Document and Entity Information
Document and Entity Information - shares | 9 Months Ended | |
Sep. 30, 2018 | Oct. 31, 2018 | |
Document And Entity Information [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Sep. 30, 2018 | |
Document Fiscal Year Focus | 2,018 | |
Document Fiscal Period Focus | Q3 | |
Trading Symbol | HCA | |
Entity Registrant Name | HCA Healthcare, Inc. | |
Entity Central Index Key | 860,730 | |
Current Fiscal Year End Date | --12-31 | |
Entity Filer Category | Large Accelerated Filer | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Common Stock, Shares Outstanding | 344,160,500 |
Condensed Consolidated Income S
Condensed Consolidated Income Statements - USD ($) shares in Thousands, $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | |
Income Statement [Abstract] | ||||
Revenues | $ 11,451 | $ 10,696 | $ 34,403 | $ 32,052 |
Salaries and benefits | 5,377 | 5,081 | 15,940 | 14,878 |
Supplies | 1,890 | 1,777 | 5,722 | 5,369 |
Other operating expenses | 2,097 | 2,075 | 6,325 | 5,970 |
Equity in earnings of affiliates | (9) | (13) | (25) | (36) |
Depreciation and amortization | 582 | 539 | 1,697 | 1,581 |
Interest expense | 442 | 427 | 1,309 | 1,257 |
Gain on sales of facilities | (6) | (7) | (420) | (10) |
Losses on retirement of debt | 9 | 39 | 9 | 39 |
Total expenses including equity in earnings of affiliates | 10,382 | 9,918 | 30,557 | 29,048 |
Income before income taxes | 1,069 | 778 | 3,846 | 3,004 |
Provision for income taxes | 173 | 248 | 702 | 902 |
Net income | 896 | 530 | 3,144 | 2,102 |
Net income attributable to noncontrolling interests | 137 | 104 | 421 | 360 |
Net income attributable to HCA Healthcare, Inc. | $ 759 | $ 426 | $ 2,723 | $ 1,742 |
Per share data: | ||||
Basic earnings | $ 2.20 | $ 1.18 | $ 7.82 | $ 4.77 |
Diluted earnings | $ 2.15 | $ 1.15 | $ 7.65 | $ 4.64 |
Shares used in earnings per share calculations (in millions): | ||||
Basic | 345,823 | 360,170 | 348,411 | 365,398 |
Diluted | 353,639 | 369,834 | 356,124 | 375,013 |
Condensed Consolidated Comprehe
Condensed Consolidated Comprehensive Income Statements - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | |
Statement of Comprehensive Income [Abstract] | ||||
Net income | $ 896 | $ 530 | $ 3,144 | $ 2,102 |
Other comprehensive income (loss) before taxes: | ||||
Foreign currency translation | (13) | 32 | (35) | 87 |
Unrealized (losses) gains on available-for-sale securities | (2) | (8) | 5 | |
Defined benefit plans | 0 | 0 | 0 | 0 |
Pension costs included in salaries and benefits | 5 | 5 | 15 | 14 |
Total defined benefit plans | 5 | 5 | 15 | 14 |
Change in fair value of derivative financial instruments | 10 | (1) | 60 | (9) |
Interest (benefits) costs included in interest expense | (3) | 4 | (5) | 17 |
Total change in fair value of derivative financial instruments | 7 | 3 | 55 | 8 |
Other comprehensive (loss) income before taxes | (3) | 40 | 27 | 114 |
Income taxes related to other comprehensive income items | 2 | 15 | 15 | 44 |
Other comprehensive (loss) income | (5) | 25 | 12 | 70 |
Comprehensive income | 891 | 555 | 3,156 | 2,172 |
Comprehensive income attributable to noncontrolling interests | 137 | 104 | 421 | 360 |
Comprehensive income attributable to HCA Healthcare, Inc. | $ 754 | $ 451 | $ 2,735 | $ 1,812 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Millions | Sep. 30, 2018 | Dec. 31, 2017 |
Current assets: | ||
Cash and cash equivalents | $ 578 | $ 732 |
Accounts receivable | 6,532 | 6,501 |
Inventories | 1,634 | 1,573 |
Other | 1,266 | 1,171 |
Total current assets | 10,010 | 9,977 |
Property and equipment, at cost | 41,978 | 40,084 |
Accumulated depreciation | (22,937) | (22,189) |
Property and equipment, net | 19,041 | 17,895 |
Investments of insurance subsidiaries | 367 | 418 |
Investments in and advances to affiliates | 238 | 199 |
Goodwill and other intangible assets | 7,759 | 7,394 |
Other | 629 | 710 |
Total assets | 38,044 | 36,593 |
Current liabilities: | ||
Accounts payable | 2,414 | 2,606 |
Accrued salaries | 1,456 | 1,369 |
Other accrued expenses | 2,170 | 1,983 |
Long-term debt due within one year | 191 | 200 |
Total current liabilities | 6,231 | 6,158 |
Long-term debt, less net debt issuance costs of $163 and $164 | 32,916 | 32,858 |
Professional liability risks | 1,239 | 1,198 |
Income taxes and other liabilities | 1,388 | 1,374 |
Stockholders' deficit: | ||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 345,085,800 shares in 2018 and 350,091,600 shares in 2017 | 3 | 4 |
Accumulated other comprehensive loss | (266) | (278) |
Retained deficit | (5,342) | (6,532) |
Stockholders' deficit attributable to HCA Healthcare, Inc. | (5,605) | (6,806) |
Noncontrolling interests | 1,875 | 1,811 |
Total stockholders' deficit | (3,730) | (4,995) |
Total liabilities and stockholders' deficit | $ 38,044 | $ 36,593 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions | Sep. 30, 2018 | Dec. 31, 2017 |
Statement of Financial Position [Abstract] | ||
Debt issuance cost | $ 163 | $ 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 | 345,085,800 | 350,091,600 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Stockholders' Deficit - USD ($) $ in Millions | Total | Common Stock [Member] | Capital in Excess of Par Value [Member] | Accumulated Other Comprehensive Loss [Member] | Retained Deficit [Member] | Equity Attributable to Noncontrolling Interests [Member] |
Balances at Dec. 31, 2016 | $ (5,633) | $ 4 | $ (338) | $ (6,968) | $ 1,669 | |
Balance, shares at Dec. 31, 2016 | 370,536,000 | |||||
Comprehensive income | 795 | 18 | 659 | 118 | ||
Repurchase of common stock | (424) | $ (32) | (392) | |||
Repurchase of common stock, shares | (5,121,000) | |||||
Share-based benefit plans | 35 | 35 | ||||
Share-based benefit plans, shares | 3,280,000 | |||||
Distributions | (145) | (145) | ||||
Other | 15 | (3) | 18 | |||
Balance at Mar. 31, 2017 | (5,357) | $ 4 | (320) | (6,701) | 1,660 | |
Balance, shares at Mar. 31, 2017 | 368,695,000 | |||||
Balances at Dec. 31, 2016 | (5,633) | $ 4 | (338) | (6,968) | 1,669 | |
Balance, shares at Dec. 31, 2016 | 370,536,000 | |||||
Comprehensive income | 2,172 | |||||
Balance at Sep. 30, 2017 | (5,066) | $ 4 | (268) | (6,516) | 1,714 | |
Balance, shares at Sep. 30, 2017 | 356,980,000 | |||||
Balances at Mar. 31, 2017 | (5,357) | $ 4 | (320) | (6,701) | 1,660 | |
Balance, shares at Mar. 31, 2017 | 368,695,000 | |||||
Comprehensive income | 822 | 27 | 657 | 138 | ||
Repurchase of common stock | (542) | (83) | (459) | |||
Repurchase of common stock, shares | (6,404,000) | |||||
Share-based benefit plans | 82 | 82 | ||||
Share-based benefit plans, shares | 604,000 | |||||
Distributions | (103) | (103) | ||||
