Document and Entity Information
Document and Entity Information - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Jan. 31, 2018 | Jun. 30, 2017 | |
Document And Entity Information [Abstract] | |||
Document Type | 10-K | ||
Amendment Flag | false | ||
Document Period End Date | Dec. 31, 2017 | ||
Document Fiscal Year Focus | 2,017 | ||
Document Fiscal Period Focus | FY | ||
Trading Symbol | HCA | ||
Entity Registrant Name | HCA Healthcare, Inc. | ||
Entity Central Index Key | 860,730 | ||
Current Fiscal Year End Date | --12-31 | ||
Entity Well-known Seasoned Issuer | Yes | ||
Entity Current Reporting Status | Yes | ||
Entity Voluntary Filers | No | ||
Entity Filer Category | Large Accelerated Filer | ||
Entity Common Stock, Shares Outstanding | 349,903,700 | ||
Entity Public Float | $ 25,351 |
Consolidated Income Statements
Consolidated Income Statements - USD ($) shares in Thousands, $ in Millions | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Income Statement [Abstract] | |||||||||||
Revenues before provision for doubtful accounts | $ 47,653 | $ 44,747 | $ 43,591 | ||||||||
Provision for doubtful accounts | 4,039 | 3,257 | 3,913 | ||||||||
Revenues | $ 11,562 | $ 10,696 | $ 10,733 | $ 10,623 | $ 10,641 | $ 10,270 | $ 10,319 | $ 10,260 | 43,614 | 41,490 | 39,678 |
Salaries and benefits | 20,059 | 18,897 | 18,115 | ||||||||
Supplies | 7,316 | 6,933 | 6,638 | ||||||||
Other operating expenses | 8,051 | 7,496 | 7,056 | ||||||||
Equity in earnings of affiliates | (45) | (54) | (46) | ||||||||
Depreciation and amortization | 2,131 | 1,966 | 1,904 | ||||||||
Interest expense | 1,690 | 1,707 | 1,665 | ||||||||
Losses (gains) on sales of facilities | 1 | 4 | 1 | 1 | 15 | 2 | 4 | 2 | (8) | (23) | 5 |
Losses on retirement of debt | 25 | 2 | 39 | 4 | 135 | ||||||
Legal claim costs (benefits) | (246) | 249 | |||||||||
Total expenses including equity in earnings of affiliates | 39,233 | 36,680 | 35,721 | ||||||||
Income before income taxes | 4,381 | 4,810 | 3,957 | ||||||||
Provision for income taxes | 1,638 | 1,378 | 1,261 | ||||||||
Net income | 641 | 530 | 795 | 777 | 1,085 | 745 | 791 | 811 | 2,743 | 3,432 | 2,696 |
Net income attributable to noncontrolling interests | 527 | 542 | 567 | ||||||||
Net income attributable to HCA Healthcare, Inc. | $ 474 | $ 426 | $ 657 | $ 659 | $ 920 | $ 618 | $ 658 | $ 694 | $ 2,216 | $ 2,890 | $ 2,129 |
Per share data: | |||||||||||
Basic earnings per share | $ 1.34 | $ 1.18 | $ 1.79 | $ 1.78 | $ 2.46 | $ 1.63 | $ 1.70 | $ 1.75 | $ 6.12 | $ 7.53 | $ 5.14 |
Diluted earnings per share | $ 1.30 | $ 1.15 | $ 1.75 | $ 1.74 | $ 2.39 | $ 1.59 | $ 1.65 | $ 1.69 | $ 5.95 | $ 7.30 | $ 4.99 |
Shares used in earnings per share calculations (in millions): | |||||||||||
Basic | 362,305 | 383,591 | 414,193 | ||||||||
Diluted | 372,221 | 395,851 | 426,721 |
Consolidated Comprehensive Inco
Consolidated Comprehensive Income Statements - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Statement of Comprehensive Income [Abstract] | |||
Net income | $ 2,743 | $ 3,432 | $ 2,696 |
Other comprehensive income (loss) before taxes: | |||
Foreign currency translation | 97 | (224) | (63) |
Unrealized gains (losses) on available-for-sale securities | 1 | (9) | 1 |
Realized gains included in other operating expenses | (2) | ||
Total unrealized gains (losses) on available-for-sale securities | (1) | (9) | 1 |
Defined benefit plans | (43) | (35) | 30 |
Pension costs included in salaries and benefits | 18 | 18 | 32 |
Total defined benefit plans | (25) | (17) | 62 |
Change in fair value of derivative financial instruments | 11 | 20 | (36) |
Interest costs included in interest expense | 20 | 109 | 125 |
Total change in fair value of derivative financial instruments | 31 | 129 | 89 |
Other comprehensive income (loss) before taxes | 102 | (121) | 89 |
Income taxes (benefits) related to other comprehensive income items | 42 | (48) | 31 |
Other comprehensive income (loss) | 60 | (73) | 58 |
Comprehensive income | 2,803 | 3,359 | 2,754 |
Comprehensive income attributable to noncontrolling interests | 527 | 542 | 567 |
Comprehensive income attributable to HCA Healthcare, Inc. | $ 2,276 | $ 2,817 | $ 2,187 |
Consolidated Balance Sheets
Consolidated Balance Sheets - USD ($) $ in Millions | Dec. 31, 2017 | Dec. 31, 2016 |
Current assets: | ||
Cash and cash equivalents | $ 732 | $ 646 |
Accounts receivable, less allowance for doubtful accounts of $5,488 and $4,988 | 6,501 | 5,826 |
Inventories | 1,573 | 1,503 |
Other | 1,171 | 1,111 |
Total current assets | 9,977 | 9,086 |
Property and equipment, at cost: | ||
Land | 1,746 | 1,611 |
Buildings | 14,249 | 13,546 |
Equipment | 22,168 | 20,580 |
Construction in progress | 1,921 | 1,318 |
Property and equipment, at cost | 40,084 | 37,055 |
Accumulated depreciation | (22,189) | (20,703) |
Property and equipment, net | 17,895 | 16,352 |
Investments of insurance subsidiaries | 418 | 336 |
Investments in and advances to affiliates | 199 | 206 |
Goodwill and other intangible assets | 7,394 | 6,704 |
Other | 710 | 1,074 |
Total assets | 36,593 | 33,758 |
Current liabilities: | ||
Accounts payable | 2,606 | 2,318 |
Accrued salaries | 1,369 | 1,265 |
Other accrued expenses | 1,983 | 2,035 |
Long-term debt due within one year | 200 | 216 |
Total current liabilities | 6,158 | 5,834 |
Long-term debt, less net debt issuance costs of $164 and $170 | 32,858 | 31,160 |
Professional liability risks | 1,198 | 1,148 |
Income taxes and other liabilities | 1,374 | 1,249 |
Stockholders' deficit: | ||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 350,091,600 shares - 2017 and 370,535,900 shares - 2016 | 4 | 4 |
Accumulated other comprehensive loss | (278) | (338) |
Retained deficit | (6,532) | (6,968) |
Stockholders' deficit attributable to HCA Healthcare, Inc. | (6,806) | (7,302) |
Noncontrolling interests | 1,811 | 1,669 |
Total stockholders' deficit | (4,995) | (5,633) |
Total liabilities and stockholders' deficit | $ 36,593 | $ 33,758 |
Consolidated Balance Sheets (Pa
Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions | Dec. 31, 2017 | Dec. 31, 2016 |
Statement of Financial Position [Abstract] | ||
Allowance for Accounts receivable | $ 5,488 | $ 4,988 |
Debt issuance cost | $ 164 | $ 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 | 350,091,600 | 370,535,900 |
Consolidated Statements of Stoc
Consolidated Statements of Stockholders' Deficit - USD ($) $ in Millions | Total | Common Stock [Member] | Capital in Excess of Par Value [Member] | Accumulated Other Comprehensive Loss [Member] | Retained Deficit [Member] | Equity Attributable to Noncontrolling Interests [Member] |
Balance at Dec. 31, 2014 | $ (6,498) | $ 4 | $ (323) | $ (7,575) | $ 1,396 | |
Balance, shares at Dec. 31, 2014 | 420,478,000 | |||||
Comprehensive income (loss) | 2,754 | 58 | 2,129 | 567 | ||
Repurchase of common stock | $ (2,397) | $ (505) | (1,892) | |||
Repurchase of common stock, shares | (31,991,000) | (31,991,000) | ||||
Share-based benefit plans | $ 523 | 523 | ||||
Share-based benefit plans, shares | 10,252,000 | |||||
Distributions | (495) | (495) | ||||
Acquisition of entities with noncontrolling interests | 85 | 85 | ||||
Other | (18) | (18) | ||||
Balance at Dec. 31, 2015 | (6,046) | $ 4 | (265) | (7,338) | 1,553 | |
Balance, shares at Dec. 31, 2015 | 398,739,000 | |||||
Comprehensive income (loss) | 3,359 | (73) | 2,890 | 542 | ||
Repurchase of common stock | $ (2,751) | (231) | (2,520) | |||
Repurchase of common stock, shares | (36,325,000) | (36,325,000) | ||||
Share-based benefit plans | $ 233 | 233 | ||||
Share-based benefit plans, shares | 8,122,000 | |||||
Distributions | (434) | (434) | ||||
Other | 6 | (2) | 8 | |||
Balance at Dec. 31, 2016 | (5,633) | $ 4 | (338) | (6,968) | 1,669 | |
Balance, shares at Dec. 31, 2016 | 370,536,000 | |||||
Comprehensive income (loss) | 2,803 | 60 | 2,216 | 527 | ||
Repurchase of common stock | $ (2,051) | (271) | (1,780) | |||
Repurchase of common stock, shares | (25,092,000) | (25,092,000) | ||||
Share-based benefit plans | $ 281 | 281 | ||||
Share-based benefit plans, shares | 4,648,000 | |||||
Distributions | (448) | (448) | ||||
Acquisition of entities with noncontrolling interests | 63 | 63 | ||||
Other | (10) | $ (10) | ||||
Balance at Dec. 31, 2017 | $ (4,995) | $ 4 | $ (278) | $ (6,532) | $ 1,811 | |
Balance, shares at Dec. 31, 2017 | 350,092,000 |
Consolidated Statements of Cash
Consolidated Statements of Cash Flows - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Cash flows from operating activities: | |||
Net income | $ 2,743 | $ 3,432 | $ 2,696 |
Increase (decrease) in cash from operating assets and liabilities: | |||
Accounts receivable | (4,640) | (3,247) | (4,114) |
Provision for doubtful accounts | 4,039 | 3,257 | 3,913 |
Accounts receivable, net | (601) | 10 | (201) |
Inventories and other assets | (69) | (112) | (314) |
Accounts payable and accrued expenses | 374 | 144 | 192 |
Depreciation and amortization | 2,131 | 1,966 | 1,904 |
Income taxes | 433 | 123 | (160) |
Losses (gains) on sales of facilities | (8) | (23) | 5 |
Losses on retirement of debt | 39 | 4 | 135 |
Legal claim costs (benefits) | (246) | 249 | |
Amortization of debt issuance costs | 31 | 34 | 35 |
Share-based compensation | 270 | 251 | 239 |
Other | 83 | 70 | 54 |
Net cash provided by (used in) operating activities | 5,426 | 5,653 | 4,734 |
Cash flows from investing activities: | |||
Purchase of property and equipment | (3,015) | (2,760) | (2,375) |
Acquisition of hospitals and health care entities | (1,212) | (576) | (351) |
Disposal of hospitals and health care entities | 25 | 26 | 73 |
Change in investments | (73) | 64 | 63 |
Other | (4) | 6 | 7 |
Net cash used in investing activities | (4,279) | (3,240) | (2,583) |
Cash flows from financing activities: | |||
Issuances of long-term debt | 1,502 | 5,400 | 5,548 |
Net change in revolving bank credit facilities | 760 | (110) | 150 |
Repayment of long-term debt | (753) | (4,475) | (4,920) |
Distributions to noncontrolling interests | (448) | (434) | (495) |
Payment of debt issuance costs | (26) | (40) | (50) |
Repurchases of common stock | (2,051) | (2,751) | (2,397) |
Other | (45) | (98) | 188 |
Net cash (used in) provided by financing activities | (1,061) | (2,508) | (1,976) |
Change in cash and cash equivalents | 86 | (95) | 175 |
Cash and cash equivalents at beginning of period | 646 | 741 | 566 |
Cash and cash equivalents at end of period | 732 | 646 | 741 |
Interest payments | 1,700 | 1,666 | 1,650 |
Income tax payments, net | $ 1,205 | $ 1,255 | $ 1,186 |
Accounting Policies
Accounting Policies | 12 Months Ended |
Dec. 31, 2017 | |
Accounting Policies [Abstract] | |
Accounting Policies | NOTE 1 — 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 December 31, 2017, these affiliates owned and operated 179 hospitals, 120 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 preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates. The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. The accounts of acquired entities are included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method. The majority of our expenses are “cost of revenue” items. Costs that could be classified as general and administrative include our corporate office costs, which were $373 million, $373 million and $327 million for the years ended December 31, 2017, 2016 and 2015, respectively. Revenues Revenues consist primarily of net patient service revenues that are recorded based upon established billing rates less allowances for contractual adjustments. Revenues are recorded during the period the health care services are provided, based upon the estimated amounts due from the patients and third-party payers. Third-party payers include federal and state agencies (under the Medicare and Medicaid programs), managed care health plans 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. Contractual payment terms in managed care agreements are generally based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service Years Ended December 31, 2017 Ratio 2016 Ratio 2015 Ratio Medicare $ 9,483 21.7 % $ 8,895 21.4 % $ 8,654 21.8 % Managed Medicare 4,788 11.0 4,355 10.5 4,133 10.4 Medicaid 1,631 3.7 1,597 3.8 1,705 4.3 Managed Medicaid 2,349 5.4 2,478 6.0 2,234 5.6 Managed care and other insurers 24,813 56.9 23,441 56.5 21,882 55.2 International (managed care and other insurers) 1,097 2.5 1,195 2.9 1,295 3.3 Other 3,492 8.0 2,786 6.7 3,688 9.3 Revenues before provision for doubtful accounts 47,653 109.2 44,747 107.8 43,591 109.9 Provision for doubtful accounts (4,039 ) (9.2 ) (3,257 ) (7.8 ) (3,913 ) (9.9 ) Revenues $ 43,614 100.0 % $ 41,490 100.0 % $ 39,678 100.0 % Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. As a result, there is at least a reasonable possibility recorded estimates will change by a material amount. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement amounts and disproportionate-share funds related primarily to cost reports filed during the respective year resulted in net increases to revenues of $41 million, $31 million and $48 million in 2017, 2016 and 2015, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in net increases to revenues of $56 million, $90 million and $85 million in 2017, 2016 and 2015, respectively. The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive. Prior to November 2017, patients treated at hospitals for nonelective care, who have income at or below 200% of the federal poverty level, are eligible for charity care. During November 2017, we expanded our charity care policy to limit the patient responsibility amounts for patients who have income above 200%, but at or below 400%, of the federal poverty level to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable multiple of the federal poverty level. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. In implementing the uninsured discount policy, we may first attempt to provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied. To quantify the total impact of and trends related to uninsured accounts, we believe it is beneficial to view charity care, uninsured discounts and the provision for doubtful accounts in combination, rather than each separately. A summary of these amounts for the years ended December 31, follows (dollars in millions): 2017 Ratio 2016 Ratio 2015 Ratio Charity care $ 4,861 21 % $ 4,151 20 % $ 3,682 20 % Uninsured discounts 14,520 62 13,047 64 10,692 59 Provision for doubtful accounts 4,039 17 3,257 16 3,913 21 Total uncompensated care $ 23,420 100 % $ 20,455 100 % $ 18,287 100 % A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions): 2017 2016 2015 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 37,557 $ 35,304 $ 33,760 Cost-to-charges 12.9 % 13.5 % 14.5 % Total uncompensated care $ 23,420 $ 20,455 $ 18,287 Multiply by the cost-to-charges 12.9 % 13.5 % 14.5 % Estimated cost of total uncompensated care $ 3,021 $ 2,761 $ 2,652 The sum of charity care, uninsured discounts and the provision for doubtful accounts, as a percentage of the sum of revenues, charity care, uninsured discounts and the provision for doubtful accounts was 34.9% for 2017, 33.0% for 2016 and 31.5% for 2015. 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. We believe the most significant impact of adopting the new standard 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 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 right-of-use Cash and Cash Equivalents Cash and cash equivalents include highly liquid investments with a maturity of three months or less when purchased. Our insurance subsidiaries’ cash equivalent investments in excess of the amounts required to pay estimated professional liability claims during the next twelve months are not included in cash and cash equivalents as these funds are not available for general corporate purposes. Carrying values of cash and cash equivalents approximate fair value due to the short-term nature of these instruments. Our cash management system provides for daily investment of available balances and the funding of outstanding checks when presented for payment. Outstanding, but unpresented, checks totaling $480 million and $565 million at December 31, 2017 and 2016, respectively, have been included in “accounts payable” in the consolidated balance sheets. Upon presentation for payment, these checks are funded through available cash balances or our credit facility. Accounts Receivable We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. Additions to the allowance for doubtful accounts are made by means of the provision for doubtful accounts. Accounts written off as uncollectible are deducted from the allowance for doubtful accounts and subsequent recoveries are added. The amount of the provision for doubtful accounts is based upon management’s assessment of historical and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. The provision for doubtful accounts and the allowance for doubtful accounts relate to “uninsured” amounts due directly from patients (including copayment and deductible amounts from patients who have health care coverage). Accounts are written off when all reasonable internal and external collection efforts have been performed. We consider the return of an account from the secondary collection agency to be the culmination of our reasonable collection efforts and the timing basis for writing off the account balance. Writeoffs are based upon specific identification and the writeoff process requires a writeoff adjustment entry to the patient accounting system. Management relies on the results of detailed reviews of historical writeoffs and recoveries at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information to utilize in estimating the collectibility of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. At December 31, 2017 and 2016, the allowance for doubtful accounts represented 100% and 98%, respectively, of the $5.488 billion and $5.116 billion, respectively, patient due accounts receivable balance. The patient due accounts receivable balance represents the estimated uninsured portion of our accounts receivable. The estimated uninsured portion of Medicaid pending and uninsured discount pending accounts is included in our patient due accounts receivable balance. Days revenues in accounts receivable were 52 days, 50 days and 53 days at December 31, 2017, 2016 and 2015, respectively. Changes in general economic conditions, patient accounting service center operations, payer mix, or federal or state governmental health care coverage could affect our collection of accounts receivable, cash flows and results of operations. Inventories Inventories are stated at the lower of cost (first-in, first-out) Property and Equipment Depreciation expense, computed using the straight-line method, was $2.111 billion in 2017, $1.946 billion in 2016 and $1.880 billion in 2015. Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four to 10 years. When events, circumstances or operating results indicate the carrying values of certain long-lived assets expected to be held and used might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar assets and independent appraisals. Long-lived assets to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers. Investments of Insurance Subsidiaries At December 31, 2017 and 2016, the investments of our 100% owned insurance subsidiaries were classified as “available-for-sale” Investments—Debt and Equity Securities Goodwill and Intangible Assets Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, an impairment loss is recognized. Fair value is estimated based upon internal evaluations of each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2017, 2016 and 2015. Since January 1, 2000, we have recognized total goodwill impairments of $102 million in the aggregate. None of the goodwill impairments related to evaluations of goodwill at the reporting unit level, as all recognized goodwill impairments during this period related to goodwill allocated to asset disposal groups. During 2017, goodwill increased by $693 million related to acquisitions and by $12 million related to foreign currency translation and other adjustments. During 2016, goodwill increased by $41 million related to acquisitions and declined by $49 million related to sales, foreign currency translation and other adjustments. During 2017, identifiable intangible assets declined by $15 million due to amortization, foreign currency translation and other adjustments. During 2016, identifiable intangible assets declined by $19 million due to amortization, foreign currency translation and other adjustments. Identifiable intangible assets are amortized over estimated lives ranging generally from three to 10 years. The gross carrying amount of identifiable intangible assets at both December 31, 2017 and 2016 was $184 million and accumulated amortization was $94 million and $79 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2017 and 2016 was $269 million. Indefinite-lived identifiable intangible assets are not amortized but are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Debt Issuance Costs Debt issuance costs are amortized based upon the terms of the respective debt obligations. The gross carrying amount of debt issuance costs at December 31, 2017 and 2016 was $353 million and $334 million, respectively, and accumulated amortization was $189 million and $164 million, respectively. Amortization of debt issuance costs is included in interest expense and was $31 million, $34 million and $35 million for 2017, 2016 and 2015, respectively. Professional Liability Claims Reserves for professional liability risks were $1.627 billion and $1.539 billion at December 31, 2017 and 2016, respectively. The current portion of the reserves, $429 million and $391 million at December 31, 2017 and 2016, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $466 million, $430 million and $344 million for 2017, 2016 and 2015, respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. Loss and loss expense reserves represent the estimated ultimate net cost of all reported and unreported losses incurred through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,500 and 2,700 individual claims at December 31, 2017 and 2016, respectively, and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During both 2017 and 2016, $357 million of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates. A portion of our professional liability risks is insured through a 100% owned insurance subsidiary. Subject to a $15 million per occurrence self-insured retention, our facilities are insured by our 100% owned insurance subsidiary for losses up to $50 million per occurrence. The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of $25 million per occurrence. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary. The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts include $19 million and $36 million at December 31, 2017 and 2016, respectively, recorded in “other assets,” and $5 million and $9 million at December 31, 2017 and 2016, respectively, recorded in “other current assets.” Financial Instruments Derivative financial instruments are employed to manage interest rate risks, and are not used for trading or speculative purposes. We recognize our interest rate swap derivative instruments in the consolidated balance sheets at fair value. Changes in the fair value of derivatives are recognized periodically in stockholders’ equity, as a component of other comprehensive income (loss), provided the derivative financial instrument qualifies for hedge accounting. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income (loss), and subsequently reclassified to earnings to offset the impact of the forecasted transactions when they occur. In the event the forecasted transaction to which a cash flow hedge relates is no longer likely, the amount in other comprehensive income (loss) is recognized in earnings and generally the derivative is terminated. The net interest paid or received on interest rate swaps is recognized as interest expense. Gains and losses resulting from the early termination of interest rate swap agreements are deferred and amortized as adjustments to interest expense over the remaining term of the debt originally associated with the terminated swap. Noncontrolling Interests in Consolidated Entities The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities. Reclassifications Certain prior year amounts have been reclassified to conform to the 2017 presentation. |
