463 ) $ 2,467 $ 698 $ (1,702 ) $ 1,742 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,812 $ (1,458 ) $ 2,476 $ 754 $ (1,772 ) $ 1,812 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 16,957 $ 16,284 $ — $ 33,241 Provision for doubtful accounts — — 1,383 1,009 — 2,392 Revenues — — 15,574 15,275 — 30,849 Salaries and benefits — — 7,074 7,059 — 14,133 Supplies — — 2,672 2,459 — 5,131 Other operating expenses 5 — 2,654 2,958 — 5,617 Equity in earnings of affiliates (1,843 ) — (4 ) (40 ) 1,843 (44 ) Depreciation and amortization — — 707 756 — 1,463 Interest expense 48 2,031 (646 ) (158 ) — 1,275 Gains on sales of facilities — — — (8 ) — (8 ) Losses on retirement of debt — 4 — — — 4 Legal claim costs — 33 — — — 33 Management fees — — (601 ) 601 — — (1,790 ) 2,068 11,856 13,627 1,843 27,604 Income (loss) before income taxes 1,790 (2,068 ) 3,718 1,648 (1,843 ) 3,245 Provision (benefit) for income taxes (180 ) (763 ) 1,347 494 — 898 Net income (loss) 1,970 (1,305 ) 2,371 1,154 (1,843 ) 2,347 Net income attributable to noncontrolling interests — — 67 310 — 377 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,970 $ (1,305 ) $ 2,304 $ 844 $ (1,843 ) $ 1,970 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,894 $ (1,288 ) $ 2,312 $ 743 $ (1,767 ) $ 1,894 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ 1 $ — $ 117 $ 600 $ — $ 718 Accounts receivable, net — — 3,003 2,977 — 5,980 Inventories — — 899 647 — 1,546 Other 33 — 438 733 — 1,204 34 — 4,457 4,957 — 9,448 Property and equipment, net — — 8,670 8,659 — 17,329 Investments of insurance subsidiaries — — — 368 — 368 Investments in and advances to affiliates 28,817 — 15 186 (28,817 ) 201 Goodwill and other intangible assets — — 1,728 5,629 — 7,357 Other 783 29 35 181 — 1,028 $ 29,634 $ 29 $ 14,905 $ 19,980 $ (28,817 ) $ 35,731 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY Current liabilities: Accounts payable $ — $ — $ 1,288 $ 1,026 $ — $ 2,314 Accrued salaries — — 704 608 — 1,312 Other accrued expenses 8 279 475 1,021 — 1,783 Long-term debt due within one year — 97 54 51 — 202 8 376 2,521 2,706 — 5,611 Long-term debt, net 994 31,275 192 290 — 32,751 Intercompany balances 34,983 (10,069 ) (28,514 ) 3,600 — — Professional liability risks — — — 1,179 — 1,179 Income taxes and other liabilities 429 2 353 472 — 1,256 36,414 21,584 (25,448) 8,247 — 40,797 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (6,780 ) (21,555 ) 40,228 10,144 (28,817 ) (6,780 ) Noncontrolling interests — — 125 1,589 — 1,714 (6,780 ) (21,555 ) 40,353 11,733 (28,817 ) (5,066 ) $ 29,634 $ 29 $ 14,905 $ 19,980 $ (28,817 ) $ 35,731 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET DECEMBER 31, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 110 $ 536 $ — $ 646 Accounts receivable, net — — 3,028 2,798 — 5,826 Inventories — — 890 613 — 1,503 Other — — 445 666 — 1,111 — — 4,473 4,613 — 9,086 Property and equipment, net — — 8,463 7,889 — 16,352 Investments of insurance subsidiaries — — — 336 — 336 Investments in and advances to affiliates 27,045 — 16 190 (27,045 ) 206 Goodwill and other intangible assets — — 1,728 4,976 — 6,704 Other 877 — 34 163 — 1,074 $ 27,922 $ — $ 14,714 $ 18,167 $ (27,045 ) $ 33,758 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY Current liabilities: Accounts payable $ — $ — $ 1,439 $ 879 $ — $ 2,318 Accrued salaries — — 704 561 — 1,265 Other accrued expenses 29 572 464 970 — 2,035 Long-term debt due within one year — 97 60 59 — 216 29 669 2,667 2,469 — 5,834 Long-term debt, net 993 29,693 199 275 — 31,160 Intercompany balances 33,784 (10,277 ) (26,447 ) 2,940 — — Professional liability risks — — — 1,148 — 1,148 Income taxes and other liabilities 418 12 387 432 — 1,249 35,224 20,097 (23,194 ) 7,264 — 39,391 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (7,302 ) (20,097 ) 37,752 9,390 (27,045 ) (7,302 ) Noncontrolling interests — — 156 1,513 — 1,669 (7,302 ) (20,097 ) 37,908 10,903 (27,045 ) (5,633 ) $ 27,922 $ — $ 14,714 $ 18,167 $ (27,045 ) $ 33,758 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,742 $ (1,463 ) $ 2,541 $ 984 $ (1,702 ) $ 2,102 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (15 ) (293 ) (1,785 ) (1,300 ) — (3,393 ) Provision for doubtful accounts — — 1,648 1,456 — 3,104 Depreciation and amortization — — 748 833 — 1,581 Income taxes (9 ) — — — — (9 ) Gains on sales of facilities — — (5 ) (5 ) — (10 ) Losses on retirement of debt — 39 — — — 39 Amortization of debt issuance costs — 23 — — — 23 Share-based compensation — — 195 — — 195 Equity in earnings of affiliates (1,702 ) — — — 1,702 — Other 58 — — 2 — 60 Net cash provided by (used in) operating activities 74 (1,694 ) 3,342 1,970 — 3,692 Cash flows from investing activities: Purchase of property and equipment — — (912 ) (1,121 ) — (2,033 ) Acquisition of hospitals and health care entities — — (9 ) (1,133 ) — (1,142 ) Disposition of hospitals and health care entities — — 12 12 — 24 Change in investments — — — (15 ) — (15 ) Other — — (2 ) (4 ) — (6 ) Net cash used in investing activities — — (911 ) (2,261 ) — (3,172 ) Cash flows from financing activities: Issuance of long-term debt — 1,500 — 2 — 1,502 Net change in revolving credit facilities — 650 — — — 650 Repayment of long-term debt — (604 ) (52 ) (44 ) — (700 ) Distributions to noncontrolling interests — — (105 ) (258 ) — (363 ) Payment of debt issuance costs — (25 ) — — — (25 ) Repurchases of common stock (1,475 ) — — — — (1,475 ) Changes in intercompany balances with affiliates, net 1,468 173 (2,267 ) 626 — — Other (66 ) — — 29 — (37 ) Net cash (used in) provided by financing activities (73 ) 1,694 (2,424 ) 355 — (448 ) Change in cash and cash equivalents 1 — 7 64 — 72 Cash and cash equivalents at beginning of period — — 110 536 — 646 Cash and cash equivalents at end of period $ 1 $ — $ 117 $ 600 $ — $ 718 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,970 $ (1,305 ) $ 2,371 $ 1,154 $ (1,843 ) $ 2,347 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (40 ) (49 ) (1,628 ) (829 ) — (2,546 ) Provision for doubtful accounts — — 1,383 1,009 — 2,392 Depreciation and amortization — — 707 756 — 1,463 Income taxes 8 — — — — 8 Gains on sales of facilities — — — (8 ) — (8 ) Losses on retirement of debt — 4 — — — 4 Legal claim costs — 33 — — — 33 Amortization of debt issuance costs — 26 — — — 26 Share-based compensation — — 196 — — 196 Equity in earnings of affiliates (1,843 ) — — — 1,843 — Other 53 — (3 ) (11 ) — 39 Net cash provided by (used in) operating activities 148 (1,291 ) 3,026 2,071 — 3,954 Cash flows from investing activities: Purchase of property and equipment — — (892 ) (992 ) — (1,884 ) Acquisition of hospitals and health care entities — — (164 ) (304 ) — (468 ) Disposition of hospitals and health care entities — — 10 13 — 23 Change in investments — — (2 ) 80 — 78 Other — — — 17 — 17 Net cash used in investing activities — — (1,048 ) (1,186 ) — (2,234 ) Cash flows from financing activities: Issuance of long-term debt — 5,400 — — — 5,400 Net change in revolving credit facilities — (70 ) — — — (70 ) Repayment of long-term debt — (4,334 ) (54 ) (36 ) — (4,424 ) Distributions to noncontrolling interests — — (46 ) (296 ) — (342 ) Payment of debt issuance costs — (40 ) — — — (40 ) Repurchases of common stock (2,213 ) — — — — (2,213 ) Changes in intercompany balances with affiliates, net 2,171 335 (1,895 ) (611 ) — — Other (105 ) — — 10 — (95 ) Net cash (used in) provided by financing activities (147 ) 1,291 (1,995 ) (933 ) — (1,784 ) Change in cash and cash equivalents 1 — (17 ) (48 ) — (64 ) Cash and cash equivalents at beginning of period — — 155 586 — 741 Cash and cash equivalents at end of period $ 1 $ — $ 138 $ 538 $ — $ 677 |
Basis of Presentation and Sig19
Basis of Presentation and Significant Accounting Policies (Policies) | 9 Months Ended |
Sep. 30, 2017 | |
Basis of Presentation | Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q Regulation S-X. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $91 million and $94 million for the quarters ended September 30, 2017 and 2016, respectively, and $273 million and $272 million for the nine months ended September 30, 2017 and 2016, respectively. Operating results for the quarter and nine months ended September 30, 2017 are not necessarily indicative of the results that may be expected for the year ending December 31, 2017. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K |
