Document and Entity Information
Document and Entity Information - shares | 6 Months Ended | |
Jun. 30, 2018 | Jul. 31, 2018 | |
Document And Entity Information [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Jun. 30, 2018 | |
Document Fiscal Year Focus | 2,018 | |
Document Fiscal Period Focus | Q2 | |
Trading Symbol | HCA | |
Entity Registrant Name | HCA Healthcare, Inc. | |
Entity Central Index Key | 860,730 | |
Current Fiscal Year End Date | --12-31 | |
Entity Filer Category | Large Accelerated Filer | |
Entity Common Stock, Shares Outstanding | 346,046,000 |
Condensed Consolidated Income S
Condensed Consolidated Income Statements - USD ($) shares in Thousands, $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Income Statement [Abstract] | ||||
Revenues | $ 11,529 | $ 10,733 | $ 22,952 | $ 21,356 |
Salaries and benefits | 5,274 | 4,896 | 10,563 | 9,797 |
Supplies | 1,917 | 1,795 | 3,832 | 3,592 |
Other operating expenses | 2,118 | 1,965 | 4,228 | 3,895 |
Equity in earnings of affiliates | (7) | (13) | (16) | (23) |
Depreciation and amortization | 562 | 521 | 1,115 | 1,042 |
Interest expense | 436 | 411 | 867 | 830 |
Gains on sales of facilities | (9) | (2) | (414) | (3) |
Total expenses including equity in earnings of affiliates | 10,291 | 9,573 | 20,175 | 19,130 |
Income before income taxes | 1,238 | 1,160 | 2,777 | 2,226 |
Provision for income taxes | 272 | 365 | 529 | 654 |
Net income | 966 | 795 | 2,248 | 1,572 |
Net income attributable to noncontrolling interests | 146 | 138 | 284 | 256 |
Net income attributable to HCA Healthcare, Inc. | $ 820 | $ 657 | $ 1,964 | $ 1,316 |
Per share data: | ||||
Basic earnings | $ 2.35 | $ 1.79 | $ 5.62 | $ 3.58 |
Diluted earnings | 2.31 | 1.75 | 5.50 | 3.48 |
Shares used in earnings per share calculations (in millions): | ||||
Cash dividends declared per share | $ 0.35 | $ 0 | $ 0.70 | $ 0 |
Basic | 348,615 | 365,847 | 349,726 | 368,056 |
Diluted | 355,039 | 375,338 | 357,388 | 377,647 |
Condensed Consolidated Comprehe
Condensed Consolidated Comprehensive Income Statements - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Statement of Comprehensive Income [Abstract] | ||||
Net income | $ 966 | $ 795 | $ 2,248 | $ 1,572 |
Other comprehensive income (loss) before taxes: | ||||
Foreign currency translation | (76) | 45 | (22) | 55 |
Unrealized (losses) gains on available-for-sale securities | (1) | 2 | (6) | 5 |
Defined benefit plans | 0 | 0 | 0 | 0 |
Pension costs included in salaries and benefits | 5 | 4 | 10 | 9 |
Total defined benefit plans | 5 | 4 | 10 | 9 |
Change in fair value of derivative financial instruments | 15 | (11) | 50 | (8) |
Interest (benefits) costs included in interest expense | (2) | 6 | (2) | 13 |
Total change in fair value of derivative financial instruments | 13 | (5) | 48 | 5 |
Other comprehensive (loss) income before taxes | (59) | 46 | 30 | 74 |
Income taxes related to other comprehensive income items | 5 | 19 | 13 | 29 |
Other comprehensive (loss) income | (64) | 27 | 17 | 45 |
Comprehensive income | 902 | 822 | 2,265 | 1,617 |
Comprehensive income attributable to noncontrolling interests | 146 | 138 | 284 | 256 |
Comprehensive income attributable to HCA Healthcare, Inc. | $ 756 | $ 684 | $ 1,981 | $ 1,361 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Millions | Jun. 30, 2018 | Dec. 31, 2017 |
Current assets: | ||
Cash and cash equivalents | $ 868 | $ 732 |
Accounts receivable | 6,592 | 6,501 |
Inventories | 1,636 | 1,573 |
Other | 1,298 | 1,171 |
Total current assets | 10,394 | 9,977 |
Property and equipment, at cost | 41,142 | 40,084 |
Accumulated depreciation | (22,598) | (22,189) |
Property and equipment, net | 18,544 | 17,895 |
Investments of insurance subsidiaries | 414 | 418 |
Investments in and advances to affiliates | 234 | 199 |
Goodwill and other intangible assets | 7,459 | 7,394 |
Other | 697 | 710 |
Total assets | 37,742 | 36,593 |
Current liabilities: | ||
Accounts payable | 2,457 | 2,606 |
Accrued salaries | 1,315 | 1,369 |
Other accrued expenses | 2,161 | 1,983 |
Long-term debt due within one year | 1,692 | 200 |
Total current liabilities | 7,625 | 6,158 |
Long-term debt, less net debt issuance costs of $151 and $164 | 31,500 | 32,858 |
Professional liability risks | 1,283 | 1,198 |
Income taxes and other liabilities | 1,459 | 1,374 |
Stockholders' deficit: | ||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 346,760,200 shares in 2018 and 350,091,600 shares in 2017 | 3 | 4 |
Accumulated other comprehensive loss | (261) | (278) |
Retained deficit | (5,731) | (6,532) |
Stockholders' deficit attributable to HCA Healthcare, Inc. | (5,989) | (6,806) |
Noncontrolling interests | 1,864 | 1,811 |
Total stockholders' deficit | (4,125) | (4,995) |
Total liabilities and stockholders' deficit | $ 37,742 | $ 36,593 |
Condensed Consolidated Balance5
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions | Jun. 30, 2018 | Dec. 31, 2017 |
Statement of Financial Position [Abstract] | ||
Debt issuance cost | $ 151 | $ 164 |
Common stock, par value | $ 0.01 | $ 0.01 |
Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 |
Common stock, shares outstanding | 346,760,200 | 350,091,600 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions | 6 Months Ended | |
Jun. 30, 2018 | Jun. 30, 2017 | |
Cash flows from operating activities: | ||
Net income | $ 2,248 | $ 1,572 |
Increase (decrease) in cash from operating assets and liabilities: | ||
Accounts receivable | (233) | 81 |
Inventories and other assets | (200) | (178) |
Accounts payable and accrued expenses | 31 | (298) |
Depreciation and amortization | 1,115 | 1,042 |
Income taxes | 118 | 267 |
Gains on sales of facilities | (414) | (3) |
Amortization of debt issuance costs | 15 | 16 |
Share-based compensation | 134 | 140 |
Other | 51 | 45 |
Net cash provided by (used in) operating activities | 2,865 | 2,684 |
Cash flows from investing activities: | ||
Purchase of property and equipment | (1,574) | (1,304) |
Acquisition of hospitals and health care entities | (538) | (295) |
Disposal of hospitals and health care entities | 799 | 14 |
Change in investments | 23 | (11) |
Other | (25) | 5 |
Net cash used in investing activities | (1,315) | (1,591) |
Cash flows from financing activities: | ||
Issuances of long-term debt | 1,502 | |
Net change in revolving bank credit facilities | 210 | (1,160) |
Repayment of long-term debt | (101) | (95) |
Distributions to noncontrolling interests | (185) | (248) |
Payment of debt issuance costs | (2) | (25) |
Payment of cash dividends | (245) | |
Repurchases of common stock | (893) | (966) |
Other | (192) | (42) |
Net cash (used in) provided by financing activities | (1,408) | (1,034) |
Effect of exchange rate changes on cash and cash equivalents | (6) | |
Change in cash and cash equivalents | 136 | 59 |
Cash and cash equivalents at beginning of period | 732 | 646 |
Cash and cash equivalents at end of period | 868 | 705 |
Interest payments | 873 | 834 |
Income tax payments, net | $ 411 | $ 387 |
Basis of Presentation and Signi
Basis of Presentation and Significant Accounting Policies | 6 Months Ended |
Jun. 30, 2018 | |
Accounting Policies [Abstract] | |
Basis of Presentation and Significant Accounting Policies | NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES Reporting Entity HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At June 30, 2018, these affiliates owned and operated 178 hospitals, 122 freestanding surgery centers and provided extensive outpatient and ancillary services. HCA Healthcare, Inc.’s facilities are located in 20 states and England. The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicated by context, refer to HCA Healthcare, Inc. and its affiliates. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q Regulation S-X. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $83 million and $82 million for the quarters ended June 30, 2018 and 2017, respectively, and $164 million each for the six months ended June 30, 2018 and 2017. Operating results for the quarter and six months ended June 30, 2018 are not necessarily indicative of the results that may be expected for the year ending December 31, 2018. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K Revenues In May 2014, the Financial Accounting Standards Board (“FASB”) issued a new standard related to revenue recognition. We adopted the new standard effective January 1, 2018, using the full retrospective method. The adoption of the new standard did not have an impact on our recognition of net revenues for any periods prior to adoption. The most significant impact of adopting the new standard is to the presentation of our consolidated income statements, where we no longer present the “Provision for doubtful accounts” as a separate line item and our “Revenues” are presented net of estimated implicit price concession revenue deductions. We also have eliminated the related presentation of “allowances for doubtful accounts” on our consolidated balance sheets as a result of the adoption of the new standard. Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual allowances under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record self-pay Quarter 2018 Ratio 2017 Ratio Medicare $ 2,425 21.0 % $ 2,272 21.2 % Managed Medicare 1,345 11.7 1,158 10.8 Medicaid 357 3.1 376 3.5 Managed Medicaid 586 5.1 527 4.9 Managed care and insurers 5,993 51.9 5,729 53.4 International (managed care and insurers) 295 2.6 269 2.5 Other 528 4.6 402 3.7 Revenues $ 11,529 100.0 % $ 10,733 100.0 % Six Months 2018 Ratio 2017 Ratio Medicare $ 4,949 21.6 % $ 4,633 21.7 % Managed Medicare 2,744 12.0 2,341 11.0 Medicaid 638 2.8 670 3.1 Managed Medicaid 1,147 5.0 1,116 5.2 Managed care and insurers 12,055 52.5 11,352 53.2 International (managed care and insurers) 600 2.6 538 2.5 Other 819 3.5 706 3.3 Revenues $ 22,952 100.0 % $ 21,356 100.0 % 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 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 non-elective The collection of outstanding receivables for Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the aging of those accounts. Accounts are written off when all reasonable internal and external collection efforts have been performed. The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period To quantify the total impact of the trends related to uninsured accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and six months ended June 30, 2018 and 2017 follows (dollars in millions): Quarter Six Months 2018 2017 2018 2017 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 9,871 $ 9,177 $ 19,738 $ 18,326 Cost-to-charges 12.6 % 13.0 % 12.5 % 12.9 % Total uncompensated care $ 6,486 $ 5,721 $ 12,738 $ 11,048 Multiply by the cost-to-charges 12.6 % 13.0 % 12.5 % 12.9 % Estimated cost of total uncompensated care $ 817 $ 743 $ 1,592 $ 1,425 Total uncompensated care as a percentage of the sum of revenues and total uncompensated care was 36.0% and 34.8% for the quarters ended June 30, 2018 and 2017, respectively, and 35.7% and 34.1% for the six months ended June 30, 2018 and 2017, respectively. The total uncompensated care amounts include charity care of $1.977 billion and $1.173 billion, and the related estimated costs of charity care were $249 million and $152 million for the quarters ended June 30, 2018 and 2017, respectively, and charity care of $3.856 billion and $2.259 billion, and the related estimated costs of charity care were $482 million and $291 million for the six months ended June 30, 2018 and 2017, respectively. Recent Pronouncements In February 2016, the FASB issued Accounting Standards Update 2016-02, Leases 2016-02”), 2016-02 2016-02 right-of-use Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Acquisitions and Dispositions
Acquisitions and Dispositions | 6 Months Ended |
Jun. 30, 2018 | |
Business Combinations [Abstract] | |
Acquisitions and Dispositions | NOTE 2 — ACQUISITIONS AND DISPOSITIONS During the six months ended June 30, 2018, we paid $360 million to acquire a hospital facility and $178 million to acquire other nonhospital health care entities. During the six months ended June 30, 2017, we paid $189 million to acquire three hospital facilities and $106 million to acquire other nonhospital health care entities. During the six months ended June 30, 2018, we received proceeds of $758 million and recognized a net pretax gain of $372 million related to the sale of the two hospital facilities in our Oklahoma market. During the six months ended June 30, 2018, we also received proceeds of $41 million and recognized a net pretax gain of $42 million related to sales of real estate and other investments. During the six months ended June 30, 2017, we received proceeds of $14 million and recognized a net pretax gain of $3 million related to sales of real estate and other investments. |