Share-Based Compensation
Share-Based Compensation | 12 Months Ended |
Dec. 31, 2017 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |
Share-Based Compensation | NOTE 2 — SHARE-BASED COMPENSATION Stock Incentive Plan Our stock incentive plan is designed to promote the long term financial interests and growth of the Company by attracting and retaining management and other personnel, motivating them to achieve long range goals and aligning their interests with those of our stockholders through opportunities for increased stock, or stock-based, ownership in the Company. Portions of the options, stock appreciation rights (“SARs”) and restricted share units (“RSUs”) granted vest solely based upon continued employment over a specific period of time, and portions of the options, SARs and RSUs, and all performance share units (“PSUs”) vest based both upon continued employment over a specific period of time and upon the achievement of predetermined financial targets over time. We granted 1,879,100 and 1,601,300 SARs and 2,787,700 and 2,628,500 RSUs and PSUs during 2017 and 2016, respectively. At December 31, 2017, there were 11,284,400 exercisable stock options and SARs, and there were 22,755,600 shares available for future grants under the stock incentive plan. Employee Stock Purchase Plan Our employee stock purchase plan (“ESPP”) provides our participating employees an opportunity to obtain shares of our common stock at a discount (through payroll deductions over three-month periods). At December 31, 2017, 8,681,600 shares of common stock were reserved for issuance under the ESPP provisions. During 2017 and 2016, the Company recognized $9 million and $8 million, respectively, of compensation expense for each year related to the ESPP. Stock Option, SAR, RSU and PSU Activity The fair value of each stock option and SAR award is estimated on the grant date, using valuation models and the weighted average assumptions indicated in the following table. Awards under our stock incentive plan generally vest based on continued employment (“Time Stock Options and SARs” and “Time RSUs”) and based upon continued employment and the achievement of certain financial targets (“Performance Stock Options and SARs”, “Performance RSUs” and “PSUs”). PSUs have a three-year cumulative earnings per share target, and the number of PSUs earned can vary from zero (for actual performance of less than 80% of target) to two times the original PSU grant (for actual performance of 120% or more of target). Each grant is valued as a single award with an expected term equal to the average expected term of the component vesting tranches. We use historical exercise behavior data and other factors to estimate the expected term of the options and SARs. The expected term of the share-based award is limited by the contractual term, and employee post-vesting termination behavior is incorporated in the historical exercise behavior data. Compensation cost is recognized on the straight-line attribution method. The straight-line attribution method requires that total compensation expense recognized must at least equal the vested portion of the grant-date fair value. The expected volatility is derived using historical stock price information for our common stock and the volatility implied by the trading of options to purchase our stock on open-market exchanges. The risk-free interest rate is the approximate yield on United States Treasury Strips having a life equal to the expected share-based award life on the date of grant. The expected life is an estimate of the number of years a share-based award will be held before it is exercised. 2017 2016 2015 Risk-free interest rate 2.13 % 1.70 % 1.59 % Expected volatility 31 % 36 % 36 % Expected life, in years 6.17 6.25 6.25 Expected dividend yield — — — Information regarding Time Stock Options and SARs and Performance Stock Options and SARs activity during 2017, 2016 and 2015 is summarized below (share amounts in thousands): Time Performance Total Weighted Weighted Aggregate Options and SARs outstanding, December 31, 2014 15,051 14,744 29,795 $ 21.39 Granted 1,746 — 1,746 69.16 Exercised (4,093 ) (3,988 ) (8,081 ) 12.77 Cancelled (539 ) (329 ) (868 ) 32.59 Options and SARs outstanding, December 31, 2015 12,165 10,427 22,592 27.73 Granted 1,601 — 1,601 69.96 Exercised (2,521 ) (4,171 ) (6,692 ) 15.85 Cancelled (309 ) (126 ) (435 ) 55.17 Options and SARs outstanding, December 31, 2016 10,936 6,130 17,066 35.65 Granted 1,879 — 1,879 81.83 Exercised (1,549 ) (1,366 ) (2,915 ) 21.49 Cancelled (110 ) (178 ) (288 ) 52.92 Options and SARs outstanding, December 31, 2017 11,156 4,586 15,742 43.47 5.4 years $ 699 Options and SARs exercisable, December 31, 2017 7,060 4,224 11,284 $ 32.49 4.4 years $ 625 The weighted average fair values of stock options and SARs granted during 2017, 2016 and 2015 were $28.47, $26.60 and $26.10 per share, respectively. The total intrinsic value of stock options and SARs exercised during the year ended December 31, 2017 was $177 million. As of December 31, 2017, the unrecognized compensation cost related to nonvested stock options and SARs was $74 million. Information regarding Time RSUs, Performance RSUs and PSUs activity during 2017, 2016 and 2015 is summarized below (share amounts in thousands): Time RSUs Performance PSUs Total RSUs Weighted RSUs and PSUs outstanding, December 31, 2014 5,895 2,781 — 8,676 $ 39.89 Granted 1,694 — 1,411 3,105 69.43 Vested (1,953 ) (928 ) — (2,881 ) 37.61 Cancelled (334 ) (113 ) (40 ) (487 ) 47.26 RSUs and PSUs outstanding, December 31, 2015 5,302 1,740 1,371 8,413 51.15 Granted 1,450 — 1,178 2,628 69.95 Vested (2,242 ) (870 ) — (3,112 ) 41.71 Cancelled (399 ) (80 ) (163 ) (642 ) 59.66 RSUs and PSUs outstanding, December 31, 2016 4,111 790 2,386 7,287 61.21 Granted 1,484 — 1,304 2,788 81.90 Vested (1,824 ) (430 ) — (2,254 ) 51.20 Cancelled (306 ) (133 ) (128 ) (567 ) 64.06 RSUs and PSUs outstanding, December 31, 2017 3,465 227 3,562 7,254 72.05 As of December 31, 2017, the unrecognized compensation cost related to RSUs and PSUs was $257 million. |
Acquisitions and Dispositions
Acquisitions and Dispositions | 12 Months Ended |
Dec. 31, 2017 | |
Business Combinations [Abstract] | |
Acquisitions and Dispositions | NOTE 3 — ACQUISITIONS AND DISPOSITIONS During 2017, we paid $1.000 billion to acquire eight hospital facilities and $212 million to acquire nonhospital health care entities. During 2016, we paid $343 million to acquire three hospital facilities and $233 million to acquire nonhospital health care entities. During 2015, we paid $15 million to acquire a hospital and $336 million to acquire nonhospital health care entities. Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values. The purchase price paid in excess of the fair value of identifiable net assets of these acquired entities aggregated $693 million, $41 million and $323 million in 2017, 2016 and 2015, respectively. The consolidated financial statements include the accounts and operations of the acquired entities subsequent to the respective acquisition dates. The pro forma effects of these acquired entities on our results of operations for periods prior to the respective acquisition dates were not significant. During 2017, we received proceeds of $25 million and recognized a net pretax gain of $8 million ($5 million after tax) related to sales of real estate and other investments. During 2016, we received proceeds of $26 million and recognized a net pretax gain of $23 million ($19 million after tax) related to sales of real estate and other investments. During 2015, we received proceeds of $73 million and recognized a net pretax loss of $5 million ($3 million after tax) related to the sale of a hospital facility and sales of real estate and other investments. |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2017 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | NOTE 4 — INCOME TAXES The provision for income taxes consists of the following (dollars in millions): 2017 2016 2015 Current: Federal $ 1,067 $ 1,129 $ 1,259 State 120 125 119 Foreign 19 37 40 Deferred: Federal 423 75 (163 ) State 3 (5 ) (27 ) Foreign 6 17 33 $ 1,638 $ 1,378 $ 1,261 Our provision for income taxes for the year ended December 31, 2017 included an increase of $301 million related to the estimated impact of tax rate changes under the 2017 Tax Cuts and Jobs Act (the “Tax Act”) on our deferred tax assets and liabilities. Our provision for income taxes for the years ended December 31, 2017 and 2016 also included tax benefits of $82 million and $162 million, respectively, related to the settlement of employee equity awards. The provision for income taxes reflects $14 million and $15 million of reductions in interest expense (net of tax) and $7 million of interest expense (net of tax) for the years ended December 31, 2017, 2016 and 2015, respectively. During 2016, the IRS completed its examination of our 2011 and 2012 tax years, resolving all outstanding federal tax issues. We reduced our provision for income taxes for the year ended December 31, 2016 by $51 million, including interest (net of tax), as a result of this resolution. Our foreign pretax income was $91 million, $149 million and $178 million for the years ended December 31, 2017, 2016 and 2015, respectively. The Tax Act was enacted on December 22, 2017. The Tax Act significantly revises U.S. corporate income taxes, including lowering the statutory corporate tax rate from 35% to 21% beginning in 2018 and imposing a mandatory one-time transition tax on undistributed foreign earnings. Due to the complexity and uncertainty regarding numerous provisions of the Tax Act, we have not completed our accounting for its effects. However, we have made reasonable estimates and recorded provisional amounts in our financial statements as of December 31, 2017. A provisional amount of $301 million related to the remeasurement of our deferred tax assets and liabilities, primarily based on the lower tax rates at which they are expected to reverse in the future, was recorded as a component of our provision for income taxes for the year ended December 31, 2017. We also reclassified a provisional amount of $127 million from our deferred tax liabilities for the one-time transition tax, based on our estimated undistributed post-1986 foreign earnings and profits. Because we had previously recorded U.S. taxes on these earnings, the transition tax liability, which is payable over an 8-year period, did not affect our 2017 provision for income taxes. As we complete our analysis of the Tax Act, collect and prepare necessary data, and interpret any additional guidance issued by federal and state taxing authorities or other standard-setting bodies, we may make adjustments to the provisional amounts and record additional amounts for those federal, state, and foreign tax assets and liabilities for which we were unable to make reasonable estimates as of December 31, 2017. Any adjustments or additional amounts recorded may materially impact our provision for income taxes and effective tax rate in the periods in which they are made. A reconciliation of the federal statutory rate to the effective income tax rate follows: 2017 2016 2015 Federal statutory rate 35.0 % 35.0 % 35.0 % State income taxes, net of federal tax benefit 2.2 2.1 1.6 Change in liability for uncertain tax positions — (1.0 ) 0.2 Tax benefit from settlements of employee equity awards (2.0 ) (3.6 ) — Impact of rate change on deferred tax balances 7.8 — — Other items, net (0.5 ) (0.2 ) 0.4 Effective income tax rate on income applicable to HCA Healthcare, Inc. 42.5 32.3 37.2 Income attributable to noncontrolling interests from consolidated partnerships (5.1 ) (3.6 ) (5.3 ) Effective income tax rate on income before income taxes 37.4 % 28.7 % 31.9 % A summary of the items comprising the deferred tax assets and liabilities at December 31 follows (dollars in millions): 2017 2016 Assets Liabilities Assets Liabilities Depreciation and fixed asset basis differences $ — $ 260 $ — $ 235 Allowances for professional liability and other risks 345 — 495 — Accounts receivable 243 — 351 — Compensation 263 — 359 — Other 420 501 794 918 $ 1,271 $ 761 $ 1,999 $ 1,153 At December 31, 2017, federal and state net operating loss carryforwards (expiring in years 2020 through 2036) available to offset future taxable income approximated $82 million and $121 million, respectively. Utilization of net operating loss carryforwards in any one year may be limited. The following table summarizes the activity related to our unrecognized tax benefits (dollars in millions): 2017 2016 Balance at January 1 $ 377 $ 487 Additions based on tax positions related to the current year 40 11 Additions for tax positions of prior years 11 8 Reductions for tax positions of prior years (13 ) (18 ) Settlements — (101 ) Lapse of applicable statutes of limitations (16 ) (10 ) Balance at December 31 $ 399 $ 377 Our liability for unrecognized tax benefits was $439 million, including accrued interest of $44 million and excluding $4 million that was recorded as reductions of the related deferred tax assets, as of December 31, 2017 ($418 million, $45 million and $4 million, respectively, as of December 31, 2016). Unrecognized tax benefits of $145 million ($137 million as of December 31, 2016) would affect the effective rate, if recognized. We are subject to examination by the IRS for tax years 2014 and later as well as by 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 | 12 Months Ended |
Dec. 31, 2017 | |
Earnings Per Share [Abstract] | |
Earnings Per Share | NOTE 5 — EARNINGS PER SHARE We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding plus the dilutive effect of outstanding stock options, SARs, RSUs and PSUs, computed using the treasury stock method. During 2017, 2016 and 2015, we repurchased 25.092 million shares, 36.325 million shares and 31.991 million shares, respectively, of our common stock. The following table sets forth the computations of basic and diluted earnings per share for the years ended December 31, 2017, 2016 and 2015 (dollars and shares in millions, except per share amounts): 2017 2016 2015 Net income attributable to HCA Healthcare, Inc. $ 2,216 $ 2,890 $ 2,129 Weighted average common shares outstanding 362.305 383.591 414.193 Effect of dilutive incremental shares 9.916 12.260 12.528 Shares used for diluted earnings per share 372.221 395.851 426.721 Earnings per share: Basic earnings per share $ 6.12 $ 7.53 $ 5.14 Diluted earnings per share $ 5.95 $ 7.30 $ 4.99 |
Investments of Insurance Subsid
Investments of Insurance Subsidiaries | 12 Months Ended |
Dec. 31, 2017 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments of Insurance Subsidiaries | NOTE 6 — INVESTMENTS OF INSURANCE SUBSIDIARIES A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions): 2017 Amortized Unrealized Fair Gains Losses States and municipalities debt securities $ 361 $ 10 $ — $ 371 Money market funds and other 101 — — 101 $ 462 $ 10 $ — 472 Amounts classified as current assets (54 ) Investment carrying value $ 418 2016 Amortized Unrealized Fair Gains Losses States and municipalities debt securities $ 345 $ 9 $ (1 ) $ 353 Money market funds and other 29 3 — 32 $ 374 $ 12 $ (1 ) 385 Amounts classified as current assets (49 ) Investment carrying value $ 336 At December 31, 2017 and 2016, the investments of our insurance subsidiaries were classified as “available-for-sale.” Scheduled maturities of investments in debt securities at December 31, 2017 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 31 $ 31 Due after one year through five years 84 86 Due after five years through ten years 187 194 Due after ten years 59 60 $ 361 $ 371 The average expected maturity of the investments in debt securities at December 31, 2017 was 4.8 years, compared to the average scheduled maturity of 6.5 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 | 12 Months Ended |
Dec. 31, 2017 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Financial Instruments | NOTE 7 — FINANCIAL INSTRUMENTS Interest Rate Swap Agreements We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between two parties based on common notional principal amounts and maturity dates. Pay-fixed The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at December 31, 2017 (dollars in millions): Notional Maturity Date Fair Pay-fixed $ 2,000 December 2021 $ 48 Pay-fixed 500 December 2022 2 During the next 12 months, we estimate $5 million will be reclassified from other comprehensive income (“OCI”) and will reduce interest expense. Derivatives — Results of Operations The following table presents the effect of our interest rate swaps on our results of operations for the year ended December 31, 2017 (dollars in millions): Derivatives in Cash Flow Hedging Amount of Gain Location of Loss Amount of Loss Interest rate swaps $ 7 Interest expense $ 20 |
Assets and Liabilities Measured
Assets and Liabilities Measured at Fair Value | 12 Months Ended |
Dec. 31, 2017 | |
Fair Value Disclosures [Abstract] | |
Assets and Liabilities Measured at Fair Value | NOTE 8 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE Accounting Standards Codification 820, Fair Value Measurements and Disclosures 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 December 31, 2017 and 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 December 31, 2017 and 2016, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): December 31, 2017 Fair Value Fair Value Measurements Using Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: States and municipalities debt securities $ 371 $ — $ 371 $ — Money market funds and other 101 101 — — Investments of insurance subsidiaries 472 101 371 — Less amounts classified as current assets (54 ) (54 ) — — $ 418 $ 47 $ 371 $ — Interest rate swaps (Other) $ 50 $ — $ 50 $ — December 31, 2016 Fair Value Fair Value Measurements Using Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: States and municipalities debt securities $ 353 $ — $ 347 $ 6 Money market funds and other 32 32 — — 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 during 2017 resulted from settlements. The estimated fair value of our long-term debt was $34.689 billion and $32.833 billion at December 31, 2017 and 2016, respectively, compared to carrying amounts, excluding net debt issuance costs, aggregating $33.222 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 | 12 Months Ended |
Dec. 31, 2017 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | NOTE 9 — LONG-TERM DEBT A summary of long-term debt at December 31, including related interest rates at December 31, 2017, follows (dollars in millions): 2017 2016 Senior secured asset-based revolving credit facility (effective interest rate of 3.0%) $ 3,680 $ 2,920 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 3.5%) 3,891 3,981 Senior secured notes (effective interest rate of 5.4%) 15,300 13,800 Other senior secured debt (effective interest rate of 5.7%) 599 593 Senior secured debt 23,470 21,294 Senior unsecured notes (effective interest rate of 6.4%) 9,752 10,252 Net debt issuance costs (164 ) (170 ) Total debt (average life of 6.8 years, rates averaging 5.2%) 33,058 31,376 Less amounts due within one year 200 216 $ 32,858 $ 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. Senior Secured Credit Facilities And Other Senior Secured Debt We have entered into the following senior secured credit facilities: (i) a $3.750 billion asset-based revolving credit facility maturing on June 28, 2022 with a borrowing base of 85% of eligible accounts receivable, subject to customary reserves and eligibility criteria ($3.680 billion outstanding at December 31, 2017) (the “ABL credit facility”); (ii) a $2.000 billion senior secured revolving credit facility maturing on June 28, 2022 (none outstanding at December 31, 2017 without giving effect to certain outstanding letters of credit); (iii) a $1.225 billion senior secured term loan A-5 B-8 B-9 Borrowings under the senior secured credit facilities bear interest at a rate equal to, at our option, either (a) a base rate determined by reference to the higher of (1) the federal funds rate plus 0.50% or (2) the prime rate of Bank of America or (b) a LIBOR rate for the currency of such borrowing for the relevant interest period, plus, in each case, an applicable margin. The applicable margin for borrowings under the senior secured credit facilities may be reduced subject to attaining certain leverage ratios. The senior secured credit facilities contain a number of covenants that restrict, subject to certain exceptions, our (and some or all of our subsidiaries’) ability to incur additional indebtedness, repay subordinated indebtedness, create liens on assets, sell assets, make investments, loans or advances, engage in certain transactions with affiliates, pay dividends and distributions, and enter into sale and leaseback transactions. In addition, we are required to satisfy and maintain a maximum total leverage ratio covenant under the cash flow credit facility and, in certain situations under the ABL credit facility, a minimum interest coverage ratio covenant. Senior secured notes consists of (i) $3.000 billion aggregate principal amount of 6.50% first lien notes due 2020; (ii) $1.350 billion aggregate principal amount of 5.875% first lien notes due 2022; (iii) $1.250 billion aggregate principal amount of 4.75% first lien notes due 2023; (iv) $1.500 billion aggregate principal amount of 3.75% first lien notes due 2019; (v) $2.000 billion aggregate principal amount of 5.00% first lien notes due 2024; (vi) $600 million aggregate principal amount of 4.25% first lien notes due 2019; (vii) $1.400 billion aggregate principal amount of 5.25% first lien notes due 2025; (viii) $1.500 billion aggregate principal amount of 5.25% first lien notes due 2026; (ix) $1.200 billion aggregate principal amount of 4.50% first lien notes due 2027; and (x) $1.500 billion aggregate principal amount of 5.50% first lien notes due 2047. Capital leases and other secured debt totaled $599 million at December 31, 2017. We use interest rate swap agreements to manage the variable rate exposure of our debt portfolio. At December 31, 2017, we had entered into effective interest rate swap agreements, in a total notional amount of $2.500 billion, in order to hedge a portion of our exposure to variable rate interest payments associated with the senior secured credit facilities. The effect of the interest rate swaps is reflected in the effective interest rates for the senior secured credit facilities. Senior Unsecured Notes Senior unsecured notes consist of (i) $7.891 billion aggregate principal amount of senior notes with maturities ranging from 2022 to 2033; (ii) an aggregate principal amount of $125 million medium-term notes maturing 2025; (iii) an aggregate principal amount of $736 million debentures with maturities ranging from 2023 to 2095; and (iv) an aggregate principal amount of $1.000 billion senior notes due 2021. General Debt Information The senior secured credit facilities and senior secured notes are fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, 100% owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture (the “1993 Indenture”) dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our ABL credit facility). All obligations under the ABL credit facility, and the guarantees of those obligations, are secured, subject to permitted liens and other exceptions, by a first-priority lien on substantially all of the receivables of the borrowers and each guarantor under such ABL credit facility (the “Receivables Collateral”). All obligations under the cash flow credit facility and the guarantees of such obligations are secured, subject to permitted liens and other exceptions, by: • a first-priority lien on the capital stock owned by HCA Inc., or by any U.S. guarantor, in each of their respective first-tier subsidiaries; • a first-priority lien on substantially all present and future assets of HCA Inc. and of each U.S. guarantor other than (i) “Principal Properties” (as defined in the 1993 Indenture), (ii) certain other real properties and (iii) deposit accounts, other bank or securities accounts, cash, leaseholds, motor-vehicles and certain other exceptions; and • a second-priority lien on certain of the Receivables Collateral. Our senior secured notes and the related guarantees are secured by first-priority liens, subject to permitted liens, on our and our subsidiary guarantors’ assets, subject to certain exceptions, that secure our cash flow credit facility on a first-priority basis and are secured by second-priority liens, subject to permitted liens, on our and our subsidiary guarantors’ assets that secure our ABL credit facility on a first-priority basis and our other cash flow credit facility on a second-priority basis. Maturities of long-term debt in years 2019 through 2022, excluding amounts under the ABL credit facility, are $2.284 billion, $4.177 billion, $1.078 billion and $3.449 billion, respectively. |