Revenues | Revenues Revenues are recorded during the period the health care services are provided, based upon the estimated amounts due from the patients and third-party payers. Third-party payers include federal and state agencies (under the Medicare and Medicaid programs), managed care health plans and commercial insurance companies (including plans offered through the health insurance exchanges), and employers. Estimates of contractual allowances under managed care health plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured 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 uninsured accounts to record net self-pay Quarter 2017 Ratio 2016 Ratio Medicare $ 2,354 22.0 % $ 2,158 21.0 % Managed Medicare 1,156 10.8 1,068 10.4 Medicaid 362 3.4 405 3.9 Managed Medicaid 582 5.4 611 6.0 Managed care and other insurers 6,039 56.4 5,863 57.1 International (managed care and other insurers) 276 2.6 285 2.8 10,769 100.6 10,390 101.2 Uninsured 849 7.9 336 3.3 Other 349 3.3 384 3.7 Revenues before provision for doubtful accounts 11,967 111.8 11,110 108.2 Provision for doubtful accounts (1,271 ) (11.8 ) (840 ) (8.2 ) Revenues $ 10,696 100.0 % $ 10,270 100.0 % Nine Months 2017 Ratio 2016 Ratio Medicare $ 7,080 22.1 % $ 6,641 21.5 % Managed Medicare 3,546 11.1 3,250 10.5 Medicaid 1,188 3.7 1,248 4.0 Managed Medicaid 1,798 5.6 1,816 5.9 Managed care and other insurers 18,071 56.4 17,324 56.2 International (managed care and other insurers) 814 2.5 926 3.0 32,497 101.4 31,205 101.1 Uninsured 1,593 5.0 750 2.4 Other 1,066 3.3 1,286 4.2 Revenues before provision for doubtful accounts 35,156 109.7 33,241 107.7 Provision for doubtful accounts (3,104 ) (9.7 ) (2,392 ) (7.7 ) Revenues $ 32,052 100.0 % $ 30,849 100.0 % |
Recent Pronouncements | Recent Pronouncements In May 2014, the Financial Accounting Standards Board (“FASB”) and the International Accounting Standards Board issued a final, converged, principles-based standard on revenue recognition. Companies across all industries will use a five-step model to recognize revenue from customer contracts. The new standard, which replaces nearly all existing revenue recognition guidance, will require significant management judgments and change the way many companies recognize revenue in their financial statements. In July 2015, the FASB decided to defer the effective date of the new revenue standard by one year to annual and interim periods beginning after December 15, 2017 for public entities and permit entities to adopt one year earlier if they choose. The FASB decided, based on its outreach to various stakeholders and continuing amendments to the new revenue standard, that a deferral was necessary to provide adequate time to effectively implement the new standard. We are continuing to evaluate the effects the adoption of this standard will have on our financial statements and financial disclosures. We believe the most significant impact will be to the presentation of our income statement where the provision for doubtful accounts will be recorded as a direct reduction to revenues and will not be presented as a separate line item. We expect to adopt the new standard using the full retrospective application, and we do not currently believe the adoption will have a significant impact on our recognition of net revenues or related disclosures for any period. In February 2016, the FASB issued Accounting Standards Update 2016-02, Leases 2016-02”), 2016-02 2016-02’s 2016-02 right-of-use |
Reclassifications | Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Earning Per Share | We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards and potential shares, computed using the treasury stock method. |
Fair Value Measurements and Disclosures | Accounting Standards Codification 820, Fair Value Measurements and Disclosures Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment. |
Cash Traded Investments | 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 the consideration of market factors and management’s judgment. |
Derivative Financial Instruments | Derivative Financial Instruments We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments. Although we determined the majority of the inputs used to value our derivatives fall within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with our derivatives utilize Level 3 inputs, such as estimates of current credit spreads to evaluate the likelihood of default by us and our counterparties. We assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions, and at September 30, 2017 and December 31, 2016, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives. |
Interest Rate Swaps [Member] | |
Interest Rate Swap Agreements | 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 |
Basis of Presentation and Sig20
Basis of Presentation and Significant Accounting Policies (Tables) | 9 Months Ended |
Sep. 30, 2017 | |
Accounting Policies [Abstract] | |
Schedule of Revenues from Third Party Payers, Uninsured and Other Payers | Our revenues from third-party payers, the uninsured and other for the quarters and nine months ended September 30, 2017 and 2016 are summarized in the following table (dollars in millions): Quarter 2017 Ratio 2016 Ratio Medicare $ 2,354 22.0 % $ 2,158 21.0 % Managed Medicare 1,156 10.8 1,068 10.4 Medicaid 362 3.4 405 3.9 Managed Medicaid 582 5.4 611 6.0 Managed care and other insurers 6,039 56.4 5,863 57.1 International (managed care and other insurers) 276 2.6 285 2.8 10,769 100.6 10,390 101.2 Uninsured 849 7.9 336 3.3 Other 349 3.3 384 3.7 Revenues before provision for doubtful accounts 11,967 111.8 11,110 108.2 Provision for doubtful accounts (1,271 ) (11.8 ) (840 ) (8.2 ) Revenues $ 10,696 100.0 % $ 10,270 100.0 % Nine Months 2017 Ratio 2016 Ratio Medicare $ 7,080 22.1 % $ 6,641 21.5 % Managed Medicare 3,546 11.1 3,250 10.5 Medicaid 1,188 3.7 1,248 4.0 Managed Medicaid 1,798 5.6 1,816 5.9 Managed care and other insurers 18,071 56.4 17,324 56.2 International (managed care and other insurers) 814 2.5 926 3.0 32,497 101.4 31,205 101.1 Uninsured 1,593 5.0 750 2.4 Other 1,066 3.3 1,286 4.2 Revenues before provision for doubtful accounts 35,156 109.7 33,241 107.7 Provision for doubtful accounts (3,104 ) (9.7 ) (2,392 ) (7.7 ) Revenues $ 32,052 100.0 % $ 30,849 100.0 % |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 9 Months Ended |
Sep. 30, 2017 | |
Earnings Per Share [Abstract] | |
Schedule of Computations of Basic and Diluted Earnings Per Share | The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2017 and 2016 (dollars and shares in millions, except per share amounts): Quarter Nine months 2017 2016 2017 2016 Net income attributable to HCA Healthcare, Inc. $ 426 $ 618 $ 1,742 $ 1,970 Weighted average common shares outstanding 360.170 378.199 365.398 386.968 Effect of dilutive incremental shares 9.664 11.393 9.615 12.609 Shares used for diluted earnings per share 369.834 389.592 375.013 399.577 Earnings per share: Basic earnings per share $ 1.18 $ 1.63 $ 4.77 $ 5.09 Diluted earnings per share $ 1.15 $ 1.59 $ 4.64 $ 4.93 |
Investments of Insurance Subs22
Investments of Insurance Subsidiaries (Tables) | 9 Months Ended |
Sep. 30, 2017 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | A summary of our insurance subsidiaries’ investments at September 30, 2017 and December 31, 2016 follows (dollars in millions): September 30, 2017 Amortized Unrealized Fair Gains Losses Debt securities: States and municipalities $ 352 $14 $— $ 366 Money market funds 52 — — 52 404 14 — 418 Equity securities 1 2 — 3 $ 405 $16 $— 421 Amounts classified as current assets (53 ) Investment carrying value $ 368 December 31, 2016 Amortized Unrealized Fair Gains Losses Debt securities: States and municipalities $ 345 $9 $(1) $ 353 Money market funds 28 — — 28 373 9 (1) 381 Equity securities 1 3 — 4 $ 374 $12 $(1) 385 Amounts classified as current assets (49 ) Investment carrying value $ 336 |
Schedule of Maturities of Investments | Scheduled maturities of investments in debt securities at September 30, 2017 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 100 $ 100 Due after one year through five years 76 80 Due after five years through ten years 178 187 Due after ten years 50 51 $ 404 $ 418 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 9 Months Ended |
Sep. 30, 2017 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges | The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at September 30, 2017 (dollars in millions): Notional Maturity Date Fair Pay-fixed $ 1,000 December 2017 $ (3 ) Pay-fixed 2,000 December 2021 30 |
Effect of Interest Rate on Results of Operations | The following table presents the effect of our interest rate swaps on our results of operations for the nine months ended September 30, 2017 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Loss Location of Loss Amount of Loss Interest rate swaps $ 6 Interest expense $ 17 |
Assets and Liabilities Measur24
Assets and Liabilities Measured at Fair Value (Tables) | 9 Months Ended |
Sep. 30, 2017 | |
Fair Value Disclosures [Abstract] | |
Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis | The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of September 30, 2017 and December 31, 2016, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): September 30, 2017 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities: States and municipalities $ 366 $ — $ 366 $ — Money market funds 52 52 — — 418 52 366 — Equity securities 3 3 — — Investments of insurance subsidiaries 421 55 366 — Less amounts classified as current assets (53 ) (52 ) (1 ) — $ 368 $ 3 $ 365 $ — Interest rate swaps (Other) $ 30 $ — $ 30 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 3 $ — $ 3 $ — December 31, 2016 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities: States and municipalities $ 353 $ — $ 347 $ 6 Money market funds 28 28 — — 381 28 347 6 Equity securities 4 4 — — Investments of insurance subsidiaries 385 32 347 6 Less amounts classified as current assets (49 ) (28 ) (21 ) — $ 336 $ 4 $ 326 $ 6 Interest rate swaps (Other) $ 31 $ — $ 31 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 12 $ — $ 12 $ — |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 9 Months Ended |