Income Taxes
Income Taxes | 6 Months Ended |
Jun. 30, 2018 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | NOTE 3 — INCOME TAXES Our provision for income taxes for the quarters ended June 30, 2018 and 2017, was $272 million and $365 million, respectively, and the effective tax rates were 24.9% and 35.8%, respectively. Our provision for income taxes for the six months ended June 30, 2018 and 2017, was $529 million and $654 million, respectively, and the effective tax rates were 21.2% and 33.2%, respectively. The reductions in the effective tax rates were primarily related to the estimated impact of tax rate changes under the 2017 Tax Cuts and Jobs Act (the “Tax Act”). Our provision for income taxes for the quarter and six months ended June 30, 2018 included tax benefits, of $122 million and $245 million, respectively, related to the reduction in our effective tax rate related to the impact of the Tax Act. Our provision for income taxes also included tax benefits related to the settlement of employee equity awards of $4 million and $9 million for the quarters ended June 30, 2018 and 2017, respectively, and $96 million and $76 million for the six months ended June 30, 2018 and 2017, respectively. The Tax Act was enacted on December 22, 2017, and it significantly revised U.S. corporate income taxes, including lowering the federal statutory corporate tax rate from 35% to 21% beginning in 2018. 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 June 30, 2018. As we complete our analysis of the Tax Act, 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 June 30, 2018. 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. Our liability for unrecognized tax benefits was $461 million, including accrued interest of $54 million, as of June 30, 2018 ($439 million and $44 million, respectively, as of December 31, 2017). Unrecognized tax benefits of $159 million ($145 million as of December 31, 2017) would affect the effective rate, if recognized. We are subject to examination by federal, state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change. |
Earnings Per Share
Earnings Per Share | 6 Months Ended |
Jun. 30, 2018 | |
Earnings Per Share [Abstract] | |
Earnings Per Share | NOTE 4 — EARNINGS PER SHARE We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards and potential shares, computed using the treasury stock method. The following table sets forth the computation of basic and diluted earnings per share for the quarters and six months ended June 30, 2018 and 2017 (dollars and shares in millions, except per share amounts): Quarter Six Months 2018 2017 2018 2017 Net income attributable to HCA Healthcare, Inc. $ 820 $ 657 $ 1,964 $ 1,316 Weighted average common shares outstanding 348.615 365.847 349.726 368.056 Effect of dilutive incremental shares 6.424 9.491 7.662 9.591 Shares used for diluted earnings per share 355.039 375.338 357.388 377.647 Earnings per share: Basic earnings $ 2.35 $ 1.79 $ 5.62 $ 3.58 Diluted earnings $ 2.31 $ 1.75 $ 5.50 $ 3.48 |
Investments of Insurance Subsid
Investments of Insurance Subsidiaries | 6 Months Ended |
Jun. 30, 2018 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments of Insurance Subsidiaries | NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES A summary of our insurance subsidiaries’ investments at June 30, 2018 and December 31, 2017 follows (dollars in millions): June 30, 2018 Amortized Unrealized Fair Gains Losses Debt securities $ 337 $ 5 $ (1 ) $ 341 Money market funds and other 118 — — 118 $ 455 $ 5 $ (1 ) 459 Amounts classified as current assets (45 ) Investment carrying value $ 414 December 31, 2017 Amortized Unrealized Fair Gains Losses 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 At June 30, 2018 and December 31, 2017, the investments of our insurance subsidiaries were classified as “available-for-sale.” Scheduled maturities of investments in debt securities at June 30, 2018 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 24 $ 25 Due after one year through five years 50 50 Due after five years through ten years 218 221 Due after ten years 45 45 $ 337 $ 341 The average expected maturity of the investments in debt securities at June 30, 2018 was 6.5 years, compared to the average scheduled maturity of 8.4 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to their scheduled maturity date. |
Financial Instruments
Financial Instruments | 6 Months Ended |
Jun. 30, 2018 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Financial Instruments | NOTE 6 — FINANCIAL INSTRUMENTS Interest Rate Swap Agreements We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between two parties based on common notional principal amounts and maturity dates. Pay-fixed The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at June 30, 2018 (dollars in millions): Notional Maturity Date Fair Pay-fixed $ 2,000 December 2021 $ 83 Pay-fixed 500 December 2022 15 During the next 12 months, we estimate $20 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 six months ended June 30, 2018 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Gain Location of Gain Amount of Gain Interest rate swaps $ 39 Interest expense $ 2 |
Assets and Liabilities Measured
Assets and Liabilities Measured at Fair Value | 6 Months Ended |
Jun. 30, 2018 | |
Fair Value Disclosures [Abstract] | |
Assets and Liabilities Measured at Fair Value | NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE Accounting Standards Codification 820, Fair Value Measurements and Disclosures Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment. Cash Traded Investments Our cash traded investments are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. 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 June 30, 2018 and December 31, 2017, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives. The following tables summarize our assets measured at fair value on a recurring basis as of June 30, 2018 and December 31, 2017, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): June 30, 2018 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 341 $ — $ 341 $ — Money market funds and other 118 118 — — Investments of insurance subsidiaries 459 118 341 — Less amounts classified as current assets (45 ) (45 ) — — $ 414 73 $ 341 $ — Interest rate swaps (Other) $ 98 $ — $ 98 $ — December 31, 2017 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: 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 $ — The estimated fair value of our long-term debt was $33.649 billion and $34.689 billion at June 30, 2018 and December 31, 2017, respectively, compared to carrying amounts, excluding net debt issuance costs, aggregating $33.343 billion and $33.222 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 | 6 Months Ended |
Jun. 30, 2018 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | NOTE 8 — LONG-TERM DEBT A summary of long-term debt at June 30, 2018 and December 31, 2017, including related interest rates at June 30, 2018, follows (dollars in millions): June 30, December 31, Senior secured asset-based revolving credit facility (effective interest rate of 3.6%) $ 3,750 $ 3,680 Senior secured revolving credit facility (effective interest rate of 3.6%) 140 — Senior secured term loan facilities (effective interest rate of 3.5%) 3,849 3,891 Senior secured notes (effective interest rate of 5.4%) 15,300 15,300 Other senior secured debt (effective interest rate of 5.8%) 552 599 Senior secured debt 23,591 23,470 Senior unsecured notes (effective interest rate of 6.4%) 9,752 9,752 Net debt issuance costs (151 ) (164 ) Total debt (average life of 6.4 years, rates averaging 5.3%) 33,192 33,058 Less amounts due within one year 1,692 200 $ 31,500 $ 32,858 |
Contingencies
Contingencies | 6 Months Ended |
Jun. 30, 2018 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | NOTE 9 — CONTINGENCIES We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity. Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act, private parties have the right to bring qui tam |
Capital Structure
Capital Structure | 6 Months Ended |
Jun. 30, 2018 | |
Text Block [Abstract] | |
Capital Structure | NOTE 10 — CAPITAL STRUCTURE The changes in stockholders’ deficit, including changes in stockholders’ deficit attributable to HCA Healthcare, Inc. and changes in equity attributable to noncontrolling interests, are as follows (dollars and shares in millions): Equity (Deficit) Attributable to HCA Healthcare, Inc. Common Stock Accumulated Retained Equity Total Shares Par Value Balances at December 31, 2017 350.092 $ 4 $ (278 ) $ (6,532 ) $ 1,811 $ (4,995 ) Comprehensive income — — 17 1,964 284 2,265 Repurchase of common stock (9.040 ) (1 ) — (892 ) — (893 ) Dividends and distributions — — — (250 ) (185 ) (435 ) Share-based benefit plans 5.708 — — (18 ) — (18 ) Dispositions of entities with noncontrolling interests — — — — (53 ) (53 ) Other — — — (3 ) 7 4 Balances at June 30, 2018 346.760 $ 3 $ (261 ) $ (5,731 ) $ 1,864 $ (4,125 ) During the six months ended June 30, 2018, we repurchased 9.040 million shares of our common stock at an average price of $98.73 per share through market purchases pursuant to the $2.0 billion share repurchase program authorized during October 2017. At June 30, 2018, we had $910 million of repurchase authorization available under the October 2017 authorization. The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized for-Sale Foreign Defined Change Total Balances at December 31, 2017 $ 7 $ (149 ) $ (168 ) $ 32 $ (278 ) Unrealized losses on available-for-sale (5 ) — — — (5 ) Foreign currency translation adjustments — (22 ) — — (22 ) Change in fair value of derivative instruments, net of $11 of income taxes — — — 39 39 Expense (income) reclassified into operations from other comprehensive income, net of $3 income tax benefit and $- income taxes, respectively — — 7 (2 ) 5 Balances at June 30, 2018 $ 2 $ (171 ) $ (161 ) $ 69 $ (261 ) |
Segment and Geographic Informat
Segment and Geographic Information | 6 Months Ended |
Jun. 30, 2018 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION We operate in one line of business, which is operating hospitals and related health care entities. We operate in two geographically organized groups: the National and American Groups. The National Group includes 88 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, South Carolina, Utah and Virginia, and the American Group includes 84 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Mississippi, Missouri, Tennessee and Texas. We also operate six hospitals in England, and these facilities are included in the Corporate and other group. Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, gains on sales of facilities, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and six months ended June 30, 2018 and 2017 are summarized in the following table (dollars in millions): Quarter Six Months 2018 2017 2018 2017 Revenues: National Group $ 5,609 $ 5,160 $ 11,177 $ 10,308 American Group 5,390 5,093 10,717 10,088 Corporate and other 530 480 1,058 960 $ 11,529 $ 10,733 $ 22,952 $ 21,356 Equity in earnings of affiliates: National Group $ (2 ) $ (4 ) $ (4 ) $ (9 ) American Group (10 ) (10 ) (19 ) (18 ) Corporate and other 5 1 7 4 $ (7 ) $ (13 ) $ (16 ) $ (23 ) Adjusted segment EBITDA: National Group $ 1,284 $ 1,162 $ 2,466 $ 2,293 American Group 1,147 1,040 2,178 2,047 Corporate and other (204 ) (112 ) (299 ) (245 ) $ 2,227 $ 2,090 $ 4,345 $ 4,095 Depreciation and amortization: National Group $ 232 $ 217 $ 457 $ 431 American Group 255 238 507 476 Corporate and other 75 66 151 135 $ 562 $ 521 $ 1,115 $ 1,042 Adjusted segment EBITDA $ 2,227 $ 2,090 $ 4,345 $ 4,095 Depreciation and amortization 562 521 1,115 1,042 Interest expense 436 411 867 830 Gains on sales of facilities (9 ) (2 ) (414 ) (3 ) Income before income taxes $ 1,238 $ 1,160 $ 2,777 $ 2,226 |
Supplemental Condensed Consolid
Supplemental Condensed Consolidating Financial Information | 6 Months Ended |