Other | (19) | (1) | (18) | |||
Balance at Jun. 30, 2017 | (5,079) | $ 4 | (293) | (6,503) | 1,713 | |
Balance, shares at Jun. 30, 2017 | 362,895,000 | |||||
Comprehensive income | 555 | 25 | 426 | 104 | ||
Repurchase of common stock | (509) | (70) | (439) | |||
Repurchase of common stock, shares | (6,322,000) | |||||
Share-based benefit plans | 71 | 71 | ||||
Share-based benefit plans, shares | 407,000 | |||||
Distributions | (115) | (115) | ||||
Other | (11) | 1 | (12) | |||
Balance at Sep. 30, 2017 | (5,066) | $ 4 | (268) | (6,516) | 1,714 | |
Balance, shares at Sep. 30, 2017 | 356,980,000 | |||||
Comprehensive income | 631 | (10) | 474 | 167 | ||
Repurchase of common stock | (576) | (86) | (490) | |||
Repurchase of common stock, shares | (7,245,000) | |||||
Share-based benefit plans | 93 | 93 | ||||
Share-based benefit plans, shares | 357,000 | |||||
Distributions | (85) | (85) | ||||
Other | (8) | 7 | (15) | |||
Balance at Dec. 31, 2017 | (4,995) | $ 4 | (278) | (6,532) | 1,811 | |
Balance, shares at Dec. 31, 2017 | 350,092,000 | |||||
Comprehensive income | 1,363 | 81 | 1,144 | 138 | ||
Repurchase of common stock | (423) | (423) | ||||
Repurchase of common stock, shares | (4,370,000) | |||||
Share-based benefit plans | (114) | (114) | ||||
Share-based benefit plans, shares | 5,265,000 | |||||
Cash dividends declared ($0.35 per share) | (126) | (126) | ||||
Distributions | (92) | (92) | ||||
Other | 47 | 47 | ||||
Balance at Mar. 31, 2018 | (4,434) | $ 4 | (197) | (6,051) | 1,810 | |
Balance, shares at Mar. 31, 2018 | 350,987,000 | |||||
Balances at Dec. 31, 2017 | (4,995) | $ 4 | (278) | (6,532) | 1,811 | |
Balance, shares at Dec. 31, 2017 | 350,092,000 | |||||
Comprehensive income | $ 3,156 | |||||
Repurchase of common stock, shares | (11,558,000) | |||||
Balance at Sep. 30, 2018 | $ (3,730) | $ 3 | (266) | (5,342) | 1,875 | |
Balance, shares at Sep. 30, 2018 | 345,086,000 | |||||
Balances at Mar. 31, 2018 | (4,434) | $ 4 | (197) | (6,051) | 1,810 | |
Balance, shares at Mar. 31, 2018 | 350,987,000 | |||||
Comprehensive income | 902 | (64) | 820 | 146 | ||
Repurchase of common stock | (470) | $ (1) | (93) | (376) | ||
Repurchase of common stock, shares | (4,670,000) | |||||
Share-based benefit plans | 96 | 96 | ||||
Share-based benefit plans, shares | 443,000 | |||||
Cash dividends declared ($0.35 per share) | (124) | (124) | ||||
Distributions | (93) | (93) | ||||
Other | 2 | 3 | (1) | |||
Balance at Jun. 30, 2018 | (4,125) | $ 3 | (261) | (5,731) | 1,864 | |
Balance, shares at Jun. 30, 2018 | 346,760,000 | |||||
Comprehensive income | 891 | (5) | 759 | 137 | ||
Repurchase of common stock | (302) | (55) | (247) | |||
Repurchase of common stock, shares | (2,518,000) | |||||
Share-based benefit plans | 54 | 54 | ||||
Share-based benefit plans, shares | 844,000 | |||||
Cash dividends declared ($0.35 per share) | (123) | (123) | ||||
Distributions | (130) | (130) | ||||
Other | (5) | $ (1) | (4) | |||
Balance at Sep. 30, 2018 | $ (3,730) | $ 3 | $ (266) | $ (5,342) | $ 1,875 | |
Balance, shares at Sep. 30, 2018 | 345,086,000 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Stockholders' Deficit (Parenthetical) - $ / shares | 3 Months Ended | ||
Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | |
Statement of Stockholders' Equity [Abstract] | |||
Cash dividends declared, per share | $ 0.35 | $ 0.35 | $ 0.35 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions | 9 Months Ended | |
Sep. 30, 2018 | Sep. 30, 2017 | |
Cash flows from operating activities: | ||
Net income | $ 3,144 | $ 2,102 |
Increase (decrease) in cash from operating assets and liabilities: | ||
Accounts receivable | (161) | (70) |
Inventories and other assets | (136) | (50) |
Accounts payable and accrued expenses | 150 | (169) |
Depreciation and amortization | 1,697 | 1,581 |
Income taxes | (9) | |
Gain on sales of facilities | (420) | (10) |
Losses on retirement of debt | 9 | 39 |
Amortization of debt issuance costs | 23 | 23 |
Share-based compensation | 204 | 195 |
Other | 76 | 60 |
Net cash provided by (used in) operating activities | 4,586 | 3,692 |
Cash flows from investing activities: | ||
Purchase of property and equipment | (2,420) | (2,033) |
Acquisition of hospitals and health care entities | (1,056) | (1,142) |
Disposal of hospitals and health care entities | 802 | 24 |
Change in investments | 65 | (15) |
Other | (6) | (6) |
Net cash used in investing activities | (2,615) | (3,172) |
Cash flows from financing activities: | ||
Issuances of long-term debt | 2,000 | 1,502 |
Net change in revolving bank credit facilities | (330) | 650 |
Repayment of long-term debt | (1,652) | (700) |
Distributions to noncontrolling interests | (315) | (363) |
Payment of debt issuance costs | (24) | (25) |
Payment of cash dividends | (366) | |
Repurchases of common stock | (1,195) | (1,475) |
Other | (232) | (37) |
Net cash (used in) provided by financing activities | (2,114) | (448) |
Effect of exchange rate changes on cash and cash equivalents | (11) | |
Change in cash and cash equivalents | (154) | 72 |
Cash and cash equivalents at beginning of period | 732 | 646 |
Cash and cash equivalents at end of period | 578 | 718 |
Interest payments | 1,422 | 1,383 |
Income tax payments, net | $ 702 | $ 911 |
Basis of Presentation and Signi
Basis of Presentation and Significant Accounting Policies | 9 Months Ended |
Sep. 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 September 30, 2018, these affiliates owned and operated 179 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 $90 million and $83 million for the quarters ended September 30, 2018 and 2017, respectively, and $254 million and $247 million for the nine months ended September 30, 2018 and 2017, respectively. Operating results for the quarter and nine months ended September 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 $ 2,404 21.0 % $ 2,298 21.5 % Managed Medicare 1,344 11.7 1,122 10.5 Medicaid 338 3.0 286 2.7 Managed Medicaid 622 5.4 537 5.0 Managed care and insurers 6,026 52.6 5,605 52.4 International (managed care and insurers) 273 2.4 276 2.6 Other 444 3.9 572 5.3 Revenues $ 11,451 100.0 % $ 10,696 100.0 % Nine Months 2018 Ratio 2017 Ratio Medicare $ 7,353 21.4 % $ 6,931 21.6 % Managed Medicare 4,088 11.9 3,463 10.8 Medicaid 976 2.8 956 3.0 Managed Medicaid 1,769 5.1 1,653 5.2 Managed care and insurers 18,081 52.6 16,957 52.9 International (managed care and insurers) 873 2.5 814 2.5 Other 1,263 3.7 1,278 4.0 Revenues $ 34,403 100.0 % $ 32,052 100.0 % 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 nine months ended September 30, 2018 and 2017 follows (dollars in millions): Quarter Nine Months 