Sep. 30, 2017 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | A summary of long-term debt at September 30, 2017 and December 31, 2016, including related interest rates at September 30, 2017, follows (dollars in millions): September 30, December 31, Senior secured asset-based revolving credit facility (effective interest rate of 2.7%) $ 3,570 $ 2,920 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 3.6%) 3,915 3,981 Senior secured notes (effective interest rate of 5.4%) 15,300 13,800 Other senior secured debt (effective interest rate of 5.8%) 587 593 Senior secured debt 23,372 21,294 Senior unsecured notes (effective interest rate of 6.4%) 9,752 10,252 Net debt issuance costs (171 ) (170 ) Total debt (average life of 7.1 years, rates averaging 5.2%) 32,953 31,376 Less amounts due within one year 202 216 $ 32,751 $ 31,160 |
Capital Structure (Tables)
Capital Structure (Tables) | 9 Months Ended |
Sep. 30, 2017 | |
Text Block [Abstract] | |
Schedule of Changes in Stockholders' Deficit and Equity | The changes in stockholders’ deficit, including changes in stockholders’ deficit attributable to HCA Healthcare, Inc. and changes in equity attributable to noncontrolling interests, are as follows (dollars and shares in millions): Equity (Deficit) Attributable to HCA Healthcare, Inc. Equity Total Common Stock Capital in Accumulated Retained Shares Par Value Balances at December 31, 2016 370.536 $ 4 $ — $ (338 ) $ (6,968 ) $ 1,669 $ (5,633 ) Comprehensive income — — — 70 1,742 360 2,172 Repurchase of common stock (17.847 ) — (185 ) — (1,290 ) — (1,475 ) Distributions — — — — — (363 ) (363 ) Share-based benefit plans 4.291 — 188 — — — 188 Other — — (3 ) — — 48 45 Balances at September 30, 2017 356.980 $ 4 $ — $ (268 ) $ (6,516 ) $ 1,714 $ (5,066 ) |
Components of Accumulated Other Comprehensive Loss | The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized for-Sale Foreign Defined Change Total Balances at December 31, 2016 $ 7 $ (211 ) $ (146 ) $ 12 $ (338 ) Unrealized gains on available-for-sale 3 — — — 3 Foreign currency translation adjustments, net of $34 of income taxes — 53 — — 53 Change in fair value of derivative instruments, net of $3 income tax benefits — — — (6 ) (6 ) Expense reclassified into operations from other comprehensive income, net of $5 and $6, respectively, income tax benefits — — 9 11 20 Balances at September 30, 2017 $ 10 $ (158 ) $ (137 ) $ 17 $ (268 ) |
Segment and Geographic Inform27
Segment and Geographic Information (Tables) | 9 Months Ended |
Sep. 30, 2017 | |
Segment Reporting [Abstract] | |
Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA and Depreciation and Amortization | The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2017 and 2016 are summarized in the following table (dollars in millions): Quarter Nine months 2017 2016 2017 2016 Revenues: National Group $ 5,036 $ 4,882 $ 15,344 $ 14,780 American Group 5,180 4,908 15,268 14,554 Corporate and other 480 480 1,440 1,515 $ 10,696 $ 10,270 $ 32,052 $ 30,849 Equity in earnings of affiliates: National Group $ (8 ) $ (13 ) $ (17 ) $ (17 ) American Group (9 ) (9 ) (27 ) (26 ) Corporate and other 4 — 8 (1 ) $ (13 ) $ (22 ) $ (36 ) $ (44 ) Adjusted segment EBITDA: National Group $ 975 $ 1,073 $ 3,268 $ 3,342 American Group 930 1,016 2,977 3,002 Corporate and other (129 ) (132 ) (374 ) (332 ) $ 1,776 $ 1,957 $ 5,871 $ 6,012 Depreciation and amortization: National Group $ 219 $ 204 $ 650 $ 602 American Group 251 231 727 675 Corporate and other 69 60 204 186 $ 539 $ 495 $ 1,581 $ 1,463 Adjusted segment EBITDA $ 1,776 $ 1,957 $ 5,871 $ 6,012 Depreciation and amortization 539 495 1,581 1,463 Interest expense 427 432 1,257 1,275 Gains on sales of facilities (7 ) (3 ) (10 ) (8 ) Losses on retirement of debt 39 4 39 4 Legal claim costs — 11 — 33 Income before income taxes $ 778 $ 1,018 $ 3,004 $ 3,245 |
Supplemental Condensed Consol28
Supplemental Condensed Consolidating Financial Information (Tables) | 9 Months Ended |
Sep. 30, 2017 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Schedule of Condensed Consolidating Comprehensive Income Statement | HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE QUARTER ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 5,897 $ 6,070 $ — $ 11,967 Provision for doubtful accounts — — 636 635 — 1,271 Revenues — — 5,261 5,435 — 10,696 Salaries and benefits — — 2,427 2,654 — 5,081 Supplies — — 889 888 — 1,777 Other operating expenses — — 963 1,112 — 2,075 Equity in earnings of affiliates (436 ) — (1 ) (12 ) 436 (13 ) Depreciation and amortization — — 249 290 — 539 Interest expense 16 792 (318 ) (63 ) — 427 Gains on sales of facilities — — (4 ) (3 ) — (7 ) Losses on retirement of debt — 39 — — — 39 Management fees — — (215 ) 215 — — (420 ) 831 3,990 5,081 436 9,918 Income (loss) before income taxes 420 (831 ) 1,271 354 (436 ) 778 Provision (benefit) for income taxes (6 ) (307 ) 460 101 — 248 Net income (loss) 426 (524 ) 811 253 (436 ) 530 Net income attributable to noncontrolling interests — — 24 80 — 104 Net income (loss) attributable to HCA Healthcare, Inc. $ 426 $ (524 ) $ 787 $ 173 $ (436 ) $ 426 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 451 $ (522 ) $ 790 $ 193 $ (461 ) $ 451 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE QUARTER ENDED SEPTEMBER 30, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 5,591 $ 5,519 $ — $ 11,110 Provision for doubtful accounts — — 391 449 — 840 Revenues — — 5,200 5,070 — 10,270 Salaries and benefits — — 2,373 2,367 — 4,740 Supplies — — 888 811 — 1,699 Other operating expenses 1 — 904 991 — 1,896 Equity in earnings of affiliates (573 ) — (1 ) (21 ) 573 (22 ) Depreciation and amortization — — 242 253 — 495 Interest expense 16 711 (235 ) (60 ) — 432 Gains on sales of facilities — — — (3 ) — (3 ) Losses on retirement of debt — 4 — — — 4 Legal claim costs — 11 — — — 11 Management fees — — (206 ) 206 — — (556 ) 726 3,965 4,544 573 9,252 Income (loss) before income taxes 556 (726 ) 1,235 526 (573 ) 1,018 Provision (benefit) for income taxes (62 ) (268 ) 447 156 — 273 Net income (loss) 618 (458 ) 788 370 (573 ) 745 Net income attributable to noncontrolling interests — — 24 103 — 127 Net income (loss) attributable to HCA Healthcare, Inc. $ 618 $ (458 ) $ 764 $ 267 $ (573 ) $ 618 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 621 $ (432 ) $ 766 $ 242 $ (576 ) $ 621 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 17,799 17,357 $ — $ 35,156 Provision for doubtful accounts — — 1,648 1,456 — 3,104 Revenues — — 16,151 15,901 — 32,052 Salaries and benefits — — 7,330 7,548 — 14,878 Supplies — — 2,771 2,598 — 5,369 Other operating expenses 5 — 2,841 3,124 — 5,970 Equity in earnings of affiliates (1,702 ) — (3 ) (33 ) 1,702 (36 ) Depreciation and amortization — — 748 833 — 1,581 Interest expense 48 2,280 (878 ) (193 ) — 1,257 Gains on sales of facilities — — (5 ) (5 ) — (10 ) Losses on retirement of debt — 39 — — — 39 Management fees — — (637 ) 637 — — (1,649 ) 2,319 12,167 14,509 1,702 29,048 Income (loss) before income taxes 1,649 (2,319 ) 3,984 1,392 (1,702 ) 3,004 Provision (benefit) for income taxes (93 ) (856 ) 1,443 408 — 902 Net income (loss) 1,742 (1,463 ) 2,541 984 (1,702 ) 2,102 Net income attributable to noncontrolling interests — — 74 286 — 360 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,742 $ (1,463 ) $ 2,467 $ 698 $ (1,702 ) $ 1,742 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,812 $ (1,458 ) $ 2,476 $ 754 $ (1,772 ) $ 1,812 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 16,957 $ 16,284 $ — $ 33,241 Provision for doubtful accounts — — 1,383 1,009 — 2,392 Revenues — — 15,574 15,275 — 30,849 Salaries and benefits — — 7,074 7,059 — 14,133 Supplies — — 2,672 2,459 — 5,131 Other operating expenses 5 — 2,654 2,958 — 5,617 Equity in earnings of affiliates (1,843 ) — (4 ) (40 ) 1,843 (44 ) Depreciation and amortization — — 707 756 — 1,463 Interest expense 48 2,031 (646 ) (158 ) — 1,275 Gains on sales of facilities — — — (8 ) — (8 ) Losses on retirement of debt — 4 — — — 4 Legal claim costs — 33 — — — 33 Management fees — — (601 ) 601 — — (1,790 ) 2,068 11,856 13,627 1,843 27,604 Income (loss) before income taxes 1,790 (2,068 ) 3,718 1,648 (1,843 ) 3,245 Provision (benefit) for income taxes (180 ) (763 ) 1,347 494 — 898 Net income (loss) 1,970 (1,305 ) 2,371 1,154 (1,843 ) 2,347 Net income attributable to noncontrolling interests — — 67 310 — 377 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,970 $ (1,305 ) $ 2,304 $ 844 $ (1,843 ) $ 1,970 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,894 $ (1,288 ) $ 2,312 $ 743 $ (1,767 ) $ 1,894 |