Jun. 30, 2018 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Supplemental Condensed Consolidating Financial Information | NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION During December 2012, HCA Healthcare, Inc. issued $1.000 billion aggregate principal amount of 6.250% senior unsecured notes due 2021. These notes are senior unsecured obligations and are not guaranteed by any of our subsidiaries. HCA Inc., a direct wholly-owned subsidiary of HCA Healthcare, Inc., is the obligor under a significant portion of our other indebtedness, including our senior secured credit facilities, senior secured notes and senior unsecured notes (other than the senior unsecured notes issued by HCA Healthcare, Inc.). The senior secured notes and senior unsecured notes issued by HCA Inc. are fully and unconditionally guaranteed by HCA Healthcare, Inc. The senior secured credit facilities and senior secured notes are fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, 100% owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our senior secured asset-based revolving credit facility). Our summarized condensed consolidating comprehensive income statements for the quarters and six months ended June 30, 2018 and 2017, condensed consolidating balance sheets at June 30, 2018 and December 31, 2017 and condensed consolidating statements of cash flows for the six months ended June 30, 2018 and 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 QUARTER ENDED JUNE 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 6,774 $ 4,755 $ — $ 11,529 Salaries and benefits — — 3,025 2,249 — 5,274 Supplies — — 1,127 790 — 1,917 Other operating expenses 4 — 1,122 992 — 2,118 Equity in earnings of affiliates (852 ) — (1 ) (6 ) 852 (7 ) Depreciation and amortization — — 329 233 — 562 Interest expense 16 867 (389 ) (58 ) — 436 Losses (gains) on sales of facilities — — 23 (32 ) — (9 ) Management fees — — (157 ) 157 — — (832 ) 867 5,079 4,325 852 10,291 Income (loss) before income taxes 832 (867 ) 1,695 430 (852 ) 1,238 Provision (benefit) for income taxes 12 (201 ) 389 72 — 272 Net income (loss) 820 (666 ) 1,306 358 (852 ) 966 Net income attributable to noncontrolling interests — — 22 124 — 146 Net income (loss) attributable to HCA Healthcare, Inc. $ 820 $ (666 ) $ 1,284 $ 234 $ (852 ) $ 820 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 756 $ (656 ) $ 1,287 $ 157 $ (788 ) $ 756 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE QUARTER ENDED JUNE 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues $ — $ — $ 6,369 $ 4,364 $ — $ 10,733 Salaries and benefits — — 2,870 2,026 — 4,896 Supplies — — 1,055 740 — 1,795 Other operating expenses 4 — 1,064 897 — 1,965 Equity in earnings of affiliates (658 ) — (1 ) (12 ) 658 (13 ) Depreciation and amortization — — 302 219 — 521 Interest expense 16 755 (315 ) (45 ) — 411 Losses (gains) on sales of facilities — — (4 ) 2 — (2 ) Management fees — — (160 ) 160 — — (638 ) 755 4,811 3,987 658 9,573 Income (loss) before income taxes 638 (755 ) 1,558 377 (658 ) 1,160 Provision (benefit) for income taxes (19 ) (279 ) 565 98 — 365 Net income (loss) 657 (476 ) 993 279 (658 ) 795 Net income attributable to noncontrolling interests — — 27 111 — 138 Net income (loss) attributable to HCA Healthcare, Inc. $ 657 $ (476 ) $ 966 $ 168 $ (658 ) $ 657 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 684 $ (480 ) $ 969 $ 196 $ (685 ) $ 684 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE SIX MONTHS ENDED JUNE 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 13,550 $ 9,402 $ — $ 22,952 Salaries and benefits — — 6,094 4,469 — 10,563 Supplies — — 2,268 1,564 — 3,832 Other operating expenses 5 — 2,250 1,973 — 4,228 Equity in earnings of affiliates (1,942 ) — (3 ) (13 ) 1,942 (16 ) Depreciation and amortization — — 652 463 — 1,115 Interest expense 32 1,704 (756 ) (113 ) — 867 Gains on sales of facilities — — (372 ) (42 ) — (414 ) Management fees — — (315 ) 315 — — (1,905 ) 1,704 9,818 8,616 1,942 20,175 Income (loss) before income taxes 1,905 (1,704 ) 3,732 786 (1,942 ) 2,777 Provision (benefit) for income taxes (59 ) (396 ) 856 128 — 529 Net income (loss) 1,964 (1,308 ) 2,876 658 (1,942 ) 2,248 Net income attributable to noncontrolling interests — — 50 234 — 284 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,964 $ (1,308 ) $ 2,826 $ 424 $ (1,942 ) $ 1,964 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,981 $ (1,271 ) $ 2,833 $ 397 $ (1,959 ) $ 1,981 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE SIX MONTHS ENDED JUNE 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues $ — $ — $ 12,705 $ 8,651 $ — $ 21,356 Salaries and benefits — — 5,774 4,023 — 9,797 Supplies — — 2,130 1,462 — 3,592 Other operating expenses 5 — 2,114 1,776 — 3,895 Equity in earnings of affiliates (1,266 ) — (3 ) (20 ) 1,266 (23 ) Depreciation and amortization — — 612 430 — 1,042 Interest expense 32 1,488 (605 ) (85 ) — 830 Gains on sales of facilities — — (3 ) — — (3 ) Management fees — — (320 ) 320 — — (1,229 ) 1,488 9,699 7,906 1,266 19,130 Income (loss) before income taxes 1,229 (1,488 ) 3,006 745 (1,266 ) 2,226 Provision (benefit) for income taxes (87 ) (549 ) 1,091 199 — 654 Net income (loss) 1,316 (939 ) 1,915 546 (1,266 ) 1,572 Net income attributable to noncontrolling interests — — 50 206 — 256 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,316 $ (939 ) $ 1,865 $ 340 $ (1,266 ) $ 1,316 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,361 $ (936 ) $ 1,871 $ 376 $ (1,311 ) $ 1,361 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET JUNE 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 197 $ 671 $ — $ 868 Accounts receivable — — 3,873 2,719 — 6,592 Inventories — — 1,093 543 — 1,636 Other — — 743 555 — 1,298 — — 5,906 4,488 — 10,394 Property and equipment, net — — 11,842 6,702 — 18,544 Investments of insurance subsidiaries — — — 414 — 414 Investments in and advances to affiliates 31,540 — 28 206 (31,540 ) 234 Goodwill and other intangible assets — — 5,429 2,030 — 7,459 Other 450 98 29 120 — 697 $ 31,990 $ 98 $ 23,234 $ 13,960 $ (31,540 ) $ 37,742 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY Current liabilities: Accounts payable $ 1 $ — $ 1,683 $ 773 $ — $ 2,457 Accrued salaries — — 836 479 — 1,315 Other accrued expenses 101 382 670 1,008 — 2,161 Long-term debt due within one year — 1,597 61 34 — 1,692 102 1,979 3,250 2,294 — 7,625 Long-term debt, net 995 30,048 282 175 — 31,500 Intercompany balances 36,325 (8,608 ) (26,352 ) (1,365 ) — — Professional liability risks — — — 1,283 — 1,283 Income taxes and other liabilities 557 — 388 514 — 1,459 37,979 23,419 (22,432) 2,901 — 41,867 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (5,989 ) (23,321 ) 45,588 9,273 (31,540 ) (5,989 ) Noncontrolling interests — — 78 1,786 — 1,864 (5,989 ) (23,321 ) 45,666 11,059 (31,540 ) (4,125 ) $ 31,990 $ 98 $ 23,234 $ 13,960 $ (31,540 ) $ 37,742 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 — — 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) EQUITY 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 STATEMENT OF CASH FLOWS FOR THE SIX MONTHS ENDED JUNE 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,964 $ (1,308 ) $ 2,876 $ 658 $ (1,942 ) $ 2,248 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities — 2 (352 ) (52 ) — (402 ) Depreciation and amortization — — 652 463 — 1,115 Income taxes 118 — — — — 118 Gains on sales of facilities — — (372 ) (42 ) — (414 ) Amortization of debt issuance costs — 15 — — — 15 Share-based compensation — — 134 — — 134 Equity in earnings of affiliates (1,942 ) — — — 1,942 — Other 43 — — 8 — 51 Net cash provided by (used in) operating activities 183 (1,291 ) 2,938 1,035 — 2,865 Cash flows from investing activities: Purchase of property and equipment — — (900 ) (674 ) — (1,574 ) Acquisition of hospitals and health care entities — — (438 ) (100 ) — (538 ) Disposition of hospitals and health care entities — — 767 32 — 799 Change in investments — — 17 6 — 23 Other — — (30 ) 5 — (25 ) Net cash used in investing activities — — (584 ) (731 ) — (1,315 ) Cash flows from financing activities: Net change in revolving credit facilities — 210 — — — 210 Repayment of long-term debt — (41 ) (38 ) (22 ) — (101 ) Distributions to noncontrolling interests — — (43 ) (142 ) — (185 ) Payment of debt issuance costs — (2 ) — — — (2 ) Payment of cash dividends (245 ) — — — — (245 ) Repurchases of common stock (893 ) — — — — (893 ) Changes in intercompany balances with affiliates, net 1,150 1,124 (2,188 ) (86 ) — — Other (196 ) — — 4 — (192 ) Net cash (used in) provided by financing activities (184 ) 1,291 (2,269 ) (246 ) — (1,408 ) Effect on exchange rate changes on cash and cash equivalents — — — (6 ) — (6 ) Change in cash and cash equivalents (1 ) — 85 52 — 136 Cash and cash equivalents at beginning of period 1 — 112 619 — 732 Cash and cash equivalents at end of period $ — $ — $ 197 $ 671 $ — $ 868 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE SIX MONTHS ENDED JUNE 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,316 $ (939 ) $ 1,915 $ 546 $ (1,266 ) $ 1,572 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities 1 (189 ) (196 ) (11 ) — (395 ) Depreciation and amortization — — 612 430 — 1,042 Income taxes 267 — — — — 267 Gains on sales of facilities — — (3 ) — — (3 ) Amortization of debt issuance costs — 16 — — — 16 Share-based compensation — — 140 — — 140 Equity in earnings of affiliates (1,266 ) — — — 1,266 — Other 39 — 1 5 — 45 Net cash provided by (used in) operating activities 357 (1,112 ) 2,469 970 — 2,684 Cash flows from investing activities: Purchase of property and equipment — — (729 ) (575 ) — (1,304 ) Acquisition of hospitals and health care entities — — (6 ) (289 ) — (295 ) Disposition of hospitals and health care entities — — 10 4 — 14 Change in investments — — — (11 ) — (11 ) Other — — 2 3 — 5 Net cash used in investing activities — — (723 ) (868 ) — (1,591 ) Cash flows from financing activities: Issuance of long-term debt — 1,500 — 2 — 1,502 Net change in revolving credit facilities — (1,160 ) — — — (1,160 ) Repayment of long-term debt — (42 ) (33 ) (20 ) — (95 ) Distributions to noncontrolling interests — — (79 ) (169 ) — (248 ) Payment of debt issuance costs — (25 ) — — — (25 ) Repurchases of common stock (966 ) — — — — (966 ) Changes in intercompany balances with affiliates, net 671 839 (1,589 ) 79 — — Other (62 ) — — 20 — (42 ) Net cash (used in) provided by financing activities (357 ) 1,112 (1,701 ) (88 ) — (1,034 ) Change in cash and cash equivalents — — 45 14 — 59 Cash and cash equivalents at beginning of period — — 113 533 — 646 Cash and cash equivalents at end of period $ — $ — $ 158 $ 547 $ — $ 705 The above supplemental condensed consolidating financial information for the quarter and six months ended June 30, 2017 has been adjusted to properly record the impact of certain subsidiaries that were non-guarantors non-guarantor Non-Guarantors As Adjustment As Adjusted Quarter ended June 30, 2017 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 657 $ — $ 657 HCA Inc. Issuer (476 ) — (476 ) Subsidiary Guarantors 862 104 966 Subsidiary Non-Guarantors 272 (104 ) 168 Eliminations (658 ) — (658 ) Condensed Consolidated $ 657 $ — $ 657 As Adjustment As Adjusted Six months ended June 30, 2017 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 1,316 $ — $ 1,316 HCA Inc. Issuer (939 ) — (939 ) Subsidiary Guarantors 1,680 185 1,865 Subsidiary Non-Guarantors 525 (185 ) 340 Eliminations (1,266 ) — (1,266 ) Condensed Consolidated $ 1,316 $ — $ 1,316 As Adjustment As Adjusted Six months ended June 30, 2017 Net cash provided (used in) operating activities: HCA Healthcare, Inc. Issuer $ 357 $ — $ 357 HCA Inc. Issuer (1,112 ) — (1,112 ) Subsidiary Guarantors 2,191 278 2,469 Subsidiary Non-Guarantors 1,248 (278 ) 970 Eliminations — — — Condensed Consolidated $ 2,684 $ — $ 2,684 |
Basis of Presentation and Sig19
Basis of Presentation and Significant Accounting Policies (Policies) | 6 Months Ended |
Jun. 30, 2018 | |
Basis of Presentation | Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q Regulation S-X. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $83 million and $82 million for the quarters ended June 30, 2018 and 2017, respectively, and $164 million each for the six months ended June 30, 2018 and 2017. Operating results for the quarter and six months ended June 30, 2018 are not necessarily indicative of the results that may be expected for the year ending December 31, 2018. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K |