Contigencies
Contigencies | 12 Months Ended |
Dec. 31, 2017 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contigencies | NOTE 10 — 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. Government Investigations, Claims and Litigation Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam |
Leases
Leases | 12 Months Ended |
Dec. 31, 2017 | |
Leases [Abstract] | |
Leases | NOTE 11 — LEASES We lease medical office buildings and certain equipment under operating lease agreements. Commitments relating to noncancellable operating leases for each of the next five years and thereafter are as follows (dollars in millions): For the Year Ended December 31, 2018 $ 289 2019 278 2020 239 2021 198 2022 157 Thereafter 1,118 2,279 Less sublease income (11 ) $ 2,268 |
Capital Stock
Capital Stock | 12 Months Ended |
Dec. 31, 2017 | |
Equity [Abstract] | |
Capital Stock | NOTE 12 — CAPITAL STOCK The amended and restated certificate of incorporation authorizes the Company to issue up to 1,800,000,000 shares of common stock, and our amended and restated by-laws Share Repurchase Transactions During October 2017, our board of directors authorized a share repurchase program for up to $2 billion of our outstanding common stock. During 2017, we repurchased 25.092 million shares of our common stock at an average price of $81.73 per share through market purchases pursuant to the $2.0 billion November 2016 (which was completed during the fourth quarter of 2017) and the $2 billion October 2017 share repurchase programs. At December 31, 2017, we had $1.802 billion of repurchase authorization available under the October 2017 authorization. During November 2016, our board of directors authorized a share repurchase program for up to $2 billion of our outstanding common stock. During May 2016, the Company repurchased 9.361 million shares of its common stock beneficially owned by affiliates of Kohlberg Kravis Roberts & Co. at a purchase price of $80.12 per share, the closing price of the Company’s common stock on the New York Stock Exchange on May 10, 2016, less a discount of 1%. During 2016, we also repurchased 26.964 million shares of our common stock at an average price of $74.20 per share through market purchases, resulting in total repurchases of 36.325 million shares of our common stock at an average price of $75.72 per share for the year ended December 31, 2016 pursuant to the $3 billion October 2015 (which was completed during the fourth quarter of 2016) and the $2 billion November 2016 share repurchase programs. At December 31, 2016, we had $1.853 billion of repurchase authorization available under the November 2016 authorization. During October 2015, May 2015 and February 2015, our board of directors authorized share repurchase programs for up to $3 billion, $1 billion and $1 billion, respectively, of our outstanding common stock. During April 2015, the Company entered into an agreement to repurchase 3.806 million shares of its common stock beneficially owned by affiliates of Bain Capital Investors, LLC (the “Bain Entities”) and certain charitable organizations that received shares of common stock as charitable contributions from certain partners and other employees of the Bain Entities at a purchase price of $77.26 per share, the closing price of the Company’s common stock on the New York Stock Exchange on April 17, 2015, less a discount of 1%. During 2015, we also repurchased 28.185 million shares of our common stock at an average price of $74.62 per share through market purchases, resulting in total repurchases pursuant to the October 2015, May 2015 and February 2015 authorizations of 31.991 million shares of our common stock at an average price of $74.93 per share. At December 31, 2015, we had $2.603 billion of repurchase authorization available under the $3.0 billion October 2015 authorization. |
Employee Benefit Plans
Employee Benefit Plans | 12 Months Ended |
Dec. 31, 2017 | |
Retirement Benefits [Abstract] | |
Employee Benefit Plans | NOTE 13 — EMPLOYEE BENEFIT PLANS We maintain defined contribution benefit plans that are available to employees who meet certain minimum requirements. Certain of the plans require that we match specified percentages of participant contributions up to certain maximum levels (generally, 100% of the first 3% to 9%, depending upon years of vesting service, of compensation deferred by participants). The cost of these plans totaled $471 million for 2017, $444 million for 2016 and $432 million for 2015. Our contributions have been funded periodically during each year. We maintain the noncontributory, nonqualified Restoration Plan to provide certain retirement benefits for eligible employees. Eligibility for the Restoration Plan is based upon earning eligible compensation in excess of the Social Security Wage Base and attaining 1,000 or more hours of service during the plan year. Company credits to participants’ account balances (the Restoration Plan is not funded) depend upon participants’ compensation, years of vesting service and certain IRS limitations related to the HCA 401(k) plan. Benefits expense under this plan was $40 million for 2017, $20 million for 2016 and $20 million for 2015. Accrued benefits liabilities under this plan totaled $201 million at December 31, 2017 and $175 million at December 31, 2016. We maintain a Supplemental Executive Retirement Plan (“SERP”) for certain executives (the SERP is not funded). The plan is designed to ensure that upon retirement the participant receives the value of a prescribed life annuity from the combination of the SERP and our other benefit plans. Benefits expense under the plan was $28 million for 2017, $22 million for 2016 and $33 million for 2015. Accrued benefits liabilities under this plan totaled $223 million at December 31, 2017 and $222 million at December 31, 2016. We maintain defined benefit pension plans which resulted from certain hospital acquisitions in prior years. Benefits expense under these plans was $14 million for 2017, $21 million for 2016, and $25 million for 2015. Accrued benefits liabilities under these plans totaled $118 million at December 31, 2017 and $111 million at December 31, 2016. |
Segment and Geographic Informat
Segment and Geographic Information | 12 Months Ended |
Dec. 31, 2017 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | NOTE 14 — SEGMENT AND GEOGRAPHIC INFORMATION We operate in one line of business, which is operating hospitals and related health care entities. We operate in two geographically organized groups: the National and American Groups. At December 31, 2017, the National Group included 87 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, South Carolina, Utah and Virginia, and the American Group included 86 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and Texas. We also operate six hospitals in England, and these facilities are included in the Corporate and other group. Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses (gains) on sales of facilities, losses on retirement of debt, legal claim costs (benefits), income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions): For the Years Ended December 31, 2017 2016 2015 Revenues: National Group $ 20,772 $ 19,845 $ 18,756 American Group 20,912 19,670 18,875 Corporate and other 1,930 1,975 2,047 $ 43,614 $ 41,490 $ 39,678 Equity in earnings of affiliates: National Group $ (21 ) $ (20 ) $ (7 ) American Group (37 ) (38 ) (32 ) Corporate and other 13 4 (7 ) $ (45 ) $ (54 ) $ (46 ) Adjusted segment EBITDA: National Group $ 4,600 $ 4,565 $ 4,271 American Group 4,231 4,173 4,207 Corporate and other (598 ) (520 ) (563 ) $ 8,233 $ 8,218 $ 7,915 Depreciation and amortization: National Group $ 867 $ 806 $ 769 American Group 986 908 885 Corporate and other 278 252 250 $ 2,131 $ 1,966 $ 1,904 For the Years Ended December 31, 2017 2016 2015 Adjusted segment EBITDA $ 8,233 $ 8,218 $ 7,915 Depreciation and amortization 2,131 1,966 1,904 Interest expense 1,690 1,707 1,665 Losses (gains) on sales of facilities (8 ) (23 ) 5 Losses on retirement of debt 39 4 135 Legal claim costs (benefits) — (246 ) 249 Income before income taxes $ 4,381 $ 4,810 $ 3,957 December 31, 2017 2016 2015 Assets: National Group $ 13,097 $ 12,320 $ 11,332 American Group 18,136 16,208 15,240 Corporate and other 5,360 5,230 6,172 $ 36,593 $ 33,758 $ 32,744 National American Corporate Total Goodwill and other intangible assets: Balance at December 31, 2014 $ 1,170 $ 4,614 $ 632 $ 6,416 Acquisitions 318 27 — 345 Foreign currency translation, amortization and other (7 ) (3 ) (20 ) (30 ) Balance at December 31, 2015 1,481 4,638 612 6,731 Acquisitions — 33 8 41 Foreign currency translation, amortization and other (23 ) (10 ) (35 ) (68 ) Balance at December 31, 2016 1,458 4,661 585 6,704 Acquisitions 19 612 62 693 Foreign currency translation, amortization and other (3 ) (8 ) 8 (3 ) Balance at December 31, 2017 $ 1,474 $ 5,265 $ 655 $ 7,394 |
Other Comprehensive Loss
Other Comprehensive Loss | 12 Months Ended |
Dec. 31, 2017 | |
Equity [Abstract] | |
Other Comprehensive Loss | NOTE 15 — 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, 2014 $ 13 $ (36 ) $ (174 ) $ (126 ) $ (323 ) Unrealized gains on available-for-sale — — — — — Foreign currency translation adjustments, net of $25 income tax benefit — (38 ) — — (38 ) Defined benefit plans, net of $11 of income taxes — — 19 — 19 Change in fair value of derivative instruments, net of $14 income tax benefit — — — (22 ) (22 ) Expense reclassified into operations from other comprehensive income, net of $12 and $46, respectively, income tax benefits — — 20 79 99 Balances at December 31, 2015 13 (74 ) (135 ) (69 ) (265 ) Unrealized losses on available-for-sale (6 ) — — — (6 ) Foreign currency translation adjustments, net of $87 income tax benefit — (137 ) — — (137 ) Defined benefit plans, net of $13 income tax benefit — — (22 ) — (22 ) Change in fair value of derivative instruments, net of $8 of income taxes — — — 12 12 Expense reclassified into operations from other comprehensive income, net of $7 and $40, respectively, income tax benefits — — 11 69 80 Balances at December 31, 2016 7 (211 ) (146 ) 12 (338 ) Unrealized gains on available-for-sale 1 — — — 1 Foreign currency translation adjustments, net of $35 of income taxes — 62 — — 62 Defined benefit plans, net of $10 income tax benefit — — (33 ) — (33 ) Change in fair value of derivative instruments, net of $4 of income taxes — — — 7 7 Expense (income) reclassified into operations from other comprehensive income, net of $1 of income taxes and $7 and $7 income tax benefits, respectively (1 ) — 11 13 23 Balances at December 31, 2017 $ 7 $ (149 ) $ (168 ) $ 32 $ (278 ) |
Accrued Expenses and Allowance
Accrued Expenses and Allowance for Doubtful Accounts | 12 Months Ended |
Dec. 31, 2017 | |
Text Block [Abstract] | |
Accrued Expenses and Allowance for Doubtful Accounts | NOTE 16 — ACCRUED EXPENSES AND ALLOWANCE FOR DOUBTFUL ACCOUNTS A summary of other accrued expenses at December 31 follows (dollars in millions): 2017 2016 Professional liability risks $ 429 $ 391 Interest 406 409 Taxes other than income 299 283 Other 849 952 $ 1,983 $ 2,035 A summary of activity for the allowance of doubtful accounts follows (dollars in millions): Balance Provision Accounts Balance Allowance for doubtful accounts: Year ended December 31, 2015 $ 5,011 $ 3,913 $ (3,598 ) $ 5,326 Year ended December 31, 2016 5,326 3,257 (3,595 ) 4,988 Year ended December 31, 2017 4,988 4,039 (3,539 ) 5,488 |
Supplemental Condensed Consolid
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information | 12 Months Ended |
Dec. 31, 2017 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information | NOTE 17 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION AND OTHER COLLATERAL-RELATED INFORMATION HCA Inc. is a 100% owned direct subsidiary of HCA Healthcare, Inc. On December 6, 2012, HCA Healthcare, Inc. issued $1.000 billion aggregate principal amount of 6.25% senior unsecured notes due 2021. These notes are senior unsecured obligations and are not guaranteed by any of our subsidiaries. The senior secured credit facilities and senior secured notes described in Note 9 are jointly and severally, and fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, 100% owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our ABL credit facility). Our condensed consolidating balance sheets at December 31, 2017 and 2016 and condensed consolidating statements of comprehensive income and cash flows for each of the three years in the period ended December 31, 2017, 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 YEAR ENDED DECEMBER 31, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 27,992 $ 19,661 $ — $ 47,653 Provision for doubtful accounts — — 2,218 1,821 — 4,039 Revenues — — 25,774 17,840 — 43,614 Salaries and benefits — — 11,619 8,440 — 20,059 Supplies — — 4,286 3,030 — 7,316 Other operating expenses 6 — 4,249 3,796 — 8,051 Equity in earnings of affiliates (2,476 ) — (6 ) (39 ) 2,476 (45 ) Depreciation and amortization — — 1,237 894 — 2,131 Interest expense 64 3,088 (1,309 ) (153 ) — 1,690 Gains on sales of facilities — — (2 ) (6 ) — (8 ) Losses on retirement of debt — 39 — — — 39 Management fees — — (621 ) 621 — — (2,406 ) 3,127 19,453 16,583 2,476 39,233 Income (loss) before income taxes 2,406 (3,127 ) 6,321 1,257 (2,476 ) 4,381 Provision (benefit) for income taxes 190 (1,154 ) 2,293 309 — 1,638 Net income (loss) 2,216 (1,973 ) 4,028 948 (2,476 ) 2,743 Net income attributable to noncontrolling interests — — 108 419 — 527 Net income (loss) attributable to HCA Healthcare, Inc. $ 2,216 $ (1,973 ) $ 3,920 $ 529 $ (2,476 ) $ 2,216 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 2,276 $ (1,953 ) $ 3,898 $ 591 $ (2,536 ) $ 2,276 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE YEAR ENDED DECEMBER 31, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 26,468 $ 18,279 $ — $ 44,747 Provision for doubtful accounts — — 2,041 1,216 — 3,257 Revenues — — 24,427 17,063 — 41,490 Salaries and benefits — — 10,971 7,926 — 18,897 Supplies — — 4,090 2,843 — 6,933 Other operating expenses 6 — 3,912 3,578 — 7,496 Equity in earnings of affiliates (2,738 ) — (7 ) (47 ) 2,738 (54 ) Depreciation and amortization — — 1,141 825 — 1,966 Interest expense 64 2,756 (970 ) (143 ) — 1,707 Losses (gains) on sales of facilities — — 4 (27 ) — (23 ) Losses on retirement of debt — 4 — — — 4 Legal claim benefits — (246 ) — — — (246 ) Management fees — — (588 ) 588 — — (2,668 ) 2,514 18,553 15,543 2,738 36,680 Income (loss) before income taxes 2,668 (2,514 ) 5,874 1,520 (2,738 ) 4,810 Provision (benefit) for income taxes (222 ) (928 ) 2,133 395 — 1,378 Net income (loss) 2,890 (1,586 ) 3,741 1,125 (2,738 ) 3,432 Net income attributable to noncontrolling interests — — 93 449 — 542 Net income (loss) attributable to HCA Healthcare, Inc. $ 2,890 $ (1,586 ) $ 3,648 $ 676 $ (2,738 ) $ 2,890 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 2,817 $ (1,505 ) $ 3,637 $ 533 $ (2,665 ) $ 2,817 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE YEAR ENDED DECEMBER 31, 2015 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 25,711 $ 17,880 $ — $ 43,591 Provision for doubtful accounts — — 2,329 1,584 — 3,913 Revenues — — 23,382 16,296 — 39,678 Salaries and benefits — — 10,593 7,522 — 18,115 Supplies — — 3,933 2,705 — 6,638 Other operating expenses (2 ) — 3,685 3,373 — 7,056 Equity in earnings of affiliates (2,352 ) — (8 ) (38 ) 2,352 (46 ) Depreciation and amortization — — 1,085 819 — 1,904 Interest expense 115 2,445 (816 ) (79 ) — 1,665 Losses on sales of facilities — — — 5 — 5 Losses on retirement of debt 122 13 — — — 135 Legal claim costs 120 129 — — — 249 Management fees — — (515 ) 515 — — (1,997 ) 2,587 17,957 14,822 2,352 35,721 Income (loss) before income taxes 1,997 (2,587 ) 5,425 1,474 (2,352 ) 3,957 Provision (benefit) for income taxes (132 ) (962 ) 1,983 372 — 1,261 Net income (loss) 2,129 (1,625 ) 3,442 1,102 (2,352 ) 2,696 Net income attributable to noncontrolling interests — — 92 475 — 567 Net income (loss) attributable to HCA Healthcare, Inc. $ 2,129 $ (1,625 ) $ 3,350 $ 627 $ (2,352 ) $ 2,129 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 2,187 $ (1,568 ) $ 3,389 $ 589 $ (2,410 ) $ 2,187 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET DECEMBER 31, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ 1 $ — $ 112 $ 619 $ — $ 732 Accounts receivable, net — — 3,693 2,808 — 6,501 Inventories — — 1,030 543 — 1,573 Other — — 663 508 — 1,171 1 — 5,498 4,478 — 9,977 Property and equipment, net — — 11,110 6,785 — 17,895 Investments of insurance subsidiaries — — — 418 — 418 Investments in and advances to affiliates 29,581 — 22 177 (29,581 ) 199 Goodwill and other intangible assets — — 4,893 2,501 — 7,394 Other 510 50 47 103 — 710 $ 30,092 $ 50 $ 21,570 $ 14,462 $ (29,581 ) $ 36,593 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) Current liabilities: Accounts payable $ — $ — $ 1,793 $ 813 $ — $ 2,606 Accrued salaries — — 862 507 — 1,369 Other accrued expenses 29 378 536 1,040 — 1,983 Long-term debt due within one year — 97 64 39 — 200 29 475 3,255 2,399 — 6,158 Long-term debt, net 995 31,367 307 189 — 32,858 Intercompany balances 35,322 (9,742 ) (25,228 ) (352 ) — — Professional liability risks — — — 1,198 — 1,198 Income taxes and other liabilities 552 — 357 465 — 1,374 36,898 22,100 (21,309 ) 3,899 — 41,588 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (6,806 ) (22,050 ) 42,755 8,876 (29,581 ) (6,806 ) Noncontrolling interests — — 124 1,687 — 1,811 (6,806 ) (22,050 ) 42,879 10,563 (29,581 ) (4,995 ) $ 30,092 $ 50 $ 21,570 $ 14,462 $ (29,581 ) $ 36,593 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET DECEMBER 31, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 113 $ 533 $ — $ 646 Accounts receivable, net — — 3,388 2,438 — 5,826 Inventories — — 1,001 502 — 1,503 Other — — 592 519 — 1,111 — — 5,094 3,992 — 9,086 Property and equipment, net — — 10,464 5,888 — 16,352 Investments of insurance subsidiaries — — — 336 — 336 Investments in and advances to affiliates 27,045 — 24 182 (27,045 ) 206 Goodwill and other intangible assets — — 4,612 2,092 — 6,704 Other 877 — 43 154 — 1,074 $ 27,922 $ — $ 20,237 $ 12,644 $ (27,045 ) $ 33,758 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) Current liabilities: Accounts payable $ — $ — $ 1,607 $ 711 $ — $ 2,318 Accrued salaries — — 811 454 — 1,265 Other accrued expenses 29 572 528 906 — 2,035 Long-term debt due within one year — 97 72 47 — 216 29 669 3,018 2,118 — 5,834 Long-term debt, net 993 29,693 304 170 — 31,160 Intercompany balances 33,784 (10,277 ) (22,495 ) (1,012 ) — — Professional liability risks — — — 1,148 — 1,148 Income taxes and other liabilities 418 12 397 422 — 1,249 35,224 20,097 (18,776 ) 2,846 — 39,391 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (7,302 ) (20,097 ) 38,857 8,285 (27,045 ) (7,302 ) Noncontrolling interests — — 156 1,513 — 1,669 (7,302 ) (20,097 ) 39,013 9,798 (27,045 ) (5,633 ) $ 27,922 $ — $ 20,237 $ 12,644 $ (27,045 ) $ 33,758 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE YEAR ENDED DECEMBER 31, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 2,216 $ (1,973 ) $ 4,028 $ 948 $ (2,476 ) $ 2,743 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Change in operating assets and liabilities — (193 ) (2,437 ) (1,705 ) — (4,335 ) Provision for doubtful accounts — — 2,218 1,821 — 4,039 Depreciation and amortization — — 1,237 894 — 2,131 Income taxes 433 — — — — 433 Gains on sales of facilities — — (2 ) (6 ) — (8 ) Losses on retirement of debt — 39 — — — 39 Amortization of debt issuance costs — 31 — — — 31 Share-based compensation — — 270 — — 270 Equity in earnings of affiliates (2,476 ) — — — 2,476 — Other 78 — — 5 — 83 Net cash provided by (used in) operating activities 251 (2,096 ) 5,314 1,957 — 5,426 Cash flows from investing activities: Purchase of property and equipment — — (1,681 ) (1,334 ) — (3,015 ) Acquisition of hospitals and health care entities — — (26 ) (1,186 ) — (1,212 ) Disposal of hospitals and health care entities — — 14 11 — 25 Change in investments — — (1 ) (72 ) — (73 ) Other — — — (4 ) — (4 ) Net cash used in investing activities — — (1,694 ) (2,585 ) — (4,279 ) Cash flows from financing activities: Issuance of long-term debt — 1,500 — 2 — 1,502 Net change in revolving bank credit facilities — 760 — — — 760 Repayment of long-term debt — (628 ) (77 ) (48 ) — (753 ) Distributions to noncontrolling interests — — (140 ) (308 ) — (448 ) Payment of debt issuance costs — (26 ) — — — (26 ) Repurchases of common stock (2,051 ) — — — — (2,051 ) Changes in intercompany balances with affiliates, net 1,867 490 (3,404 ) 1,047 — — Other (66 ) — — 21 — (45 ) Net cash (used in) provided by financing activities (250 ) 2,096 (3,621 ) 714 — (1,061 ) Change in cash and cash equivalents 1 — (1 ) 86 — 86 Cash and cash equivalents at beginning of period — — 113 533 — 646 Cash and cash equivalents at end of period $ 1 $ — $ 112 $ 619 $ — $ 732 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE YEAR ENDED DECEMBER 31, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 2,890 $ (1,586 ) $ 3,741 $ 1,125 $ (2,738 ) $ 3,432 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Change in operating assets and liabilities (25 ) 39 (2,180 ) (1,049 ) — (3,215 ) Provision for doubtful accounts — — 2,041 1,216 — 3,257 Depreciation and amortization — — 1,141 825 — 1,966 Income taxes 123 — — — — 123 Losses (gains) on sales of facilities — — 4 (27 ) — (23 ) Losses on retirement of debt — 4 — — — 4 Legal claim benefits — (246 ) — — — (246 ) Amortization of debt issuance costs 1 33 — — — 34 Share-based compensation — — 251 — — 251 Equity in earnings of affiliates (2,738 ) — — — 2,738 — Other 71 — — (1 ) — 70 Net cash provided by (used in) operating activities 322 (1,756 ) 4,998 2,089 — 5,653 Cash flows from investing activities: Purchase of property and equipment — — (1,554 ) (1,206 ) — (2,760 ) Acquisition of hospitals and health care entities — — (199 ) (377 ) — (576 ) Disposal of hospitals and health care entities — — 10 16 — 26 Change in investments — — (15 ) 79 — 64 Other — — — 6 — 6 Net cash used in investing activities — — (1,758 ) (1,482 ) — (3,240 ) Cash flows from financing activities: Issuance of long-term debt — 5,400 — — — 5,400 Net change in revolving bank credit facilities — (110 ) — — — (110 ) Repayment of long-term debt — (4,358 ) (74 ) (43 ) — (4,475 ) Distributions to noncontrolling interests — — (64 ) (370 ) — (434 ) Payment of debt issuance costs — (40 ) — — — (40 ) Repurchases of common stock (2,751 ) — — — — (2,751 ) Changes in intercompany balances with affiliates, net 2,532 864 (3,149 ) (247 ) — — Other (103 ) — — 5 — (98 ) Net cash (used in) provided by financing activities (322 ) 1,756 (3,287 ) (655 ) — (2,508 ) Change in cash and cash equivalents — — (47 ) (48 ) — (95 ) Cash and cash equivalents at beginning of period — — 160 581 — 741 Cash and cash equivalents at end of period $ — $ — $ 113 $ 533 $ — $ 646 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE YEAR ENDED DECEMBER 31, 2015 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 2,129 $ (1,625 ) $ 3,442 $ 1,102 $ (2,352 ) $ 2,696 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Change in operating assets and liabilities (12 ) 44 (2,786 ) (1,482 ) — (4,236 ) Provision for doubtful accounts — — 2,329 1,584 — 3,913 Depreciation and amortization — — 1,085 819 — 1,904 Income taxes (160 ) — — — — (160 ) Losses on sales of facilities — — — 5 — 5 Losses on retirement of debt 122 13 — — — 135 Legal claim costs 20 129 — — — 149 Amortization of debt issuance costs 3 32 — — — 35 Share-based compensation — — 239 — — 239 Equity in earnings of affiliates (2,352 ) — — — 2,352 — Other 66 3 (5 ) (10 ) — 54 Net cash (used in) provided by operating activities (184 ) (1,404 ) 4,304 2,018 — 4,734 Cash flows from investing activities: Purchase of property and equipment — — (1,560 ) (815 ) — (2,375 ) Acquisition of hospitals and health care entities — — (51 ) (300 ) — (351 ) Disposal of hospitals and health care entities — — 48 25 — 73 Change in investments — — 7 56 — 63 Other — — (6 ) 13 — 7 Net cash used in investing activities — — (1,562 ) (1,021 ) — (2,583 ) Cash flows from financing activities: Issuance of long-term debt — 5,548 — — — 5,548 Net change in revolving bank credit facilities — 150 — — — 150 Repayment of long-term debt (1,632 ) (3,189 ) (60 ) (39 ) — (4,920 ) Distributions to noncontrolling interests — — (85 ) (410 ) — (495 ) Payment of debt issuance costs — (50 ) — — — (50 ) Repurchases of common stock (2,397 ) — — — — (2,397 ) Changes in intercompany balances with affiliates, net 4,006 (1,055 ) (2,526 ) (425 ) — — Other 207 — — (19 ) — 188 Net cash provided by (used in) financing activities 184 1,404 (2,671 ) (893 ) — (1,976 ) Change in cash and cash equivalents — — 71 104 — 175 Cash and cash equivalents at beginning of period — — 89 477 — 566 Cash and cash equivalents at end of period $ — $ — $ 160 $ 581 $ — $ 741 The above supplemental condensed consolidating financial information as of December 31, 2016, and for the years ended December 31, 2016 and 2015, has been adjusted to properly record the impact of certain subsidiaries that were non-guarantors non-guarantor Non-Guarantors As Adjustment As Adjusted Year ended December 31, 2016 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 2,890 $ — $ 2,890 HCA Inc. Issuer (1,586 ) — (1,586 ) Subsidiary Guarantors 3,235 413 3,648 Subsidiary Non-Guarantors 1,089 (413 ) 676 Eliminations (2,738 ) — (2,738 ) Condensed Consolidated $ 2,890 $ — $ 2,890 As Adjustment As Adjusted December 31, 2016 Total assets: HCA Healthcare, Inc. Issuer $ 27,922 $ — $ 27,922 HCA Inc. Issuer — — — Subsidiary Guarantors 14,714 5,523 (a) 20,237 Subsidiary Non-Guarantors 18,167 (5,523 )(a) 12,644 Eliminations (27,045 ) — (27,045 ) Condensed Consolidated $ 33,758 $ — $ 33,758 (a) Amounts include $2,884 of goodwill and other intangible assets and $2,001 of property and equipment, net. As Adjustment As Adjusted December 31, 2016 Total liabilities: HCA Healthcare, Inc. Issuer $ 35,224 $ — $ 35,224 HCA Inc. Issuer 20,097 — 20,097 Subsidiary Guarantors (23,194 ) 4,418 (b) (18,776 ) Subsidiary Non-Guarantors 7,264 (4,418 )(b) 2,846 Eliminations — — — Condensed Consolidated $ 39,391 $ — $ 39,391 (b) Amounts include $3,952 of intercompany balances. As Adjustment As Adjusted Year ended December 31, 2016 Net cash provided (used in) operating activities: HCA Healthcare, Inc. Issuer $ 322 $ — $ 322 HCA Inc. Issuer (1,756 ) — (1,756 ) Subsidiary Guarantors 4,425 573 4,998 Subsidiary Non-Guarantors 2,662 (573 ) 2,089 Eliminations — — — Condensed Consolidated $ 5,653 $ — $ 5,653 As Adjustment As Adjusted Year ended December 31, 2015 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 2,129 $ — $ 2,129 HCA Inc. Issuer (1,625 ) — (1,625 ) Subsidiary Guarantors 2,970 380 3,350 Subsidiary Non-Guarantors 1,007 (380 ) 627 Eliminations (2,352 ) — (2,352 ) Condensed Consolidated $ 2,129 $ — $ 2,129 As Adjustment As Adjusted Year ended December 31, 2015 Net cash provided (used in) operating activities: HCA Healthcare, Inc. Issuer $ (184 ) $ — $ (184 ) HCA Inc. Issuer (1,404 ) — (1,404 ) Subsidiary Guarantors 3,772 532 4,304 Subsidiary Non-Guarantors 2,550 (532 ) 2,018 Eliminations — — — Condensed Consolidated $ 4,734 $ — $ 4,734 Healthtrust, Inc. — The Hospital Company (“Healthtrust”) is the first-tier subsidiary of HCA Inc. The common stock of Healthtrust has been pledged as collateral for the senior secured credit facilities and senior secured notes described in Note 9. Rule 3-16 S-X Reconciliations of the HCA Healthcare, Inc. Consolidated Statements of Stockholders’ Deficit presentation to the Healthtrust, Inc. — The Hospital Company Consolidated Statements of Stockholder’s Deficit presentation for the years ended December 31, 2017, 2016 and 2015 are as follows (dollars in millions): 2017 2016 2015 Presentation in HCA Healthcare, Inc. Consolidated Statements of Stockholders’ Deficit: Share-based benefit plans $ 281 $ 233 $ 523 Other (10 ) (2 ) (18 ) Presentation in Healthtrust, Inc. — The Hospital Company Consolidated Statements of Stockholder’s Deficit: Distributions from HCA Healthcare, Inc., net of contributions to HCA Healthcare, Inc. $ 271 $ 231 $ 505 Due to the consolidated financial statements of Healthtrust being substantially identical to the consolidated financial statements of HCA, except for the items presented in the table above, the separate consolidated financial statements of Healthtrust are not presented. |
Accounting Policies (Policies)
Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2017 | |
Basis of Presentation | Basis of Presentation The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates. The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. The accounts of acquired entities are included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method. The majority of our expenses are “cost of revenue” items. Costs that could be classified as general and administrative include our corporate office costs, which were $373 million, $373 million and $327 million for the years ended December 31, 2017, 2016 and 2015, respectively. |
Revenues | Revenues Revenues consist primarily of net patient service revenues that are recorded based upon established billing rates less allowances for contractual adjustments. Revenues are recorded during the period the health care services are provided, based upon the estimated amounts due from the patients and third-party payers. Third-party payers include federal and state agencies (under the Medicare and Medicaid programs), managed care health plans 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. Contractual payment terms in managed care agreements are generally based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service Years Ended December 31, 2017 Ratio 2016 Ratio 2015 Ratio Medicare $ 9,483 21.7 % $ 8,895 21.4 % $ 8,654 21.8 % Managed Medicare 4,788 11.0 4,355 10.5 4,133 10.4 Medicaid 1,631 3.7 1,597 3.8 1,705 4.3 Managed Medicaid 2,349 5.4 2,478 6.0 2,234 5.6 Managed care and other insurers 24,813 56.9 23,441 56.5 21,882 55.2 International (managed care and other insurers) 1,097 2.5 1,195 2.9 1,295 3.3 Other 3,492 8.0 2,786 6.7 3,688 9.3 Revenues before provision for doubtful accounts 47,653 109.2 44,747 107.8 43,591 109.9 Provision for doubtful accounts (4,039 ) (9.2 ) (3,257 ) (7.8 ) (3,913 ) (9.9 ) Revenues $ 43,614 100.0 % $ 41,490 100.0 % $ 39,678 100.0 % Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. As a result, there is at least a reasonable possibility recorded estimates will change by a material amount. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement amounts and disproportionate-share funds related primarily to cost reports filed during the respective year resulted in net increases to revenues of $41 million, $31 million and $48 million in 2017, 2016 and 2015, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in net increases to revenues of $56 million, $90 million and $85 million in 2017, 2016 and 2015, respectively. The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive. Prior to November 2017, patients treated at hospitals for nonelective care, who have income at or below 200% of the federal poverty level, are eligible for charity care. During November 2017, we expanded our charity care policy to limit the patient responsibility amounts for patients who have income above 200%, but at or below 400%, of the federal poverty level to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable multiple of the federal poverty level. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. In implementing the uninsured discount policy, we may first attempt to provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied. To quantify the total impact of and trends related to uninsured accounts, we believe it is beneficial to view charity care, uninsured discounts and the provision for doubtful accounts in combination, rather than each separately. A summary of these amounts for the years ended December 31, follows (dollars in millions): 2017 Ratio 2016 Ratio 2015 Ratio Charity care $ 4,861 21 % $ 4,151 20 % $ 3,682 20 % Uninsured discounts 14,520 62 13,047 64 10,692 59 Provision for doubtful accounts 4,039 17 3,257 16 3,913 21 Total uncompensated care $ 23,420 100 % $ 20,455 100 % $ 18,287 100 % A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions): 2017 2016 2015 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 37,557 $ 35,304 $ 33,760 Cost-to-charges 12.9 % 13.5 % 14.5 % Total uncompensated care $ 23,420 $ 20,455 $ 18,287 Multiply by the cost-to-charges 12.9 % 13.5 % 14.5 % Estimated cost of total uncompensated care $ 3,021 $ 2,761 $ 2,652 The sum of charity care, uninsured discounts and the provision for doubtful accounts, as a percentage of the sum of revenues, charity care, uninsured discounts and the provision for doubtful accounts was 34.9% for 2017, 33.0% for 2016 and 31.5% for 2015. |
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. We believe the most significant impact of adopting the new standard 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 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 right-of-use |
Cash and Cash Equivalents | Cash and Cash Equivalents Cash and cash equivalents include highly liquid investments with a maturity of three months or less when purchased. Our insurance subsidiaries’ cash equivalent investments in excess of the amounts required to pay estimated professional liability claims during the next twelve months are not included in cash and cash equivalents as these funds are not available for general corporate purposes. Carrying values of cash and cash equivalents approximate fair value due to the short-term nature of these instruments. Our cash management system provides for daily investment of available balances and the funding of outstanding checks when presented for payment. Outstanding, but unpresented, checks totaling $480 million and $565 million at December 31, 2017 and 2016, respectively, have been included in “accounts payable” in the consolidated balance sheets. Upon presentation for payment, these checks are funded through available cash balances or our credit facility. |
Accounts Receivable | Accounts Receivable We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. Additions to the allowance for doubtful accounts are made by means of the provision for doubtful accounts. Accounts written off as uncollectible are deducted from the allowance for doubtful accounts and subsequent recoveries are added. The amount of the provision for doubtful accounts is based upon management’s assessment of historical and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. The provision for doubtful accounts and the allowance for doubtful accounts relate to “uninsured” amounts due directly from patients (including copayment and deductible amounts from patients who have health care coverage). Accounts are written off when all reasonable internal and external collection efforts have been performed. We consider the return of an account from the secondary collection agency to be the culmination of our reasonable collection efforts and the timing basis for writing off the account balance. Writeoffs are based upon specific identification and the writeoff process requires a writeoff adjustment entry to the patient accounting system. Management relies on the results of detailed reviews of historical writeoffs and recoveries at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information to utilize in estimating the collectibility of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. At December 31, 2017 and 2016, the allowance for doubtful accounts represented 100% and 98%, respectively, of the $5.488 billion and $5.116 billion, respectively, patient due accounts receivable balance. The patient due accounts receivable balance represents the estimated uninsured portion of our accounts receivable. The estimated uninsured portion of Medicaid pending and uninsured discount pending accounts is included in our patient due accounts receivable balance. Days revenues in accounts receivable were 52 days, 50 days and 53 days at December 31, 2017, 2016 and 2015, respectively. Changes in general economic conditions, patient accounting service center operations, payer mix, or federal or state governmental health care coverage could affect our collection of accounts receivable, cash flows and results of operations. |
Inventories | Inventories Inventories are stated at the lower of cost (first-in, first-out) |
Property and Equipment | Property and Equipment Depreciation expense, computed using the straight-line method, was $2.111 billion in 2017, $1.946 billion in 2016 and $1.880 billion in 2015. Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four to 10 years. When events, circumstances or operating results indicate the carrying values of certain long-lived assets expected to be held and used might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar assets and independent appraisals. Long-lived assets to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers. |
Investments of Insurance Subsidiaries | Investments of Insurance Subsidiaries At December 31, 2017 and 2016, the investments of our 100% owned insurance subsidiaries were classified as “available-for-sale” Investments—Debt and Equity Securities |
Goodwill and Intangible Assets | Goodwill and Intangible Assets Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, an impairment loss is recognized. Fair value is estimated based upon internal evaluations of each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2017, 2016 and 2015. Since January 1, 2000, we have recognized total goodwill impairments of $102 million in the aggregate. None of the goodwill impairments related to evaluations of goodwill at the reporting unit level, as all recognized goodwill impairments during this period related to goodwill allocated to asset disposal groups. During 2017, goodwill increased by $693 million related to acquisitions and by $12 million related to foreign currency translation and other adjustments. During 2016, goodwill increased by $41 million related to acquisitions and declined by $49 million related to sales, foreign currency translation and other adjustments. During 2017, identifiable intangible assets declined by $15 million due to amortization, foreign currency translation and other adjustments. During 2016, identifiable intangible assets declined by $19 million due to amortization, foreign currency translation and other adjustments. Identifiable intangible assets are amortized over estimated lives ranging generally from three to 10 years. The gross carrying amount of identifiable intangible assets at both December 31, 2017 and 2016 was $184 million and accumulated amortization was $94 million and $79 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2017 and 2016 was $269 million. Indefinite-lived identifiable intangible assets are not amortized but are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist. |
Debt Issuance Costs | Debt Issuance Costs Debt issuance costs are amortized based upon the terms of the respective debt obligations. The gross carrying amount of debt issuance costs at December 31, 2017 and 2016 was $353 million and $334 million, respectively, and accumulated amortization was $189 million and $164 million, respectively. Amortization of debt issuance costs is included in interest expense and was $31 million, $34 million and $35 million for 2017, 2016 and 2015, respectively. |
Professional Liability Claims | Professional Liability Claims Reserves for professional liability risks were $1.627 billion and $1.539 billion at December 31, 2017 and 2016, respectively. The current portion of the reserves, $429 million and $391 million at December 31, 2017 and 2016, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $466 million, $430 million and $344 million for 2017, 2016 and 2015, respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. Loss and loss expense reserves represent the estimated ultimate net cost of all reported and unreported losses incurred through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,500 and 2,700 individual claims at December 31, 2017 and 2016, respectively, and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During both 2017 and 2016, $357 million of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates. A portion of our professional liability risks is insured through a 100% owned insurance subsidiary. Subject to a $15 million per occurrence self-insured retention, our facilities are insured by our 100% owned insurance subsidiary for losses up to $50 million per occurrence. The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of $25 million per occurrence. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary. The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts include $19 million and $36 million at December 31, 2017 and 2016, respectively, recorded in “other assets,” and $5 million and $9 million at December 31, 2017 and 2016, respectively, recorded in “other current assets.” |
Financial Instruments | Financial Instruments Derivative financial instruments are employed to manage interest rate risks, and are not used for trading or speculative purposes. We recognize our interest rate swap derivative instruments in the consolidated balance sheets at fair value. Changes in the fair value of derivatives are recognized periodically in stockholders’ equity, as a component of other comprehensive income (loss), provided the derivative financial instrument qualifies for hedge accounting. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income (loss), and subsequently reclassified to earnings to offset the impact of the forecasted transactions when they occur. In the event the forecasted transaction to which a cash flow hedge relates is no longer likely, the amount in other comprehensive income (loss) is recognized in earnings and generally the derivative is terminated. The net interest paid or received on interest rate swaps is recognized as interest expense. Gains and losses resulting from the early termination of interest rate swap agreements are deferred and amortized as adjustments to interest expense over the remaining term of the debt originally associated with the terminated swap. |
Noncontrolling Interests in Consolidated Entities | Noncontrolling Interests in Consolidated Entities The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities. |
Reclassifications | Reclassifications Certain prior year amounts have been reclassified to conform to the 2017 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 stock options, SARs, RSUs and PSUs, 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 December 31, 2017 and 2016, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives. |
Interest Rate Swaps [Member] | |
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 |
Accounting Policies (Tables)
Accounting Policies (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Accounting Policies [Abstract] | |
Schedule of Revenues from Third Party Payers, Uninsured and Other Payers | Our revenues from third party payers and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions): Years Ended December 31, 2017 Ratio 2016 Ratio 2015 Ratio Medicare $ 9,483 21.7 % $ 8,895 21.4 % $ 8,654 21.8 % Managed Medicare 4,788 11.0 4,355 10.5 4,133 10.4 Medicaid 1,631 3.7 1,597 3.8 1,705 4.3 Managed Medicaid 2,349 5.4 2,478 6.0 2,234 5.6 Managed care and other insurers 24,813 56.9 23,441 56.5 21,882 55.2 International (managed care and other insurers) 1,097 2.5 1,195 2.9 1,295 3.3 Other 3,492 8.0 2,786 6.7 3,688 9.3 Revenues before provision for doubtful accounts 47,653 109.2 44,747 107.8 43,591 109.9 Provision for doubtful accounts (4,039 ) (9.2 ) (3,257 ) (7.8 ) (3,913 ) (9.9 ) Revenues $ 43,614 100.0 % $ 41,490 100.0 % $ 39,678 100.0 % |
Schedule of Revenue Deductions Related to Uninsured Accounts | A summary of these amounts for the years ended December 31, follows (dollars in millions): 2017 Ratio 2016 Ratio 2015 Ratio Charity care $ 4,861 21 % $ 4,151 20 % $ 3,682 20 % Uninsured discounts 14,520 62 13,047 64 10,692 59 Provision for doubtful accounts 4,039 17 3,257 16 3,913 21 Total uncompensated care $ 23,420 100 % $ 20,455 100 % $ 18,287 100 % |
Schedule of Estimated Cost of Uncompensated Care | A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions): 2017 2016 2015 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 37,557 $ 35,304 $ 33,760 Cost-to-charges 12.9 % 13.5 % 14.5 % Total uncompensated care $ 23,420 $ 20,455 $ 18,287 Multiply by the cost-to-charges 12.9 % 13.5 % 14.5 % Estimated cost of total uncompensated care $ 3,021 $ 2,761 $ 2,652 |
Share-Based Compensation (Table
Share-Based Compensation (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |
Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models | expected share-based award life on the date of grant. The expected life is an estimate of the number of years a share-based award will be held before it is exercised. 2017 2016 2015 Risk-free interest rate 2.13 % 1.70 % 1.59 % Expected volatility 31 % 36 % 36 % Expected life, in years 6.17 6.25 6.25 Expected dividend yield — — — |
Schedule of Stock Option Activity | Information regarding Time Stock Options and SARs and Performance Stock Options and SARs activity during 2017, 2016 and 2015 is summarized below (share amounts in thousands): Time Performance Total Weighted Weighted Aggregate Options and SARs outstanding, December 31, 2014 15,051 14,744 29,795 $ 21.39 Granted 1,746 — 1,746 69.16 Exercised (4,093 ) (3,988 ) (8,081 ) 12.77 Cancelled (539 ) (329 ) (868 ) 32.59 Options and SARs outstanding, December 31, 2015 12,165 10,427 22,592 27.73 Granted 1,601 — 1,601 69.96 Exercised (2,521 ) (4,171 ) (6,692 ) 15.85 Cancelled (309 ) (126 ) (435 ) 55.17 Options and SARs outstanding, December 31, 2016 10,936 6,130 17,066 35.65 Granted 1,879 — 1,879 81.83 Exercised (1,549 ) (1,366 ) (2,915 ) 21.49 Cancelled (110 ) (178 ) (288 ) 52.92 Options and SARs outstanding, December 31, 2017 11,156 4,586 15,742 43.47 5.4 years $ 699 Options and SARs exercisable, December 31, 2017 7,060 4,224 11,284 $ 32.49 4.4 years $ 625 |
Schedule of Restricted Stock Units Activity | Information regarding Time RSUs, Performance RSUs and PSUs activity during 2017, 2016 and 2015 is summarized below (share amounts in thousands): Time RSUs Performance PSUs Total RSUs Weighted RSUs and PSUs outstanding, December 31, 2014 5,895 2,781 — 8,676 $ 39.89 Granted 1,694 — 1,411 3,105 69.43 Vested (1,953 ) (928 ) — (2,881 ) 37.61 Cancelled (334 ) (113 ) (40 ) (487 ) 47.26 RSUs and PSUs outstanding, December 31, 2015 5,302 1,740 1,371 8,413 51.15 Granted 1,450 — 1,178 2,628 69.95 Vested (2,242 ) (870 ) — (3,112 ) 41.71 Cancelled (399 ) (80 ) (163 ) (642 ) 59.66 RSUs and PSUs outstanding, December 31, 2016 4,111 790 2,386 7,287 61.21 Granted 1,484 — 1,304 2,788 81.90 Vested (1,824 ) (430 ) — (2,254 ) 51.20 Cancelled (306 ) (133 ) (128 ) (567 ) 64.06 RSUs and PSUs outstanding, December 31, 2017 3,465 227 3,562 7,254 72.05 |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Income Tax Disclosure [Abstract] | |
Schedule of Provision for Income Taxes | The provision for income taxes consists of the following (dollars in millions): 2017 2016 2015 Current: Federal $ 1,067 $ 1,129 $ 1,259 State 120 125 119 Foreign 19 37 40 Deferred: Federal 423 75 (163 ) State 3 (5 ) (27 ) Foreign 6 17 33 $ 1,638 $ 1,378 $ 1,261 |
Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate | A reconciliation of the federal statutory rate to the effective income tax rate follows: 2017 2016 2015 Federal statutory rate 35.0 % 35.0 % 35.0 % State income taxes, net of federal tax benefit 2.2 2.1 1.6 Change in liability for uncertain tax positions — (1.0 ) 0.2 Tax benefit from settlements of employee equity awards (2.0 ) (3.6 ) — Impact of rate change on deferred tax balances 7.8 — — Other items, net (0.5 ) (0.2 ) 0.4 Effective income tax rate on income applicable to HCA Healthcare, Inc. 42.5 32.3 37.2 Income attributable to noncontrolling interests from consolidated partnerships (5.1 ) (3.6 ) (5.3 ) Effective income tax rate on income before income taxes 37.4 % 28.7 % 31.9 % |