Schedule of Condensed Consolidating Balance Sheet | HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ 1 $ — $ 117 $ 600 $ — $ 718 Accounts receivable, net — — 3,003 2,977 — 5,980 Inventories — — 899 647 — 1,546 Other 33 — 438 733 — 1,204 34 — 4,457 4,957 — 9,448 Property and equipment, net — — 8,670 8,659 — 17,329 Investments of insurance subsidiaries — — — 368 — 368 Investments in and advances to affiliates 28,817 — 15 186 (28,817 ) 201 Goodwill and other intangible assets — — 1,728 5,629 — 7,357 Other 783 29 35 181 — 1,028 $ 29,634 $ 29 $ 14,905 $ 19,980 $ (28,817 ) $ 35,731 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY Current liabilities: Accounts payable $ — $ — $ 1,288 $ 1,026 $ — $ 2,314 Accrued salaries — — 704 608 — 1,312 Other accrued expenses 8 279 475 1,021 — 1,783 Long-term debt due within one year — 97 54 51 — 202 8 376 2,521 2,706 — 5,611 Long-term debt, net 994 31,275 192 290 — 32,751 Intercompany balances 34,983 (10,069 ) (28,514 ) 3,600 — — Professional liability risks — — — 1,179 — 1,179 Income taxes and other liabilities 429 2 353 472 — 1,256 36,414 21,584 (25,448) 8,247 — 40,797 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (6,780 ) (21,555 ) 40,228 10,144 (28,817 ) (6,780 ) Noncontrolling interests — — 125 1,589 — 1,714 (6,780 ) (21,555 ) 40,353 11,733 (28,817 ) (5,066 ) $ 29,634 $ 29 $ 14,905 $ 19,980 $ (28,817 ) $ 35,731 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET DECEMBER 31, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 110 $ 536 $ — $ 646 Accounts receivable, net — — 3,028 2,798 — 5,826 Inventories — — 890 613 — 1,503 Other — — 445 666 — 1,111 — — 4,473 4,613 — 9,086 Property and equipment, net — — 8,463 7,889 — 16,352 Investments of insurance subsidiaries — — — 336 — 336 Investments in and advances to affiliates 27,045 — 16 190 (27,045 ) 206 Goodwill and other intangible assets — — 1,728 4,976 — 6,704 Other 877 — 34 163 — 1,074 $ 27,922 $ — $ 14,714 $ 18,167 $ (27,045 ) $ 33,758 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY Current liabilities: Accounts payable $ — $ — $ 1,439 $ 879 $ — $ 2,318 Accrued salaries — — 704 561 — 1,265 Other accrued expenses 29 572 464 970 — 2,035 Long-term debt due within one year — 97 60 59 — 216 29 669 2,667 2,469 — 5,834 Long-term debt, net 993 29,693 199 275 — 31,160 Intercompany balances 33,784 (10,277 ) (26,447 ) 2,940 — — Professional liability risks — — — 1,148 — 1,148 Income taxes and other liabilities 418 12 387 432 — 1,249 35,224 20,097 (23,194 ) 7,264 — 39,391 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (7,302 ) (20,097 ) 37,752 9,390 (27,045 ) (7,302 ) Noncontrolling interests — — 156 1,513 — 1,669 (7,302 ) (20,097 ) 37,908 10,903 (27,045 ) (5,633 ) $ 27,922 $ — $ 14,714 $ 18,167 $ (27,045 ) $ 33,758 |
Schedule of Condensed Consolidating Statement of Cash Flows | HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,742 $ (1,463 ) $ 2,541 $ 984 $ (1,702 ) $ 2,102 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (15 ) (293 ) (1,785 ) (1,300 ) — (3,393 ) Provision for doubtful accounts — — 1,648 1,456 — 3,104 Depreciation and amortization — — 748 833 — 1,581 Income taxes (9 ) — — — — (9 ) Gains on sales of facilities — — (5 ) (5 ) — (10 ) Losses on retirement of debt — 39 — — — 39 Amortization of debt issuance costs — 23 — — — 23 Share-based compensation — — 195 — — 195 Equity in earnings of affiliates (1,702 ) — — — 1,702 — Other 58 — — 2 — 60 Net cash provided by (used in) operating activities 74 (1,694 ) 3,342 1,970 — 3,692 Cash flows from investing activities: Purchase of property and equipment — — (912 ) (1,121 ) — (2,033 ) Acquisition of hospitals and health care entities — — (9 ) (1,133 ) — (1,142 ) Disposition of hospitals and health care entities — — 12 12 — 24 Change in investments — — — (15 ) — (15 ) Other — — (2 ) (4 ) — (6 ) Net cash used in investing activities — — (911 ) (2,261 ) — (3,172 ) Cash flows from financing activities: Issuance of long-term debt — 1,500 — 2 — 1,502 Net change in revolving credit facilities — 650 — — — 650 Repayment of long-term debt — (604 ) (52 ) (44 ) — (700 ) Distributions to noncontrolling interests — — (105 ) (258 ) — (363 ) Payment of debt issuance costs — (25 ) — — — (25 ) Repurchases of common stock (1,475 ) — — — — (1,475 ) Changes in intercompany balances with affiliates, net 1,468 173 (2,267 ) 626 — — Other (66 ) — — 29 — (37 ) Net cash (used in) provided by financing activities (73 ) 1,694 (2,424 ) 355 — (448 ) Change in cash and cash equivalents 1 — 7 64 — 72 Cash and cash equivalents at beginning of period — — 110 536 — 646 Cash and cash equivalents at end of period $ 1 $ — $ 117 $ 600 $ — $ 718 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,970 $ (1,305 ) $ 2,371 $ 1,154 $ (1,843 ) $ 2,347 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (40 ) (49 ) (1,628 ) (829 ) — (2,546 ) Provision for doubtful accounts — — 1,383 1,009 — 2,392 Depreciation and amortization — — 707 756 — 1,463 Income taxes 8 — — — — 8 Gains on sales of facilities — — — (8 ) — (8 ) Losses on retirement of debt — 4 — — — 4 Legal claim costs — 33 — — — 33 Amortization of debt issuance costs — 26 — — — 26 Share-based compensation — — 196 — — 196 Equity in earnings of affiliates (1,843 ) — — — 1,843 — Other 53 — (3 ) (11 ) — 39 Net cash provided by (used in) operating activities 148 (1,291 ) 3,026 2,071 — 3,954 Cash flows from investing activities: Purchase of property and equipment — — (892 ) (992 ) — (1,884 ) Acquisition of hospitals and health care entities — — (164 ) (304 ) — (468 ) Disposition of hospitals and health care entities — — 10 13 — 23 Change in investments — — (2 ) 80 — 78 Other — — — 17 — 17 Net cash used in investing activities — — (1,048 ) (1,186 ) — (2,234 ) Cash flows from financing activities: Issuance of long-term debt — 5,400 — — — 5,400 Net change in revolving credit facilities — (70 ) — — — (70 ) Repayment of long-term debt — (4,334 ) (54 ) (36 ) — (4,424 ) Distributions to noncontrolling interests — — (46 ) (296 ) — (342 ) Payment of debt issuance costs — (40 ) — — — (40 ) Repurchases of common stock (2,213 ) — — — — (2,213 ) Changes in intercompany balances with affiliates, net 2,171 335 (1,895 ) (611 ) — — Other (105 ) — — 10 — (95 ) Net cash (used in) provided by financing activities (147 ) 1,291 (1,995 ) (933 ) — (1,784 ) Change in cash and cash equivalents 1 — (17 ) (48 ) — (64 ) Cash and cash equivalents at beginning of period — — 155 586 — 741 Cash and cash equivalents at end of period $ 1 $ — $ 138 $ 538 $ — $ 677 |
Basis of Presentation and Sig29
Basis of Presentation and Significant Accounting Policies - Additional Information (Detail) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2017USD ($)StateHospitalSurgery_Center | Sep. 30, 2016USD ($) | Sep. 30, 2017USD ($)StateHospitalSurgery_Center | Sep. 30, 2016USD ($) | |
Accounting Policies [Abstract] | ||||
Number of owned and operated hospitals | Hospital | 177 | 177 | ||
Number of freestanding surgery centers | Surgery_Center | 119 | 119 | ||
Number of facilities locations | State | 20 | 20 | ||
General and administrative expense | $ | $ 91 | $ 94 | $ 273 | $ 272 |
Basis of Presentation and Sig30
Basis of Presentation and Significant Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2017 | Sep. 30, 2016 | Sep. 30, 2017 | Sep. 30, 2016 | |
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 10,769 | $ 10,390 | $ 32,497 | $ 31,205 |
Uninsured | 849 | 336 | 1,593 | 750 |
Other | 349 | 384 | 1,066 | 1,286 |
Revenues before provision for doubtful accounts | 11,967 | 11,110 | 35,156 | 33,241 |
Provision for doubtful accounts | (1,271) | (840) | (3,104) | (2,392) |
Revenues | $ 10,696 | $ 10,270 | $ 32,052 | $ 30,849 |
Revenues from third party payers, Ratio | 100.60% | 101.20% | 101.40% | 101.10% |
Uninsured, Ratio | 7.90% | 3.30% | 5.00% | 2.40% |
Other, Ratio | 3.30% | 3.70% | 3.30% | 4.20% |
Revenues before provision for doubtful accounts, Ratio | 111.80% | 108.20% | 109.70% | 107.70% |
Provision for doubtful accounts, Ratio | (11.80%) | (8.20%) | (9.70%) | (7.70%) |
Revenues ratio from third party payers | 100.00% | 100.00% | 100.00% | 100.00% |
Medicare [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 2,354 | $ 2,158 | $ 7,080 | $ 6,641 |
Revenues from third party payers, Ratio | 22.00% | 21.00% | 22.10% | 21.50% |
Managed Medicare [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 1,156 | $ 1,068 | $ 3,546 | $ 3,250 |
Revenues from third party payers, Ratio | 10.80% | 10.40% | 11.10% | 10.50% |
Medicaid [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 362 | $ 405 | $ 1,188 | $ 1,248 |
Revenues from third party payers, Ratio | 3.40% | 3.90% | 3.70% | 4.00% |
Managed Medicaid [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 582 | $ 611 | $ 1,798 | $ 1,816 |
Revenues from third party payers, Ratio | 5.40% | 6.00% | 5.60% | 5.90% |
Managed Care and Other Insurers [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 6,039 | $ 5,863 | $ 18,071 | $ 17,324 |
Revenues from third party payers, Ratio | 56.40% | 57.10% | 56.40% | 56.20% |
International (Managed Care and Other Insurers) [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 276 | $ 285 | $ 814 | $ 926 |
Revenues from third party payers, Ratio | 2.60% | 2.80% | 2.50% | 3.00% |
Acquisitions and Dispositions -