Revenues | Revenues In May 2014, the Financial Accounting Standards Board (“FASB”) issued a new standard related to revenue recognition. We adopted the new standard effective January 1, 2018, using the full retrospective method. The adoption of the new standard did not have an impact on our recognition of net revenues for any periods prior to adoption. The most significant impact of adopting the new standard is to the presentation of our consolidated income statements, where we no longer present the “Provision for doubtful accounts” as a separate line item and our “Revenues” are presented net of estimated implicit price concession revenue deductions. We also have eliminated the related presentation of “allowances for doubtful accounts” on our consolidated balance sheets as a result of the adoption of the new standard. Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual allowances under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record self-pay Quarter 2018 Ratio 2017 Ratio Medicare $ 2,425 21.0 % $ 2,272 21.2 % Managed Medicare 1,345 11.7 1,158 10.8 Medicaid 357 3.1 376 3.5 Managed Medicaid 586 5.1 527 4.9 Managed care and insurers 5,993 51.9 5,729 53.4 International (managed care and insurers) 295 2.6 269 2.5 Other 528 4.6 402 3.7 Revenues $ 11,529 100.0 % $ 10,733 100.0 % Six Months 2018 Ratio 2017 Ratio Medicare $ 4,949 21.6 % $ 4,633 21.7 % Managed Medicare 2,744 12.0 2,341 11.0 Medicaid 638 2.8 670 3.1 Managed Medicaid 1,147 5.0 1,116 5.2 Managed care and insurers 12,055 52.5 11,352 53.2 International (managed care and insurers) 600 2.6 538 2.5 Other 819 3.5 706 3.3 Revenues $ 22,952 100.0 % $ 21,356 100.0 % 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 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 non-elective The collection of outstanding receivables for Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the aging of those accounts. Accounts are written off when all reasonable internal and external collection efforts have been performed. The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period To quantify the total impact of the trends related to uninsured accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and six months ended June 30, 2018 and 2017 follows (dollars in millions): Quarter Six Months 2018 2017 2018 2017 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 9,871 $ 9,177 $ 19,738 $ 18,326 Cost-to-charges 12.6 % 13.0 % 12.5 % 12.9 % Total uncompensated care $ 6,486 $ 5,721 $ 12,738 $ 11,048 Multiply by the cost-to-charges 12.6 % 13.0 % 12.5 % 12.9 % Estimated cost of total uncompensated care $ 817 $ 743 $ 1,592 $ 1,425 Total uncompensated care as a percentage of the sum of revenues and total uncompensated care was 36.0% and 34.8% for the quarters ended June 30, 2018 and 2017, respectively, and 35.7% and 34.1% for the six months ended June 30, 2018 and 2017, respectively. The total uncompensated care amounts include charity care of $1.977 billion and $1.173 billion, and the related estimated costs of charity care were $249 million and $152 million for the quarters ended June 30, 2018 and 2017, respectively, and charity care of $3.856 billion and $2.259 billion, and the related estimated costs of charity care were $482 million and $291 million for the six months ended June 30, 2018 and 2017, respectively. |
Recent Pronouncements | Recent Pronouncements In February 2016, the FASB issued Accounting Standards Update 2016-02, Leases 2016-02”), 2016-02 2016-02 right-of-use |
Reclassifications | Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Earning Per Share | We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards and potential shares, computed using the treasury stock method. |
Fair Value Measurements and Disclosures | Accounting Standards Codification 820, Fair Value Measurements and Disclosures Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment. |
Cash Traded Investments | Cash Traded Investments Our cash traded investments are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. |
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 June 30, 2018 and December 31, 2017, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives. |
Interest Rate Swaps [Member] | |
Interest Rate Swap Agreements | Interest Rate Swap Agreements We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between two parties based on common notional principal amounts and maturity dates. Pay-fixed |
Basis of Presentation and Sig20
Basis of Presentation and Significant Accounting Policies (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Accounting Policies [Abstract] | |
Schedule of Revenues from Third Party Payers, Uninsured and Other Payers | Our revenues from third-party payers and others (including uninsured patients) for the quarters and six months ended June 30, 2018 and 2017 are summarized in the following table (dollars in millions): Quarter 2018 Ratio 2017 Ratio Medicare $ 2,425 21.0 % $ 2,272 21.2 % Managed Medicare 1,345 11.7 1,158 10.8 Medicaid 357 3.1 376 3.5 Managed Medicaid 586 5.1 527 4.9 Managed care and insurers 5,993 51.9 5,729 53.4 International (managed care and insurers) 295 2.6 269 2.5 Other 528 4.6 402 3.7 Revenues $ 11,529 100.0 % $ 10,733 100.0 % Six Months 2018 Ratio 2017 Ratio Medicare $ 4,949 21.6 % $ 4,633 21.7 % Managed Medicare 2,744 12.0 2,341 11.0 Medicaid 638 2.8 670 3.1 Managed Medicaid 1,147 5.0 1,116 5.2 Managed care and insurers 12,055 52.5 11,352 53.2 International (managed care and insurers) 600 2.6 538 2.5 Other 819 3.5 706 3.3 Revenues $ 22,952 100.0 % $ 21,356 100.0 % |
Schedule of Estimated Cost of Uncompensated Care | A summary of the estimated cost of total uncompensated care for the quarters and six months ended June 30, 2018 and 2017 follows (dollars in millions): Quarter Six Months 2018 2017 2018 2017 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 9,871 $ 9,177 $ 19,738 $ 18,326 Cost-to-charges 12.6 % 13.0 % 12.5 % 12.9 % Total uncompensated care $ 6,486 $ 5,721 $ 12,738 $ 11,048 Multiply by the cost-to-charges 12.6 % 13.0 % 12.5 % 12.9 % Estimated cost of total uncompensated care $ 817 $ 743 $ 1,592 $ 1,425 |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Earnings Per Share [Abstract] | |
Schedule of Computations of Basic and Diluted Earnings Per Share | The following table sets forth the computation of basic and diluted earnings per share for the quarters and six months ended June 30, 2018 and 2017 (dollars and shares in millions, except per share amounts): Quarter Six Months 2018 2017 2018 2017 Net income attributable to HCA Healthcare, Inc. $ 820 $ 657 $ 1,964 $ 1,316 Weighted average common shares outstanding 348.615 365.847 349.726 368.056 Effect of dilutive incremental shares 6.424 9.491 7.662 9.591 Shares used for diluted earnings per share 355.039 375.338 357.388 377.647 Earnings per share: Basic earnings $ 2.35 $ 1.79 $ 5.62 $ 3.58 Diluted earnings $ 2.31 $ 1.75 $ 5.50 $ 3.48 |
Investments of Insurance Subs22
Investments of Insurance Subsidiaries (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | A summary of our insurance subsidiaries’ investments at June 30, 2018 and December 31, 2017 follows (dollars in millions): June 30, 2018 Amortized Unrealized Fair Gains Losses Debt securities $ 337 $ 5 $ (1 ) $ 341 Money market funds and other 118 — — 118 $ 455 $ 5 $ (1 ) 459 Amounts classified as current assets (45 ) Investment carrying value $ 414 December 31, 2017 Amortized Unrealized Fair Gains Losses 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 |
Schedule of Maturities of Investments | Scheduled maturities of investments in debt securities at June 30, 2018 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 24 $ 25 Due after one year through five years 50 50 Due after five years through ten years 218 221 Due after ten years 45 45 $ 337 $ 341 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
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 June 30, 2018 (dollars in millions): Notional Maturity Date Fair Pay-fixed $ 2,000 December 2021 $ 83 Pay-fixed 500 December 2022 15 |
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 six months ended June 30, 2018 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Gain Location of Gain Amount of Gain Interest rate swaps $ 39 Interest expense $ 2 |
Assets and Liabilities Measur24
Assets and Liabilities Measured at Fair Value (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Fair Value Disclosures [Abstract] | |
Schedule of Assets Measured at Fair Value on Recurring Basis | The following tables summarize our assets measured at fair value on a recurring basis as of June 30, 2018 and December 31, 2017, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): June 30, 2018 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 341 $ — $ 341 $ — Money market funds and other 118 118 — — Investments of insurance subsidiaries 459 118 341 — Less amounts classified as current assets (45 ) (45 ) — — $ 414 73 $ 341 $ — Interest rate swaps (Other) $ 98 $ — $ 98 $ — December 31, 2017 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: 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 $ — |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | A summary of long-term debt at June 30, 2018 and December 31, 2017, including related interest rates at June 30, 2018, follows (dollars in millions): June 30, December 31, Senior secured asset-based revolving credit facility (effective interest rate of 3.6%) $ 3,750 $ 3,680 Senior secured revolving credit facility (effective interest rate of 3.6%) 140 — Senior secured term loan facilities (effective interest rate of 3.5%) 3,849 3,891 Senior secured notes (effective interest rate of 5.4%) 15,300 15,300 Other senior secured debt (effective interest rate of 5.8%) 552 599 Senior secured debt 23,591 23,470 Senior unsecured notes (effective interest rate of 6.4%) 9,752 9,752 Net debt issuance costs (151 ) (164 ) Total debt (average life of 6.4 years, rates averaging 5.3%) 33,192 33,058 Less amounts due within one year 1,692 200 $ 31,500 $ 32,858 |
Capital Structure (Tables)
Capital Structure (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Text Block [Abstract] | |
Schedule of Changes in Stockholders' Deficit and Equity | The changes in stockholders’ deficit, including changes in stockholders’ deficit attributable to HCA Healthcare, Inc. and changes in equity attributable to noncontrolling interests, are as follows (dollars and shares in millions): Equity (Deficit) Attributable to HCA Healthcare, Inc. Common Stock Accumulated Retained Equity Total Shares Par Value Balances at December 31, 2017 350.092 $ 4 $ (278 ) $ (6,532 ) $ 1,811 $ (4,995 ) Comprehensive income — — 17 1,964 284 2,265 Repurchase of common stock (9.040 ) (1 ) — (892 ) — (893 ) Dividends and distributions — — — (250 ) (185 ) (435 ) Share-based benefit plans 5.708 — — (18 ) — (18 ) Dispositions of entities with noncontrolling interests — — — — (53 ) (53 ) Other — — — (3 ) 7 4 Balances at June 30, 2018 346.760 $ 3 $ (261 ) $ (5,731 ) $ 1,864 $ (4,125 ) |
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, 2017 $ 7 $ (149 ) $ (168 ) $ 32 $ (278 ) Unrealized losses on available-for-sale (5 ) — — — (5 ) Foreign currency translation adjustments — (22 ) — — (22 ) Change in fair value of derivative instruments, net of $11 of income taxes — — — 39 39 Expense (income) reclassified into operations from other comprehensive income, net of $3 income tax benefit and $- income taxes, respectively — — 7 (2 ) 5 Balances at June 30, 2018 $ 2 $ (171 ) $ (161 ) $ 69 $ (261 ) |
Segment and Geographic Inform27
Segment and Geographic Information (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Segment Reporting [Abstract] | |
Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA and Depreciation and Amortization | of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and six months ended June 30, 2018 and 2017 are summarized in the following table (dollars in millions): Quarter Six Months 2018 2017 2018 2017 Revenues: National Group $ 5,609 $ 5,160 $ 11,177 $ 10,308 American Group 5,390 5,093 10,717 10,088 Corporate and other 530 480 1,058 960 $ 11,529 $ 10,733 $ 22,952 $ 21,356 Equity in earnings of affiliates: National Group $ (2 ) $ (4 ) $ (4 ) $ (9 ) American Group (10 ) (10 ) (19 ) (18 ) Corporate and other 5 1 7 4 $ (7 ) $ (13 ) $ (16 ) $ (23 ) Adjusted segment EBITDA: National Group $ 1,284 $ 1,162 $ 2,466 $ 2,293 American Group 1,147 1,040 2,178 2,047 Corporate and other (204 ) (112 ) (299 ) (245 ) $ 2,227 $ 2,090 $ 4,345 $ 4,095 Depreciation and amortization: National Group $ 232 $ 217 $ 457 $ 431 American Group 255 238 507 476 Corporate and other 75 66 151 135 $ 562 $ 521 $ 1,115 $ 1,042 Adjusted segment EBITDA $ 2,227 $ 2,090 $ 4,345 $ 4,095 Depreciation and amortization 562 521 1,115 1,042 Interest expense 436 411 867 830 Gains on sales of facilities (9 ) (2 ) (414 ) (3 ) Income before income taxes $ 1,238 $ 1,160 $ 2,777 $ 2,226 |