Schedule of Deferred Tax Assets and Liabilities | A summary of the items comprising the deferred tax assets and liabilities at December 31 follows (dollars in millions): 2017 2016 Assets Liabilities Assets Liabilities Depreciation and fixed asset basis differences $ — $ 260 $ — $ 235 Allowances for professional liability and other risks 345 — 495 — Accounts receivable 243 — 351 — Compensation 263 — 359 — Other 420 501 794 918 $ 1,271 $ 761 $ 1,999 $ 1,153 |
Schedule of Activity Related to Unrecognized Tax Benefits | The following table summarizes the activity related to our unrecognized tax benefits (dollars in millions): 2017 2016 Balance at January 1 $ 377 $ 487 Additions based on tax positions related to the current year 40 11 Additions for tax positions of prior years 11 8 Reductions for tax positions of prior years (13 ) (18 ) Settlements — (101 ) Lapse of applicable statutes of limitations (16 ) (10 ) Balance at December 31 $ 399 $ 377 |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Earnings Per Share [Abstract] | |
Schedule of Computations of Basic and Diluted Earnings Per Share | The following table sets forth the computations of basic and diluted earnings per share for the years ended December 31, 2017, 2016 and 2015 (dollars and shares in millions, except per share amounts): 2017 2016 2015 Net income attributable to HCA Healthcare, Inc. $ 2,216 $ 2,890 $ 2,129 Weighted average common shares outstanding 362.305 383.591 414.193 Effect of dilutive incremental shares 9.916 12.260 12.528 Shares used for diluted earnings per share 372.221 395.851 426.721 Earnings per share: Basic earnings per share $ 6.12 $ 7.53 $ 5.14 Diluted earnings per share $ 5.95 $ 7.30 $ 4.99 |
Investments of Insurance Subs30
Investments of Insurance Subsidiaries (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions): 2017 Amortized Unrealized Fair Gains Losses States and municipalities debt securities $ 361 $ 10 $ — $ 371 Money market funds and other 101 — — 101 $ 462 $ 10 $ — 472 Amounts classified as current assets (54 ) Investment carrying value $ 418 2016 Amortized Unrealized Fair Gains Losses States and municipalities debt securities $ 345 $ 9 $ (1 ) $ 353 Money market funds and other 29 3 — 32 $ 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 December 31, 2017 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 31 $ 31 Due after one year through five years 84 86 Due after five years through ten years 187 194 Due after ten years 59 60 $ 361 $ 371 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 12 Months Ended |
Dec. 31, 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 December 31, 2017 (dollars in millions): Notional Maturity Date Fair Pay-fixed $ 2,000 December 2021 $ 48 Pay-fixed 500 December 2022 2 |
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 year ended December 31, 2017 (dollars in millions): Derivatives in Cash Flow Hedging Amount of Gain Location of Loss Amount of Loss Interest rate swaps $ 7 Interest expense $ 20 |
Assets and Liabilities Measur32
Assets and Liabilities Measured at Fair Value (Tables) | 12 Months Ended |
Dec. 31, 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 December 31, 2017 and 2016, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): December 31, 2017 Fair Value Fair Value Measurements Using Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: States and municipalities debt securities $ 371 $ — $ 371 $ — Money market funds and other 101 101 — — Investments of insurance subsidiaries 472 101 371 — Less amounts classified as current assets (54 ) (54 ) — — $ 418 $ 47 $ 371 $ — Interest rate swaps (Other) $ 50 $ — $ 50 $ — December 31, 2016 Fair Value Fair Value Measurements Using Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: States and municipalities debt securities $ 353 $ — $ 347 $ 6 Money market funds and other 32 32 — — 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) | 12 Months Ended |
Dec. 31, 2017 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | A summary of long-term debt at December 31, including related interest rates at December 31, 2017, follows (dollars in millions): 2017 2016 Senior secured asset-based revolving credit facility (effective interest rate of 3.0%) $ 3,680 $ 2,920 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 3.5%) 3,891 3,981 Senior secured notes (effective interest rate of 5.4%) 15,300 13,800 Other senior secured debt (effective interest rate of 5.7%) 599 593 Senior secured debt 23,470 21,294 Senior unsecured notes (effective interest rate of 6.4%) 9,752 10,252 Net debt issuance costs (164 ) (170 ) Total debt (average life of 6.8 years, rates averaging 5.2%) 33,058 31,376 Less amounts due within one year 200 216 $ 32,858 $ 31,160 |
Leases (Tables)
Leases (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Leases [Abstract] | |
Schedule of Commitments Relating to Noncancellable Operating Leases | Commitments relating to noncancellable operating leases for each of the next five years and thereafter are as follows (dollars in millions): For the Year Ended December 31, 2018 $ 289 2019 278 2020 239 2021 198 2022 157 Thereafter 1,118 2,279 Less sublease income (11 ) $ 2,268 |
Segment and Geographic Inform35
Segment and Geographic Information (Tables) | 12 Months Ended |
Dec. 31, 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, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions): For the Years Ended December 31, 2017 2016 2015 Revenues: National Group $ 20,772 $ 19,845 $ 18,756 American Group 20,912 19,670 18,875 Corporate and other 1,930 1,975 2,047 $ 43,614 $ 41,490 $ 39,678 Equity in earnings of affiliates: National Group $ (21 ) $ (20 ) $ (7 ) American Group (37 ) (38 ) (32 ) Corporate and other 13 4 (7 ) $ (45 ) $ (54 ) $ (46 ) Adjusted segment EBITDA: National Group $ 4,600 $ 4,565 $ 4,271 American Group 4,231 4,173 4,207 Corporate and other (598 ) (520 ) (563 ) $ 8,233 $ 8,218 $ 7,915 Depreciation and amortization: National Group $ 867 $ 806 $ 769 American Group 986 908 885 Corporate and other 278 252 250 $ 2,131 $ 1,966 $ 1,904 For the Years Ended December 31, 2017 2016 2015 Adjusted segment EBITDA $ 8,233 $ 8,218 $ 7,915 Depreciation and amortization 2,131 1,966 1,904 Interest expense 1,690 1,707 1,665 Losses (gains) on sales of facilities (8 ) (23 ) 5 Losses on retirement of debt 39 4 135 Legal claim costs (benefits) — (246 ) 249 Income before income taxes $ 4,381 $ 4,810 $ 3,957 December 31, 2017 2016 2015 Assets: National Group $ 13,097 $ 12,320 $ 11,332 American Group 18,136 16,208 15,240 Corporate and other 5,360 5,230 6,172 $ 36,593 $ 33,758 $ 32,744 National American Corporate Total Goodwill and other intangible assets: Balance at December 31, 2014 $ 1,170 $ 4,614 $ 632 $ 6,416 Acquisitions 318 27 — 345 Foreign currency translation, amortization and other (7 ) (3 ) (20 ) (30 ) Balance at December 31, 2015 1,481 4,638 612 6,731 Acquisitions — 33 8 41 Foreign currency translation, amortization and other (23 ) (10 ) (35 ) (68 ) Balance at December 31, 2016 1,458 4,661 585 6,704 Acquisitions 19 612 62 693 Foreign currency translation, amortization and other (3 ) (8 ) 8 (3 ) Balance at December 31, 2017 $ 1,474 $ 5,265 $ 655 $ 7,394 |
Other Comprehensive Loss (Table
Other Comprehensive Loss (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Equity [Abstract] | |
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, 2014 $ 13 $ (36 ) $ (174 ) $ (126 ) $ (323 ) Unrealized gains on available-for-sale — — — — — Foreign currency translation adjustments, net of $25 income tax benefit — (38 ) — — (38 ) Defined benefit plans, net of $11 of income taxes — — 19 — 19 Change in fair value of derivative instruments, net of $14 income tax benefit — — — (22 ) (22 ) Expense reclassified into operations from other comprehensive income, net of $12 and $46, respectively, income tax benefits — — 20 79 99 Balances at December 31, 2015 13 (74 ) (135 ) (69 ) (265 ) Unrealized losses on available-for-sale (6 ) — — — (6 ) Foreign currency translation adjustments, net of $87 income tax benefit — (137 ) — — (137 ) Defined benefit plans, net of $13 income tax benefit — — (22 ) — (22 ) Change in fair value of derivative instruments, net of $8 of income taxes — — — 12 12 Expense reclassified into operations from other comprehensive income, net of $7 and $40, respectively, income tax benefits — — 11 69 80 Balances at December 31, 2016 7 (211 ) (146 ) 12 (338 ) Unrealized gains on available-for-sale 1 — — — 1 Foreign currency translation adjustments, net of $35 of income taxes — 62 — — 62 Defined benefit plans, net of $10 income tax benefit — — (33 ) — (33 ) Change in fair value of derivative instruments, net of $4 of income taxes — — — 7 7 Expense (income) reclassified into operations from other comprehensive income, net of $1 of income taxes and $7 and $7 income tax benefits, respectively (1 ) — 11 13 23 Balances at December 31, 2017 $ 7 $ (149 ) $ (168 ) $ 32 $ (278 ) |
Accrued Expenses and Allowanc37
Accrued Expenses and Allowance for Doubtful Accounts (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Text Block [Abstract] | |
Summary of Other Accrued Expenses | A summary of other accrued expenses at December 31 follows (dollars in millions): 2017 2016 Professional liability risks $ 429 $ 391 Interest 406 409 Taxes other than income 299 283 Other 849 952 $ 1,983 $ 2,035 |
Summary of Allowance of Doubtful Accounts | A summary of activity for the allowance of doubtful accounts follows (dollars in millions): Balance Provision Accounts Balance Allowance for doubtful accounts: Year ended December 31, 2015 $ 5,011 $ 3,913 $ (3,598 ) $ 5,326 Year ended December 31, 2016 5,326 3,257 (3,595 ) 4,988 Year ended December 31, 2017 4,988 4,039 (3,539 ) 5,488 |
Supplemental Condensed Consol38
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information (Tables) | 12 Months Ended |
Dec. 31, 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 YEAR ENDED DECEMBER 31, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 27,992 $ 19,661 $ — $ 47,653 Provision for doubtful accounts — — 2,218 1,821 — 4,039 Revenues — — 25,774 17,840 — 43,614 Salaries and benefits — — 11,619 8,440 — 20,059 Supplies — — 4,286 3,030 — 7,316 Other operating expenses 6 — 4,249 3,796 — 8,051 Equity in earnings of affiliates (2,476 ) — (6 ) (39 ) 2,476 (45 ) Depreciation and amortization — — 1,237 894 — 2,131 Interest expense 64 3,088 (1,309 ) (153 ) — 1,690 Gains on sales of facilities — — (2 ) (6 ) — (8 ) Losses on retirement of debt — 39 — — — 39 Management fees — — (621 ) 621 — — (2,406 ) 3,127 19,453 16,583 2,476 39,233 Income (loss) before income taxes 2,406 (3,127 ) 6,321 1,257 (2,476 ) 4,381 Provision (benefit) for income taxes 190 (1,154 ) 2,293 309 — 1,638 Net income (loss) 2,216 (1,973 ) 4,028 948 (2,476 ) 2,743 Net income attributable to noncontrolling interests — — 108 419 — 527 Net income (loss) attributable to HCA Healthcare, Inc. $ 2,216 $ (1,973 ) $ 3,920 $ 529 $ (2,476 ) $ 2,216 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 2,276 $ (1,953 ) $ 3,898 $ 591 $ (2,536 ) $ 2,276 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE YEAR ENDED DECEMBER 31, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 26,468 $ 18,279 $ — $ 44,747 Provision for doubtful accounts — — 2,041 1,216 — 3,257 Revenues — — 24,427 17,063 — 41,490 Salaries and benefits — — 10,971 7,926 — 18,897 Supplies — — 4,090 2,843 — 6,933 Other operating expenses 6 — 3,912 3,578 — 7,496 Equity in earnings of affiliates (2,738 ) — (7 ) (47 ) 2,738 (54 ) Depreciation and amortization — — 1,141 825 — 1,966 Interest expense 64 2,756 (970 ) (143 ) — 1,707 Losses (gains) on sales of facilities — — 4 (27 ) — (23 ) Losses on retirement of debt — 4 — — — 4 Legal claim benefits — (246 ) — — — (246 ) Management fees — — (588 ) 588 — — (2,668 ) 2,514 18,553 15,543 2,738 36,680 Income (loss) before income taxes 2,668 (2,514 ) 5,874 1,520 (2,738 ) 4,810 Provision (benefit) for income taxes (222 ) (928 ) 2,133 395 — 1,378 Net income (loss) 2,890 (1,586 ) 3,741 1,125 (2,738 ) 3,432 Net income attributable to noncontrolling interests — — 93 449 — 542 Net income (loss) attributable to HCA Healthcare, Inc. $ 2,890 $ (1,586 ) $ 3,648 $ 676 $ (2,738 ) $ 2,890 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 2,817 $ (1,505 ) $ 3,637 $ 533 $ (2,665 ) $ 2,817 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE YEAR ENDED DECEMBER 31, 2015 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues before provision for doubtful accounts $ — $ — $ 25,711 $ 17,880 $ — $ 43,591 Provision for doubtful accounts — — 2,329 1,584 — 3,913 Revenues — — 23,382 16,296 — 39,678 Salaries and benefits — — 10,593 7,522 — 18,115 Supplies — — 3,933 2,705 — 6,638 Other operating expenses (2 ) — 3,685 3,373 — 7,056 Equity in earnings of affiliates (2,352 ) — (8 ) (38 ) 2,352 (46 ) Depreciation and amortization — — 1,085 819 — 1,904 Interest expense 115 2,445 (816 ) (79 ) — 1,665 Losses on sales of facilities — — — 5 — 5 Losses on retirement of debt 122 13 — — — 135 Legal claim costs 120 129 — — — 249 Management fees — — (515 ) 515 — — (1,997 ) 2,587 17,957 14,822 2,352 35,721 Income (loss) before income taxes 1,997 (2,587 ) 5,425 1,474 (2,352 ) 3,957 Provision (benefit) for income taxes (132 ) (962 ) 1,983 372 — 1,261 Net income (loss) 2,129 (1,625 ) 3,442 1,102 (2,352 ) 2,696 Net income attributable to noncontrolling interests — — 92 475 — 567 Net income (loss) attributable to HCA Healthcare, Inc. $ 2,129 $ (1,625 ) $ 3,350 $ 627 $ (2,352 ) $ 2,129 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 2,187 $ (1,568 ) $ 3,389 $ 589 $ (2,410 ) $ 2,187 |
Schedule of Condensed Consolidating Balance Sheet | HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET DECEMBER 31, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ 1 $ — $ 112 $ 619 $ — $ 732 Accounts receivable, net — — 3,693 2,808 — 6,501 Inventories — — 1,030 543 — 1,573 Other — — 663 508 — 1,171 1 — 5,498 4,478 — 9,977 Property and equipment, net — — 11,110 6,785 — 17,895 Investments of insurance subsidiaries — — — 418 — 418 Investments in and advances to affiliates 29,581 — 22 177 (29,581 ) 199 Goodwill and other intangible assets — — 4,893 2,501 — 7,394 Other 510 50 47 103 — 710 $ 30,092 $ 50 $ 21,570 $ 14,462 $ (29,581 ) $ 36,593 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) Current liabilities: Accounts payable $ — $ — $ 1,793 $ 813 $ — $ 2,606 Accrued salaries — — 862 507 — 1,369 Other accrued expenses 29 378 536 1,040 — 1,983 Long-term debt due within one year — 97 64 39 — 200 29 475 3,255 2,399 — 6,158 Long-term debt, net 995 31,367 307 189 — 32,858 Intercompany balances 35,322 (9,742 ) (25,228 ) (352 ) — — Professional liability risks — — — 1,198 — 1,198 Income taxes and other liabilities 552 — 357 465 — 1,374 36,898 22,100 (21,309 ) 3,899 — 41,588 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (6,806 ) (22,050 ) 42,755 8,876 (29,581 ) (6,806 ) Noncontrolling interests — — 124 1,687 — 1,811 (6,806 ) (22,050 ) 42,879 10,563 (29,581 ) (4,995 ) $ 30,092 $ 50 $ 21,570 $ 14,462 $ (29,581 ) $ 36,593 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET DECEMBER 31, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 113 $ 533 $ — $ 646 Accounts receivable, net — — 3,388 2,438 — 5,826 Inventories — — 1,001 502 — 1,503 Other — — 592 519 — 1,111 — — 5,094 3,992 — 9,086 Property and equipment, net — — 10,464 5,888 — 16,352 Investments of insurance subsidiaries — — — 336 — 336 Investments in and advances to affiliates 27,045 — 24 182 (27,045 ) 206 Goodwill and other intangible assets — — 4,612 2,092 — 6,704 Other 877 — 43 154 — 1,074 $ 27,922 $ — $ 20,237 $ 12,644 $ (27,045 ) $ 33,758 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) Current liabilities: Accounts payable $ — $ — $ 1,607 $ 711 $ — $ 2,318 Accrued salaries — — 811 454 — 1,265 Other accrued expenses 29 572 528 906 — 2,035 Long-term debt due within one year — 97 72 47 — 216 29 669 3,018 2,118 — 5,834 Long-term debt, net 993 29,693 304 170 — 31,160 Intercompany balances 33,784 (10,277 ) (22,495 ) (1,012 ) — — Professional liability risks — — — 1,148 — 1,148 Income taxes and other liabilities 418 12 397 422 — 1,249 35,224 20,097 (18,776 ) 2,846 — 39,391 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (7,302 ) (20,097 ) 38,857 8,285 (27,045 ) (7,302 ) Noncontrolling interests — — 156 1,513 — 1,669 (7,302 ) (20,097 ) 39,013 9,798 (27,045 ) (5,633 ) $ 27,922 $ — $ 20,237 $ 12,644 $ (27,045 ) $ 33,758 |
Schedule of Condensed Consolidating Statement of Cash Flows | HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE YEAR ENDED DECEMBER 31, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 2,216 $ (1,973 ) $ 4,028 $ 948 $ (2,476 ) $ 2,743 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Change in operating assets and liabilities — (193 ) (2,437 ) (1,705 ) — (4,335 ) Provision for doubtful accounts — — 2,218 1,821 — 4,039 Depreciation and amortization — — 1,237 894 — 2,131 Income taxes 433 — — — — 433 Gains on sales of facilities — — (2 ) (6 ) — (8 ) Losses on retirement of debt — 39 — — — 39 Amortization of debt issuance costs — 31 — — — 31 Share-based compensation — — 270 — — 270 Equity in earnings of affiliates (2,476 ) — — — 2,476 — Other 78 — — 5 — 83 Net cash provided by (used in) operating activities 251 (2,096 ) 5,314 1,957 — 5,426 Cash flows from investing activities: Purchase of property and equipment — — (1,681 ) (1,334 ) — (3,015 ) Acquisition of hospitals and health care entities — — (26 ) (1,186 ) — (1,212 ) Disposal of hospitals and health care entities — — 14 11 — 25 Change in investments — — (1 ) (72 ) — (73 ) Other — — — (4 ) — (4 ) Net cash used in investing activities — — (1,694 ) (2,585 ) — (4,279 ) Cash flows from financing activities: Issuance of long-term debt — 1,500 — 2 — 1,502 Net change in revolving bank credit facilities — 760 — — — 760 Repayment of long-term debt — (628 ) (77 ) (48 ) — (753 ) Distributions to noncontrolling interests — — (140 ) (308 ) — (448 ) Payment of debt issuance costs — (26 ) — — — (26 ) Repurchases of common stock (2,051 ) — — — — (2,051 ) Changes in intercompany balances with affiliates, net 1,867 490 (3,404 ) 1,047 — — Other (66 ) — — 21 — (45 ) Net cash (used in) provided by financing activities (250 ) 2,096 (3,621 ) 714 — (1,061 ) Change in cash and cash equivalents 1 — (1 ) 86 — 86 Cash and cash equivalents at beginning of period — — 113 533 — 646 Cash and cash equivalents at end of period $ 1 $ — $ 112 $ 619 $ — $ 732 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE YEAR ENDED DECEMBER 31, 2016 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 2,890 $ (1,586 ) $ 3,741 $ 1,125 $ (2,738 ) $ 3,432 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Change in operating assets and liabilities (25 ) 39 (2,180 ) (1,049 ) — (3,215 ) Provision for doubtful accounts — — 2,041 1,216 — 3,257 Depreciation and amortization — — 1,141 825 — 1,966 Income taxes 123 — — — — 123 Losses (gains) on sales of facilities — — 4 (27 ) — (23 ) Losses on retirement of debt — 4 — — — 4 Legal claim benefits — (246 ) — — — (246 ) Amortization of debt issuance costs 1 33 — — — 34 Share-based compensation — — 251 — — 251 Equity in earnings of affiliates (2,738 ) — — — 2,738 — Other 71 — — (1 ) — 70 Net cash provided by (used in) operating activities 322 (1,756 ) 4,998 2,089 — 5,653 Cash flows from investing activities: Purchase of property and equipment — — (1,554 ) (1,206 ) — (2,760 ) Acquisition of hospitals and health care entities — — (199 ) (377 ) — (576 ) Disposal of hospitals and health care entities — — 10 16 — 26 Change in investments — — (15 ) 79 — 64 Other — — — 6 — 6 Net cash used in investing activities — — (1,758 ) (1,482 ) — (3,240 ) Cash flows from financing activities: Issuance of long-term debt — 5,400 — — — 5,400 Net change in revolving bank credit facilities — (110 ) — — — (110 ) Repayment of long-term debt — (4,358 ) (74 ) (43 ) — (4,475 ) Distributions to noncontrolling interests — — (64 ) (370 ) — (434 ) Payment of debt issuance costs — (40 ) — — — (40 ) Repurchases of common stock (2,751 ) — — — — (2,751 ) Changes in intercompany balances with affiliates, net 2,532 864 (3,149 ) (247 ) — — Other (103 ) — — 5 — (98 ) Net cash (used in) provided by financing activities (322 ) 1,756 (3,287 ) (655 ) — (2,508 ) Change in cash and cash equivalents — — (47 ) (48 ) — (95 ) Cash and cash equivalents at beginning of period — — 160 581 — 741 Cash and cash equivalents at end of period $ — $ — $ 113 $ 533 $ — $ 646 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE YEAR ENDED DECEMBER 31, 2015 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 2,129 $ (1,625 ) $ 3,442 $ 1,102 $ (2,352 ) $ 2,696 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Change in operating assets and liabilities (12 ) 44 (2,786 ) (1,482 ) — (4,236 ) Provision for doubtful accounts — — 2,329 1,584 — 3,913 Depreciation and amortization — — 1,085 819 — 1,904 Income taxes (160 ) — — — — (160 ) Losses on sales of facilities — — — 5 — 5 Losses on retirement of debt 122 13 — — — 135 Legal claim costs 20 129 — — — 149 Amortization of debt issuance costs 3 32 — — — 35 Share-based compensation — — 239 — — 239 Equity in earnings of affiliates (2,352 ) — — — 2,352 — Other 66 3 (5 ) (10 ) — 54 Net cash (used in) provided by operating activities (184 ) (1,404 ) 4,304 2,018 — 4,734 Cash flows from investing activities: Purchase of property and equipment — — (1,560 ) (815 ) — (2,375 ) Acquisition of hospitals and health care entities — — (51 ) (300 ) — (351 ) Disposal of hospitals and health care entities — — 48 25 — 73 Change in investments — — 7 56 — 63 Other — — (6 ) 13 — 7 Net cash used in investing activities — — (1,562 ) (1,021 ) — (2,583 ) Cash flows from financing activities: Issuance of long-term debt — 5,548 — — — 5,548 Net change in revolving bank credit facilities — 150 — — — 150 Repayment of long-term debt (1,632 ) (3,189 ) (60 ) (39 ) — (4,920 ) Distributions to noncontrolling interests — — (85 ) (410 ) — (495 ) Payment of debt issuance costs — (50 ) — — — (50 ) Repurchases of common stock (2,397 ) — — — — (2,397 ) Changes in intercompany balances with affiliates, net 4,006 (1,055 ) (2,526 ) (425 ) — — Other 207 — — (19 ) — 188 Net cash provided by (used in) financing activities 184 1,404 (2,671 ) (893 ) — (1,976 ) Change in cash and cash equivalents — — 71 104 — 175 Cash and cash equivalents at beginning of period — — 89 477 — 566 Cash and cash equivalents at end of period $ — $ — $ 160 $ 581 $ — $ 741 |
Summary of Restatement Adjustments to Financial Statements | The application of these adjustments to the consolidating information for 2016 and 2015 is summarized as follows (dollars in millions): As Adjustment As Adjusted Year ended December 31, 2016 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 2,890 $ — $ 2,890 HCA Inc. Issuer (1,586 ) — (1,586 ) Subsidiary Guarantors 3,235 413 3,648 Subsidiary Non-Guarantors 1,089 (413 ) 676 Eliminations (2,738 ) — (2,738 ) Condensed Consolidated $ 2,890 $ — $ 2,890 As Adjustment As Adjusted December 31, 2016 Total assets: HCA Healthcare, Inc. Issuer $ 27,922 $ — $ 27,922 HCA Inc. Issuer — — — Subsidiary Guarantors 14,714 5,523 (a) 20,237 Subsidiary Non-Guarantors 18,167 (5,523 )(a) 12,644 Eliminations (27,045 ) — (27,045 ) Condensed Consolidated $ 33,758 $ — $ 33,758 (a) Amounts include $2,884 of goodwill and other intangible assets and $2,001 of property and equipment, net. As Adjustment As Adjusted December 31, 2016 Total liabilities: HCA Healthcare, Inc. Issuer $ 35,224 $ — $ 35,224 HCA Inc. Issuer 20,097 — 20,097 Subsidiary Guarantors (23,194 ) 4,418 (b) (18,776 ) Subsidiary Non-Guarantors 7,264 (4,418 )(b) 2,846 Eliminations — — — Condensed Consolidated $ 39,391 $ — $ 39,391 (b) Amounts include $3,952 of intercompany balances. As Adjustment As Adjusted Year ended December 31, 2016 Net cash provided (used in) operating activities: HCA Healthcare, Inc. Issuer $ 322 $ — $ 322 HCA Inc. Issuer (1,756 ) — (1,756 ) Subsidiary Guarantors 4,425 573 4,998 Subsidiary Non-Guarantors 2,662 (573 ) 2,089 Eliminations — — — Condensed Consolidated $ 5,653 $ — $ 5,653 As Adjustment As Adjusted Year ended December 31, 2015 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 2,129 $ — $ 2,129 HCA Inc. Issuer (1,625 ) — (1,625 ) Subsidiary Guarantors 2,970 380 3,350 Subsidiary Non-Guarantors 1,007 (380 ) 627 Eliminations (2,352 ) — (2,352 ) Condensed Consolidated $ 2,129 $ — $ 2,129 As Adjustment As Adjusted Year ended December 31, 2015 Net cash provided (used in) operating activities: HCA Healthcare, Inc. Issuer $ (184 ) $ — $ (184 ) HCA Inc. Issuer (1,404 ) — (1,404 ) Subsidiary Guarantors 3,772 532 4,304 Subsidiary Non-Guarantors 2,550 (532 ) 2,018 Eliminations — — — Condensed Consolidated $ 4,734 $ — $ 4,734 |