2018 2017 2018 2017 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 9,946 $ 9,472 $ 29,684 $ 27,798 Cost-to-charges 12.7 % 13.4 % 12.6 % 13.1 % Total uncompensated care $ 6,786 $ 6,089 $ 19,524 $ 17,137 Multiply by the cost-to-charges 12.7 % 13.4 % 12.6 % 13.1 % Estimated cost of total uncompensated care $ 862 $ 816 $ 2,460 $ 2,245 Total uncompensated care as a percentage of the sum of revenues and total uncompensated care was 37.2% and 36.3% for the quarters ended September 30, 2018 and 2017, respectively, and 36.2% and 34.8% for the nine months ended September 30, 2018 and 2017, respectively. The total uncompensated care amounts include charity care of $2.314 billion and $1.235 billion, and the related estimated costs of charity care were $295 million and $167 million for the quarters ended September 30, 2018 and 2017, respectively, and charity care of $6.170 billion and $3.494 billion, and the related estimated costs of charity care were $777 million and $458 million for the nine months ended September 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 During October 2018, the SEC adopted a final rule affecting interim financial statements which requires a reconciliation of changes in stockholders’ equity in the notes to the financial statements or as a separate statement. We have included a single statement presentation of our condensed consolidated statements of stockholders’ deficit for the quarters and nine months ended September 30, 2018 and 2017. Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Acquisitions and Dispositions
Acquisitions and Dispositions | 9 Months Ended |
Sep. 30, 2018 | |
Business Combinations [Abstract] | |
Acquisitions and Dispositions | NOTE 2 — ACQUISITIONS AND DISPOSITIONS During the nine months ended September 30, 2018, we paid $788 million to acquire two hospital facilities and $268 million to acquire other nonhospital health care entities. During the nine months ended September 30, 2017, we paid $1.000 billion to acquire seven hospital facilities and $142 million to acquire other nonhospital health care entities. Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values. The purchase price paid in excess of the fair value of identifiable net assets of these acquired entities aggregated $433 million and $655 million for the nine months ended September 30, 2018 and 2017, respectively. The consolidated financial statements include the accounts and operations of the acquired entities subsequent to the respective acquisition dates. The pro forma effects of these acquired entities on our results of operations for periods prior to the respective acquisition dates were not significant. During the nine months ended September 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 nine months ended September 30, 2018, we also received proceeds of $44 million and recognized a net pretax gain of $48 million related to sales of real estate and other investments. During the nine months ended September 30, 2017, we received proceeds of $24 million and recognized a net pretax gain of $10 million related to sales of real estate and other investments. |
Income Taxes
Income Taxes | 9 Months Ended |
Sep. 30, 2018 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | NOTE 3 — INCOME TAXES Our provision for income taxes for the quarters ended September 30, 2018 and 2017, was $173 million and $248 million, respectively, and the effective tax rates were 18.6% and 36.7%, respectively. Our provision for income taxes for the nine months ended September 30, 2018 and 2017, was $702 million and $902 million, respectively, and the effective tax rates were 20.5% and 34.1%, respectively. The reductions in the effective tax rates for 2018 periods 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 nine months ended September 30, 2018 included tax benefits, of $132 million and $377 million, respectively, related to the reduction in our effective tax rate associated with the impact of the Tax Act. Our provision for income taxes also included tax benefits related to the settlement of employee equity awards of $23 million and $4 million for the quarters ended September 30, 2018 and 2017, respectively, and $119 million and $80 million for the nine months ended September 30, 2018 and 2017, respectively. We also recorded a reduction to the provision for income taxes of $28 million during the quarter ended September 30, 2018 for tax credits related to certain 2017 hurricane-related expenses. 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 September 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 September 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 $440 million, including accrued interest of $45 million, as of September 30, 2018 ($439 million and $44 million, respectively, as of December 31, 2017). Unrecognized tax benefits of $145 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 | 9 Months Ended |
Sep. 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 nine months ended September 30, 2018 and 2017 (dollars and shares in millions, except per share amounts): Quarter Nine Months 2018 2017 2018 2017 Net income attributable to HCA Healthcare, Inc. $ 759 $ 426 $ 2,723 $ 1,742 Weighted average common shares outstanding 345.823 360.170 348.411 365.398 Effect of dilutive incremental shares 7.816 9.664 7.713 9.615 Shares used for diluted earnings per share 353.639 369.834 356.124 375.013 Earnings per share: Basic earnings $ 2.20 $ 1.18 $ 7.82 $ 4.77 Diluted earnings $ 2.15 $ 1.15 $ 7.65 $ 4.64 |
Investments of Insurance Subsid
Investments of Insurance Subsidiaries | 9 Months Ended |
Sep. 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 September 30, 2018 and December 31, 2017 follows (dollars in millions): September 30, 2018 Amortized Unrealized Fair Gains Losses Debt securities $ 343 $ 4 $ (2 ) $ 345 Money market funds and other 68 — — 68 $ 411 $ 4 $ (2 ) 413 Amounts classified as current assets (46 ) Investment carrying value $ 367 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 September 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 September 30, 2018 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 9 $ 9 Due after one year through five years 57 58 Due after five years through ten years 210 212 Due after ten years 67 66 $ 343 $ 345 The average expected maturity of the investments in debt securities at September 30, 2018 was 5.7 years, compared to the average scheduled maturity of 10.1 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to their scheduled maturity date. |
Financial Instruments
Financial Instruments | 9 Months Ended |