Supplemental Condensed Consol28
Supplemental Condensed Consolidating Financial Information (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Schedule of Condensed Consolidating Comprehensive Income Statement | HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE QUARTER ENDED JUNE 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 6,774 $ 4,755 $ — $ 11,529 Salaries and benefits — — 3,025 2,249 — 5,274 Supplies — — 1,127 790 — 1,917 Other operating expenses 4 — 1,122 992 — 2,118 Equity in earnings of affiliates (852 ) — (1 ) (6 ) 852 (7 ) Depreciation and amortization — — 329 233 — 562 Interest expense 16 867 (389 ) (58 ) — 436 Losses (gains) on sales of facilities — — 23 (32 ) — (9 ) Management fees — — (157 ) 157 — — (832 ) 867 5,079 4,325 852 10,291 Income (loss) before income taxes 832 (867 ) 1,695 430 (852 ) 1,238 Provision (benefit) for income taxes 12 (201 ) 389 72 — 272 Net income (loss) 820 (666 ) 1,306 358 (852 ) 966 Net income attributable to noncontrolling interests — — 22 124 — 146 Net income (loss) attributable to HCA Healthcare, Inc. $ 820 $ (666 ) $ 1,284 $ 234 $ (852 ) $ 820 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 756 $ (656 ) $ 1,287 $ 157 $ (788 ) $ 756 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE QUARTER ENDED JUNE 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues $ — $ — $ 6,369 $ 4,364 $ — $ 10,733 Salaries and benefits — — 2,870 2,026 — 4,896 Supplies — — 1,055 740 — 1,795 Other operating expenses 4 — 1,064 897 — 1,965 Equity in earnings of affiliates (658 ) — (1 ) (12 ) 658 (13 ) Depreciation and amortization — — 302 219 — 521 Interest expense 16 755 (315 ) (45 ) — 411 Losses (gains) on sales of facilities — — (4 ) 2 — (2 ) Management fees — — (160 ) 160 — — (638 ) 755 4,811 3,987 658 9,573 Income (loss) before income taxes 638 (755 ) 1,558 377 (658 ) 1,160 Provision (benefit) for income taxes (19 ) (279 ) 565 98 — 365 Net income (loss) 657 (476 ) 993 279 (658 ) 795 Net income attributable to noncontrolling interests — — 27 111 — 138 Net income (loss) attributable to HCA Healthcare, Inc. $ 657 $ (476 ) $ 966 $ 168 $ (658 ) $ 657 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 684 $ (480 ) $ 969 $ 196 $ (685 ) $ 684 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE SIX MONTHS ENDED JUNE 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 13,550 $ 9,402 $ — $ 22,952 Salaries and benefits — — 6,094 4,469 — 10,563 Supplies — — 2,268 1,564 — 3,832 Other operating expenses 5 — 2,250 1,973 — 4,228 Equity in earnings of affiliates (1,942 ) — (3 ) (13 ) 1,942 (16 ) Depreciation and amortization — — 652 463 — 1,115 Interest expense 32 1,704 (756 ) (113 ) — 867 Gains on sales of facilities — — (372 ) (42 ) — (414 ) Management fees — — (315 ) 315 — — (1,905 ) 1,704 9,818 8,616 1,942 20,175 Income (loss) before income taxes 1,905 (1,704 ) 3,732 786 (1,942 ) 2,777 Provision (benefit) for income taxes (59 ) (396 ) 856 128 — 529 Net income (loss) 1,964 (1,308 ) 2,876 658 (1,942 ) 2,248 Net income attributable to noncontrolling interests — — 50 234 — 284 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,964 $ (1,308 ) $ 2,826 $ 424 $ (1,942 ) $ 1,964 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,981 $ (1,271 ) $ 2,833 $ 397 $ (1,959 ) $ 1,981 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE SIX MONTHS ENDED JUNE 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues $ — $ — $ 12,705 $ 8,651 $ — $ 21,356 Salaries and benefits — — 5,774 4,023 — 9,797 Supplies — — 2,130 1,462 — 3,592 Other operating expenses 5 — 2,114 1,776 — 3,895 Equity in earnings of affiliates (1,266 ) — (3 ) (20 ) 1,266 (23 ) Depreciation and amortization — — 612 430 — 1,042 Interest expense 32 1,488 (605 ) (85 ) — 830 Gains on sales of facilities — — (3 ) — — (3 ) Management fees — — (320 ) 320 — — (1,229 ) 1,488 9,699 7,906 1,266 19,130 Income (loss) before income taxes 1,229 (1,488 ) 3,006 745 (1,266 ) 2,226 Provision (benefit) for income taxes (87 ) (549 ) 1,091 199 — 654 Net income (loss) 1,316 (939 ) 1,915 546 (1,266 ) 1,572 Net income attributable to noncontrolling interests — — 50 206 — 256 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,316 $ (939 ) $ 1,865 $ 340 $ (1,266 ) $ 1,316 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,361 $ (936 ) $ 1,871 $ 376 $ (1,311 ) $ 1,361 |
Schedule of Condensed Consolidating Balance Sheet | HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET JUNE 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 197 $ 671 $ — $ 868 Accounts receivable — — 3,873 2,719 — 6,592 Inventories — — 1,093 543 — 1,636 Other — — 743 555 — 1,298 — — 5,906 4,488 — 10,394 Property and equipment, net — — 11,842 6,702 — 18,544 Investments of insurance subsidiaries — — — 414 — 414 Investments in and advances to affiliates 31,540 — 28 206 (31,540 ) 234 Goodwill and other intangible assets — — 5,429 2,030 — 7,459 Other 450 98 29 120 — 697 $ 31,990 $ 98 $ 23,234 $ 13,960 $ (31,540 ) $ 37,742 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY Current liabilities: Accounts payable $ 1 $ — $ 1,683 $ 773 $ — $ 2,457 Accrued salaries — — 836 479 — 1,315 Other accrued expenses 101 382 670 1,008 — 2,161 Long-term debt due within one year — 1,597 61 34 — 1,692 102 1,979 3,250 2,294 — 7,625 Long-term debt, net 995 30,048 282 175 — 31,500 Intercompany balances 36,325 (8,608 ) (26,352 ) (1,365 ) — — Professional liability risks — — — 1,283 — 1,283 Income taxes and other liabilities 557 — 388 514 — 1,459 37,979 23,419 (22,432) 2,901 — 41,867 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (5,989 ) (23,321 ) 45,588 9,273 (31,540 ) (5,989 ) Noncontrolling interests — — 78 1,786 — 1,864 (5,989 ) (23,321 ) 45,666 11,059 (31,540 ) (4,125 ) $ 31,990 $ 98 $ 23,234 $ 13,960 $ (31,540 ) $ 37,742 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 — — 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) EQUITY 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 |
Schedule of Condensed Consolidating Statement of Cash Flows | HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE SIX MONTHS ENDED JUNE 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,964 $ (1,308 ) $ 2,876 $ 658 $ (1,942 ) $ 2,248 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities — 2 (352 ) (52 ) — (402 ) Depreciation and amortization — — 652 463 — 1,115 Income taxes 118 — — — — 118 Gains on sales of facilities — — (372 ) (42 ) — (414 ) Amortization of debt issuance costs — 15 — — — 15 Share-based compensation — — 134 — — 134 Equity in earnings of affiliates (1,942 ) — — — 1,942 — Other 43 — — 8 — 51 Net cash provided by (used in) operating activities 183 (1,291 ) 2,938 1,035 — 2,865 Cash flows from investing activities: Purchase of property and equipment — — (900 ) (674 ) — (1,574 ) Acquisition of hospitals and health care entities — — (438 ) (100 ) — (538 ) Disposition of hospitals and health care entities — — 767 32 — 799 Change in investments — — 17 6 — 23 Other — — (30 ) 5 — (25 ) Net cash used in investing activities — — (584 ) (731 ) — (1,315 ) Cash flows from financing activities: Net change in revolving credit facilities — 210 — — — 210 Repayment of long-term debt — (41 ) (38 ) (22 ) — (101 ) Distributions to noncontrolling interests — — (43 ) (142 ) — (185 ) Payment of debt issuance costs — (2 ) — — — (2 ) Payment of cash dividends (245 ) — — — — (245 ) Repurchases of common stock (893 ) — — — — (893 ) Changes in intercompany balances with affiliates, net 1,150 1,124 (2,188 ) (86 ) — — Other (196 ) — — 4 — (192 ) Net cash (used in) provided by financing activities (184 ) 1,291 (2,269 ) (246 ) — (1,408 ) Effect on exchange rate changes on cash and cash equivalents — — — (6 ) — (6 ) Change in cash and cash equivalents (1 ) — 85 52 — 136 Cash and cash equivalents at beginning of period 1 — 112 619 — 732 Cash and cash equivalents at end of period $ — $ — $ 197 $ 671 $ — $ 868 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE SIX MONTHS ENDED JUNE 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,316 $ (939 ) $ 1,915 $ 546 $ (1,266 ) $ 1,572 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities 1 (189 ) (196 ) (11 ) — (395 ) Depreciation and amortization — — 612 430 — 1,042 Income taxes 267 — — — — 267 Gains on sales of facilities — — (3 ) — — (3 ) Amortization of debt issuance costs — 16 — — — 16 Share-based compensation — — 140 — — 140 Equity in earnings of affiliates (1,266 ) — — — 1,266 — Other 39 — 1 5 — 45 Net cash provided by (used in) operating activities 357 (1,112 ) 2,469 970 — 2,684 Cash flows from investing activities: Purchase of property and equipment — — (729 ) (575 ) — (1,304 ) Acquisition of hospitals and health care entities — — (6 ) (289 ) — (295 ) Disposition of hospitals and health care entities — — 10 4 — 14 Change in investments — — — (11 ) — (11 ) Other — — 2 3 — 5 Net cash used in investing activities — — (723 ) (868 ) — (1,591 ) Cash flows from financing activities: Issuance of long-term debt — 1,500 — 2 — 1,502 Net change in revolving credit facilities — (1,160 ) — — — (1,160 ) Repayment of long-term debt — (42 ) (33 ) (20 ) — (95 ) Distributions to noncontrolling interests — — (79 ) (169 ) — (248 ) Payment of debt issuance costs — (25 ) — — — (25 ) Repurchases of common stock (966 ) — — — — (966 ) Changes in intercompany balances with affiliates, net 671 839 (1,589 ) 79 — — Other (62 ) — — 20 — (42 ) Net cash (used in) provided by financing activities (357 ) 1,112 (1,701 ) (88 ) — (1,034 ) Change in cash and cash equivalents — — 45 14 — 59 Cash and cash equivalents at beginning of period — — 113 533 — 646 Cash and cash equivalents at end of period $ — $ — $ 158 $ 547 $ — $ 705 |
Summary of Restatement Adjustments to Financial Statements | The application of these adjustments to the consolidating information for the quarter and six months ended June 30, 2017 is summarized as follows (dollars in millions): As Adjustment As Adjusted Quarter ended June 30, 2017 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 657 $ — $ 657 HCA Inc. Issuer (476 ) — (476 ) Subsidiary Guarantors 862 104 966 Subsidiary Non-Guarantors 272 (104 ) 168 Eliminations (658 ) — (658 ) Condensed Consolidated $ 657 $ — $ 657 As Adjustment As Adjusted Six months ended June 30, 2017 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 1,316 $ — $ 1,316 HCA Inc. Issuer (939 ) — (939 ) Subsidiary Guarantors 1,680 185 1,865 Subsidiary Non-Guarantors 525 (185 ) 340 Eliminations (1,266 ) — (1,266 ) Condensed Consolidated $ 1,316 $ — $ 1,316 As Adjustment As Adjusted Six months ended June 30, 2017 Net cash provided (used in) operating activities: HCA Healthcare, Inc. Issuer $ 357 $ — $ 357 HCA Inc. Issuer (1,112 ) — (1,112 ) Subsidiary Guarantors 2,191 278 2,469 Subsidiary Non-Guarantors 1,248 (278 ) 970 Eliminations — — — Condensed Consolidated $ 2,684 $ — $ 2,684 |
Basis of Presentation and Sig29
Basis of Presentation and Significant Accounting Policies - Additional Information (Detail) $ in Millions | Oct. 31, 2017 | Nov. 30, 2017 | Jun. 30, 2018USD ($)StateHospitalSurgery_Center | Jun. 30, 2017USD ($) | Jun. 30, 2018USD ($)StateHospitalSurgery_Center | Jun. 30, 2017USD ($) | Dec. 31, 2017USD ($) |
Summary Of Significant Accounting Policies [Line Items] | |||||||
Number of owned and operated hospitals | Hospital | 178 | 178 | |||||
Number of freestanding surgery centers | Surgery_Center | 122 | 122 | |||||
Number of facilities locations | State | 20 | 20 | |||||
General and administrative expense | $ 83 | $ 82 | $ 164 | $ 164 | |||
Estimated implicit price concessions recorded as reductions to revenues and accounts receivable | $ 5,736 | $ 5,488 | |||||
Percentage of sum of revenues and uncompensated care | 36.00% | 34.80% | 35.70% | 34.10% | |||
Charity care amount | $ 1,977 | $ 1,173 | $ 3,856 | $ 2,259 | |||
Estimated costs of charity care | $ 249 | $ 152 | $ 482 | $ 291 | |||
Inpatient Services [Member] | |||||||
Summary Of Significant Accounting Policies [Line Items] | |||||||