Acquisitions and Dispositions - Additional Information (Detail) $ in Thousands | Oct. 01, 2017Hospital | Sep. 30, 2017USD ($)Hospital | Sep. 30, 2016USD ($)Hospital |
Business Acquisition [Line Items] | |||
Number of hospitals purchased | Hospital | 7 | 3 | |
Effective date of Acquisition | Oct. 1, 2017 | ||
Proceeds from sale of business | $ 24,000 | $ 23,000 | |
Subsequent Event [Member] | |||
Business Acquisition [Line Items] | |||
Number of hospitals purchased | Hospital | 1 | ||
Real Estate and Other Investments [Member] | |||
Business Acquisition [Line Items] | |||
Proceeds from sale of business | 24,000 | 23,000 | |
Pretax gain (loss) on sales of business | 10,000 | 8,000 | |
Hospitals [Member] | |||
Business Acquisition [Line Items] | |||
Aggregate purchase price | 1,000,000 | 343,000 | |
Nonhospital Health Care [Member] | |||
Business Acquisition [Line Items] | |||
Aggregate purchase price | $ 142,000 | $ 125,000 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2017 | Sep. 30, 2016 | Sep. 30, 2017 | Sep. 30, 2016 | Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | |||||
Liability for unrecognized tax benefits | $ 429 | $ 429 | $ 418 | ||
Unrecognized tax benefits, accrued interest | 40 | 40 | 45 | ||
Unrecognized tax benefits that would impact effective tax rate | 136 | 136 | $ 137 | ||
Provision for tax benefits related to settlement of employee awards | 4 | $ 11 | 80 | $ 129 | |
Reductions in interest (net of tax) | $ 4 | 17 | $ 16 | 17 | |
Provision for income taxes | $ 51 | $ 51 |
Earnings Per Share - Schedule o
Earnings Per Share - Schedule of Computations of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2017 | Sep. 30, 2016 | Sep. 30, 2017 | Sep. 30, 2016 | |
Earnings Per Share [Abstract] | ||||
Net income attributable to HCA Healthcare, Inc. | $ 426 | $ 618 | $ 1,742 | $ 1,970 |
Weighted average common shares outstanding | 360,170 | 378,199 | 365,398 | 386,968 |
Effect of dilutive incremental shares | 9,664 | 11,393 | 9,615 | 12,609 |
Shares used for diluted earnings per share | 369,834 | 389,592 | 375,013 | 399,577 |
Basic earnings per share | $ 1.18 | $ 1.63 | $ 4.77 | $ 5.09 |
Diluted earnings per share | $ 1.15 | $ 1.59 | $ 4.64 | $ 4.93 |
Investments of Insurance Subs34
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions | Sep. 30, 2017 | Dec. 31, 2016 |
Schedule of Available-for-sale Securities [Line Items] | ||
Amortized Cost | $ 405 | $ 374 |
Unrealized Amounts, Gains | 16 | 12 |
Unrealized Amounts, Losses | (1) | |
Fair Value | 421 | 385 |
Amounts classified as current assets | (53) | (49) |
Investment carrying value | 368 | 336 |
Debt Securities [Member] | ||
Schedule of Available-for-sale Securities [Line Items] | ||
Amortized Cost | 404 | 373 |
Unrealized Amounts, Gains | 14 | 9 |
Unrealized Amounts, Losses | (1) | |
Fair Value | 418 | 381 |
Debt Securities [Member] | States and Municipalities [Member] | ||
Schedule of Available-for-sale Securities [Line Items] | ||
Amortized Cost | 352 | 345 |
Unrealized Amounts, Gains | 14 | 9 |
Unrealized Amounts, Losses | (1) | |
Fair Value | 366 | 353 |
Debt Securities [Member] | Money Market Funds [Member] | ||
Schedule of Available-for-sale Securities [Line Items] | ||
Amortized Cost | 52 | 28 |
Fair Value | 52 | 28 |
Equity Securities [Member] | ||
Schedule of Available-for-sale Securities [Line Items] | ||
Amortized Cost | 1 | 1 |
Unrealized Amounts, Gains | 2 | 3 |
Fair Value | $ 3 | $ 4 |
Investments of Insurance Subs35
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions | Sep. 30, 2017USD ($) |
Investments, Debt and Equity Securities [Abstract] | |
Due in one year or less, Amortized Cost | $ 100 |
Due after one year through five years, Amortized Cost | 76 |
Due after five years through ten years, Amortized Cost | 178 |
Due after ten years, Amortized Cost | 50 |
Amortized Cost, Total | 404 |
Due in one year or less, Fair Value | 100 |
Due after one year through five years, Fair Value | 80 |
Due after five years through ten years, Fair Value | 187 |
Due after ten years, Fair Value | 51 |
Fair Value, Total | $ 418 |
Investments of Insurance Subs36
Investments of Insurance Subsidiaries - Additional Information (Detail) | 9 Months Ended |
Sep. 30, 2017 | |
Investments, Debt and Equity Securities [Abstract] | |
Available for sale securities expected maturity of debt securities | 4 years |
Available for sale securities average scheduled maturity | 5 years 6 months |
Financial Instruments - Schedul
Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) - Pay-Fixed Interest Rate Swaps [Member] | 9 Months Ended |
Sep. 30, 2017USD ($) | |
Maturity Date, 2017 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 1,000,000,000 |
Fair Value | $ (3,000,000) |
Maturity Date | Dec. 31, 2017 |
Maturity Date, 2021 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 2,000,000,000 |
Fair Value | $ 30,000,000 |
Maturity Date | Dec. 31, 2021 |
Financial Instruments - Additio
Financial Instruments - Additional Information (Detail) $ in Millions | 9 Months Ended |
Sep. 30, 2017USD ($) | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Estimated amount reclassified from other comprehensive income to interest expense | $ 3 |
Financial Instruments - Effect
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2017 | Sep. 30, 2016 | Sep. 30, 2017 | Sep. 30, 2016 | |
Derivative Instruments, Gain (Loss) [Line Items] | ||||
Interest expense | $ 427 | $ 432 | $ 1,257 | $ 1,275 |
Interest Rate Swaps [Member] | ||||
Derivative Instruments, Gain (Loss) [Line Items] | ||||
Amount of Loss Recognized in OCI on Derivatives, Net of Tax | 6 | |||
Reclassification out of Accumulated Other Comprehensive Income [Member] | Interest Rate Swaps [Member] | ||||
Derivative Instruments, Gain (Loss) [Line Items] | ||||
Interest expense | $ 17 |
Assets and Liabilities Measur40
Assets and Liabilities Measured at Fair Value - Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Millions | Sep. 30, 2017 | Dec. 31, 2016 |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | $ 421 | $ 385 |
Less amounts classified as current assets | (53) | (49) |
Investments of insurance subsidiaries, noncurrent | 368 | 336 |
Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Interest rate swaps (Other) | 30 | 31 |
Liabilities, Fair Value | 3 | 12 |
Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 418 | 381 |
Debt Securities [Member] | States and Municipalities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 366 | 353 |
Debt Securities [Member] | Money Market Funds [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 52 | 28 |
Equity Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 3 | 4 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 55 | 32 |
Less amounts classified as current assets | (52) | (28) |
Investments of insurance subsidiaries, noncurrent | 3 | 4 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 52 | 28 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Debt Securities [Member] | Money Market Funds [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 52 | 28 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Equity Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 3 | 4 |
Significant Other Observable Inputs (Level 2) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 366 | 347 |
Less amounts classified as current assets | (1) | (21) |
Investments of insurance subsidiaries, noncurrent | 365 | 326 |
Significant Other Observable Inputs (Level 2) [Member] | Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Interest rate swaps (Other) | 30 | 31 |
Liabilities, Fair Value | 3 | 12 |
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 366 | 347 |
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member] | States and Municipalities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | $ 366 | 347 |
Significant Unobservable Inputs (Level 3) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 6 | |
Investments of insurance subsidiaries, noncurrent | 6 | |
Significant Unobservable Inputs (Level 3) [Member] | Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 6 | |
Significant Unobservable Inputs (Level 3) [Member] | Debt Securities [Member] | States and Municipalities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | $ 6 |
Assets and Liabilities Measur41
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions | 9 Months Ended | |
Sep. 30, 2017 | Dec. 31, 2016 | |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Estimated fair value of long-term debt | $ 34,998 | $ 32,833 |
Carrying amounts of long-term debt | 33,124 | $ 31,546 |
Significant Unobservable Inputs (Level 3) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Reduction of insurance subsidiaries resulted from settlements | $ 6 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions | Sep. 30, 2017 | Dec. 31, 2016 |
Debt Instrument [Line Items] | ||
Senior secured debt | $ 23,372 | $ 21,294 |
Net debt issuance costs | (171) | (170) |
Total debt (average life of 7.1 years, rates averaging 5.2%) | 32,953 | 31,376 |
Less amounts due within one year | 202 | 216 |
Long-term debt | 32,751 | 31,160 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 3,570 | 2,920 |
Senior Secured Term Loan Facilities [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 3,915 | 3,981 |