Sep. 30, 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 September 30, 2018 (dollars in millions): Notional Maturity Date Fair Pay-fixed $ 2,000 December 2021 $ 88 Pay-fixed 500 December 2022 17 During the next 12 months, we estimate $26 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 nine months ended September 30, 2018 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Gain Location of Gain Amount of Gain Interest rate swaps $ 46 Interest expense $ 5 |
Assets and Liabilities Measured
Assets and Liabilities Measured at Fair Value | 9 Months Ended |
Sep. 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 September 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 September 30, 2018 and December 31, 2017, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): September 30, 2018 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 345 $ — $ 345 $ — Money market funds and other 68 68 — — Investments of insurance subsidiaries 413 68 345 — Less amounts classified as current assets (46 ) (46 ) — — $ 367 22 $ 345 $ — Interest rate swaps (Other) $ 105 $ — $ 105 $ — 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 $34.125 billion and $34.689 billion at September 30, 2018 and December 31, 2017, respectively, compared to carrying amounts, excluding net debt issuance costs, aggregating $33.270 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 | 9 Months Ended |
Sep. 30, 2018 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | NOTE 8 — LONG-TERM DEBT A summary of long-term debt at September 30, 2018 and December 31, 2017, including related interest rates at September 30, 2018, follows (dollars in millions): September 30, December 31, Senior secured asset-based revolving credit facility (effective interest rate of 3.7%) $ 3,350 $ 3,680 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 3.6%) 3,825 3,891 Senior secured notes (effective interest rate of 5.6%) 13,800 15,300 Other senior secured debt (effective interest rate of 5.8%) 543 599 Senior secured debt 21,518 23,470 Senior unsecured notes (effective interest rate of 6.3%) 11,752 9,752 Net debt issuance costs (163 ) (164 ) Total debt (average life of 6.6 years, rates averaging 5.4%) 33,107 33,058 Less amounts due within one year 191 200 $ 32,916 $ 32,858 During August 2018, we issued $2.000 billion aggregate principal amount of senior notes comprised of $1.000 billion aggregate principal amount of 5.375% notes due 2026 and $1.000 billion aggregate principal amount of 5.625% notes due 2028. We used the net proceeds for general corporate purposes, including funding the purchase of a hospital, and the redemption of all $1.500 billion aggregate principal amount of our existing 3.750% senior secured notes maturing in March 2019. The pretax loss on retirement of debt was $9 million. |
Contingencies
Contingencies | 9 Months Ended |
Sep. 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 |
Share Repurchases Transactions
Share Repurchases Transactions and Other Comprehensive Loss | 9 Months Ended |
Sep. 30, 2018 | |
Federal Home Loan Banks [Abstract] | |
Share Repurchases Transactions and Other Comprehensive Loss | NOTE 10 — SHARE REPURCHASES TRANSACTIONS AND OTHER COMPREHENSIVE LOSS During the nine months ended September 30, 2018, we repurchased 11.558 million shares of our common stock at an average price of $103.42 per share through market purchases pursuant to the $2.0 billion share repurchase program authorized during October 2017. At September 30, 2018, we had $607 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 (7 ) — — — (7 ) Foreign currency translation adjustments — (35 ) — — (35 ) Change in fair value of derivative instruments, net of $14 of income taxes — — — 46 46 Expense (income) reclassified into operations from other comprehensive income, net of $3 income tax benefit and $1 of income taxes, respectively — — 12 (4 ) 8 Balances at September 30, 2018 $ — $ (184 ) $ (156 ) $ 74 $ (266 ) |
Segment and Geographic Informat
Segment and Geographic Information | 9 Months Ended |
Sep. 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 85 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, losses on retirement of debt, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2018 and 2017 are summarized in the following table (dollars in millions): Quarter Nine Months 2018 2017 2018 2017 Revenues: National Group $ 5,542 $ 5,036 $ 16,719 $ 15,344 American Group 5,396 5,180 16,113 15,268 Corporate and other 513 480 1,571 1,440 $ 11,451 $ 10,696 $ 34,403 $ 32,052 Equity in earnings of affiliates: National Group $ (1 ) $ (8 ) $ (5 ) $ (17 ) American Group (10 ) (9 ) (29 ) (27 ) Corporate and other 2 4 9 8 $ (9 ) $ (13 ) $ (25 ) $ (36 ) Adjusted segment EBITDA: National Group $ 1,127 $ 975 $ 3,593 $ 3,268 American Group 1,072 930 3,250 2,977 Corporate and other (103 ) (129 ) (402 ) (374 ) $ 2,096 $ 1,776 $ 6,441 $ 5,871 Depreciation and amortization: National Group $ 245 $ 219 $ 702 $ 650 American Group 258 251 765 727 Corporate and other 79 69 230 204 $ 582 $ 539 $ 1,697 $ 1,581 Adjusted segment EBITDA $ 2,096 $ 1,776 $ 6,441 $ 5,871 Depreciation and amortization 582 539 1,697 1,581 Interest expense 442 427 1,309 1,257 Gains on sales of facilities (6 ) (7 ) (420 ) (10 ) Losses on retirement of debt 9 39 9 39 Income before income taxes $ 1,069 $ 778 $ 3,846 $ 3,004 |
Supplemental Condensed Consolid
Supplemental Condensed Consolidating Financial Information | 9 Months Ended |
Sep. 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 nine months ended September 30, 2018 and 2017, condensed consolidating balance sheets at September 30, 2018 and December 31, 2017 and condensed consolidating statements of cash flows for the nine months ended September 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 SEPTEMBER 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 6,747 $ 4,704 $ — $ 11,451 Salaries and benefits — — 3,090 2,287 — 5,377 Supplies — — 1,115 775 — 1,890 Other operating expenses 2 — 1,137 958 — 2,097 Equity in earnings of affiliates (728 ) — (2 ) (7 ) 728 (9 ) Depreciation and amortization — — 340 242 — 582 Interest expense (income) 16 913 (423 ) (64 ) — 442 Losses (gains) on sales of facilities — — (6 ) — — (6 ) Losses on retirement of debt — 9 — — — 9 Management fees — — (158 ) 158 — — (710 ) 922 5,093 4,349 728 10,382 Income (loss) before income taxes 710 (922 ) 1,654 355 (728 ) 1,069 Provision (benefit) for income taxes (49 ) (214 ) 379 57 — 173 Net income (loss) 759 (708 ) 1,275 298 (728 ) 896 Net income attributable to noncontrolling interests — — 22 115 — 137 Net income (loss) attributable to HCA Healthcare, Inc. $ 759 $ (708 ) $ 1,253 $ 183 $ (728 ) $ 759 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 754 $ (703 ) $ 