Performance obligations for inpatient/ outpatient services satisfied period | 5 days | 5 days | |||||
Maximum [Member] | |||||||
Summary Of Significant Accounting Policies [Line Items] | |||||||
Percentage of income of federal poverty level eligible for charity care | 200.00% | 400.00% | |||||
Maximum [Member] | Outpatient Services [Member] | |||||||
Summary Of Significant Accounting Policies [Line Items] | |||||||
Performance obligations for inpatient/ outpatient services satisfied period | 1 day | 1 day | |||||
Minimum [Member] | |||||||
Summary Of Significant Accounting Policies [Line Items] | |||||||
Percentage of income of federal poverty level eligible for charity care | 200.00% |
Basis of Presentation and Sig30
Basis of Presentation and Significant Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Revenues From Third Party Payers [Line Items] | ||||
Other | $ 11,529 | $ 10,733 | $ 22,952 | $ 21,356 |
Other, Ratio | 4.60% | 3.70% | 3.50% | 3.30% |
Revenues ratio from third party payers | 100.00% | 100.00% | 100.00% | 100.00% |
Medicare [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 2,425 | $ 2,272 | $ 4,949 | $ 4,633 |
Revenues from third party payers, Ratio | 21.00% | 21.20% | 21.60% | 21.70% |
Managed Medicare [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 1,345 | $ 1,158 | $ 2,744 | $ 2,341 |
Revenues from third party payers, Ratio | 11.70% | 10.80% | 12.00% | 11.00% |
Medicaid [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 357 | $ 376 | $ 638 | $ 670 |
Revenues from third party payers, Ratio | 3.10% | 3.50% | 2.80% | 3.10% |
Managed Medicaid [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 586 | $ 527 | $ 1,147 | $ 1,116 |
Revenues from third party payers, Ratio | 5.10% | 4.90% | 5.00% | 5.20% |
Managed Care and Insurers [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 5,993 | $ 5,729 | $ 12,055 | $ 11,352 |
Revenues from third party payers, Ratio | 51.90% | 53.40% | 52.50% | 53.20% |
International (Managed Care and Other Insurers) [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 295 | $ 269 | $ 600 | $ 538 |
Revenues from third party payers, Ratio | 2.60% | 2.50% | 2.60% | 2.50% |
Product and Service, Other [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Other | $ 528 | $ 402 | $ 819 | $ 706 |
Health Care, Patient Service [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Other | $ 11,529 | $ 10,733 | $ 22,952 | $ 21,356 |
Basis of Presentation and Sig31
Basis of Presentation and Significant Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Accounting Policies [Abstract] | ||||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ 9,871 | $ 9,177 | $ 19,738 | $ 18,326 |
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) | 12.60% | 13.00% | 12.50% | 12.90% |
Total uncompensated care | $ 6,486 | $ 5,721 | $ 12,738 | $ 11,048 |
Multiply by the cost-to-charges ratio | 12.60% | 13.00% | 12.50% | 12.90% |
Estimated cost of total uncompensated care | $ 817 | $ 743 | $ 1,592 | $ 1,425 |
Acquisitions and Dispositions -
Acquisitions and Dispositions - Additional Information (Detail) $ in Millions | 6 Months Ended | |
Jun. 30, 2018USD ($)Hospital | Jun. 30, 2017USD ($)Hospital | |
Business Acquisition [Line Items] | ||
Number of hospitals purchased | Hospital | 3 | |
Proceeds from sale of business | $ 799 | $ 14 |
Real Estate and Other Investments [Member] | ||
Business Acquisition [Line Items] | ||
Pretax gain (loss) on sales of business | 42 | 3 |
Proceeds from sale of business | 41 | 14 |
Discontinued Operations, Disposed of by Sale [Member] | Oklahoma [Member] | ||
Business Acquisition [Line Items] | ||
Pretax gain (loss) on sales of business | 372 | |
Proceeds from sale of business | $ 758 | |
Number of hospitals sold | Hospital | 2 | |
Hospitals [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | $ 360 | 189 |
Nonhospital Health Care [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | $ 178 | $ 106 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | 12 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | Dec. 31, 2017 | |
Income Tax Disclosure [Abstract] | |||||
Provision for income taxes | $ 272 | $ 365 | $ 529 | $ 654 | |
Effective tax rates | 24.90% | 35.80% | 21.20% | 33.20% | |
Provision for tax benefits related to settlement of employee awards | $ 4 | $ 9 | $ 96 | $ 76 | |
Provision for income tax benefit excluding gains on sale | 122 | $ 245 | |||
Effective tax rate | 21.00% | 35.00% | |||
Liability for unrecognized tax benefits | 461 | $ 461 | $ 439 | ||
Unrecognized tax benefits, accrued interest | 54 | 54 | 44 | ||
Unrecognized tax benefits that would impact effective tax rate | $ 159 | $ 159 | $ 145 |
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 | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Earnings Per Share [Abstract] | ||||
Net income attributable to HCA Healthcare, Inc. | $ 820 | $ 657 | $ 1,964 | $ 1,316 |
Weighted average common shares outstanding | 348,615 | 365,847 | 349,726 | 368,056 |
Effect of dilutive incremental shares | 6,424 | 9,491 | 7,662 | 9,591 |
Shares used for diluted earnings per share | 355,039 | 375,338 | 357,388 | 377,647 |
Basic earnings | $ 2.35 | $ 1.79 | $ 5.62 | $ 3.58 |
Diluted earnings | $ 2.31 | $ 1.75 | $ 5.50 | $ 3.48 |
Investments of Insurance Subs35
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions | Jun. 30, 2018 | Dec. 31, 2017 |
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | $ 455 | $ 462 |
Unrealized Amounts, Gains | 5 | 10 |
Unrealized Amounts, Losses | (1) | |
Fair Value | 459 | 472 |
Amounts classified as current assets | (45) | (54) |
Investment carrying value | 414 | 418 |
Money Market Funds and Other [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 118 | 101 |
Fair Value | 118 | 101 |
Debt Securities [Member] | States and Municipalities [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 337 | 361 |
Unrealized Amounts, Gains | 5 | 10 |
Unrealized Amounts, Losses | (1) | |
Fair Value | $ 341 | $ 371 |
Investments of Insurance Subs36
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions | Jun. 30, 2018USD ($) |
Investments, Debt and Equity Securities [Abstract] | |
Due in one year or less, Amortized Cost | $ 24 |
Due after one year through five years, Amortized Cost | 50 |
Due after five years through ten years, Amortized Cost | 218 |
Due after ten years, Amortized Cost | 45 |
Amortized Cost, Total | 337 |
Due in one year or less, Fair Value | 25 |
Due after one year through five years, Fair Value | 50 |
Due after five years through ten years, Fair Value | 221 |
Due after ten years, Fair Value | 45 |
Fair Value, Total | $ 341 |
Investments of Insurance Subs37
Investments of Insurance Subsidiaries - Additional Information (Detail) | 6 Months Ended |
Jun. 30, 2018 | |
Investments, Debt and Equity Securities [Abstract] | |
Available for sale securities expected maturity of debt securities | 6 years 6 months |
Available for sale securities average scheduled maturity | 8 years 4 months 24 days |
Financial Instruments - Schedul
Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) - Pay-Fixed Interest Rate Swaps [Member] | 6 Months Ended |
Jun. 30, 2018USD ($) | |
Maturity Date, 2021 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 2,000,000,000 |
Fair Value | $ 83,000,000 |
Maturity Date | Dec. 31, 2021 |
Maturity Date, 2022 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 500,000,000 |
Fair Value | $ 15,000,000 |
Maturity Date | Dec. 31, 2022 |
Financial Instruments - Additio
Financial Instruments - Additional Information (Detail) $ in Millions | 6 Months Ended |
Jun. 30, 2018USD ($) | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Estimated amount reclassified from other comprehensive income and reduce interest expense | $ 20 |
Financial Instruments - Effect
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Derivative Instruments, Gain (Loss) [Line Items] | ||||
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | $ 15 | $ (11) | $ 50 | $ (8) |
Interest Rate Swaps [Member] | ||||
Derivative Instruments, Gain (Loss) [Line Items] | ||||
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | 39 | |||
Interest Rate Swaps [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | ||||
Derivative Instruments, Gain (Loss) [Line Items] | ||||
Interest rate swaps | $ 2 |
Assets and Liabilities Measur41
Assets and Liabilities Measured at Fair Value - Schedule of Assets Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Millions | Jun. 30, 2018 | Dec. 31, 2017 |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | $ 459 | $ 472 |
Less amounts classified as current assets | (45) | (54) |
Investments of insurance subsidiaries, noncurrent | 414 | 418 |
Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Derivative Asset | 98 | 50 |
States and Municipalities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Securities, Available-for-sale Securities | 341 | 371 |
Money Market Funds and Other [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 118 | 101 |
Quoted Prices in Active Markets for Identical Assets (Level 1) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 118 | 101 |
Less amounts classified as current assets | (45) | (54) |
Investments of insurance subsidiaries, noncurrent | 73 | 47 |
Quoted Prices in Active Markets for Identical Assets (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 Disclosure | 118 | 101 |
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 Disclosure | 341 | 371 |
Investments of insurance subsidiaries, noncurrent | 341 | 371 |
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] | ||
Derivative Asset | 98 | 50 |
Significant Other Observable Inputs (Level 2) [Member] | States and Municipalities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Securities, Available-for-sale Securities | $ 341 | $ 371 |
Assets and Liabilities Measur42
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions | Jun. 30, 2018 | Dec. 31, 2017 |
Fair Value Disclosures [Abstract] | ||
Estimated fair value of long-term debt | $ 33,649 | $ 34,689 |
Carrying amounts of long-term debt | $ 33,343 | $ 33,222 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions | Jun. 30, 2018 | Dec. 31, 2017 |
Debt Instrument [Line Items] | ||
Senior secured debt | $ 23,591 | $ 23,470 |
Net debt issuance costs | (151) | (164) |
Total debt (average life of 6.6 years, rates averaging 5.2%) | 33,192 | 33,058 |
Less amounts due within one year | 1,692 | 200 |
Long-term debt | 31,500 | 32,858 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 3,750 | 3,680 |
Senior Secured Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 140 | |
Senior Secured Term Loan Facilities [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 3,849 | 3,891 |
Senior Secured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 15,300 | 15,300 |
Other Senior Secured Debt [Member] | ||
Debt Instrument [Line Items] | ||
Other senior secured debt | 552 | 599 |
Senior Unsecured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior unsecured notes | $ 9,752 | $ 9,752 |
Long-Term Debt - Schedule of 44
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | 6 Months Ended |
Jun. 30, 2018 | |
Debt Instrument [Line Items] | |
Total debt average term | 6 years 15 days |
Total debt average rate | 5.30% |
Senior Secured Asset-Based Revolving Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 3.60% |
Senior Secured Revolving Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 3.60% |
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 | 5.80% |
Senior Unsecured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 6.40% |
Capital Structure - Schedule of
Capital Structure - Schedule of Changes in Stockholders' Deficit and Equity (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Capital Structure [Line Items] | ||||
Beginning Balances | $ (4,995) | |||
Comprehensive income | $ 902 | $ 822 | 2,265 | $ 1,617 |
Repurchase of common stock | (893) | |||
Dividends and distributions | (435) | |||
Share-based benefit plans | (18) | |||
Dispositions of entities with noncontrolling interests | (53) | |||
Other | 4 | |||
Ending Balances | (4,125) | (4,125) | ||
Common Stock [Member] | ||||
Capital Structure [Line Items] | ||||
Beginning Balances | 4 | |||
Repurchase of common stock | (1) | |||
Ending Balances | $ 3 | $ 3 | ||
Beginning Balances, Shares | 350,092,000 | |||
Repurchase of common stock, shares | (9,040,000) | |||
Share-based benefit plans, Shares | 5,708,000 | |||