Schedule of Consolidated Statements of Stockholder's Deficit | The Hospital Company Consolidated Statements of Stockholder’s Deficit presentation for the years ended December 31, 2017, 2016 and 2015 are as follows (dollars in millions): 2017 2016 2015 Presentation in HCA Healthcare, Inc. Consolidated Statements of Stockholders’ Deficit: Share-based benefit plans $ 281 $ 233 $ 523 Other (10 ) (2 ) (18 ) Presentation in Healthtrust, Inc. — The Hospital Company Consolidated Statements of Stockholder’s Deficit: Distributions from HCA Healthcare, Inc., net of contributions to HCA Healthcare, Inc. $ 271 $ 231 $ 505 |
Accounting Policies - Additiona
Accounting Policies - Additional Information (Detail) | Oct. 31, 2017 | Dec. 31, 2017USD ($)ClaimStateHospitalSurgery_Center | Dec. 31, 2016USD ($)Claim | Dec. 31, 2015USD ($) | Dec. 31, 2017USD ($)ClaimStateHospitalSurgery_Center |
Summary Of Significant Accounting Policies [Line Items] | |||||
Number of owned and operated hospitals | Hospital | 179 | 179 | |||
Number of freestanding surgery centers | Surgery_Center | 120 | 120 | |||
Number of facilities locations | State | 20 | 20 | |||
General and administrative expense | $ 373,000,000 | $ 373,000,000 | $ 327,000,000 | ||
Adjustments to estimated reimbursement filed during respective year | 41,000,000 | 31,000,000 | 48,000,000 | ||
Adjustments to estimated reimbursement filed during previous years | $ 56,000,000 | $ 90,000,000 | $ 85,000,000 | ||
Percentage of the sum of revenues, uninsured discounts and charity care | 34.90% | 33.00% | 31.50% | ||
Outstanding checks unpresented for payment | $ 480,000,000 | $ 565,000,000 | $ 480,000,000 | ||
Allowance for doubtful accounts percentage of accounts receivable | 100.00% | 98.00% | |||
Allowance for doubtful accounts | $ 5,488,000,000 | $ 5,116,000,000 | 5,488,000,000 | ||
Days revenues in accounts receivable | 52 days | 50 days | 53 days | ||
Depreciation expense | $ 2,111,000,000 | $ 1,946,000,000 | $ 1,880,000,000 | ||
Goodwill impairments | 0 | 0 | 0 | 102,000,000 | |
Goodwill acquired during period | 693,000,000 | 41,000,000 | |||
Intangible assets decreased | 15,000,000 | 19,000,000 | |||
Gross carrying amount of intangible assets | 184,000,000 | 184,000,000 | |||
Accumulated amortization of intangible assets | 94,000,000 | 79,000,000 | 94,000,000 | ||
Gross carrying amount of indefinite-lived intangible assets | 269,000,000 | 269,000,000 | 269,000,000 | ||
Deferred loan costs | 353,000,000 | 334,000,000 | 353,000,000 | ||
Deferred loan costs, accumulated amortization | 189,000,000 | 164,000,000 | 189,000,000 | ||
Amortization of debt issuance costs | 31,000,000 | 34,000,000 | 35,000,000 | ||
Reserves for professional liability risks | 1,627,000,000 | 1,539,000,000 | 1,627,000,000 | ||
Current portion of professional liability risks reserves | 429,000,000 | 391,000,000 | $ 429,000,000 | ||
Provisions for losses related to professional liability risks | $ 466,000,000 | $ 430,000,000 | $ 344,000,000 | ||
Reserves for professional liability risks cover individual claims | Claim | 2,500 | 2,700 | 2,500 | ||
Net payments of professional and general liability claims | $ 357,000,000 | $ 357,000,000 | |||
Self-insured retention amount per occurrence | 15,000,000 | ||||
Maximum amount losses per occurrence | 50,000,000 | ||||
Reinsurance for professional liability risks retention level of amount per occurrence | 25,000,000 | ||||
Amounts receivable under reinsurance contracts recorded in other assets | 19,000,000 | 36,000,000 | $ 19,000,000 | ||
Amounts receivable under reinsurance contracts recorded in other current assets | $ 5,000,000 | 9,000,000 | $ 5,000,000 | ||
Insurance Subsidiary [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Insurance subsidiary ownership percentage | 100.00% | 100.00% | |||
Sales, Foreign Currency Translation and Other [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Goodwill increase (decrease) | $ (49,000,000) | ||||
Foreign Currency Translation And Other [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Goodwill increase (decrease) | $ 12,000,000 | ||||
Maximum [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Percentage of income of federal poverty level eligible for charity care | 200.00% | 400.00% | |||
Finite lived intangible asset useful life | 10 years | ||||
Maximum [Member] | Building and Improvements [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Estimated useful lives in years | 40 years | ||||
Maximum [Member] | Equipment [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Estimated useful lives in years | 10 years | ||||
Minimum [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Percentage of income of federal poverty level eligible for charity care | 200.00% | ||||
Finite lived intangible asset useful life | 3 years | ||||
Minimum [Member] | Building and Improvements [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Estimated useful lives in years | 10 years | ||||
Minimum [Member] | Equipment [Member] | |||||
Summary Of Significant Accounting Policies [Line Items] | |||||
Estimated useful lives in years | 4 years |
Accounting Policies - Schedule
Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($) $ in Millions | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Revenues From Third Party Payers [Line Items] | |||||||||||
Other | $ 3,492 | $ 2,786 | $ 3,688 | ||||||||
Revenues before provision for doubtful accounts | 47,653 | 44,747 | 43,591 | ||||||||
Provision for doubtful accounts | (4,039) | (3,257) | (3,913) | ||||||||
Revenues | $ 11,562 | $ 10,696 | $ 10,733 | $ 10,623 | $ 10,641 | $ 10,270 | $ 10,319 | $ 10,260 | $ 43,614 | $ 41,490 | $ 39,678 |
Other, Ratio | 8.00% | 6.70% | 9.30% | ||||||||
Revenues before provision for doubtful accounts, Ratio | 109.20% | 107.80% | 109.90% | ||||||||
Provision for doubtful accounts, Ratio | (9.20%) | (7.80%) | (9.90%) | ||||||||
Revenues ratio from third party payers | 100.00% | 100.00% | 100.00% | ||||||||
Medicare [Member] | |||||||||||
Revenues From Third Party Payers [Line Items] | |||||||||||
Revenues from third party payers | $ 9,483 | $ 8,895 | $ 8,654 | ||||||||
Revenues from third party payers, Ratio | 21.70% | 21.40% | 21.80% | ||||||||
Managed Medicare [Member] | |||||||||||
Revenues From Third Party Payers [Line Items] | |||||||||||
Revenues from third party payers | $ 4,788 | $ 4,355 | $ 4,133 | ||||||||
Revenues from third party payers, Ratio | 11.00% | 10.50% | 10.40% | ||||||||
Medicaid [Member] | |||||||||||
Revenues From Third Party Payers [Line Items] | |||||||||||
Revenues from third party payers | $ 1,631 | $ 1,597 | $ 1,705 | ||||||||
Revenues from third party payers, Ratio | 3.70% | 3.80% | 4.30% | ||||||||
Managed Medicaid [Member] | |||||||||||
Revenues From Third Party Payers [Line Items] | |||||||||||
Revenues from third party payers | $ 2,349 | $ 2,478 | $ 2,234 | ||||||||
Revenues from third party payers, Ratio | 5.40% | 6.00% | 5.60% | ||||||||
Managed Care and Other Insurers [Member] | |||||||||||
Revenues From Third Party Payers [Line Items] | |||||||||||
Revenues from third party payers | $ 24,813 | $ 23,441 | $ 21,882 | ||||||||
Revenues from third party payers, Ratio | 56.90% | 56.50% | 55.20% | ||||||||
International (Managed Care and Other Insurers) [Member] | |||||||||||
Revenues From Third Party Payers [Line Items] | |||||||||||
Revenues from third party payers | $ 1,097 | $ 1,195 | $ 1,295 | ||||||||
Revenues from third party payers, Ratio | 2.50% | 2.90% | 3.30% |
Accounting Policies - Schedul41
Accounting Policies - Schedule of Revenue Deductions Related to Uninsured Accounts (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Regulatory Assets [Abstract] | |||
Charity care | $ 4,861 | $ 4,151 | $ 3,682 |
Uninsured discounts | 14,520 | 13,047 | 10,692 |
Provision for doubtful accounts | 4,039 | 3,257 | 3,913 |
Total uncompensated care | $ 23,420 | $ 20,455 | $ 18,287 |
Charity care, ratio | 21.00% | 20.00% | 20.00% |
Uninsured discounts, ratio | 62.00% | 64.00% | 59.00% |
Provision for doubtful accounts, ratio | 17.00% | 16.00% | 21.00% |
Total uncompensated care, ratio | 100.00% | 100.00% | 100.00% |
Accounting Policies - Schedul42
Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Accounting Policies [Abstract] | |||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ 37,557 | $ 35,304 | $ 33,760 |
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) | 12.90% | 13.50% | 14.50% |
Total uncompensated care | $ 23,420 | $ 20,455 | $ 18,287 |
Multiply by the cost-to-charges ratio | 12.90% | 13.50% | 14.50% |
Estimated cost of total uncompensated care | $ 3,021 | $ 2,761 | $ 2,652 |
Share-Based Compensation - Addi
Share-Based Compensation - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Weighted Average Fair Value of Stock Options Granted | $ 28.47 | $ 26.60 | $ 26.10 |
Total Intrinsic Value of Stock Options | $ 177 | ||
Unrecognized Compensation Cost Related to Nonvested Awards | $ 74 | ||
Employee Stock Purchase Plan ("ESPP") [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Common stock were reserved for issuance | 8,681,600 | ||
Compensation expense | $ 9 | $ 8 | |
Restricted Stock Units and Performance Stock Units [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Number of share-based awards granted | 2,788,000 | 2,628,000 | 3,105,000 |
Number of share-based awards vested | 2,254,000 | 3,112,000 | 2,881,000 |
Unrecognized Compensation Cost Related to Nonvested Awards | $ 257 | ||
Restricted Stock Units [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Number of share-based awards granted | 2,787,700 | 2,628,500 | |
Stock Appreciation Rights (SARs) [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Number of share-based awards granted | 1,879,100 | 1,601,300 | |
Number of share-based awards vested | 11,284,400 | ||
Shares Available for Future Grants | 22,755,600 |
Share-Based Compensation - Sche
Share-Based Compensation - Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models (Detail) | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |||
Risk-free interest rate | 2.13% | 1.70% | 1.59% |
Expected volatility | 31.00% | 36.00% | 36.00% |
Expected life, in years | 6 years 2 months 1 day | 6 years 3 months | 6 years 3 months |
Expected dividend yield | 0.00% | 0.00% | 0.00% |
Share-Based Compensation - Sc45
Share-Based Compensation - Schedule of Stock Option Activity (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Stock Options outstanding, Weighted Average Exercise Price, Beginning Balance | $ 35.65 | $ 27.73 | $ 21.39 |
Granted, Weighted Average Exercise Price | 81.83 | 69.96 | 69.16 |
Exercised, Weighted Average Exercise Price | 21.49 | 15.85 | 12.77 |
Cancelled, Weighted Average Exercise Price | 52.92 | 55.17 | 32.59 |
Stock Options outstanding, Weighted Average Exercise Price, Ending Balance | 43.47 | $ 35.65 | $ 27.73 |
Options exercisable, Weighted Average Exercise Price | $ 32.49 | ||
Options outstanding, Weighted Average Remaining Contractual Term | 5 years 4 months 24 days | ||
Options exercisable, Weighted Average Remaining Contractual Term | 4 years 4 months 24 days | ||
Options outstanding, Aggregate Intrinsic Value | $ 699 | ||
Options exercisable, Aggregate Intrinsic Value | $ 625 | ||
Time Based Stock Options and SARs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Stock Options Outstanding, Beginning Balance | 10,936 | 12,165 | 15,051 |
Granted, Stock Options | 1,879 | 1,601 | 1,746 |
Exercised, Stock Options | (1,549) | (2,521) | (4,093) |
Cancelled, Stock Options | (110) | (309) | (539) |
Stock Options Outstanding, Ending Balance | 11,156 | 10,936 | 12,165 |
Stock Options Exercisable, Ending Balance | 7,060 | ||
Performance Stock Options and SARs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Stock Options Outstanding, Beginning Balance | 6,130 | 10,427 | 14,744 |
Exercised, Stock Options | (1,366) | (4,171) | (3,988) |
Cancelled, Stock Options | (178) | (126) | (329) |
Stock Options Outstanding, Ending Balance | 4,586 | 6,130 | 10,427 |
Stock Options Exercisable, Ending Balance | 4,224 | ||
Total Stock Options and Stock SARs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Stock Options Outstanding, Beginning Balance | 17,066 | 22,592 | 29,795 |
Granted, Stock Options | 1,879 | 1,601 | 1,746 |
Exercised, Stock Options | (2,915) | (6,692) | (8,081) |
Cancelled, Stock Options | (288) | (435) | (868) |
Stock Options Outstanding, Ending Balance | 15,742 | 17,066 | 22,592 |
Stock Options Exercisable, Ending Balance | 11,284 |
Share-Based Compensation - Sc46
Share-Based Compensation - Schedule of Restricted Stock Units Activity (Detail) - $ / shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Restricted Stock Units and Performance Stock Units [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs Outstanding, Beginning Balance | 7,287 | 8,413 | 8,676 |
RSUs and PSUs, Granted | 2,788 | 2,628 | 3,105 |
RSUs and PSUs, Vested | (2,254) | (3,112) | (2,881) |
RSUs and PSUs, Cancelled | (567) | (642) | (487) |
RSUs and PSUs Outstanding, Ending Balance | 7,254 | 7,287 | 8,413 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Beginning balance | $ 61.21 | $ 51.15 | $ 39.89 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Granted | 81.90 | 69.95 | 69.43 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Vested | 51.20 | 41.71 | 37.61 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Cancelled | 64.06 | 59.66 | 47.26 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Ending balance | $ 72.05 | $ 61.21 | $ 51.15 |
Restricted Stock Units and Performance Stock Units [Member] | Time Based Stock Options and SARs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs Outstanding, Beginning Balance | 4,111 | 5,302 | 5,895 |
RSUs and PSUs, Granted | 1,484 | 1,450 | 1,694 |
RSUs and PSUs, Vested | (1,824) | (2,242) | (1,953) |
RSUs and PSUs, Cancelled | (306) | (399) | (334) |
RSUs and PSUs Outstanding, Ending Balance | 3,465 | 4,111 | 5,302 |
Restricted Stock Units and Performance Stock Units [Member] | Performance Based Stock Options and RSUs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs Outstanding, Beginning Balance | 790 | 1,740 | 2,781 |
RSUs and PSUs, Vested | (430) | (870) | (928) |
RSUs and PSUs, Cancelled | (133) | (80) | (113) |
RSUs and PSUs Outstanding, Ending Balance | 227 | 790 | 1,740 |
Performance Shares PSUs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs Outstanding, Beginning Balance | 2,386 | 1,371 | |
RSUs and PSUs, Granted | 1,304 | 1,178 | 1,411 |
RSUs and PSUs, Cancelled | (128) | (163) | (40) |
RSUs and PSUs Outstanding, Ending Balance | 3,562 | 2,386 | 1,371 |
Acquisitions and Dispositions -
Acquisitions and Dispositions - Additional Information (Detail) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017USD ($)Hospital | Dec. 31, 2016USD ($)Hospital | Dec. 31, 2015USD ($)Hospital | |
Business Acquisition [Line Items] | |||
Number of hospitals purchased | Hospital | 8 | 3 | 1 |
Proceeds from sale of business | $ 25 | $ 26 | $ 73 |
Real Estate and Other Investments [Member] | |||
Business Acquisition [Line Items] | |||
Pretax gain (loss) on sales of business | 8 | 23 | (5) |
Pretax gain (loss) after tax | 5 | 19 | 3 |
Proceeds from sale of business | 25 | 26 | 73 |
Hospitals [Member] | |||
Business Acquisition [Line Items] | |||
Aggregate purchase price | 1,000 | 343 | 15 |
Nonhospital Health Care [Member] | |||
Business Acquisition [Line Items] | |||
Aggregate purchase price | 212 | 233 | 336 |
Other [Member] | |||
Business Acquisition [Line Items] | |||
Fair value of identifiable net assets of acquired entities | $ 693 | $ 41 | $ 323 |
Income Taxes - Schedule of Prov
Income Taxes - Schedule of Provision for Income Taxes (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Income Tax Disclosure [Abstract] | |||
Current, Federal | $ 1,067 | $ 1,129 | $ 1,259 |
Current, State | 120 | 125 | 119 |
Current, Foreign | 19 | 37 | 40 |
Deferred, Federal | 423 | 75 | (163) |
Deferred, State | 3 | (5) | (27) |
Deferred, Foreign | 6 | 17 | 33 |
Provision for income taxes | $ 1,638 | $ 1,378 | $ 1,261 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | |||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Income Tax Contingency [Line Items] | ||||
Provision for income taxes included an increase related to estimated impact of tax rate changes | $ 301 | |||
Provision for tax benefits related to settlement of employee awards | 82 | $ 162 | ||
Reductions in interest (net of tax) | 14 | 15 | $ 7 | |
Provision for income taxes | 51 | |||
Foreign pretax income | $ 91 | $ 149 | $ 178 | |
Effective tax rate | 35.00% | 35.00% | 35.00% | |
Provisional amount related to remeasurement of deferred tax assets and liabilities, recorded as a component of provision for income taxes | $ 301 | |||
Provisional amount reclassified from deferred tax liabilities for the one-time transition tax | 127 | |||
State net operating loss carryforwards | 121 | |||
Federal net operating loss carryforwards | 82 | |||
Liability for unrecognized tax benefits | 439 | $ 418 | ||
Unrecognized tax benefits, accrued interest | 44 | 45 | ||
Unrecognized tax benefits that would impact effective tax rate | 145 | 137 | ||
Deferred tax assets, reductions | $ 4 | $ 4 | ||
Scenario, Forecast [Member] | ||||
Income Tax Contingency [Line Items] | ||||
Effective tax rate | 21.00% | |||
State and Local Jurisdiction [Member] | Minimum [Member] | ||||
Income Tax Contingency [Line Items] | ||||
Net operating loss carryforwards, expiration date | 2,020 | |||
State and Local Jurisdiction [Member] | Maximum [Member] | ||||
Income Tax Contingency [Line Items] | ||||
Net operating loss carryforwards, expiration date | 2,036 |
Income Taxes - Schedule of Reco
Income Taxes - Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate (Detail) | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Income Tax Disclosure [Abstract] | |||
Federal statutory rate | 35.00% | 35.00% | 35.00% |
State income taxes, net of federal tax benefit | 2.20% | 2.10% | 1.60% |
Change in liability for uncertain tax positions | (1.00%) | 0.20% | |
Tax benefit from settlements of employee equity awards | (2.00%) | (3.60%) | |
Impact of rate change on deferred tax balances | 7.80% | ||
Other items, net | (0.50%) | (0.20%) | 0.40% |
Effective income tax rate on income applicable to HCA Healthcare, Inc. | 42.50% | 32.30% | 37.20% |
Income attributable to noncontrolling interests from consolidated partnerships | (5.10%) | (3.60%) | (5.30%) |
Effective income tax rate on income before income taxes | 37.40% | 28.70% | 31.90% |
Income Taxes - Schedule of Defe
Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Millions | Dec. 31, 2017 | Dec. 31, 2016 |
Income Tax Disclosure [Abstract] | ||
Depreciation and fixed asset basis differences, Assets | $ 0 | $ 0 |
Allowances for professional liability and other risks, Assets | 345 | 495 |
Accounts receivable, Assets | 243 | 351 |
Compensation, Assets | 263 | 359 |
Other, Assets | 420 | 794 |
Deferred tax assets | 1,271 | 1,999 |
Depreciation and fixed asset basis differences, Liabilities | 260 | 235 |
Allowances for professional liability and other risks, Liabilities | 0 | 0 |
Accounts receivable, Liabilities | 0 | 0 |
Compensation, Liabilities | 0 | 0 |
Other, Liabilities | 501 | 918 |
Deferred tax liabilities | $ 761 | $ 1,153 |
Income Taxes - Schedule of Acti
Income Taxes - Schedule of Activity Related to Unrecognized Tax Benefits (Detail) - USD ($) $ in Millions | 12 Months Ended | |
Dec. 31, 2017 | Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | ||
Beginning Balance | $ 377 | $ 487 |
Additions based on tax positions related to the current year | 40 | 11 |
Additions for tax positions of prior years | 11 | 8 |
Reductions for tax positions of prior years | (13) | (18) |
Settlements | (101) | |
Lapse of applicable statutes of limitations | (16) | (10) |
Ending Balance | $ 399 | $ 377 |
Earnings Per Share - Additional
Earnings Per Share - Additional information (Detail) - shares | 1 Months Ended | 12 Months Ended | ||
Oct. 31, 2017 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Earnings Per Share [Abstract] | ||||
Common stock repurchased | 25,092,000 | 25,092,000 | 36,325,000 | 31,991,000 |
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 | 12 Months Ended | |||||||||
Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Earnings Per Share [Abstract] | |||||||||||
Net income attributable to HCA Healthcare, Inc. | $ 474 | $ 426 | $ 657 | $ 659 | $ 920 | $ 618 | $ 658 | $ 694 | $ 2,216 | $ 2,890 | $ 2,129 |
Weighted average common shares outstanding | 362,305 | 383,591 | 414,193 | ||||||||
Effect of dilutive incremental shares | 9,916 | 12,260 | 12,528 | ||||||||
Shares used for diluted earnings per share | 372,221 | 395,851 | 426,721 | ||||||||
Basic earnings per share | $ 1.34 | $ 1.18 | $ 1.79 | $ 1.78 | $ 2.46 | $ 1.63 | $ 1.70 | $ 1.75 | $ 6.12 | $ 7.53 | $ 5.14 |
Diluted earnings per share | $ 1.30 | $ 1.15 | $ 1.75 | $ 1.74 | $ 2.39 | $ 1.59 | $ 1.65 | $ 1.69 | $ 5.95 | $ 7.30 | $ 4.99 |
Investments of Insurance Subs55
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions | Dec. 31, 2017 | Dec. 31, 2016 |
Schedule of Available-for-sale Securities [Line Items] | ||
Amortized Cost | $ 462 | $ 374 |
Unrealized Amounts, Gains | 10 | 12 |
Unrealized Amounts, Losses | (1) | |
Fair Value | 472 | 385 |
Amounts classified as current assets | (54) | (49) |
Investment carrying value | 418 | 336 |
Money Market Funds and Other [Member] | ||
Schedule of Available-for-sale Securities [Line Items] | ||
Amortized Cost | 101 | 29 |
Unrealized Amounts, Gains | 3 | |
Fair Value | 101 | 32 |
Debt Securities [Member] | States and Municipalities [Member] | ||
Schedule of Available-for-sale Securities [Line Items] | ||
Amortized Cost | 361 | 345 |
Unrealized Amounts, Gains | 10 | 9 |
Unrealized Amounts, Losses | (1) | |
Fair Value | $ 371 | $ 353 |
Investments of Insurance Subs56
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions | Dec. 31, 2017USD ($) |
Investments, Debt and Equity Securities [Abstract] | |
Due in one year or less, Amortized Cost | $ 31 |
Due after one year through five years, Amortized Cost | 84 |
Due after five years through ten years, Amortized Cost | 187 |
Due after ten years, Amortized Cost | 59 |
Amortized Cost, Total | 361 |
Due in one year or less, Fair Value | 31 |
Due after one year through five years, Fair Value | 86 |
Due after five years through ten years, Fair Value | 194 |
Due after ten years, Fair Value | 60 |
Fair Value, Total | $ 371 |
Investments of Insurance Subs57
Investments of Insurance Subsidiaries - Additional Information (Detail) | 12 Months Ended |
Dec. 31, 2017 | |
Investments, Debt and Equity Securities [Abstract] | |
Available for sale securities expected maturity of debt securities | 4 years 9 months 18 days |
Available for sale securities average scheduled maturity | 6 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] | 12 Months Ended |
Dec. 31, 2017USD ($) | |
Maturity Date, 2021 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 2,000,000,000 |
Fair Value | $ 48,000,000 |
Maturity Date | Dec. 31, 2021 |
Maturity Date, 2022 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 500,000,000 |
Fair Value | $ 2,000,000 |
Maturity Date | Dec. 31, 2022 |
Financial Instruments - Additio
Financial Instruments - Additional Information (Detail) $ in Millions | 12 Months Ended |
Dec. 31, 2017USD ($) | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Estimated amount reclassified from other comprehensive income and reduce interest expense | $ 5 |
Financial Instruments - Effect
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Derivative Instruments, Gain (Loss) [Line Items] | |||
Interest expense | $ 1,690 | $ 1,707 | $ 1,665 |
Interest Rate Swaps [Member] | |||
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | 7 | ||
Reclassification out of Accumulated Other Comprehensive Income [Member] | Interest Rate Swaps [Member] | |||
Derivative Instruments, Gain (Loss) [Line Items] | |||
Interest expense | $ 20 |
Assets and Liabilities Measur61
Assets and Liabilities Measured at Fair Value - Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Millions | Dec. 31, 2017 | Dec. 31, 2016 |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | $ 472 | $ 385 |
Less amounts classified as current assets | (54) | (49) |