1,258 $ 168 $ (723 ) $ 754 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE QUARTER ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues $ — $ — $ 6,303 $ 4,393 $ — $ 10,696 Salaries and benefits — — 2,915 2,166 — 5,081 Supplies — — 1,033 744 — 1,777 Other operating expenses — — 1,093 982 — 2,075 Equity in earnings of affiliates (436 ) — (1 ) (12 ) 436 (13 ) Depreciation and amortization — — 311 228 — 539 Interest expense (income) 16 792 (342 ) (39 ) — 427 Gains on sales of facilities — — (3 ) (4 ) — (7 ) Losses on retirement of debt — 39 — — — 39 Management fees — — (159 ) 159 — — (420 ) 831 4,847 4,224 436 9,918 Income (loss) before income taxes 420 (831 ) 1,456 169 (436 ) 778 Provision (benefit) for income taxes (6 ) (307 ) 528 33 — 248 Net income (loss) 426 (524 ) 928 136 (436 ) 530 Net income attributable to noncontrolling interests — — 24 80 — 104 Net income (loss) attributable to HCA Healthcare, Inc. $ 426 $ (524 ) $ 904 $ 56 $ (436 ) $ 426 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 451 $ (522 ) $ 907 $ 76 $ (461 ) $ 451 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 20,297 $ 14,106 $ — $ 34,403 Salaries and benefits — — 9,184 6,756 — 15,940 Supplies — — 3,383 2,339 — 5,722 Other operating expenses 7 — 3,387 2,931 — 6,325 Equity in earnings of affiliates (2,670 ) — (5 ) (20 ) 2,670 (25 ) Depreciation and amortization — — 992 705 — 1,697 Interest expense (income) 48 2,617 (1,179 ) (177 ) — 1,309 Gains on sales of facilities — — (378 ) (42 ) — (420 ) Losses on retirement of debt — 9 — — — 9 Management fees — — (473 ) 473 — — (2,615 ) 2,626 14,911 12,965 2,670 30,557 Income (loss) before income taxes 2,615 (2,626 ) 5,386 1,141 (2,670 ) 3,846 Provision (benefit) for income taxes (108 ) (610 ) 1,235 185 — 702 Net income (loss) 2,723 (2,016 ) 4,151 956 (2,670 ) 3,144 Net income attributable to noncontrolling interests — — 72 349 — 421 Net income (loss) attributable to HCA Healthcare, Inc. $ 2,723 $ (2,016 ) $ 4,079 $ 607 $ (2,670 ) $ 2,723 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 2,735 $ (1,974 ) $ 4,091 $ 565 $ (2,682 ) $ 2,735 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues $ — $ — $ 19,008 $ 13,044 $ — $ 32,052 Salaries and benefits — — 8,689 6,189 — 14,878 Supplies — — 3,163 2,206 — 5,369 Other operating expenses 5 — 3,207 2,758 — 5,970 Equity in earnings of affiliates (1,702 ) — (4 ) (32 ) 1,702 (36 ) Depreciation and amortization — — 923 658 — 1,581 Interest expense (income) 48 2,280 (947 ) (124 ) — 1,257 Gains on sales of facilities — — (6 ) (4 ) — (10 ) Losses on retirement of debt — 39 — — — 39 Management fees — — (479 ) 479 — — (1,649 ) 2,319 14,546 12,130 1,702 29,048 Income (loss) before income taxes 1,649 (2,319 ) 4,462 914 (1,702 ) 3,004 Provision (benefit) for income taxes (93 ) (856 ) 1,619 232 — 902 Net income (loss) 1,742 (1,463 ) 2,843 682 (1,702 ) 2,102 Net income attributable to noncontrolling interests — — 74 286 — 360 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,742 $ (1,463 ) $ 2,769 $ 396 $ (1,702 ) $ 1,742 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,812 $ (1,458 ) $ 2,778 $ 452 $ (1,772 ) $ 1,812 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET SEPTEMBER 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 105 $ 473 $ — $ 578 Accounts receivable — — 3,854 2,678 — 6,532 Inventories — — 1,088 546 — 1,634 Other 47 — 667 552 — 1,266 47 — 5,714 4,249 — 10,010 Property and equipment, net — — 12,192 6,849 — 19,041 Investments of insurance subsidiaries — — — 367 — 367 Investments in and advances to affiliates 32,263 — 29 209 (32,263 ) 238 Goodwill and other intangible assets — — 5,736 2,023 — 7,759 Other 389 106 29 105 — 629 $ 32,699 $ 106 $ 23,700 $ 13,802 $ (32,263 ) $ 38,044 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY Current liabilities: Accounts payable $ — $ — $ 1,627 $ 787 $ — $ 2,414 Accrued salaries — — 914 542 — 1,456 Other accrued expenses 10 296 790 1,074 — 2,170 Long-term debt due within one year — 97 61 33 — 191 10 393 3,392 2,436 — 6,231 Long-term debt, net 996 31,471 281 168 — 32,916 Intercompany balances 36,790 (7,734 ) (27,263 ) (1,793 ) — — Professional liability risks — — — 1,239 — 1,239 Income taxes and other liabilities 508 — 364 516 — 1,388 38,304 24,130 (23,226 ) 2,566 — 41,774 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (5,605 ) (24,024 ) 46,846 9,441 (32,263 ) (5,605 ) Noncontrolling interests — — 80 1,795 — 1,875 (5,605 ) (24,024 ) 46,926 11,236 (32,263 ) (3,730 ) $ 32,699 $ 106 $ 23,700 $ 13,802 $ (32,263 ) $ 38,044 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 NINE MONTHS ENDED SEPTEMBER 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 2,723 $ (2,016 ) $ 4,151 $ 956 $ (2,670 ) $ 3,144 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (15 ) (83 ) (154 ) 105 — (147 ) Depreciation and amortization — — 992 705 — 1,697 Gains on sales of facilities — — (378 ) (42 ) — (420 ) Losses on retirement of debt — 9 — — — 9 Amortization of debt issuance costs — 23 — — — 23 Share-based compensation — — 204 — — 204 Equity in earnings of affiliates (2,670 ) — — — 2,670 — Other 67 — — 9 — 76 Net cash provided by (used in) operating activities 105 (2,067 ) 4,815 1,733 — 4,586 Cash flows from investing activities: Purchase of property and equipment — — (1,425 ) (995 ) — (2,420 ) Acquisition of hospitals and health care entities — — (894 ) (162 ) — (1,056 ) Disposition of hospitals and health care entities — — 770 32 — 802 Change in investments — — 19 46 — 65 Other — — (18 ) 12 — (6 ) Net cash used in investing activities — — (1,548 ) (1,067 ) — (2,615 ) Cash flows from financing activities: Issuance of long-term debt — 2,000 — — — 2,000 Net change in revolving credit facilities — (330 ) — — — (330 ) Repayment of long-term debt — (1,566 ) (44 ) (42 ) — (1,652 ) Distributions to noncontrolling interests — — (63 ) (252 ) — (315 ) Payment of debt issuance costs — (24 ) — — — (24 ) Payment of cash dividends (366 ) — — — — (366 ) Repurchases of common stock (1,195 ) — — — — (1,195 ) Changes in intercompany balances with affiliates, net 1,697 1,987 (3,167 ) (517 ) — — Other (242 ) — — 10 — (232 ) Net cash (used in) provided by financing activities (106 ) 2,067 (3,274 ) (801 ) — (2,114 ) Effect on exchange rate changes on cash and cash equivalents — — — (11 ) — (11 ) Change in cash and cash equivalents (1 ) — (7 ) (146 ) — (154 ) Cash and cash equivalents at beginning of period 1 — 112 619 — 732 Cash and cash equivalents at end of period $ — $ — $ 105 $ 473 $ — $ 578 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,742 $ (1,463 ) $ 2,843 $ 682 $ (1,702 ) $ 2,102 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (15 ) (293 ) (191 ) 210 — (289 ) Depreciation and amortization — — 923 658 — 1,581 Income taxes (9 ) — — — — (9 ) Gains on sales of facilities — — (6 ) (4 ) — (10 ) Losses on retirement of debt — 39 — — — 39 Amortization of debt issuance costs — 23 — — — 23 Share-based compensation — — 195 — — 195 Equity in earnings of affiliates (1,702 ) — — — 1,702 — Other 58 — 2 — — 60 Net cash provided by (used in) operating activities 74 (1,694 ) 3,766 1,546 — 3,692 Cash flows from investing activities: Purchase of property and equipment — — (1,161 ) (872 ) — (2,033 ) Acquisition of hospitals and health care entities — — (9 ) (1,133 ) — (1,142 ) Disposition of hospitals and health care entities — — 12 12 — 24 Change in investments — — 1 (16 ) — (15 ) Other — — (7 ) 1 — (6 ) Net cash used in investing activities — — (1,164 ) (2,008 ) — (3,172 ) Cash flows from financing activities: Issuance of long-term debt — 1,500 — 2 — 1,502 Net change in revolving credit facilities — 650 — — — 650 Repayment of long-term debt — (604 ) (54 ) (42 ) — (700 ) Distributions to noncontrolling interests — — (105 ) (258 ) — (363 ) Payment of debt issuance costs — (25 ) — — — (25 ) Repurchases of common stock (1,475 ) — — — — (1,475 ) Changes in intercompany balances with affiliates, net 1,468 173 (2,439 ) 798 — — Other (66 ) — 1 28 — (37 ) Net cash (used in) provided by financing activities (73 ) 1,694 (2,597 ) 528 — (448 ) Change in cash and cash equivalents 1 — 5 66 — 72 Cash and cash equivalents at beginning of period — — 114 532 — 646 Cash and cash equivalents at end of period $ 1 $ — $ 119 $ 598 $ — $ 718 The above supplemental condensed consolidating financial information for the quarter and nine months ended September 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 September 30, 2017 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 426 $ — $ 426 HCA Inc. Issuer (524 ) — (524 ) Subsidiary Guarantors 787 117 904 Subsidiary Non-Guarantors 173 (117 ) 56 Eliminations (436 ) — (436 ) Condensed Consolidated $ 426 $ — $ 426 As Adjustment As Adjusted Nine months ended September 30, 2017 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 1,742 $ — $ 1,742 HCA Inc. Issuer (1,463 ) — (1,463 ) Subsidiary Guarantors 2,467 302 2,769 Subsidiary Non-Guarantors 698 (302 ) 396 Eliminations (1,702 ) — (1,702 ) Condensed Consolidated $ 1,742 $ — $ 1,742 As Adjustment As Adjusted Nine months ended September 30, 2017 Net cash provided (used in) operating activities: HCA Healthcare, Inc. Issuer $ 74 $ — $ 74 HCA Inc. Issuer (1,694 ) — (1,694 ) Subsidiary Guarantors 3,342 424 3,766 Subsidiary Non-Guarantors 1,970 (424 ) 1,546 Eliminations — — — Condensed Consolidated $ 3,692 $ — $ 3,692 |
Basis of Presentation and Sig_2
Basis of Presentation and Significant Accounting Policies (Policies) | 9 Months Ended |
Sep. 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 $90 million and $83 million for the quarters ended September 30, 2018 and 2017, respectively, and $254 million and $247 million for the nine months ended September 30, 2018 and 2017, respectively. Operating results for the quarter and nine months ended September 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 $ 2,404 21.0 % $ 2,298 21.5 % Managed Medicare 1,344 11.7 1,122 10.5 Medicaid 338 3.0 286 2.7 Managed Medicaid 622 5.4 537 5.0 Managed care and insurers 6,026 52.6 5,605 52.4 International (managed care and insurers) 273 2.4 276 2.6 Other 444 3.9 572 5.3 Revenues $ 11,451 100.0 % $ 10,696 100.0 % Nine Months 2018 Ratio 2017 Ratio Medicare $ 7,353 21.4 % $ 6,931 21.6 % Managed Medicare 4,088 11.9 3,463 10.8 Medicaid 976 2.8 956 3.0 Managed Medicaid 1,769 5.1 1,653 5.2 Managed care and insurers 18,081 52.6 16,957 52.9 International (managed care and insurers) 873 2.5 814 2.5 Other 1,263 3.7 1,278 4.0 Revenues $ 34,403 100.0 % $ 32,052 100.0 % 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 nine months ended September 30, 2018 and 2017 follows (dollars in millions): Quarter Nine Months 2018 2017 2018 2017 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 9,946 $ 9,472 $ 29,684 $ 27,798 Cost-to-charges 12.7 % 13.4 % 12.6 % 13.1 % Total uncompensated care $ 6,786 $ 6,089 $ 19,524 $ 17,137 Multiply by the cost-to-charges 12.7 % 13.4 % 12.6 % 13.1 % Estimated cost of total uncompensated care $ 862 $ 816 $ 2,460 $ 2,245 Total uncompensated care as a percentage of the sum of revenues and total uncompensated care was 37.2% and 36.3% for the quarters ended September 30, 2018 and 2017, respectively, and 36.2% and 34.8% for the nine months ended September 30, 2018 and 2017, respectively. The total uncompensated care amounts include charity care of $2.314 billion and $1.235 billion, and the related estimated costs of charity care were $295 million and $167 million for the quarters ended September 30, 2018 and 2017, respectively, and charity care of $6.170 billion and $3.494 billion, and the related estimated costs of charity care were $777 million and $458 million for the nine months ended September 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 During October 2018, the SEC adopted a final rule affecting interim financial statements which requires a reconciliation of changes in stockholders’ equity in the notes to the financial statements or as a separate statement. We have included a single statement presentation of our condensed consolidated statements of stockholders’ deficit for the quarters and nine months ended September 30, 2018 and 2017. |
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 September 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 Sig_3
Basis of Presentation and Significant Accounting Policies (Tables) | 9 Months Ended |
Sep. 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 nine months ended September 30, 2018 and 2017 are summarized in the following table (dollars in millions): Quarter 2018 Ratio 2017 Ratio Medicare $ 2,404 21.0 % $ 2,298 21.5 % Managed Medicare 1,344 11.7 1,122 10.5 Medicaid 338 3.0 286 2.7 Managed Medicaid 622 5.4 537 5.0 Managed care and insurers 6,026 52.6 5,605 52.4 International (managed care and insurers) 273 2.4 276 2.6 Other 444 3.9 572 5.3 Revenues $ 11,451 100.0 % $ 10,696 100.0 % Nine Months 2018 Ratio 2017 Ratio Medicare $ 7,353 21.4 % $ 6,931 21.6 % Managed Medicare 4,088 11.9 3,463 10.8 Medicaid 976 2.8 956 3.0 Managed Medicaid 1,769 5.1 1,653 5.2 Managed care and insurers 18,081 52.6 16,957 52.9 International (managed care and insurers) 873 2.5 814 2.5 Other 1,263 3.7 1,278 4.0 Revenues $ 34,403 100.0 % $ 32,052 100.0 % |