Ending Balances, Shares | 346,760,000 | 346,760,000 | ||
Accumulated Other Comprehensive Loss [Member] | ||||
Capital Structure [Line Items] | ||||
Beginning Balances | $ (278) | |||
Comprehensive income | 17 | |||
Ending Balances | $ (261) | (261) | ||
Retained Deficit [Member] | ||||
Capital Structure [Line Items] | ||||
Beginning Balances | (6,532) | |||
Comprehensive income | 1,964 | |||
Repurchase of common stock | (892) | |||
Dividends and distributions | (250) | |||
Share-based benefit plans | (18) | |||
Other | (3) | |||
Ending Balances | (5,731) | (5,731) | ||
Equity Attributable to Noncontrolling Interests [Member] | ||||
Capital Structure [Line Items] | ||||
Beginning Balances | 1,811 | |||
Comprehensive income | 284 | |||
Dividends and distributions | (185) | |||
Dispositions of entities with noncontrolling interests | (53) | |||
Other | 7 | |||
Ending Balances | $ 1,864 | $ 1,864 |
Capital Structure - Additional
Capital Structure - Additional Information (Detail) - Common Stock [Member] - USD ($) | 6 Months Ended | |
Jun. 30, 2018 | Oct. 31, 2017 | |
Capital Structure [Line Items] | ||
Repurchase of common stock, shares | 9,040,000 | |
Repurchase price of common stock, per share | $ 98.73 | |
Share repurchase program, remaining authorized repurchase amount | $ 910,000,000 | |
Share repurchase program authorized amount | $ 2,000,000,000 |
Capital Structure - Components
Capital Structure - Components of Accumulated Other Comprehensive Loss (Detail) $ in Millions | 6 Months Ended |
Jun. 30, 2018USD ($) | |
Equity [Abstract] | |
Unrealized gains on available-for-sale securities, beginning balances | $ 7 |
Unrealized losses on available-for-sale securities, net of income tax benefit | (5) |
Unrealized gains on available-for-sale securities, ending balances | 2 |
Foreign currency translation adjustments, beginning balances | (149) |
Foreign currency translation adjustments | (22) |
Foreign currency translation adjustments, ending balances | (171) |
Defined benefit plans, beginning balances | (168) |
Defined benefit plans, (income) expense reclassified into operations from other comprehensive income | 7 |
Defined benefit plans, ending balances | (161) |
Change in fair value of derivative instruments, beginning balances | 32 |
Change in fair value of derivative instruments net of income taxes | 39 |
Change in fair value of derivative instruments, ending balances | 69 |
Accumulated other comprehensive income, net of tax, beginning balances | (278) |
Unrealized losses on available-for-sale securities, net of income tax benefit | (5) |
Foreign currency translation adjustments | (22) |
Change in fair value of derivative instruments | 39 |
Expense (income) reclassified into operations from other comprehensive income, Total | 5 |
Accumulated other comprehensive income (loss), net of tax, ending balances | $ (261) |
Capital Structure - Component48
Capital Structure - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) $ in Millions | 6 Months Ended |
Jun. 30, 2018USD ($) | |
Equity [Abstract] | |
Unrealized losses on available-for-sale securities, tax benefit portion | $ 1 |
Defined benefit plans, Expense (income) reclassified into operations from other comprehensive income, Income tax benefit | 3 |
Change in fair value of derivative instruments, change in fair value of derivative instruments, income taxes | $ 11 |
Segment and Geographic Inform49
Segment and Geographic Information - Additional Information (Detail) | 6 Months Ended |
Jun. 30, 2018Hospital | |
Segment Reporting Information [Line Items] | |
Number of geographically organized groups | 2 |
Number of owned and operated hospitals | 178 |
Reorganization Group [Member] | National Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 88 |
Reorganization Group [Member] | American Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 84 |
Reorganization Group [Member] | Corporate and Other [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 6 |
Segment and Geographic Inform50
Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization and Assets (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Segment Reporting Information [Line Items] | ||||
Revenues | $ 11,529 | $ 10,733 | $ 22,952 | $ 21,356 |
Equity in earnings of affiliates | 7 | 13 | 16 | 23 |
Adjusted segment EBITDA | 2,227 | 2,090 | 4,345 | 4,095 |
Depreciation and amortization | 562 | 521 | 1,115 | 1,042 |
Interest expense | 436 | 411 | 867 | 830 |
Gains on sales of facilities | (9) | (2) | (414) | (3) |
Income before income taxes | 1,238 | 1,160 | 2,777 | 2,226 |
National Group [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 5,609 | 5,160 | 11,177 | 10,308 |
Equity in earnings of affiliates | (2) | (4) | (4) | (9) |
Adjusted segment EBITDA | 1,284 | 1,162 | 2,466 | 2,293 |
Depreciation and amortization | 232 | 217 | 457 | 431 |
American Group [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 5,390 | 5,093 | 10,717 | 10,088 |
Equity in earnings of affiliates | (10) | (10) | (19) | (18) |
Adjusted segment EBITDA | 1,147 | 1,040 | 2,178 | 2,047 |
Depreciation and amortization | 255 | 238 | 507 | 476 |
Corporate and Other [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 530 | 480 | 1,058 | 960 |
Equity in earnings of affiliates | 5 | 1 | 7 | 4 |
Adjusted segment EBITDA | (204) | (112) | (299) | (245) |
Depreciation and amortization | $ 75 | $ 66 | $ 151 | $ 135 |
Supplemental Condensed Consol51
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Additional Information (Detail) - USD ($) | Jun. 30, 2018 | Dec. 31, 2012 |
Supplemental Condensed Consolidating Financial Information [Line Items] | ||
Ownership percentage held by parent | 100.00% | |
Senior Unsecured Notes Due 2021 [Member] | ||
Supplemental Condensed Consolidating Financial Information [Line Items] | ||
Debt instrument, principal amount | $ 1,000,000,000 | |
Debt instrument, stated interest | 6.25% |
Supplemental Condensed Consol52
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Comprehensive Income Statement (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Condensed Statement of Income Captions [Line Items] | ||||
Revenues | $ 11,529 | $ 10,733 | $ 22,952 | $ 21,356 |
Salaries and benefits | 5,274 | 4,896 | 10,563 | 9,797 |
Supplies | 1,917 | 1,795 | 3,832 | 3,592 |
Other operating expenses | 2,118 | 1,965 | 4,228 | 3,895 |
Equity in earnings of affiliates | (7) | (13) | (16) | (23) |
Depreciation and amortization | 562 | 521 | 1,115 | 1,042 |
Interest expense | 436 | 411 | 867 | 830 |
Losses (gains) on sales of facilities | (9) | (2) | (414) | (3) |
Total expenses including equity in earnings of affiliates | 10,291 | 9,573 | 20,175 | 19,130 |
Income (loss) before income taxes | 1,238 | 1,160 | 2,777 | 2,226 |
Provision (benefit) for income taxes | 272 | 365 | 529 | 654 |
Net income (loss) | 966 | 795 | 2,248 | 1,572 |
Net income attributable to noncontrolling interests | 146 | 138 | 284 | 256 |
Net income (loss) attributable to HCA Healthcare, Inc. | 820 | 657 | 1,964 | 1,316 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 756 | 684 | 1,981 | 1,361 |
Health Care, Patient Service [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Revenues | 11,529 | 10,733 | 22,952 | 21,356 |
HCA Healthcare, Inc. Issuer [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Other operating expenses | 4 | 4 | 5 | 5 |
Equity in earnings of affiliates | (852) | (658) | (1,942) | (1,266) |
Interest expense | 16 | 16 | 32 | 32 |
Total expenses including equity in earnings of affiliates | (832) | (638) | (1,905) | (1,229) |
Income (loss) before income taxes | 832 | 638 | 1,905 | 1,229 |
Provision (benefit) for income taxes | 12 | (19) | (59) | (87) |
Net income (loss) | 820 | 657 | 1,964 | 1,316 |
Net income (loss) attributable to HCA Healthcare, Inc. | 820 | 657 | 1,964 | 1,316 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 756 | 684 | 1,981 | 1,361 |
HCA Inc. Issuer [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Interest expense | 867 | 755 | 1,704 | 1,488 |
Total expenses including equity in earnings of affiliates | 867 | 755 | 1,704 | 1,488 |
Income (loss) before income taxes | (867) | (755) | (1,704) | (1,488) |
Provision (benefit) for income taxes | (201) | (279) | (396) | (549) |
Net income (loss) | (666) | (476) | (1,308) | (939) |
Net income (loss) attributable to HCA Healthcare, Inc. | (666) | (476) | (1,308) | (939) |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | (656) | (480) | (1,271) | (936) |
Subsidiary Guarantors [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Salaries and benefits | 3,025 | 2,870 | 6,094 | 5,774 |
Supplies | 1,127 | 1,055 | 2,268 | 2,130 |
Other operating expenses | 1,122 | 1,064 | 2,250 | 2,114 |
Equity in earnings of affiliates | (1) | (1) | (3) | (3) |
Depreciation and amortization | 329 | 302 | 652 | 612 |
Interest expense | (389) | (315) | (756) | (605) |
Losses (gains) on sales of facilities | 23 | (4) | (372) | (3) |
Management fees | (157) | (160) | (315) | (320) |
Total expenses including equity in earnings of affiliates | 5,079 | 4,811 | 9,818 | 9,699 |
Income (loss) before income taxes | 1,695 | 1,558 | 3,732 | 3,006 |
Provision (benefit) for income taxes | 389 | 565 | 856 | 1,091 |
Net income (loss) | 1,306 | 993 | 2,876 | 1,915 |
Net income attributable to noncontrolling interests | 22 | 27 | 50 | 50 |
Net income (loss) attributable to HCA Healthcare, Inc. | 1,284 | 966 | 2,826 | 1,865 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 1,287 | 969 | 2,833 | 1,871 |
Subsidiary Guarantors [Member] | Health Care, Patient Service [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Revenues | 6,774 | 6,369 | 13,550 | 12,705 |
Subsidiary Non-Guarantors [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Salaries and benefits | 2,249 | 2,026 | 4,469 | 4,023 |
Supplies | 790 | 740 | 1,564 | 1,462 |
Other operating expenses | 992 | 897 | 1,973 | 1,776 |
Equity in earnings of affiliates | (6) | (12) | (13) | (20) |
Depreciation and amortization | 233 | 219 | 463 | 430 |
Interest expense | (58) | (45) | (113) | (85) |
Losses (gains) on sales of facilities | (32) | 2 | (42) | |
Management fees | 157 | 160 | 315 | 320 |
Total expenses including equity in earnings of affiliates | 4,325 | 3,987 | 8,616 | 7,906 |
Income (loss) before income taxes | 430 | 377 | 786 | 745 |
Provision (benefit) for income taxes | 72 | 98 | 128 | 199 |
Net income (loss) | 358 | 279 | 658 | 546 |
Net income attributable to noncontrolling interests | 124 | 111 | 234 | 206 |
Net income (loss) attributable to HCA Healthcare, Inc. | 234 | 168 | 424 | 340 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 157 | 196 | 397 | 376 |
Subsidiary Non-Guarantors [Member] | Health Care, Patient Service [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Revenues | 4,755 | 4,364 | 9,402 | 8,651 |
Eliminations [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Equity in earnings of affiliates | 852 | 658 | 1,942 | 1,266 |
Total expenses including equity in earnings of affiliates | 852 | 658 | 1,942 | 1,266 |
Income (loss) before income taxes | (852) | (658) | (1,942) | (1,266) |
Net income (loss) | (852) | (658) | (1,942) | (1,266) |
Net income (loss) attributable to HCA Healthcare, Inc. | (852) | (658) | (1,942) | (1,266) |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | $ (788) | $ (685) | $ (1,959) | $ (1,311) |
Supplemental Condensed Consol53
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Balance Sheet (Detail) - USD ($) $ in Millions | Jun. 30, 2018 | Dec. 31, 2017 |
Current assets: | ||
Cash and cash equivalents | $ 868 | $ 732 |
Accounts receivable | 6,592 | 6,501 |
Inventories | 1,636 | 1,573 |
Other | 1,298 | 1,171 |
Total current assets | 10,394 | 9,977 |
Property and equipment, net | 18,544 | 17,895 |
Investments of insurance subsidiaries | 414 | 418 |
Investments in and advances to affiliates | 234 | 199 |
Goodwill and other intangible assets | 7,459 | 7,394 |
Other | 697 | 710 |
Total assets | 37,742 | 36,593 |
Current liabilities: | ||
Accounts payable | 2,457 | 2,606 |
Accrued salaries | 1,315 | 1,369 |
Other accrued expenses | 2,161 | 1,983 |
Long-term debt due within one year | 1,692 | 200 |
Total current liabilities | 7,625 | 6,158 |
Long-term debt, net | 31,500 | 32,858 |
Professional liability risks | 1,283 | 1,198 |
Income taxes and other liabilities | 1,459 | 1,374 |
Total liabilities | 41,867 | 41,588 |
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (5,989) | (6,806) |