Investments of insurance subsidiaries, noncurrent | 418 | 336 |
Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Interest rate swaps (Other) | 50 | 31 |
Liabilities, Fair Value | 12 | |
Money Market Funds and Other [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 101 | 32 |
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 | 371 | 353 |
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 | 101 | 32 |
Less amounts classified as current assets | (54) | (28) |
Investments of insurance subsidiaries, noncurrent | 47 | 4 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Money Market Funds and Other [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value | 101 | 32 |
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 | 371 | 347 |
Less amounts classified as current assets | (21) | |
Investments of insurance subsidiaries, noncurrent | 371 | 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) | 50 | 31 |
Liabilities, Fair Value | 12 | |
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 | $ 371 | 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] | 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 Measur62
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | |
Dec. 31, 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 | $ 34,689 | $ 32,833 |
Carrying amounts of long-term debt | 33,222 | $ 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 | Dec. 31, 2017 | Dec. 31, 2016 |
Debt Instrument [Line Items] | ||
Senior secured debt | $ 23,470 | $ 21,294 |
Net debt issuance costs | (164) | (170) |
Total debt (average life of 6.8 years, rates averaging 5.2%) | 33,058 | 31,376 |
Less amounts due within one year | 200 | 216 |
Long-term debt | 32,858 | 31,160 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 3,680 | 2,920 |
Senior Secured Term Loan Facilities [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 3,891 | 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 | 599 | 593 |
Senior Unsecured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior unsecured notes | $ 9,752 | $ 10,252 |
Long-Term Debt - Schedule of 64
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | 12 Months Ended |
Dec. 31, 2017 | |
Debt Instrument [Line Items] | |
Total debt average term | 6 years 9 months 18 days |
Total debt average rate | 5.20% |
Senior Secured Asset-Based Revolving Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 3.00% |
Senior Secured Term Loan Facilities [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 3.50% |
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 | 5.70% |
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 | 12 Months Ended | |||||
Jul. 31, 2017 | Jun. 30, 2017 | Sep. 30, 2017 | Sep. 30, 2016 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 06, 2012 | |
Debt Instrument [Line Items] | ||||||||
Pretax loss on retirement of debt | $ (25,000,000) | $ (2,000,000) | $ (39,000,000) | $ (4,000,000) | $ (135,000,000) | |||
Capital leases and other secured debt | 599,000,000 | |||||||
Maturity of long-term debt in 2019 | 2,284,000,000 | |||||||
Maturity of long-term debt in 2020 | 4,177,000,000 | |||||||
Maturity of long-term debt in 2021 | 1,078,000,000 | |||||||
Maturity of long-term debt in 2022 | 3,449,000,000 | |||||||
Interest Rate Swaps [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Notional amount, total | $ 2,500,000,000 | |||||||
Federal Fund Rate [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument basis spread | 0.50% | |||||||
Minimum [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, maturities range | 2,019 | |||||||
Maximum [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, maturities range | 2,022 | |||||||
Asset-Based Revolving Credit Facility Maturing on June 28, 2022 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Credit facility, maximum amount | $ 3,750,000,000 | $ 3,750,000,000 | ||||||
Debt instrument maturity date | Jun. 28, 2022 | Jun. 28, 2022 | ||||||
Additional incremental credit facilities | $ 1,500,000,000 | |||||||
Credit facility, commitment fee for unutilized commitments | 0.25% | |||||||
Percentage of senior secured credit facility over eligible accounts receivable | 85.00% | |||||||
Line of credit outstanding | $ 3,680,000,000 | |||||||
Senior Secured Revolving Credit Facility Maturing On June 28, 2022 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Credit facility, maximum amount | $ 2,000,000,000 | |||||||
Debt instrument maturity date | Jun. 28, 2022 | |||||||
Line of credit outstanding | $ 0 | |||||||
Senior Secured Term Loan A-5 Facility Maturing On June 10, 2020 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Credit facility, maximum amount | $ 1,225,000,000 | |||||||
Debt instrument maturity date | Jun. 10, 2020 | |||||||
Senior Secured Term Loan B-8 Facility Maturing On February 15, 2024 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Credit facility, maximum amount | $ 1,188,000,000 | |||||||
Debt instrument maturity date | Feb. 15, 2024 | |||||||
Senior Secured Term Loan B-9 Facility Maturing On March 18, 2023 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Credit facility, maximum amount | $ 1,478,000,000 | |||||||
Debt instrument maturity date | Mar. 18, 2023 | |||||||
4.25 Percentage First Lien Notes Due 2019 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 600,000,000 | |||||||
Senior Unsecured Note Maturities Ranging 2022 to 2033 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 7,891,000,000 | |||||||
Senior Unsecured Note Maturities Ranging 2022 to 2033 [Member] | Minimum [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, maturities range | 2,022 | |||||||
Senior Unsecured Note Maturities Ranging 2022 to 2033 [Member] | Maximum [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, maturities range | 2,033 | |||||||
Senior Unsecured Note Maturity Year 2025 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 125,000,000 | |||||||
Senior Unsecured Note Maturities Ranging 2023 to 2095 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 736,000,000 | |||||||
Senior Unsecured Note Maturities Ranging 2023 to 2095 [Member] | Minimum [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, maturities range | 2,023 | |||||||
Senior Unsecured Note Maturities Ranging 2023 to 2095 [Member] | Maximum [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, maturities range | 2,095 | |||||||
Senior Unsecured Notes Due 2021 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 1,000,000,000 | $ 1,000,000,000 | ||||||
Debt instrument, stated interest | 6.25% | |||||||
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 | $ 1,500,000,000 | ||||||
Debt instrument, stated interest | 5.50% | 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 | |||||||
Senior Notes [Member] | Senior Secured Notes Due 2020 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 3,000,000,000 | |||||||
Debt instrument, stated interest | 6.50% | |||||||
Senior Notes [Member] | Senior Secured Notes Due 2022 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 1,350,000,000 | |||||||
Debt instrument, stated interest | 5.875% | |||||||
Senior Notes [Member] | Senior Secured Notes Due 2023 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 1,250,000,000 | |||||||
Debt instrument, stated interest | 4.75% | |||||||
Senior Notes [Member] | Senior Secured Notes Due 2019 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 1,500,000,000 | |||||||
Debt instrument, stated interest | 3.75% | |||||||
Senior Notes [Member] | Senior Secured Notes Due 2024 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 2,000,000,000 | |||||||
Debt instrument, stated interest | 5.00% | |||||||
Senior Notes [Member] | 4.25 Percentage First Lien Notes Due 2019 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, stated interest | 4.25% | |||||||
Senior Notes [Member] | Senior Secured Notes Due 2025 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 1,400,000,000 | |||||||
Debt instrument, stated interest | 5.25% | |||||||
Senior Notes [Member] | Senior Secured Notes Due 2026 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 1,500,000,000 | |||||||
Debt instrument, stated interest | 5.25% | |||||||
Senior Notes [Member] | Senior Secured Notes Due 2027 [Member] | ||||||||
Debt Instrument [Line Items] | ||||||||
Debt instrument, principal amount | $ 1,200,000,000 | |||||||
Debt instrument, stated interest | 4.50% |
Leases - Schedule of Commitment
Leases - Schedule of Commitments Relating to Noncancellable Operating Leases (Detail) $ in Millions | Dec. 31, 2017USD ($) |
Leases [Abstract] | |
2,018 | $ 289 |
2,019 | 278 |
2,020 | 239 |
2,021 | 198 |
2,022 | 157 |
Thereafter | 1,118 |
Operating leases future minimum payments due, gross | 2,279 |
Less sublease income | (11) |
Commitments relating to noncancellable operating leases | $ 2,268 |
Capital Stock - Additional Info
Capital Stock - Additional Information (Detail) | 1 Months Ended | 12 Months Ended | ||||||||
Oct. 31, 2017USD ($)$ / sharesshares | May 31, 2016$ / sharesshares | Dec. 31, 2017$ / sharesDirectorsshares | Dec. 31, 2016USD ($)$ / sharesshares | Dec. 31, 2015USD ($)$ / sharesshares | Nov. 30, 2016USD ($) | Oct. 31, 2015USD ($) | May 31, 2015USD ($) | Apr. 30, 2015shares | Feb. 28, 2015USD ($) | |
Capital Structure [Line Items] | ||||||||||
Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 | ||||||||
Repurchase of common stock, shares | 25,092,000 | 25,092,000 | 36,325,000 | 31,991,000 | ||||||
Repurchase price of common stock, per share | $ / shares | $ 81.73 | $ 75.72 | $ 74.62 | |||||||
Share repurchase program, remaining authorized repurchase amount | $ | $ 1,802,000 | $ 1,853,000,000 | ||||||||
Share repurchase program authorized amount | $ | $ 2,000,000,000 | $ 3,000,000,000 | $ 2,000,000,000 | $ 3,000,000,000 | $ 1,000,000,000 | $ 1,000,000,000 | ||||
Repurchase of common stock, shares | 31,991,000 | 28,185,000 | ||||||||
Stock repurchase program, authorized per share | $ / shares | $ 74.93 | |||||||||
Share Repurchase Program Two [Member] | ||||||||||
Capital Structure [Line Items] | ||||||||||
Repurchase of common stock, shares | 26,964,000 | |||||||||
Repurchase price of common stock, per share | $ / shares | $ 74.20 | |||||||||
Share Repurchase Transaction, October, 2015 [Member] | ||||||||||
Capital Structure [Line Items] | ||||||||||
Share repurchase program, remaining authorized repurchase amount | $ | $ 2.603 | |||||||||
Kohlberg Kravis Roberts & Co [Member] | Share Repurchase Program One [Member] | ||||||||||
Capital Structure [Line Items] | ||||||||||
Repurchase of common stock, shares | 9,361,000 | |||||||||
Repurchase price of common stock, per share | $ / shares | $ 80.12 | |||||||||
Percentage of discount on share repurchase | 1.00% | |||||||||
The Bain Entities [Member] | ||||||||||
Capital Structure [Line Items] | ||||||||||
Repurchase price of common stock, per share | $ / shares | $ 77.26 | |||||||||
Percentage of discount on share repurchase | 1.00% | |||||||||
Repurchase of common stock, shares | 3,806,000 | |||||||||
Minimum [Member] | ||||||||||
Capital Structure [Line Items] | ||||||||||
Number of directors as per the amended and restated by-laws | Directors | 3 |
Employee Benefit Plans - Additi
Employee Benefit Plans - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Defined Contribution Benefit Plans [Member] | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Percentage of employer contribution to match participant contribution in defined contribution plan, net | 100.00% | ||
Cost of defined benefit plans | $ 471 | $ 444 | $ 432 |
Defined benefit plan cost | 14 | 21 | 25 |
Defined benefit plan obligation | $ 118 | 111 | |
Defined Contribution Benefit Plans [Member] | Minimum [Member] | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Percentage of employer contribution to match participant contribution in defined contribution plan | 3.00% | ||
Defined Contribution Benefit Plans [Member] | Maximum [Member] | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Percentage of employer contribution to match participant contribution in defined contribution plan | 9.00% | ||
Restoration Plan [Member] | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Number of hours of service required to qualify for the plan | 1,000 or more hours | ||
Noncontributory and nonqualified plan, benefit expense | $ 40 | 20 | 20 |
Noncontributory and nonqualified plan, accrued benefits liabilities | 201 | 175 | |
Supplemental Executive Retirement Plan [Member] | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Defined benefit plan cost | 28 | 22 | $ 33 |
Defined benefit plan obligation | $ 223 | $ 222 |
Segment and Geographic Inform69
Segment and Geographic Information - Additional Information (Detail) | 12 Months Ended |
Dec. 31, 2017Hospital | |
Segment Reporting Information [Line Items] | |
Number of geographically organized groups | 2 |
Number of owned and operated hospitals | 179 |
Reorganization Group [Member] | National Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 87 |
Reorganization Group [Member] | American Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 86 |
Reorganization Group [Member] | Corporate and Other [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 6 |
Segment and Geographic Inform70
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 | 12 Months Ended | |||||||||
Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Segment Reporting Information [Line Items] | |||||||||||
Revenues | $ 11,562 | $ 10,696 | $ 10,733 | $ 10,623 | $ 10,641 | $ 10,270 | $ 10,319 | $ 10,260 | $ 43,614 | $ 41,490 | $ 39,678 |
Equity in earnings of affiliates | 45 | 54 | 46 | ||||||||
Adjusted segment EBITDA | 8,233 | 8,218 | 7,915 | ||||||||
Depreciation and amortization | 2,131 | 1,966 | 1,904 | ||||||||
Interest expense | 1,690 | 1,707 | 1,665 | ||||||||
Losses (gains) on sales of facilities | 1 | 4 | $ 1 | 1 | 15 | 2 | $ 4 | 2 | (8) | (23) | 5 |
Losses on retirement of debt | $ 25 | $ 2 | 39 | 4 | 135 | ||||||
Legal claim costs (benefits) | (246) | 249 | |||||||||
Income before income taxes | 4,381 | 4,810 | 3,957 | ||||||||
Assets | 36,593 | 33,758 | 36,593 | 33,758 | 32,744 | ||||||
Goodwill and other intangible assets, Beginning Balance | 6,704 | 6,731 | 6,704 | 6,731 | 6,416 | ||||||
Goodwill and other intangible assets, Acquisitions | 693 | 41 | 345 | ||||||||
Goodwill and other intangible assets, Foreign currency translation and other | (68) | (30) | |||||||||
Goodwill and other intangible assets, Sales, foreign currency translation, amortization and other | (3) | ||||||||||
Goodwill and other intangible assets, Ending Balance | 7,394 | 6,704 | 7,394 | 6,704 | 6,731 | ||||||
National Group [Member] | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Revenues | 20,772 | 19,845 | 18,756 | ||||||||
Equity in earnings of affiliates | (21) | (20) | (7) | ||||||||
Adjusted segment EBITDA | 4,600 | 4,565 | 4,271 | ||||||||
Depreciation and amortization | 867 | 806 | 769 | ||||||||
Assets | 13,097 | 12,320 | 13,097 | 12,320 | 11,332 | ||||||
Goodwill and other intangible assets, Beginning Balance | 1,458 | 1,481 | 1,458 | 1,481 | 1,170 | ||||||
Goodwill and other intangible assets, Acquisitions | 19 | 318 | |||||||||
Goodwill and other intangible assets, Foreign currency translation and other | (23) | (7) | |||||||||
Goodwill and other intangible assets, Sales, foreign currency translation, amortization and other | (3) | ||||||||||
Goodwill and other intangible assets, Ending Balance | 1,474 | 1,458 | 1,474 | 1,458 | 1,481 | ||||||
American Group [Member] | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Revenues | 20,912 | 19,670 | 18,875 | ||||||||
Equity in earnings of affiliates | (37) | (38) | (32) | ||||||||
Adjusted segment EBITDA | 4,231 | 4,173 | 4,207 | ||||||||
Depreciation and amortization | 986 | 908 | 885 | ||||||||
Assets | 18,136 | 16,208 | 18,136 | 16,208 | 15,240 | ||||||
Goodwill and other intangible assets, Beginning Balance | 4,661 | 4,638 | 4,661 | 4,638 | 4,614 | ||||||
Goodwill and other intangible assets, Acquisitions | 612 | 33 | 27 | ||||||||
Goodwill and other intangible assets, Foreign currency translation and other | (10) | (3) | |||||||||
Goodwill and other intangible assets, Sales, foreign currency translation, amortization and other | (8) | ||||||||||
Goodwill and other intangible assets, Ending Balance | 5,265 | 4,661 | 5,265 | 4,661 | 4,638 | ||||||
Corporate and Other [Member] | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Revenues | 1,930 | 1,975 | 2,047 | ||||||||
Equity in earnings of affiliates | 13 | 4 | (7) | ||||||||
Adjusted segment EBITDA | (598) | (520) | (563) | ||||||||
Depreciation and amortization | 278 | 252 | 250 | ||||||||
Assets | 5,360 | 5,230 | 5,360 | 5,230 | 6,172 | ||||||
Goodwill and other intangible assets, Beginning Balance | $ 585 | $ 612 | 585 | 612 | 632 | ||||||
Goodwill and other intangible assets, Acquisitions | 62 | 8 | |||||||||
Goodwill and other intangible assets, Foreign currency translation and other | (35) | (20) | |||||||||
Goodwill and other intangible assets, Sales, foreign currency translation, amortization and other | 8 | ||||||||||
Goodwill and other intangible assets, Ending Balance | $ 655 | $ 585 | $ 655 | $ 585 | $ 612 |
Other Comprehensive Loss - Comp
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Equity [Abstract] | |||
Unrealized gains on available-for-sale securities, beginning balances | $ 7 | $ 13 | $ 13 |
Unrealized gains (losses) on available-for-sale securities, net of income taxes | 1 | (6) | |
Unrealized gains on available-for-sale securities, ending balances | 7 | 13 | |
Foreign currency translation adjustments, beginning balances | (211) | (74) | (36) |
Foreign currency translation adjustments | 62 | (137) | (38) |
Foreign currency translation adjustments, ending balances | (149) | (211) | (74) |
Defined benefit plans, beginning balances | (146) | (135) | (174) |
Defined benefit plans | (33) | (22) | 19 |
Defined benefit plans, (income) expense reclassified into operations from other comprehensive income | 11 | 11 | 20 |
Defined benefit plans, ending balances | (168) | (146) | (135) |
Change in fair value of derivative instruments, beginning balances | 12 | (69) | (126) |
Change in fair value of derivative instruments | 7 | 12 | (22) |
Change in fair value of derivatives instruments, (income) expense reclassified into operations from other comprehensive income | 13 | 69 | 79 |
Change in fair value of derivative instruments, ending balances | 32 | 12 | (69) |
Accumulated other comprehensive income (loss), net of tax, beginning balances | (338) | (265) | (323) |
Unrealized gains (losses) on available-for-sale securities, net of income taxes | 1 | (6) | |
Foreign currency translation adjustments | 62 | (137) | (38) |
Defined benefit plans | (33) | (22) | 19 |
Change in fair value of derivative instruments, net of income tax benefit | 7 | 12 | (22) |
Expense (income) reclassified into operations from other comprehensive income, Total | 23 | 80 | 99 |
Accumulated other comprehensive income (loss), net of tax, ending balances | $ (278) | $ (338) | $ (265) |
Other Comprehensive Loss - Co72
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Equity [Abstract] | |||
Unrealized gains (losses) on available-for-sale securities, tax portion | $ 3 | $ 1 | |
Foreign currency translation adjustments, income tax benefit | $ 35 | 87 | 25 |
Defined benefit plans, income tax expense (benefit) | (10) | 13 | 11 |
Change in fair value of derivative instruments, income tax expense (benefit) | 4 | (8) | (14) |
Defined benefit plans, Expense reclassified into operations from other comprehensive income, Income tax benefits | 7 | 7 | 12 |
Change in fair value of derivative instruments, Expense reclassified into operations from other comprehensive income, Income tax benefits | 7 | $ 40 | $ 46 |
Expense (income) reclassified into operations from other comprehensive income, net of tax | $ 1 |
Accrued Expenses and Allowanc73
Accrued Expenses and Allowance for Doubtful Accounts - Summary of Other Accrued Expenses (Detail) - USD ($) $ in Millions | Dec. 31, 2017 | Dec. 31, 2016 |
Payables and Accruals [Abstract] | ||
Professional liability risks | $ 429 | $ 391 |
Interest | 406 | 409 |
Taxes other than income | 299 | 283 |
Other | 849 | 952 |
Other accrued expenses | $ 1,983 | $ 2,035 |
Accrued Expenses and Allowanc74
Accrued Expenses and Allowance for Doubtful Accounts - Summary of Allowance of Doubtful Accounts (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Payables and Accruals [Abstract] | |||
Balance at Beginning of Year | $ 4,988 | $ 5,326 | $ 5,011 |
Provision for Doubtful Accounts | 4,039 | 3,257 | 3,913 |
Accounts Written off, Net of Recoveries | (3,539) | (3,595) | (3,598) |
Balance at End of Year | $ 5,488 | $ 4,988 | $ 5,326 |
Supplemental Condensed Consol75
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Additional Information (Detail) - USD ($) | Dec. 31, 2017 | Dec. 06, 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 | $ 1,000,000,000 |
Debt instrument, stated interest | 6.25% |
Supplemental Condensed Consol76
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Comprehensive Income Statement (Detail) - USD ($) $ in Millions | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Condensed Statement of Income Captions [Line Items] | |||||||||||
Revenues before provision for doubtful accounts | $ 47,653 | $ 44,747 | $ 43,591 | ||||||||
Provision for doubtful accounts | 4,039 | 3,257 | 3,913 | ||||||||
Revenues | $ 11,562 | $ 10,696 | $ 10,733 | $ 10,623 | $ 10,641 | $ 10,270 | $ 10,319 | $ 10,260 | 43,614 | 41,490 | 39,678 |
Salaries and benefits | 20,059 | 18,897 | 18,115 | ||||||||
Supplies | 7,316 | 6,933 | 6,638 | ||||||||
Other operating expenses | 8,051 | 7,496 | 7,056 | ||||||||
Equity in earnings of affiliates | (45) | (54) | (46) | ||||||||
Depreciation and amortization | 2,131 | 1,966 | 1,904 | ||||||||
Interest expense | 1,690 | 1,707 | 1,665 | ||||||||
Losses (gains) on sales of facilities | 1 | 4 | 1 | 1 | 15 | 2 | 4 | 2 | (8) | (23) | 5 |
Losses on retirement of debt | 25 | 2 | 39 | 4 | 135 | ||||||
Legal claim costs (benefits) | (246) | 249 | |||||||||
Total expenses including equity in earnings of affiliates | 39,233 | 36,680 | 35,721 | ||||||||
Income (loss) before income taxes | 4,381 | 4,810 | 3,957 | ||||||||
Provision (benefit) for income taxes | 1,638 | 1,378 | 1,261 | ||||||||
Net income (loss) | 641 | 530 | 795 | 777 | 1,085 | 745 | 791 | 811 | 2,743 | 3,432 | 2,696 |
Net income attributable to noncontrolling interests | 527 | 542 | 567 | ||||||||
Net income (loss) attributable to HCA Healthcare, Inc. | $ 474 | $ 426 | $ 657 | $ 659 | $ 920 | $ 618 | $ 658 | $ 694 | 2,216 | 2,890 | 2,129 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 2,276 | 2,817 | 2,187 | ||||||||
HCA Healthcare, Inc. Issuer [Member] | |||||||||||
Condensed Statement of Income Captions [Line Items] | |||||||||||
Other operating expenses | 6 | 6 | (2) | ||||||||
Equity in earnings of affiliates | (2,476) | (2,738) | (2,352) | ||||||||
Interest expense | 64 | 64 | 115 | ||||||||
Losses on retirement of debt | 122 | ||||||||||
Legal claim costs (benefits) | 120 | ||||||||||
Total expenses including equity in earnings of affiliates | (2,406) | (2,668) | (1,997) | ||||||||
Income (loss) before income taxes | 2,406 | 2,668 | 1,997 | ||||||||
Provision (benefit) for income taxes | 190 | (222) | (132) | ||||||||
Net income (loss) | 2,216 | 2,890 | 2,129 | ||||||||
Net income (loss) attributable to HCA Healthcare, Inc. | 2,216 | 2,890 | 2,129 | ||||||||
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 2,276 | 2,817 | 2,187 | ||||||||
HCA Inc. Issuer [Member] | |||||||||||
Condensed Statement of Income Captions [Line Items] | |||||||||||
Interest expense | 3,088 | 2,756 | 2,445 | ||||||||
Losses on retirement of debt | 39 | 4 | 13 | ||||||||
Legal claim costs (benefits) | (246) | 129 | |||||||||
Total expenses including equity in earnings of affiliates | 3,127 | 2,514 | 2,587 | ||||||||
Income (loss) before income taxes | (3,127) | (2,514) | (2,587) | ||||||||
Provision (benefit) for income taxes | (1,154) | (928) | (962) | ||||||||
Net income (loss) | (1,973) | (1,586) | (1,625) | ||||||||
Net income (loss) attributable to HCA Healthcare, Inc. | (1,973) | (1,586) | (1,625) | ||||||||
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | (1,953) | (1,505) | (1,568) | ||||||||
Subsidiary Guarantors [Member] | |||||||||||
Condensed Statement of Income Captions [Line Items] | |||||||||||