Senior Secured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 15,300 | 13,800 |
Other Senior Secured Debt [Member] | ||
Debt Instrument [Line Items] | ||
Other senior secured debt | 587 | 593 |
Senior Unsecured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior unsecured notes | $ 9,752 | $ 10,252 |
Long-Term Debt - Schedule of 43
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | 9 Months Ended |
Sep. 30, 2017 | |
Debt Instrument [Line Items] | |
Total debt average term | 7 years 1 month 6 days |
Total debt average rate | 5.20% |
Senior Secured Asset-Based Revolving Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 2.70% |
Senior Secured Term Loan Facilities [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 3.60% |
Senior Secured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5.40% |
Other Senior Secured Debt [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5.80% |
Senior Unsecured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 6.40% |
Long-Term Debt - Additional Inf
Long-Term Debt - Additional Information (Detail) - USD ($) | 1 Months Ended | 3 Months Ended | 9 Months Ended | |||
Jul. 31, 2017 | Jun. 30, 2017 | Sep. 30, 2017 | Sep. 30, 2016 | Sep. 30, 2017 | Sep. 30, 2016 | |
Debt Instrument [Line Items] | ||||||
Pretax loss on retirement of debt | $ (39,000,000) | $ (4,000,000) | $ (39,000,000) | $ (4,000,000) | ||
Asset-Based Revolving Credit Facility Maturing on June 28, 2022 [Member] | ||||||
Debt Instrument [Line Items] | ||||||
Credit facility, maximum amount | $ 3,750,000,000 | |||||
Debt instrument maturity date | Jun. 28, 2022 | |||||
Additional incremental credit facilities | $ 1,500,000,000 | |||||
Credit facility, commitment fee for unutilized commitments | 0.25% | |||||
Senior Notes [Member] | ||||||
Debt Instrument [Line Items] | ||||||
Debt instrument maturity date | Oct. 31, 2018 | |||||
Senior Notes [Member] | Senior Secured Notes Due 2047 [Member] | ||||||
Debt Instrument [Line Items] | ||||||
Debt instrument, principal amount | $ 1,500,000,000 | |||||
Debt instrument, stated interest | 5.50% | |||||
Senior Notes [Member] | Senior Secured Notes Due 2018 [Member] | ||||||
Debt Instrument [Line Items] | ||||||
Debt instrument, stated interest | 8.00% | |||||
Proceeds from new term loan | $ 500,000,000 | |||||
Pretax loss on retirement of debt | $ 39,000,000 |
Capital Structure - Schedule of
Capital Structure - Schedule of Changes in Stockholders' Deficit and Equity (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2017 | Sep. 30, 2016 | Sep. 30, 2017 | Sep. 30, 2016 | |
Capital Structure [Line Items] | ||||
Beginning Balances | $ (5,633) | |||
Comprehensive income | $ 555 | $ 748 | 2,172 | $ 2,271 |
Repurchase of common stock | (1,475) | |||
Distributions | (363) | |||
Share-based benefit plans | 188 | |||
Other | 45 | |||
Ending Balances | (5,066) | (5,066) | ||
Common Stock [Member] | ||||
Capital Structure [Line Items] | ||||
Beginning Balances | 4 | |||
Ending Balances | $ 4 | $ 4 | ||
Beginning Balances, Shares | 370,536,000 | |||
Repurchase of common stock, shares | (17,847,000) | |||
Share-based benefit plans, Shares | 4,291,000 | |||
Ending Balances, Shares | 356,980,000 | 356,980,000 | ||
Capital in Excess of Par Value [Member] | ||||
Capital Structure [Line Items] | ||||
Repurchase of common stock | $ (185) | |||
Share-based benefit plans | 188 | |||
Other | (3) | |||
Accumulated Other Comprehensive Loss [Member] | ||||
Capital Structure [Line Items] | ||||
Beginning Balances | (338) | |||
Comprehensive income | 70 | |||
Ending Balances | $ (268) | (268) | ||
Retained Deficit [Member] | ||||
Capital Structure [Line Items] | ||||
Beginning Balances | (6,968) | |||
Comprehensive income | 1,742 | |||
Repurchase of common stock | (1,290) | |||
Ending Balances | (6,516) | (6,516) | ||
Equity Attributable to Noncontrolling Interests [Member] | ||||
Capital Structure [Line Items] | ||||
Beginning Balances | 1,669 | |||
Comprehensive income | 360 | |||
Distributions | (363) | |||
Other | 48 | |||
Ending Balances | $ 1,714 | $ 1,714 |
Capital Structure - Additional
Capital Structure - Additional Information (Detail) - Common Stock [Member] - USD ($) | 9 Months Ended | ||
Sep. 30, 2017 | Oct. 31, 2017 | Nov. 30, 2016 | |
Capital Structure [Line Items] | |||
Repurchase of common stock, shares | (17,847,000) | ||
Repurchase price of common stock, per share | $ 82.62 | ||
Share repurchase program, remaining authorized repurchase amount | $ 379,000,000 | ||
Share repurchase program authorized amount | $ 2,000,000,000 | ||
Subsequent Event [Member] | |||
Capital Structure [Line Items] | |||
Share repurchase program authorized amount | $ 2,000,000,000 |
Capital Structure - Components
Capital Structure - Components of Accumulated Other Comprehensive Loss (Detail) $ in Millions | 9 Months Ended |
Sep. 30, 2017USD ($) | |
Equity [Abstract] | |
Unrealized gains on available-for-sale securities, beginning balances | $ 7 |
Unrealized gains on available-for-sale securities, net of income taxes | 3 |
Unrealized gains on available-for-sale securities, ending balances | 10 |
Foreign currency translation adjustments, beginning balances | (211) |
Foreign currency translation adjustments | 53 |
Foreign currency translation adjustments, ending balances | (158) |
Defined benefit plans, beginning balances | (146) |
Defined benefit plans, (income) expense reclassified into operations from other comprehensive income | 9 |
Defined benefit plans, ending balances | (137) |
Change in fair value of derivative instruments, beginning balances | 12 |
Change in fair value of derivative instruments net of income taxes | (6) |
Change in fair value of derivatives instruments, (income) expense reclassified into operations from other comprehensive income | 11 |
Change in fair value of derivative instruments, ending balances | 17 |
Accumulated other comprehensive income, net of tax, beginning balances | (338) |
Unrealized gains on available-for-sale securities, net of income taxes | 3 |
Foreign currency translation adjustments | 53 |
Change in fair value of derivative instruments | (6) |
Expense reclassified into operations from other comprehensive income, Total | 20 |
Accumulated other comprehensive income (loss), net of tax, ending balances | $ (268) |
Capital Structure - Component48
Capital Structure - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) $ in Millions | 9 Months Ended |
Sep. 30, 2017USD ($) | |
Equity [Abstract] | |
Unrealized gains on available-for-sale securities, tax portion | $ 2 |
Foreign currency translation adjustments, income taxes | 34 |
Defined benefit plans, Expense reclassified into operations from other comprehensive income, Income tax benefits | 5 |
Change in fair value of derivative instruments, change in fair value of derivative instruments, income taxes | 3 |
Change in fair value of derivative instruments, Expense reclassified into operations from other comprehensive income, income tax benefits | $ 6 |
Segment and Geographic Inform49
Segment and Geographic Information - Additional Information (Detail) - Hospital | 3 Months Ended | |
Sep. 30, 2017 | Dec. 31, 2016 | |
Segment Reporting Information [Line Items] | ||
Number of geographically organized groups | 2 | |
Number of owned and operated hospitals | 177 | |
Reorganization Group [Member] | National Group [Member] | ||
Segment Reporting Information [Line Items] | ||
Number of owned and operated hospitals | 86 | |
Reorganization Group [Member] | American Group [Member] | ||
Segment Reporting Information [Line Items] | ||
Number of owned and operated hospitals | 85 | |
Reorganization Group [Member] | Corporate and Other [Member] | ||
Segment Reporting Information [Line Items] | ||
Number of owned and operated hospitals | 6 |
Segment and Geographic Inform50
Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization and Assets (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2017 | Sep. 30, 2016 | Sep. 30, 2017 | Sep. 30, 2016 | |
Segment Reporting Information [Line Items] | ||||
Revenues | $ 10,696 | $ 10,270 | $ 32,052 | $ 30,849 |
Equity in earnings of affiliates | 13 | 22 | 36 | 44 |
Adjusted segment EBITDA | 1,776 | 1,957 | 5,871 | 6,012 |
Depreciation and amortization | 539 | 495 | 1,581 | 1,463 |
Interest expense | 427 | 432 | 1,257 | 1,275 |
Gains on sales of facilities | (7) | (3) | (10) | (8) |
Losses on retirement of debt | 39 | 4 | 39 | 4 |
Legal claim costs | 11 | 33 | ||
Income before income taxes | 778 | 1,018 | 3,004 | 3,245 |
National Group [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 5,036 | 4,882 | 15,344 | 14,780 |
Equity in earnings of affiliates | (8) | (13) | (17) | (17) |
Adjusted segment EBITDA | 975 | 1,073 | 3,268 | 3,342 |
Depreciation and amortization | 219 | 204 | 650 | 602 |
American Group [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 5,180 | 4,908 | 15,268 | 14,554 |
Equity in earnings of affiliates | (9) | (9) | (27) | (26) |
Adjusted segment EBITDA | 930 | 1,016 | 2,977 | 3,002 |
Depreciation and amortization | 251 | 231 | 727 | 675 |