Noncontrolling interests | 1,864 | 1,811 |
Total stockholders' deficit | (4,125) | (4,995) |
Total liabilities and stockholders' deficit | 37,742 | 36,593 |
HCA Healthcare, Inc. Issuer [Member] | ||
Current assets: | ||
Cash and cash equivalents | 1 | |
Total current assets | 1 | |
Investments in and advances to affiliates | 31,540 | 29,581 |
Other | 450 | 510 |
Total assets | 31,990 | 30,092 |
Current liabilities: | ||
Accounts payable | 1 | |
Other accrued expenses | 101 | 29 |
Total current liabilities | 102 | 29 |
Long-term debt, net | 995 | 995 |
Intercompany balances | 36,325 | 35,322 |
Income taxes and other liabilities | 557 | 552 |
Total liabilities | 37,979 | 36,898 |
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (5,989) | (6,806) |
Total stockholders' deficit | (5,989) | (6,806) |
Total liabilities and stockholders' deficit | 31,990 | 30,092 |
HCA Inc. Issuer [Member] | ||
Current assets: | ||
Other | 98 | 50 |
Total assets | 98 | 50 |
Current liabilities: | ||
Other accrued expenses | 382 | 378 |
Long-term debt due within one year | 1,597 | 97 |
Total current liabilities | 1,979 | 475 |
Long-term debt, net | 30,048 | 31,367 |
Intercompany balances | (8,608) | (9,742) |
Total liabilities | 23,419 | 22,100 |
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (23,321) | (22,050) |
Total stockholders' deficit | (23,321) | (22,050) |
Total liabilities and stockholders' deficit | 98 | 50 |
Subsidiary Guarantors [Member] | ||
Current assets: | ||
Cash and cash equivalents | 197 | 112 |
Accounts receivable | 3,873 | 3,693 |
Inventories | 1,093 | 1,030 |
Other | 743 | 663 |
Total current assets | 5,906 | 5,498 |
Property and equipment, net | 11,842 | 11,110 |
Investments in and advances to affiliates | 28 | 22 |
Goodwill and other intangible assets | 5,429 | 4,893 |
Other | 29 | 47 |
Total assets | 23,234 | 21,570 |
Current liabilities: | ||
Accounts payable | 1,683 | 1,793 |
Accrued salaries | 836 | 862 |
Other accrued expenses | 670 | 536 |
Long-term debt due within one year | 61 | 64 |
Total current liabilities | 3,250 | 3,255 |
Long-term debt, net | 282 | 307 |
Intercompany balances | (26,352) | (25,228) |
Income taxes and other liabilities | 388 | 357 |
Total liabilities | (22,432) | (21,309) |
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 45,588 | 42,755 |
Noncontrolling interests | 78 | 124 |
Total stockholders' deficit | 45,666 | 42,879 |
Total liabilities and stockholders' deficit | 23,234 | 21,570 |
Subsidiary Non-Guarantors [Member] | ||
Current assets: | ||
Cash and cash equivalents | 671 | 619 |
Accounts receivable | 2,719 | 2,808 |
Inventories | 543 | 543 |
Other | 555 | 508 |
Total current assets | 4,488 | 4,478 |
Property and equipment, net | 6,702 | 6,785 |
Investments of insurance subsidiaries | 414 | 418 |
Investments in and advances to affiliates | 206 | 177 |
Goodwill and other intangible assets | 2,030 | 2,501 |
Other | 120 | 103 |
Total assets | 13,960 | 14,462 |
Current liabilities: | ||
Accounts payable | 773 | 813 |
Accrued salaries | 479 | 507 |
Other accrued expenses | 1,008 | 1,040 |
Long-term debt due within one year | 34 | 39 |
Total current liabilities | 2,294 | 2,399 |
Long-term debt, net | 175 | 189 |
Intercompany balances | (1,365) | (352) |
Professional liability risks | 1,283 | 1,198 |
Income taxes and other liabilities | 514 | 465 |
Total liabilities | 2,901 | 3,899 |
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 9,273 | 8,876 |
Noncontrolling interests | 1,786 | 1,687 |
Total stockholders' deficit | 11,059 | 10,563 |
Total liabilities and stockholders' deficit | 13,960 | 14,462 |
Eliminations [Member] | ||
Current assets: | ||
Investments in and advances to affiliates | (31,540) | (29,581) |
Total assets | (31,540) | (29,581) |
Current liabilities: | ||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (31,540) | (29,581) |
Total stockholders' deficit | (31,540) | (29,581) |
Total liabilities and stockholders' deficit | $ (31,540) | $ (29,581) |
Supplemental Condensed Consol54
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Statement of Cash Flows (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Cash flows from operating activities: | ||||
Net income (loss) | $ 966 | $ 795 | $ 2,248 | $ 1,572 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (402) | (395) | ||
Depreciation and amortization | 562 | 521 | 1,115 | 1,042 |
Income taxes | 118 | 267 | ||
Losses (gains) on sales of facilities | (9) | (2) | (414) | (3) |
Amortization of debt issuance costs | 15 | 16 | ||
Share-based compensation | 134 | 140 | ||
Other | 51 | 45 | ||
Net cash provided by (used in) operating activities | 2,865 | 2,684 | ||
Cash flows from investing activities: | ||||
Purchase of property and equipment | (1,574) | (1,304) | ||
Acquisition of hospitals and health care entities | (538) | (295) | ||
Disposition of hospitals and health care entities | 799 | 14 | ||
Change in investments | 23 | (11) | ||
Other | (25) | 5 | ||
Net cash used in investing activities | (1,315) | (1,591) | ||
Cash flows from financing activities: | ||||
Issuance of long-term debt | 1,502 | |||
Net change in revolving credit facilities | 210 | (1,160) | ||
Repayment of long-term debt | (101) | (95) | ||
Distributions to noncontrolling interests | (185) | (248) | ||
Payment of debt issuance costs | (2) | (25) | ||
Payment of cash dividends | (245) | |||
Repurchases of common stock | (893) | (966) | ||
Other | (192) | (42) | ||
Net cash (used in) provided by financing activities | (1,408) | (1,034) | ||
Effect on exchange rate changes on cash and cash equivalents | (6) | |||
Change in cash and cash equivalents | 136 | 59 | ||
Cash and cash equivalents at beginning of period | 732 | 646 | ||
Cash and cash equivalents at end of period | 868 | 705 | 868 | 705 |
Eliminations [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | (852) | (658) | (1,942) | (1,266) |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Equity in earnings of affiliates | 1,942 | 1,266 | ||
HCA Healthcare, Inc. Issuer [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | 820 | 657 | 1,964 | 1,316 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | 1 | |||
Income taxes | 118 | 267 | ||
Equity in earnings of affiliates | (1,942) | (1,266) | ||
Other | 43 | 39 | ||
Net cash provided by (used in) operating activities | 183 | 357 | ||
Cash flows from financing activities: | ||||
Payment of cash dividends | (245) | |||
Repurchases of common stock | (893) | (966) | ||
Changes in intercompany balances with affiliates, net | 1,150 | 671 | ||
Other | (196) | (62) | ||
Net cash (used in) provided by financing activities | (184) | (357) | ||
Change in cash and cash equivalents | (1) | |||
Cash and cash equivalents at beginning of period | 1 | |||
HCA Inc. Issuer [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | (666) | (476) | (1,308) | (939) |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | 2 | (189) | ||
Amortization of debt issuance costs | 15 | 16 | ||
Net cash provided by (used in) operating activities | (1,291) | (1,112) | ||
Cash flows from financing activities: | ||||
Issuance of long-term debt | 1,500 | |||
Net change in revolving credit facilities | 210 | (1,160) | ||
Repayment of long-term debt | (41) | (42) | ||
Payment of debt issuance costs | (2) | (25) | ||
Changes in intercompany balances with affiliates, net | 1,124 | 839 | ||
Net cash (used in) provided by financing activities | 1,291 | 1,112 | ||
Subsidiary Guarantors [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | 1,306 | 993 | 2,876 | 1,915 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (352) | (196) | ||
Depreciation and amortization | 329 | 302 | 652 | 612 |
Losses (gains) on sales of facilities | 23 | (4) | (372) | (3) |
Share-based compensation | 134 | 140 | ||
Other | 1 | |||
Net cash provided by (used in) operating activities | 2,938 | 2,469 | ||
Cash flows from investing activities: | ||||
Purchase of property and equipment | (900) | (729) | ||
Acquisition of hospitals and health care entities | (438) | (6) | ||
Disposition of hospitals and health care entities | 767 | 10 | ||
Change in investments | 17 | |||
Other | (30) | 2 | ||
Net cash used in investing activities | (584) | (723) | ||
Cash flows from financing activities: | ||||
Repayment of long-term debt | (38) | (33) | ||
Distributions to noncontrolling interests | (43) | (79) | ||
Changes in intercompany balances with affiliates, net | (2,188) | (1,589) | ||
Net cash (used in) provided by financing activities | (2,269) | (1,701) | ||
Change in cash and cash equivalents | 85 | 45 | ||
Cash and cash equivalents at beginning of period | 112 | 113 | ||
Cash and cash equivalents at end of period | 197 | 158 | 197 | 158 |
Subsidiary Non-Guarantors [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | 358 | 279 | 658 | 546 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (52) | (11) | ||
Depreciation and amortization | 233 | 219 | 463 | 430 |
Losses (gains) on sales of facilities | (32) | 2 | (42) | |
Other | 8 | 5 | ||
Net cash provided by (used in) operating activities | 1,035 | 970 | ||
Cash flows from investing activities: | ||||
Purchase of property and equipment | (674) | (575) | ||
Acquisition of hospitals and health care entities | (100) | (289) | ||
Disposition of hospitals and health care entities | 32 | 4 | ||
Change in investments | 6 | (11) | ||
Other | 5 | 3 | ||
Net cash used in investing activities | (731) | (868) | ||
Cash flows from financing activities: | ||||
Issuance of long-term debt | 2 | |||
Repayment of long-term debt | (22) | (20) | ||
Distributions to noncontrolling interests | (142) | (169) | ||
Changes in intercompany balances with affiliates, net | (86) | 79 | ||
Other | 4 | 20 | ||
Net cash (used in) provided by financing activities | (246) | (88) | ||
Effect on exchange rate changes on cash and cash equivalents | (6) | |||
Change in cash and cash equivalents | 52 | 14 | ||
Cash and cash equivalents at beginning of period | 619 | 533 | ||
Cash and cash equivalents at end of period | $ 671 | $ 547 | $ 671 | $ 547 |
Supplemental Condensed Consol55
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Summary of Restatement Adjustments to Financial Statements (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | $ 820 | $ 657 | $ 1,964 | $ 1,316 |
Net cash provided by operating activities | 2,684 | |||
HCA Healthcare, Inc. Issuer [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 820 | 657 | 1,964 | 1,316 |
Net cash provided by operating activities | 357 | |||
HCA Inc. Issuer [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | (666) | (476) | (1,308) | (939) |
Net cash provided by operating activities | (1,112) | |||
Subsidiary Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 1,284 | 966 | 2,826 | 1,865 |
Net cash provided by operating activities | 2,469 | |||
Subsidiary Non-Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 234 | 168 | 424 | 340 |
Net cash provided by operating activities | 970 | |||
Eliminations [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | $ (852) | (658) | $ (1,942) | (1,266) |
As Previously Reported [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 657 | 1,316 | ||
Net cash provided by operating activities | 2,684 | |||
As Previously Reported [Member] | HCA Healthcare, Inc. Issuer [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 657 | 1,316 | ||
Net cash provided by operating activities | 357 | |||
As Previously Reported [Member] | HCA Inc. Issuer [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | (476) | (939) | ||
Net cash provided by operating activities | (1,112) | |||
As Previously Reported [Member] | Subsidiary Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 862 | 1,680 | ||
Net cash provided by operating activities | 2,191 | |||
As Previously Reported [Member] | Subsidiary Non-Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 272 | 525 | ||
Net cash provided by operating activities | 1,248 | |||
As Previously Reported [Member] | Eliminations [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | (658) | (1,266) | ||
Adjustment [Member] | Subsidiary Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 104 | 185 | ||
Net cash provided by operating activities | 278 | |||
Adjustment [Member] | Subsidiary Non-Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | $ (104) | (185) | ||
Net cash provided by operating activities | $ (278) |