Schedule of Estimated Cost of Uncompensated Care | A summary of the estimated cost of total uncompensated care for the quarters and nine months ended September 30, 2018 and 2017 follows (dollars in millions): Quarter Nine Months 2018 2017 2018 2017 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 9,946 $ 9,472 $ 29,684 $ 27,798 Cost-to-charges 12.7 % 13.4 % 12.6 % 13.1 % Total uncompensated care $ 6,786 $ 6,089 $ 19,524 $ 17,137 Multiply by the cost-to-charges 12.7 % 13.4 % 12.6 % 13.1 % Estimated cost of total uncompensated care $ 862 $ 816 $ 2,460 $ 2,245 |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 9 Months Ended |
Sep. 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 nine months ended September 30, 2018 and 2017 (dollars and shares in millions, except per share amounts): Quarter Nine Months 2018 2017 2018 2017 Net income attributable to HCA Healthcare, Inc. $ 759 $ 426 $ 2,723 $ 1,742 Weighted average common shares outstanding 345.823 360.170 348.411 365.398 Effect of dilutive incremental shares 7.816 9.664 7.713 9.615 Shares used for diluted earnings per share 353.639 369.834 356.124 375.013 Earnings per share: Basic earnings $ 2.20 $ 1.18 $ 7.82 $ 4.77 Diluted earnings $ 2.15 $ 1.15 $ 7.65 $ 4.64 |
Investments of Insurance Subs_2
Investments of Insurance Subsidiaries (Tables) | 9 Months Ended |
Sep. 30, 2018 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | A summary of our insurance subsidiaries’ investments at September 30, 2018 and December 31, 2017 follows (dollars in millions): September 30, 2018 Amortized Unrealized Fair Gains Losses Debt securities $ 343 $ 4 $ (2 ) $ 345 Money market funds and other 68 — — 68 $ 411 $ 4 $ (2 ) 413 Amounts classified as current assets (46 ) Investment carrying value $ 367 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 September 30, 2018 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 9 $ 9 Due after one year through five years 57 58 Due after five years through ten years 210 212 Due after ten years 67 66 $ 343 $ 345 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 9 Months Ended |
Sep. 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 September 30, 2018 (dollars in millions): Notional Maturity Date Fair Pay-fixed $ 2,000 December 2021 $ 88 Pay-fixed 500 December 2022 17 |
Effect of Interest Rate on Results of Operations | The following table presents the effect of our interest rate swaps on our results of operations for the nine months ended September 30, 2018 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Gain Location of Gain Amount of Gain Interest rate swaps $ 46 Interest expense $ 5 |
Assets and Liabilities Measur_2
Assets and Liabilities Measured at Fair Value (Tables) | 9 Months Ended |
Sep. 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 September 30, 2018 and December 31, 2017, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): September 30, 2018 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 345 $ — $ 345 $ — Money market funds and other 68 68 — — Investments of insurance subsidiaries 413 68 345 — Less amounts classified as current assets (46 ) (46 ) — — $ 367 22 $ 345 $ — Interest rate swaps (Other) $ 105 $ — $ 105 $ — 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) | 9 Months Ended |
Sep. 30, 2018 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | A summary of long-term debt at September 30, 2018 and December 31, 2017, including related interest rates at September 30, 2018, follows (dollars in millions): September 30, December 31, Senior secured asset-based revolving credit facility (effective interest rate of 3.7%) $ 3,350 $ 3,680 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 3.6%) 3,825 3,891 Senior secured notes (effective interest rate of 5.6%) 13,800 15,300 Other senior secured debt (effective interest rate of 5.8%) 543 599 Senior secured debt 21,518 23,470 Senior unsecured notes (effective interest rate of 6.3%) 11,752 9,752 Net debt issuance costs (163 ) (164 ) Total debt (average life of 6.6 years, rates averaging 5.4%) 33,107 33,058 Less amounts due within one year 191 200 $ 32,916 $ 32,858 |
Share Repurchases Transaction_2
Share Repurchases Transactions and Other Comprehensive Loss (Tables) | 9 Months Ended |
Sep. 30, 2018 | |
Federal Home Loan Banks [Abstract] | |
Components of Accumulated Other Comprehensive Loss | The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized for-Sale Foreign Defined Change Total Balances at December 31, 2017 $ 7 $ (149 ) $ (168 ) $ 32 $ (278 ) Unrealized losses on available-for-sale (7 ) — — — (7 ) Foreign currency translation adjustments — (35 ) — — (35 ) Change in fair value of derivative instruments, net of $14 of income taxes — — — 46 46 Expense (income) reclassified into operations from other comprehensive income, net of $3 income tax benefit and $1 of income taxes, respectively — — 12 (4 ) 8 Balances at September 30, 2018 $ — $ (184 ) $ (156 ) $ 74 $ (266 ) |
Segment and Geographic Inform_2
Segment and Geographic Information (Tables) | 9 Months Ended |
Sep. 30, 2018 | |
Segment Reporting [Abstract] | |
Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA and Depreciation and Amortization | The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2018 and 2017 are summarized in the following table (dollars in millions): Quarter Nine Months 2018 2017 2018 2017 Revenues: National Group $ 5,542 $ 5,036 $ 16,719 $ 15,344 American Group 5,396 5,180 16,113 15,268 Corporate and other 513 480 1,571 1,440 $ 11,451 $ 10,696 $ 34,403 $ 32,052 Equity in earnings of affiliates: National Group $ (1 ) $ (8 ) $ (5 ) $ (17 ) American Group (10 ) (9 ) (29 ) (27 ) Corporate and other 2 4 9 8 $ (9 ) $ (13 ) $ (25 ) $ (36 ) Adjusted segment EBITDA: National Group $ 1,127 $ 975 $ 3,593 $ 3,268 American Group 1,072 930 3,250 2,977 Corporate and other (103 ) (129 ) (402 ) (374 ) $ 2,096 $ 1,776 $ 6,441 $ 5,871 Depreciation and amortization: National Group $ 245 $ 219 $ 702 $ 650 American Group 258 251 765 727 Corporate and other 79 69 230 204 $ 582 $ 539 $ 1,697 $ 1,581 Adjusted segment EBITDA $ 2,096 $ 1,776 $ 6,441 $ 5,871 Depreciation and amortization 582 539 1,697 1,581 Interest expense 442 427 1,309 1,257 Gains on sales of facilities (6 ) (7 ) (420 ) (10 ) Losses on retirement of debt 9 39 9 39 Income before income taxes $ 1,069 $ 778 $ 3,846 $ 3,004 |
Supplemental Condensed Consol_2
Supplemental Condensed Consolidating Financial Information (Tables) | 9 Months Ended |