Corporate and Other [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 480 | 480 | 1,440 | 1,515 |
Equity in earnings of affiliates | 4 | 8 | (1) | |
Adjusted segment EBITDA | (129) | (132) | (374) | (332) |
Depreciation and amortization | $ 69 | $ 60 | $ 204 | $ 186 |
Supplemental Condensed Consol51
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Additional Information (Detail) - USD ($) | Sep. 30, 2017 | Dec. 31, 2012 |
Supplemental Condensed Consolidating Financial Information [Line Items] | ||
Ownership percentage held by parent | 100.00% | |
Senior Unsecured Notes Due 2021 [Member] | ||
Supplemental Condensed Consolidating Financial Information [Line Items] | ||
Debt instrument, principal amount | $ 1,000,000,000 | |
Debt instrument, stated interest | 6.25% |
Supplemental Condensed Consol52
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Comprehensive Income Statement (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2017 | Sep. 30, 2016 | Sep. 30, 2017 | Sep. 30, 2016 | |
Condensed Statement of Income Captions [Line Items] | ||||
Revenues before provision for doubtful accounts | $ 11,967 | $ 11,110 | $ 35,156 | $ 33,241 |
Provision for doubtful accounts | 1,271 | 840 | 3,104 | 2,392 |
Revenues | 10,696 | 10,270 | 32,052 | 30,849 |
Salaries and benefits | 5,081 | 4,740 | 14,878 | 14,133 |
Supplies | 1,777 | 1,699 | 5,369 | 5,131 |
Other operating expenses | 2,075 | 1,896 | 5,970 | 5,617 |
Equity in earnings of affiliates | (13) | (22) | (36) | (44) |
Depreciation and amortization | 539 | 495 | 1,581 | 1,463 |
Interest expense | 427 | 432 | 1,257 | 1,275 |
Gains on sales of facilities | (7) | (3) | (10) | (8) |
Losses on retirement of debt | 39 | 4 | 39 | 4 |
Legal claim costs | 11 | 33 | ||
Total expenses including equity in earnings of affiliates | 9,918 | 9,252 | 29,048 | 27,604 |
Income (loss) before income taxes | 778 | 1,018 | 3,004 | 3,245 |
Provision (benefit) for income taxes | 248 | 273 | 902 | 898 |
Net income (loss) | 530 | 745 | 2,102 | 2,347 |
Net income attributable to noncontrolling interests | 104 | 127 | 360 | 377 |
Net income (loss) attributable to HCA Healthcare, Inc. | 426 | 618 | 1,742 | 1,970 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 451 | 621 | 1,812 | 1,894 |
HCA Healthcare, Inc. Issuer [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Other operating expenses | 1 | 5 | 5 | |
Equity in earnings of affiliates | (436) | (573) | (1,702) | (1,843) |
Interest expense | 16 | 16 | 48 | 48 |
Total expenses including equity in earnings of affiliates | (420) | (556) | (1,649) | (1,790) |
Income (loss) before income taxes | 420 | 556 | 1,649 | 1,790 |
Provision (benefit) for income taxes | (6) | (62) | (93) | (180) |
Net income (loss) | 426 | 618 | 1,742 | 1,970 |
Net income (loss) attributable to HCA Healthcare, Inc. | 426 | 618 | 1,742 | 1,970 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 451 | 621 | 1,812 | 1,894 |
HCA Inc. Issuer [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Interest expense | 792 | 711 | 2,280 | 2,031 |
Losses on retirement of debt | 39 | 4 | 39 | 4 |
Legal claim costs | 11 | 33 | ||
Total expenses including equity in earnings of affiliates | 831 | 726 | 2,319 | 2,068 |
Income (loss) before income taxes | (831) | (726) | (2,319) | (2,068) |
Provision (benefit) for income taxes | (307) | (268) | (856) | (763) |
Net income (loss) | (524) | (458) | (1,463) | (1,305) |
Net income (loss) attributable to HCA Healthcare, Inc. | (524) | (458) | (1,463) | (1,305) |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | (522) | (432) | (1,458) | (1,288) |
Subsidiary Guarantors [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Revenues before provision for doubtful accounts | 5,897 | 5,591 | 17,799 | 16,957 |
Provision for doubtful accounts | 636 | 391 | 1,648 | 1,383 |
Revenues | 5,261 | 5,200 | 16,151 | 15,574 |
Salaries and benefits | 2,427 | 2,373 | 7,330 | 7,074 |
Supplies | 889 | 888 | 2,771 | 2,672 |
Other operating expenses | 963 | 904 | 2,841 | 2,654 |
Equity in earnings of affiliates | (1) | (1) | (3) | (4) |
Depreciation and amortization | 249 | 242 | 748 | 707 |
Interest expense | (318) | (235) | (878) | (646) |
Gains on sales of facilities | (4) | (5) | ||
Management fees | (215) | (206) | (637) | (601) |
Total expenses including equity in earnings of affiliates | 3,990 | 3,965 | 12,167 | 11,856 |
Income (loss) before income taxes | 1,271 | 1,235 | 3,984 | 3,718 |
Provision (benefit) for income taxes | 460 | 447 | 1,443 | 1,347 |
Net income (loss) | 811 | 788 | 2,541 | 2,371 |
Net income attributable to noncontrolling interests | 24 | 24 | 74 | 67 |
Net income (loss) attributable to HCA Healthcare, Inc. | 787 | 764 | 2,467 | 2,304 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 790 | 766 | 2,476 | 2,312 |
Subsidiary Non-Guarantors [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Revenues before provision for doubtful accounts | 6,070 | 5,519 | 17,357 | 16,284 |
Provision for doubtful accounts | 635 | 449 | 1,456 | 1,009 |
Revenues | 5,435 | 5,070 | 15,901 | 15,275 |
Salaries and benefits | 2,654 | 2,367 | 7,548 | 7,059 |
Supplies | 888 | 811 | 2,598 | 2,459 |
Other operating expenses | 1,112 | 991 | 3,124 | 2,958 |
Equity in earnings of affiliates | (12) | (21) | (33) | (40) |
Depreciation and amortization | 290 | 253 | 833 | 756 |
Interest expense | (63) | (60) | (193) | (158) |
Gains on sales of facilities | (3) | (3) | (5) | (8) |
Management fees | 215 | 206 | 637 | 601 |
Total expenses including equity in earnings of affiliates | 5,081 | 4,544 | 14,509 | 13,627 |
Income (loss) before income taxes | 354 | 526 | 1,392 | 1,648 |
Provision (benefit) for income taxes | 101 | 156 | 408 | 494 |
Net income (loss) | 253 | 370 | 984 | 1,154 |
Net income attributable to noncontrolling interests | 80 | 103 | 286 | 310 |
Net income (loss) attributable to HCA Healthcare, Inc. | 173 | 267 | 698 | 844 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 193 | 242 | 754 | 743 |
Eliminations [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Equity in earnings of affiliates | 436 | 573 | 1,702 | 1,843 |
Total expenses including equity in earnings of affiliates | 436 | 573 | 1,702 | 1,843 |
Income (loss) before income taxes | (436) | (573) | (1,702) | (1,843) |
Net income (loss) | (436) | (573) | (1,702) | (1,843) |
Net income (loss) attributable to HCA Healthcare, Inc. | (436) | (573) | (1,702) | (1,843) |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | $ (461) | $ (576) | $ (1,772) | $ (1,767) |
Supplemental Condensed Consol53
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Balance Sheet (Detail) - USD ($) $ in Millions | Sep. 30, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Dec. 31, 2015 |
Current assets: | ||||
Cash and cash equivalents | $ 718 | $ 646 | $ 677 | $ 741 |
Accounts receivable, net | 5,980 | 5,826 | ||
Inventories | 1,546 | 1,503 | ||
Other | 1,204 | 1,111 | ||
Total current assets | 9,448 | 9,086 | ||
Property and equipment, net | 17,329 | 16,352 | ||
Investments of insurance subsidiaries | 368 | 336 | ||
Investments in and advances to affiliates | 201 | 206 | ||
Goodwill and other intangible assets | 7,357 | 6,704 | ||
Other | 1,028 | 1,074 | ||
Total assets | 35,731 | 33,758 | ||
Current liabilities: | ||||
Accounts payable | 2,314 | 2,318 | ||
Accrued salaries | 1,312 | 1,265 | ||
Other accrued expenses | 1,783 | 2,035 | ||
Long-term debt due within one year | 202 | 216 | ||
Total current liabilities | 5,611 | 5,834 | ||
Long-term debt, net | 32,751 | 31,160 | ||
Professional liability risks | 1,179 | 1,148 | ||
Income taxes and other liabilities | 1,256 | 1,249 | ||
Total liabilities | 40,797 | 39,391 | ||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (6,780) | (7,302) | ||
Noncontrolling interests | 1,714 | 1,669 | ||
Total stockholders' deficit | (5,066) | (5,633) | ||
Total liabilities and stockholders' deficit | 35,731 | 33,758 | ||
HCA Healthcare, Inc. Issuer [Member] | ||||
Current assets: | ||||
Cash and cash equivalents | 1 | 1 | ||
Other | 33 | |||
Total current assets | 34 | |||
Investments in and advances to affiliates | 28,817 | 27,045 | ||
Other | 783 | 877 | ||
Total assets | 29,634 | 27,922 | ||
Current liabilities: | ||||
Other accrued expenses | 8 | 29 | ||
Total current liabilities | 8 | 29 | ||
Long-term debt, net | 994 | 993 | ||
Intercompany balances | 34,983 | 33,784 | ||
Income taxes and other liabilities | 429 | 418 | ||
Total liabilities | 36,414 | 35,224 | ||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (6,780) | (7,302) | ||
Total stockholders' deficit | (6,780) | (7,302) | ||
Total liabilities and stockholders' deficit | 29,634 | 27,922 | ||
HCA Inc. Issuer [Member] | ||||
Current assets: | ||||
Other | 29 | |||
Total assets | 29 | |||
Current liabilities: | ||||
Other accrued expenses | 279 | 572 | ||
Long-term debt due within one year | 97 | 97 | ||
Total current liabilities | 376 | 669 | ||
Long-term debt, net | 31,275 | 29,693 | ||
Intercompany balances | (10,069) | (10,277) | ||
Income taxes and other liabilities | 2 | 12 | ||
Total liabilities | 21,584 | 20,097 | ||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (21,555) | (20,097) | ||