Revenues before provision for doubtful accounts | 27,992 | 26,468 | 25,711 | ||||||||
Provision for doubtful accounts | 2,218 | 2,041 | 2,329 | ||||||||
Revenues | 25,774 | 24,427 | 23,382 | ||||||||
Salaries and benefits | 11,619 | 10,971 | 10,593 | ||||||||
Supplies | 4,286 | 4,090 | 3,933 | ||||||||
Other operating expenses | 4,249 | 3,912 | 3,685 | ||||||||
Equity in earnings of affiliates | (6) | (7) | (8) | ||||||||
Depreciation and amortization | 1,237 | 1,141 | 1,085 | ||||||||
Interest expense | (1,309) | (970) | (816) | ||||||||
Losses (gains) on sales of facilities | (2) | 4 | |||||||||
Management fees | (621) | (588) | (515) | ||||||||
Total expenses including equity in earnings of affiliates | 19,453 | 18,553 | 17,957 | ||||||||
Income (loss) before income taxes | 6,321 | 5,874 | 5,425 | ||||||||
Provision (benefit) for income taxes | 2,293 | 2,133 | 1,983 | ||||||||
Net income (loss) | 4,028 | 3,741 | 3,442 | ||||||||
Net income attributable to noncontrolling interests | 108 | 93 | 92 | ||||||||
Net income (loss) attributable to HCA Healthcare, Inc. | 3,920 | 3,648 | 3,350 | ||||||||
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 3,898 | 3,637 | 3,389 | ||||||||
Subsidiary Non-Guarantors [Member] | |||||||||||
Condensed Statement of Income Captions [Line Items] | |||||||||||
Revenues before provision for doubtful accounts | 19,661 | 18,279 | 17,880 | ||||||||
Provision for doubtful accounts | 1,821 | 1,216 | 1,584 | ||||||||
Revenues | 17,840 | 17,063 | 16,296 | ||||||||
Salaries and benefits | 8,440 | 7,926 | 7,522 | ||||||||
Supplies | 3,030 | 2,843 | 2,705 | ||||||||
Other operating expenses | 3,796 | 3,578 | 3,373 | ||||||||
Equity in earnings of affiliates | (39) | (47) | (38) | ||||||||
Depreciation and amortization | 894 | 825 | 819 | ||||||||
Interest expense | (153) | (143) | (79) | ||||||||
Losses (gains) on sales of facilities | (6) | (27) | 5 | ||||||||
Management fees | 621 | 588 | 515 | ||||||||
Total expenses including equity in earnings of affiliates | 16,583 | 15,543 | 14,822 | ||||||||
Income (loss) before income taxes | 1,257 | 1,520 | 1,474 | ||||||||
Provision (benefit) for income taxes | 309 | 395 | 372 | ||||||||
Net income (loss) | 948 | 1,125 | 1,102 | ||||||||
Net income attributable to noncontrolling interests | 419 | 449 | 475 | ||||||||
Net income (loss) attributable to HCA Healthcare, Inc. | 529 | 676 | 627 | ||||||||
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 591 | 533 | 589 | ||||||||
Eliminations [Member] | |||||||||||
Condensed Statement of Income Captions [Line Items] | |||||||||||
Equity in earnings of affiliates | 2,476 | 2,738 | 2,352 | ||||||||
Total expenses including equity in earnings of affiliates | 2,476 | 2,738 | 2,352 | ||||||||
Income (loss) before income taxes | (2,476) | (2,738) | (2,352) | ||||||||
Net income (loss) | (2,476) | (2,738) | (2,352) | ||||||||
Net income (loss) attributable to HCA Healthcare, Inc. | (2,476) | (2,738) | (2,352) | ||||||||
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | $ (2,536) | $ (2,665) | $ (2,410) |
Supplemental Condensed Consol77
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Balance Sheet (Detail) - USD ($) $ in Millions | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 |
Current assets: | ||||
Cash and cash equivalents | $ 732 | $ 646 | $ 741 | $ 566 |
Accounts receivable, net | 6,501 | 5,826 | ||
Inventories | 1,573 | 1,503 | ||
Other | 1,171 | 1,111 | ||
Total current assets | 9,977 | 9,086 | ||
Property and equipment, net | 17,895 | 16,352 | ||
Investments of insurance subsidiaries | 418 | 336 | ||
Investments in and advances to affiliates | 199 | 206 | ||
Goodwill and other intangible assets | 7,394 | 6,704 | 6,731 | 6,416 |
Other | 710 | 1,074 | ||
Total assets | 36,593 | 33,758 | 32,744 | |
Current liabilities: | ||||
Accounts payable | 2,606 | 2,318 | ||
Accrued salaries | 1,369 | 1,265 | ||
Other accrued expenses | 1,983 | 2,035 | ||
Long-term debt due within one year | 200 | 216 | ||
Total current liabilities | 6,158 | 5,834 | ||
Long-term debt, net | 32,858 | 31,160 | ||
Professional liability risks | 1,198 | 1,148 | ||
Income taxes and other liabilities | 1,374 | 1,249 | ||
Total liabilities | 41,588 | 39,391 | ||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (6,806) | (7,302) | ||
Noncontrolling interests | 1,811 | 1,669 | ||
Total stockholders' deficit | (4,995) | (5,633) | (6,046) | (6,498) |
Total liabilities and stockholders' deficit | 36,593 | 33,758 | ||
HCA Healthcare, Inc. Issuer [Member] | ||||
Current assets: | ||||
Cash and cash equivalents | 1 | |||
Total current assets | 1 | |||
Investments in and advances to affiliates | 29,581 | 27,045 | ||
Other | 510 | 877 | ||
Total assets | 30,092 | 27,922 | ||
Current liabilities: | ||||
Other accrued expenses | 29 | 29 | ||
Total current liabilities | 29 | 29 | ||
Long-term debt, net | 995 | 993 | ||
Intercompany balances | 35,322 | 33,784 | ||
Income taxes and other liabilities | 552 | 418 | ||
Total liabilities | 36,898 | 35,224 | ||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (6,806) | (7,302) | ||
Total stockholders' deficit | (6,806) | (7,302) | ||
Total liabilities and stockholders' deficit | 30,092 | 27,922 | ||
HCA Inc. Issuer [Member] | ||||
Current assets: | ||||
Other | 50 | |||
Total assets | 50 | |||
Current liabilities: | ||||
Other accrued expenses | 378 | 572 | ||
Long-term debt due within one year | 97 | 97 | ||
Total current liabilities | 475 | 669 | ||
Long-term debt, net | 31,367 | 29,693 | ||
Intercompany balances | (9,742) | (10,277) | ||
Income taxes and other liabilities | 12 | |||
Total liabilities | 22,100 | 20,097 | ||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (22,050) | (20,097) | ||
Total stockholders' deficit | (22,050) | (20,097) | ||
Total liabilities and stockholders' deficit | 50 | |||
Subsidiary Guarantors [Member] | ||||
Current assets: | ||||
Cash and cash equivalents | 112 | 113 | 160 | 89 |
Accounts receivable, net | 3,693 | 3,388 | ||
Inventories | 1,030 | 1,001 | ||
Other | 663 | 592 | ||
Total current assets | 5,498 | 5,094 | ||
Property and equipment, net | 11,110 | 10,464 | ||
Investments in and advances to affiliates | 22 | 24 | ||
Goodwill and other intangible assets | 4,893 | 4,612 | ||
Other | 47 | 43 | ||
Total assets | 21,570 | 20,237 | ||
Current liabilities: | ||||
Accounts payable | 1,793 | 1,607 | ||
Accrued salaries | 862 | 811 | ||
Other accrued expenses | 536 | 528 | ||
Long-term debt due within one year | 64 | 72 | ||
Total current liabilities | 3,255 | 3,018 | ||
Long-term debt, net | 307 | 304 | ||
Intercompany balances | (25,228) | (22,495) | ||
Income taxes and other liabilities | 357 | 397 | ||
Total liabilities | (21,309) | (18,776) | ||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 42,755 | 38,857 | ||
Noncontrolling interests | 124 | 156 | ||
Total stockholders' deficit | 42,879 | 39,013 | ||
Total liabilities and stockholders' deficit | 21,570 | 20,237 | ||
Subsidiary Non-Guarantors [Member] | ||||
Current assets: | ||||
Cash and cash equivalents | 619 | 533 | $ 581 | $ 477 |
Accounts receivable, net | 2,808 | 2,438 | ||
Inventories | 543 | 502 | ||
Other | 508 | 519 | ||
Total current assets | 4,478 | 3,992 | ||
Property and equipment, net | 6,785 | 5,888 | ||
Investments of insurance subsidiaries | 418 | 336 | ||
Investments in and advances to affiliates | 177 | 182 | ||
Goodwill and other intangible assets | 2,501 | 2,092 | ||
Other | 103 | 154 | ||
Total assets | 14,462 | 12,644 | ||
Current liabilities: | ||||
Accounts payable | 813 | 711 | ||
Accrued salaries | 507 | 454 | ||
Other accrued expenses | 1,040 | 906 | ||
Long-term debt due within one year | 39 | 47 | ||
Total current liabilities | 2,399 | 2,118 | ||
Long-term debt, net | 189 | 170 | ||
Intercompany balances | (352) | (1,012) | ||
Professional liability risks | 1,198 | 1,148 | ||
Income taxes and other liabilities | 465 | 422 | ||
Total liabilities | 3,899 | 2,846 | ||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 8,876 | 8,285 | ||
Noncontrolling interests | 1,687 | 1,513 | ||
Total stockholders' deficit | 10,563 | 9,798 | ||
Total liabilities and stockholders' deficit | 14,462 | 12,644 | ||
Eliminations [Member] | ||||
Current assets: | ||||
Investments in and advances to affiliates | (29,581) | (27,045) | ||
Total assets | (29,581) | (27,045) | ||
Current liabilities: | ||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (29,581) | (27,045) | ||
Total stockholders' deficit | (29,581) | (27,045) | ||
Total liabilities and stockholders' deficit | $ (29,581) | $ (27,045) |
Supplemental Condensed Consol78
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 | 12 Months Ended | |||||||||
Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Cash flows from operating activities: | |||||||||||
Net income (loss) | $ 641 | $ 530 | $ 795 | $ 777 | $ 1,085 | $ 745 | $ 791 | $ 811 | $ 2,743 | $ 3,432 | $ 2,696 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||
Change in operating assets and liabilities | (4,335) | (3,215) | (4,236) | ||||||||
Provision for doubtful accounts | 4,039 | 3,257 | 3,913 | ||||||||
Depreciation and amortization | 2,131 | 1,966 | 1,904 | ||||||||
Income taxes | 433 | 123 | (160) | ||||||||
Losses (gains) on sales of facilities | 1 | 4 | $ 1 | 1 | 15 | 2 | $ 4 | 2 | (8) | (23) | 5 |
Losses on retirement of debt | $ 25 | $ 2 | 39 | 4 | 135 | ||||||
Legal claim costs (benefits) | (246) | 249 | |||||||||
Legal claim costs | 149 | ||||||||||
Amortization of debt issuance costs | 31 | 34 | 35 | ||||||||
Share-based compensation | 270 | 251 | 239 | ||||||||
Other | 83 | 70 | 54 | ||||||||
Net cash provided by (used in) operating activities | 5,426 | 5,653 | 4,734 | ||||||||
Cash flows from investing activities: | |||||||||||
Purchase of property and equipment | (3,015) | (2,760) | (2,375) | ||||||||
Acquisition of hospitals and health care entities | (1,212) | (576) | (351) | ||||||||
Disposal of hospitals and health care entities | 25 | 26 | 73 | ||||||||
Change in investments | (73) | 64 | 63 | ||||||||
Other | (4) | 6 | 7 | ||||||||
Net cash used in investing activities | (4,279) | (3,240) | (2,583) | ||||||||
Cash flows from financing activities: | |||||||||||
Issuance of long-term debt | 1,502 | 5,400 | 5,548 | ||||||||
Net change in revolving bank credit facilities | 760 | (110) | 150 | ||||||||
Repayment of long-term debt | (753) | (4,475) | (4,920) | ||||||||
Distributions to noncontrolling interests | (448) | (434) | (495) | ||||||||
Payment of debt issuance costs | (26) | (40) | (50) | ||||||||
Repurchases of common stock | (2,051) | (2,751) | (2,397) | ||||||||
Other | (45) | (98) | 188 | ||||||||
Net cash (used in) provided by financing activities | (1,061) | (2,508) | (1,976) | ||||||||
Change in cash and cash equivalents | 86 | (95) | 175 | ||||||||
Cash and cash equivalents at beginning of period | 646 | 741 | 646 | 741 | 566 | ||||||
Cash and cash equivalents at end of period | 732 | 646 | 732 | 646 | 741 | ||||||
Eliminations [Member] | |||||||||||
Cash flows from operating activities: | |||||||||||
Net income (loss) | (2,476) | (2,738) | (2,352) | ||||||||
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||
Equity in earnings of affiliates | 2,476 | 2,738 | 2,352 | ||||||||
HCA Healthcare, Inc. Issuer [Member] | |||||||||||
Cash flows from operating activities: | |||||||||||
Net income (loss) | 2,216 | 2,890 | 2,129 | ||||||||
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||
Change in operating assets and liabilities | (25) | (12) | |||||||||
Income taxes | 433 | 123 | (160) | ||||||||
Losses on retirement of debt | 122 | ||||||||||
Legal claim costs (benefits) | 120 | ||||||||||
Legal claim costs | 20 | ||||||||||
Amortization of debt issuance costs | 1 | 3 | |||||||||
Equity in earnings of affiliates | (2,476) | (2,738) | (2,352) | ||||||||
Other | 78 | 71 | 66 | ||||||||
Net cash provided by (used in) operating activities | 251 | 322 | (184) | ||||||||
Cash flows from financing activities: | |||||||||||
Repayment of long-term debt | (1,632) | ||||||||||
Repurchases of common stock | (2,051) | (2,751) | (2,397) | ||||||||
Changes in intercompany balances with affiliates, net | 1,867 | 2,532 | 4,006 | ||||||||
Other | (66) | (103) | 207 | ||||||||
Net cash (used in) provided by financing activities | (250) | (322) | 184 | ||||||||
Change in cash and cash equivalents | 1 | ||||||||||
Cash and cash equivalents at end of period | 1 | 1 | |||||||||
HCA Inc. Issuer [Member] | |||||||||||
Cash flows from operating activities: | |||||||||||
Net income (loss) | (1,973) | (1,586) | (1,625) | ||||||||
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||
Change in operating assets and liabilities | (193) | 39 | 44 | ||||||||
Losses on retirement of debt | 39 | 4 | 13 | ||||||||
Legal claim costs (benefits) | (246) | 129 | |||||||||
Legal claim costs | 129 | ||||||||||
Amortization of debt issuance costs | 31 | 33 | 32 | ||||||||
Other | 3 | ||||||||||
Net cash provided by (used in) operating activities | (2,096) | (1,756) | (1,404) | ||||||||
Cash flows from financing activities: | |||||||||||
Issuance of long-term debt | 1,500 | 5,400 | 5,548 | ||||||||
Net change in revolving bank credit facilities | 760 | (110) | 150 | ||||||||
Repayment of long-term debt | (628) | (4,358) | (3,189) | ||||||||
Payment of debt issuance costs | (26) | (40) | (50) | ||||||||
Changes in intercompany balances with affiliates, net | 490 | 864 | (1,055) | ||||||||
Net cash (used in) provided by financing activities | 2,096 | 1,756 | 1,404 | ||||||||
Subsidiary Guarantors [Member] | |||||||||||
Cash flows from operating activities: | |||||||||||
Net income (loss) | 4,028 | 3,741 | 3,442 | ||||||||
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||
Change in operating assets and liabilities | (2,437) | (2,180) | (2,786) | ||||||||
Provision for doubtful accounts | 2,218 | 2,041 | 2,329 | ||||||||
Depreciation and amortization | 1,237 | 1,141 | 1,085 | ||||||||
Losses (gains) on sales of facilities | (2) | 4 | |||||||||
Share-based compensation | 270 | 251 | 239 | ||||||||
Other | (5) | ||||||||||
Net cash provided by (used in) operating activities | 5,314 | 4,998 | 4,304 | ||||||||
Cash flows from investing activities: | |||||||||||
Purchase of property and equipment | (1,681) | (1,554) | (1,560) | ||||||||
Acquisition of hospitals and health care entities | (26) | (199) | (51) | ||||||||
Disposal of hospitals and health care entities | 14 | 10 | 48 | ||||||||
Change in investments | (1) | (15) | 7 | ||||||||
Other | (6) | ||||||||||
Net cash used in investing activities | (1,694) | (1,758) | (1,562) | ||||||||
Cash flows from financing activities: | |||||||||||
Repayment of long-term debt | (77) | (74) | (60) | ||||||||
Distributions to noncontrolling interests | (140) | (64) | (85) | ||||||||
Changes in intercompany balances with affiliates, net | (3,404) | (3,149) | (2,526) | ||||||||
Net cash (used in) provided by financing activities | (3,621) | (3,287) | (2,671) | ||||||||
Change in cash and cash equivalents | (1) | (47) | 71 | ||||||||
Cash and cash equivalents at beginning of period | 113 | 160 | 113 | 160 | 89 | ||||||
Cash and cash equivalents at end of period | 112 | 113 | 112 | 113 | 160 | ||||||
Subsidiary Non-Guarantors [Member] | |||||||||||
Cash flows from operating activities: | |||||||||||
Net income (loss) | 948 | 1,125 | 1,102 | ||||||||
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | |||||||||||
Change in operating assets and liabilities | (1,705) | (1,049) | (1,482) | ||||||||
Provision for doubtful accounts | 1,821 | 1,216 | 1,584 | ||||||||
Depreciation and amortization | 894 | 825 | 819 | ||||||||
Losses (gains) on sales of facilities | (6) | (27) | 5 | ||||||||
Other | 5 | (1) | (10) | ||||||||
Net cash provided by (used in) operating activities | 1,957 | 2,089 | 2,018 | ||||||||
Cash flows from investing activities: | |||||||||||
Purchase of property and equipment | (1,334) | (1,206) | (815) | ||||||||
Acquisition of hospitals and health care entities | (1,186) | (377) | (300) | ||||||||
Disposal of hospitals and health care entities | 11 | 16 | 25 | ||||||||
Change in investments | (72) | 79 | 56 | ||||||||
Other | (4) | 6 | 13 | ||||||||
Net cash used in investing activities | (2,585) | (1,482) | (1,021) | ||||||||
Cash flows from financing activities: | |||||||||||
Issuance of long-term debt | 2 | ||||||||||
Repayment of long-term debt | (48) | (43) | (39) | ||||||||
Distributions to noncontrolling interests | (308) | (370) | (410) | ||||||||
Changes in intercompany balances with affiliates, net | 1,047 | (247) | (425) | ||||||||
Other | 21 | 5 | (19) | ||||||||
Net cash (used in) provided by financing activities | 714 | (655) | (893) | ||||||||
Change in cash and cash equivalents | 86 | (48) | 104 | ||||||||
Cash and cash equivalents at beginning of period | $ 533 | $ 581 | 533 | 581 | 477 | ||||||
Cash and cash equivalents at end of period | $ 619 | $ 533 | $ 619 | $ 533 | $ 581 |
Supplemental Condensed Consol79
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Summary of Restatement Adjustments to Financial Statements (Detail) - USD ($) $ in Millions | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | $ 474 | $ 426 | $ 657 | $ 659 | $ 920 | $ 618 | $ 658 | $ 694 | $ 2,216 | $ 2,890 | $ 2,129 |
Total assets | 36,593 | 33,758 | 36,593 | 33,758 | 32,744 | ||||||
Total liabilities | 41,588 | 39,391 | 41,588 | 39,391 | |||||||
Net cash provided (used in) operating activities | 5,426 | 5,653 | 4,734 | ||||||||
HCA Healthcare, Inc. Issuer [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | 2,216 | 2,890 | 2,129 | ||||||||
Total assets | 30,092 | 27,922 | 30,092 | 27,922 | |||||||
Total liabilities | 36,898 | 35,224 | 36,898 | 35,224 | |||||||
Net cash provided (used in) operating activities | 251 | 322 | (184) | ||||||||
HCA Inc. Issuer [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | (1,973) | (1,586) | (1,625) | ||||||||
Total assets | 50 | 50 | |||||||||
Total liabilities | 22,100 | 20,097 | 22,100 | 20,097 | |||||||
Net cash provided (used in) operating activities | (2,096) | (1,756) | (1,404) | ||||||||
Subsidiary Guarantors [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | 3,920 | 3,648 | 3,350 | ||||||||
Total assets | 21,570 | 20,237 | 21,570 | 20,237 | |||||||
Total liabilities | (21,309) | (18,776) | (21,309) | (18,776) | |||||||
Net cash provided (used in) operating activities | 5,314 | 4,998 | 4,304 | ||||||||
Subsidiary Non-Guarantors [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | 529 | 676 | 627 | ||||||||
Total assets | 14,462 | 12,644 | 14,462 | 12,644 | |||||||
Total liabilities | 3,899 | 2,846 | 3,899 | 2,846 | |||||||
Net cash provided (used in) operating activities | 1,957 | 2,089 | 2,018 | ||||||||
Eliminations [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | (2,476) | (2,738) | (2,352) | ||||||||
Total assets | $ (29,581) | (27,045) | $ (29,581) | (27,045) | |||||||
As Previously Reported [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | 2,890 | 2,129 | |||||||||
Total assets | 33,758 | 33,758 | |||||||||
Total liabilities | 39,391 | 39,391 | |||||||||
Net cash provided (used in) operating activities | 5,653 | 4,734 | |||||||||
As Previously Reported [Member] | HCA Healthcare, Inc. Issuer [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | 2,890 | 2,129 | |||||||||
Total assets | 27,922 | 27,922 | |||||||||
Total liabilities | 35,224 | 35,224 | |||||||||
Net cash provided (used in) operating activities | 322 | (184) | |||||||||
As Previously Reported [Member] | HCA Inc. Issuer [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | (1,586) | (1,625) | |||||||||
Total liabilities | 20,097 | 20,097 | |||||||||
Net cash provided (used in) operating activities | (1,756) | (1,404) | |||||||||
As Previously Reported [Member] | Subsidiary Guarantors [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | 3,235 | 2,970 | |||||||||
Total assets | 14,714 | 14,714 | |||||||||
Total liabilities | (23,194) | (23,194) | |||||||||
Net cash provided (used in) operating activities | 4,425 | 3,772 | |||||||||
As Previously Reported [Member] | Subsidiary Non-Guarantors [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | 1,089 | 1,007 | |||||||||
Total assets | 18,167 | 18,167 | |||||||||
Total liabilities | 7,264 | 7,264 | |||||||||
Net cash provided (used in) operating activities | 2,662 | 2,550 | |||||||||
As Previously Reported [Member] | Eliminations [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | (2,738) | (2,352) | |||||||||
Total assets | (27,045) | (27,045) | |||||||||
Adjustment [Member] | Subsidiary Guarantors [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | 413 | 380 | |||||||||
Total assets | 5,523 | 5,523 | |||||||||
Total liabilities | 4,418 | 4,418 | |||||||||
Net cash provided (used in) operating activities | 573 | 532 | |||||||||
Adjustment [Member] | Subsidiary Non-Guarantors [Member] | |||||||||||
Adjustments or Reclassifications [Line Items] | |||||||||||
Net income (loss) attributable to HCA Healthcare, Inc | (413) | (380) | |||||||||
Total assets | (5,523) | (5,523) | |||||||||
Total liabilities | $ (4,418) | (4,418) | |||||||||
Net cash provided (used in) operating activities | $ (573) | $ (532) |
Supplemental Condensed Consol80
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Summary of Restatement Adjustments to Financial Statements (Parenthetical) (Detail) - USD ($) $ in Millions | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 |
Adjustments or Reclassifications [Line Items] | ||||
Goodwill and other intangible assets | $ 7,394 | $ 6,704 | $ 6,731 | $ 6,416 |
Property and equipment, net | 17,895 | 16,352 | ||
Subsidiary Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Goodwill and other intangible assets | 4,893 | 4,612 | ||
Property and equipment, net | 11,110 | 10,464 | ||
Intercompany balances | (25,228) | (22,495) | ||
Subsidiary Guarantors [Member] | Adjustment [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Goodwill and other intangible assets | 2,884 | |||
Property and equipment, net | 2,001 | |||
Subsidiary Non-Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Goodwill and other intangible assets | 2,501 | 2,092 | ||
Property and equipment, net | 6,785 | 5,888 | ||
Intercompany balances | $ (352) | (1,012) | ||
Subsidiary Non-Guarantors [Member] | Adjustment [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Goodwill and other intangible assets | 2,884 | |||
Property and equipment, net | 2,001 | |||
Intercompany balances | $ 3,952 |
Supplemental Condensed Consol81
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Consolidated Statements of Stockholder's Deficit (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Share-based benefit plans | $ 281 | $ 233 | $ 523 |
Other | 10 | (6) | 18 |
Healthtrust, Inc. [Member] | |||
Share-based benefit plans | 281 | 233 | 523 |
Other | (10) | (2) | (18) |
Distributions from HCA Holdings, Inc., net of contributions to HCA Holdings, Inc. | $ 271 | $ 231 | $ 505 |
Quarterly Consolidated Financia
Quarterly Consolidated Financial Information - Schedule of Quarterly Consolidated Financial Information (Detail) - USD ($) $ / shares in Units, $ in Millions | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Quarterly Financial Information Disclosure [Abstract] | |||||||||||
Revenues | $ 11,562 | $ 10,696 | $ 10,733 | $ 10,623 | $ 10,641 | $ 10,270 | $ 10,319 | $ 10,260 | $ 43,614 | $ 41,490 | $ 39,678 |
Net income | 641 | 530 | 795 | 777 | 1,085 | 745 | 791 | 811 | 2,743 | 3,432 | 2,696 |
Net income attributable to HCA Healthcare, Inc. | $ 474 | $ 426 | $ 657 | $ 659 | $ 920 | $ 618 | $ 658 | $ 694 | $ 2,216 | $ 2,890 | $ 2,129 |
Basic earnings per share | $ 1.34 | $ 1.18 | $ 1.79 | $ 1.78 | $ 2.46 | $ 1.63 | $ 1.70 | $ 1.75 | $ 6.12 | $ 7.53 | $ 5.14 |
Diluted earnings per share | $ 1.30 | $ 1.15 | $ 1.75 | $ 1.74 | $ 2.39 | $ 1.59 | $ 1.65 | $ 1.69 | $ 5.95 | $ 7.30 | $ 4.99 |
Quarterly Consolidated Financ83
Quarterly Consolidated Financial Information - Schedule of Quarterly Consolidated Financial Information (Parenthetical) (Detail) - USD ($) $ in Millions | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Quarterly Financial Information Disclosure [Abstract] | |||||||||||
Losses (gains) on sales of facilities | $ 1 | $ 4 | $ 1 | $ 1 | $ 15 | $ 2 | $ 4 | $ 2 | $ (8) | $ (23) | $ 5 |
Losses on retirement of debt | $ 25 | 2 | $ 39 | $ 4 | $ 135 | ||||||
Legal claim costs (benefits), net of tax | $ 176 | $ 7 | $ 7 | $ 7 |