Total stockholders' deficit | (21,555) | (20,097) | ||
Total liabilities and stockholders' deficit | 29 | |||
Subsidiary Guarantors [Member] | ||||
Current assets: | ||||
Cash and cash equivalents | 117 | 110 | 138 | 155 |
Accounts receivable, net | 3,003 | 3,028 | ||
Inventories | 899 | 890 | ||
Other | 438 | 445 | ||
Total current assets | 4,457 | 4,473 | ||
Property and equipment, net | 8,670 | 8,463 | ||
Investments in and advances to affiliates | 15 | 16 | ||
Goodwill and other intangible assets | 1,728 | 1,728 | ||
Other | 35 | 34 | ||
Total assets | 14,905 | 14,714 | ||
Current liabilities: | ||||
Accounts payable | 1,288 | 1,439 | ||
Accrued salaries | 704 | 704 | ||
Other accrued expenses | 475 | 464 | ||
Long-term debt due within one year | 54 | 60 | ||
Total current liabilities | 2,521 | 2,667 | ||
Long-term debt, net | 192 | 199 | ||
Intercompany balances | (28,514) | (26,447) | ||
Income taxes and other liabilities | 353 | 387 | ||
Total liabilities | (25,448) | (23,194) | ||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 40,228 | 37,752 | ||
Noncontrolling interests | 125 | 156 | ||
Total stockholders' deficit | 40,353 | 37,908 | ||
Total liabilities and stockholders' deficit | 14,905 | 14,714 | ||
Subsidiary Non-Guarantors [Member] | ||||
Current assets: | ||||
Cash and cash equivalents | 600 | 536 | $ 538 | $ 586 |
Accounts receivable, net | 2,977 | 2,798 | ||
Inventories | 647 | 613 | ||
Other | 733 | 666 | ||
Total current assets | 4,957 | 4,613 | ||
Property and equipment, net | 8,659 | 7,889 | ||
Investments of insurance subsidiaries | 368 | 336 | ||
Investments in and advances to affiliates | 186 | 190 | ||
Goodwill and other intangible assets | 5,629 | 4,976 | ||
Other | 181 | 163 | ||
Total assets | 19,980 | 18,167 | ||
Current liabilities: | ||||
Accounts payable | 1,026 | 879 | ||
Accrued salaries | 608 | 561 | ||
Other accrued expenses | 1,021 | 970 | ||
Long-term debt due within one year | 51 | 59 | ||
Total current liabilities | 2,706 | 2,469 | ||
Long-term debt, net | 290 | 275 | ||
Intercompany balances | 3,600 | 2,940 | ||
Professional liability risks | 1,179 | 1,148 | ||
Income taxes and other liabilities | 472 | 432 | ||
Total liabilities | 8,247 | 7,264 | ||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 10,144 | 9,390 | ||
Noncontrolling interests | 1,589 | 1,513 | ||
Total stockholders' deficit | 11,733 | 10,903 | ||
Total liabilities and stockholders' deficit | 19,980 | 18,167 | ||
Eliminations [Member] | ||||
Current assets: | ||||
Investments in and advances to affiliates | (28,817) | (27,045) | ||
Total assets | (28,817) | (27,045) | ||
Current liabilities: | ||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (28,817) | (27,045) | ||
Total stockholders' deficit | (28,817) | (27,045) | ||
Total liabilities and stockholders' deficit | $ (28,817) | $ (27,045) |
Supplemental Condensed Consol54
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Statement of Cash Flows (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2017 | Sep. 30, 2016 | Sep. 30, 2017 | Sep. 30, 2016 | |
Cash flows from operating activities: | ||||
Net income (loss) | $ 530 | $ 745 | $ 2,102 | $ 2,347 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (3,393) | (2,546) | ||
Provision for doubtful accounts | 1,271 | 840 | 3,104 | 2,392 |
Depreciation and amortization | 539 | 495 | 1,581 | 1,463 |
Income taxes | (9) | 8 | ||
Gains on sales of facilities | (7) | (3) | (10) | (8) |
Losses on retirement of debt | 39 | 4 | 39 | 4 |
Legal claim costs | 11 | 33 | ||
Amortization of debt issuance costs | 23 | 26 | ||
Share-based compensation | 195 | 196 | ||
Other | 60 | 39 | ||
Net cash provided by (used in) operating activities | 3,692 | 3,954 | ||
Cash flows from investing activities: | ||||
Purchase of property and equipment | (2,033) | (1,884) | ||
Acquisition of hospitals and health care entities | (1,142) | (468) | ||
Disposition of hospitals and health care entities | 24 | 23 | ||
Change in investments | (15) | 78 | ||
Other | (6) | 17 | ||
Net cash used in investing activities | (3,172) | (2,234) | ||
Cash flows from financing activities: | ||||
Issuance of long-term debt | 1,502 | 5,400 | ||
Net change in revolving credit facilities | 650 | (70) | ||
Repayment of long-term debt | (700) | (4,424) | ||
Distributions to noncontrolling interests | (363) | (342) | ||
Payment of debt issuance costs | (25) | (40) | ||
Repurchases of common stock | (1,475) | (2,213) | ||
Other | (37) | (95) | ||
Net cash (used in) provided by financing activities | (448) | (1,784) | ||
Change in cash and cash equivalents | 72 | (64) | ||
Cash and cash equivalents at beginning of period | 646 | 741 | ||
Cash and cash equivalents at end of period | 718 | 677 | 718 | 677 |
Eliminations [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | (436) | (573) | (1,702) | (1,843) |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Equity in earnings of affiliates | 1,702 | 1,843 | ||
HCA Healthcare, Inc. Issuer [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | 426 | 618 | 1,742 | 1,970 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (15) | (40) | ||
Income taxes | (9) | 8 | ||
Equity in earnings of affiliates | (1,702) | (1,843) | ||
Other | 58 | 53 | ||
Net cash provided by (used in) operating activities | 74 | 148 | ||
Cash flows from financing activities: | ||||
Repurchases of common stock | (1,475) | (2,213) | ||
Changes in intercompany balances with affiliates, net | 1,468 | 2,171 | ||
Other | (66) | (105) | ||
Net cash (used in) provided by financing activities | (73) | (147) | ||
Change in cash and cash equivalents | 1 | 1 | ||
Cash and cash equivalents at end of period | 1 | 1 | 1 | 1 |
HCA Inc. Issuer [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | (524) | (458) | (1,463) | (1,305) |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (293) | (49) | ||
Losses on retirement of debt | 39 | 4 | 39 | 4 |
Legal claim costs | 11 | 33 | ||
Amortization of debt issuance costs | 23 | 26 | ||
Net cash provided by (used in) operating activities | (1,694) | (1,291) | ||
Cash flows from financing activities: | ||||
Issuance of long-term debt | 1,500 | 5,400 | ||
Net change in revolving credit facilities | 650 | (70) | ||
Repayment of long-term debt | (604) | (4,334) | ||
Payment of debt issuance costs | (25) | (40) | ||
Changes in intercompany balances with affiliates, net | 173 | 335 | ||
Net cash (used in) provided by financing activities | 1,694 | 1,291 | ||
Subsidiary Guarantors [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | 811 | 788 | 2,541 | 2,371 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (1,785) | (1,628) | ||
Provision for doubtful accounts | 636 | 391 | 1,648 | 1,383 |
Depreciation and amortization | 249 | 242 | 748 | 707 |
Gains on sales of facilities | (4) | (5) | ||
Share-based compensation | 195 | 196 | ||
Other | (3) | |||
Net cash provided by (used in) operating activities | 3,342 | 3,026 | ||
Cash flows from investing activities: | ||||
Purchase of property and equipment | (912) | (892) | ||
Acquisition of hospitals and health care entities | (9) | (164) | ||
Disposition of hospitals and health care entities | 12 | 10 | ||
Change in investments | (2) | |||
Other | (2) | |||
Net cash used in investing activities | (911) | (1,048) | ||
Cash flows from financing activities: | ||||
Repayment of long-term debt | (52) | (54) | ||
Distributions to noncontrolling interests | (105) | (46) | ||
Changes in intercompany balances with affiliates, net | (2,267) | (1,895) | ||
Net cash (used in) provided by financing activities | (2,424) | (1,995) | ||
Change in cash and cash equivalents | 7 | (17) | ||
Cash and cash equivalents at beginning of period | 110 | 155 | ||
Cash and cash equivalents at end of period | 117 | 138 | 117 | 138 |
Subsidiary Non-Guarantors [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | 253 | 370 | 984 | 1,154 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (1,300) | (829) | ||
Provision for doubtful accounts | 635 | 449 | 1,456 | 1,009 |
Depreciation and amortization | 290 | 253 | 833 | 756 |
Gains on sales of facilities | (3) | (3) | (5) | (8) |
Other | 2 | (11) | ||
Net cash provided by (used in) operating activities | 1,970 | 2,071 | ||
Cash flows from investing activities: | ||||
Purchase of property and equipment | (1,121) | (992) | ||
Acquisition of hospitals and health care entities | (1,133) | (304) | ||
Disposition of hospitals and health care entities | 12 | 13 | ||
Change in investments | (15) | 80 | ||
Other | (4) | 17 | ||
Net cash used in investing activities | (2,261) | (1,186) | ||
Cash flows from financing activities: | ||||
Issuance of long-term debt | 2 | |||
Repayment of long-term debt | (44) | (36) | ||
Distributions to noncontrolling interests | (258) | (296) | ||
Changes in intercompany balances with affiliates, net | 626 | (611) | ||
Other | 29 | 10 | ||
Net cash (used in) provided by financing activities | 355 | (933) | ||
Change in cash and cash equivalents | 64 | (48) | ||
Cash and cash equivalents at beginning of period | 536 | 586 | ||
Cash and cash equivalents at end of period | $ 600 | $ 538 | $ 600 | $ 538 |