Sep. 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 SEPTEMBER 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 6,747 $ 4,704 $ — $ 11,451 Salaries and benefits — — 3,090 2,287 — 5,377 Supplies — — 1,115 775 — 1,890 Other operating expenses 2 — 1,137 958 — 2,097 Equity in earnings of affiliates (728 ) — (2 ) (7 ) 728 (9 ) Depreciation and amortization — — 340 242 — 582 Interest expense (income) 16 913 (423 ) (64 ) — 442 Losses (gains) on sales of facilities — — (6 ) — — (6 ) Losses on retirement of debt — 9 — — — 9 Management fees — — (158 ) 158 — — (710 ) 922 5,093 4,349 728 10,382 Income (loss) before income taxes 710 (922 ) 1,654 355 (728 ) 1,069 Provision (benefit) for income taxes (49 ) (214 ) 379 57 — 173 Net income (loss) 759 (708 ) 1,275 298 (728 ) 896 Net income attributable to noncontrolling interests — — 22 115 — 137 Net income (loss) attributable to HCA Healthcare, Inc. $ 759 $ (708 ) $ 1,253 $ 183 $ (728 ) $ 759 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 754 $ (703 ) $ 1,258 $ 168 $ (723 ) $ 754 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE QUARTER ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues $ — $ — $ 6,303 $ 4,393 $ — $ 10,696 Salaries and benefits — — 2,915 2,166 — 5,081 Supplies — — 1,033 744 — 1,777 Other operating expenses — — 1,093 982 — 2,075 Equity in earnings of affiliates (436 ) — (1 ) (12 ) 436 (13 ) Depreciation and amortization — — 311 228 — 539 Interest expense (income) 16 792 (342 ) (39 ) — 427 Gains on sales of facilities — — (3 ) (4 ) — (7 ) Losses on retirement of debt — 39 — — — 39 Management fees — — (159 ) 159 — — (420 ) 831 4,847 4,224 436 9,918 Income (loss) before income taxes 420 (831 ) 1,456 169 (436 ) 778 Provision (benefit) for income taxes (6 ) (307 ) 528 33 — 248 Net income (loss) 426 (524 ) 928 136 (436 ) 530 Net income attributable to noncontrolling interests — — 24 80 — 104 Net income (loss) attributable to HCA Healthcare, Inc. $ 426 $ (524 ) $ 904 $ 56 $ (436 ) $ 426 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 451 $ (522 ) $ 907 $ 76 $ (461 ) $ 451 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 20,297 $ 14,106 $ — $ 34,403 Salaries and benefits — — 9,184 6,756 — 15,940 Supplies — — 3,383 2,339 — 5,722 Other operating expenses 7 — 3,387 2,931 — 6,325 Equity in earnings of affiliates (2,670 ) — (5 ) (20 ) 2,670 (25 ) Depreciation and amortization — — 992 705 — 1,697 Interest expense (income) 48 2,617 (1,179 ) (177 ) — 1,309 Gains on sales of facilities — — (378 ) (42 ) — (420 ) Losses on retirement of debt — 9 — — — 9 Management fees — — (473 ) 473 — — (2,615 ) 2,626 14,911 12,965 2,670 30,557 Income (loss) before income taxes 2,615 (2,626 ) 5,386 1,141 (2,670 ) 3,846 Provision (benefit) for income taxes (108 ) (610 ) 1,235 185 — 702 Net income (loss) 2,723 (2,016 ) 4,151 956 (2,670 ) 3,144 Net income attributable to noncontrolling interests — — 72 349 — 421 Net income (loss) attributable to HCA Healthcare, Inc. $ 2,723 $ (2,016 ) $ 4,079 $ 607 $ (2,670 ) $ 2,723 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 2,735 $ (1,974 ) $ 4,091 $ 565 $ (2,682 ) $ 2,735 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Revenues $ — $ — $ 19,008 $ 13,044 $ — $ 32,052 Salaries and benefits — — 8,689 6,189 — 14,878 Supplies — — 3,163 2,206 — 5,369 Other operating expenses 5 — 3,207 2,758 — 5,970 Equity in earnings of affiliates (1,702 ) — (4 ) (32 ) 1,702 (36 ) Depreciation and amortization — — 923 658 — 1,581 Interest expense (income) 48 2,280 (947 ) (124 ) — 1,257 Gains on sales of facilities — — (6 ) (4 ) — (10 ) Losses on retirement of debt — 39 — — — 39 Management fees — — (479 ) 479 — — (1,649 ) 2,319 14,546 12,130 1,702 29,048 Income (loss) before income taxes 1,649 (2,319 ) 4,462 914 (1,702 ) 3,004 Provision (benefit) for income taxes (93 ) (856 ) 1,619 232 — 902 Net income (loss) 1,742 (1,463 ) 2,843 682 (1,702 ) 2,102 Net income attributable to noncontrolling interests — — 74 286 — 360 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,742 $ (1,463 ) $ 2,769 $ 396 $ (1,702 ) $ 1,742 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,812 $ (1,458 ) $ 2,778 $ 452 $ (1,772 ) $ 1,812 |
Schedule of Condensed Consolidating Balance Sheet | HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET SEPTEMBER 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 105 $ 473 $ — $ 578 Accounts receivable — — 3,854 2,678 — 6,532 Inventories — — 1,088 546 — 1,634 Other 47 — 667 552 — 1,266 47 — 5,714 4,249 — 10,010 Property and equipment, net — — 12,192 6,849 — 19,041 Investments of insurance subsidiaries — — — 367 — 367 Investments in and advances to affiliates 32,263 — 29 209 (32,263 ) 238 Goodwill and other intangible assets — — 5,736 2,023 — 7,759 Other 389 106 29 105 — 629 $ 32,699 $ 106 $ 23,700 $ 13,802 $ (32,263 ) $ 38,044 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY Current liabilities: Accounts payable $ — $ — $ 1,627 $ 787 $ — $ 2,414 Accrued salaries — — 914 542 — 1,456 Other accrued expenses 10 296 790 1,074 — 2,170 Long-term debt due within one year — 97 61 33 — 191 10 393 3,392 2,436 — 6,231 Long-term debt, net 996 31,471 281 168 — 32,916 Intercompany balances 36,790 (7,734 ) (27,263 ) (1,793 ) — — Professional liability risks — — — 1,239 — 1,239 Income taxes and other liabilities 508 — 364 516 — 1,388 38,304 24,130 (23,226 ) 2,566 — 41,774 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (5,605 ) (24,024 ) 46,846 9,441 (32,263 ) (5,605 ) Noncontrolling interests — — 80 1,795 — 1,875 (5,605 ) (24,024 ) 46,926 11,236 (32,263 ) (3,730 ) $ 32,699 $ 106 $ 23,700 $ 13,802 $ (32,263 ) $ 38,044 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 NINE MONTHS ENDED SEPTEMBER 30, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 2,723 $ (2,016 ) $ 4,151 $ 956 $ (2,670 ) $ 3,144 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (15 ) (83 ) (154 ) 105 — (147 ) Depreciation and amortization — — 992 705 — 1,697 Gains on sales of facilities — — (378 ) (42 ) — (420 ) Losses on retirement of debt — 9 — — — 9 Amortization of debt issuance costs — 23 — — — 23 Share-based compensation — — 204 — — 204 Equity in earnings of affiliates (2,670 ) — — — 2,670 — Other 67 — — 9 — 76 Net cash provided by (used in) operating activities 105 (2,067 ) 4,815 1,733 — 4,586 Cash flows from investing activities: Purchase of property and equipment — — (1,425 ) (995 ) — (2,420 ) Acquisition of hospitals and health care entities — — (894 ) (162 ) — (1,056 ) Disposition of hospitals and health care entities — — 770 32 — 802 Change in investments — — 19 46 — 65 Other — — (18 ) 12 — (6 ) Net cash used in investing activities — — (1,548 ) (1,067 ) — (2,615 ) Cash flows from financing activities: Issuance of long-term debt — 2,000 — — — 2,000 Net change in revolving credit facilities — (330 ) — — — (330 ) Repayment of long-term debt — (1,566 ) (44 ) (42 ) — (1,652 ) Distributions to noncontrolling interests — — (63 ) (252 ) — (315 ) Payment of debt issuance costs — (24 ) — — — (24 ) Payment of cash dividends (366 ) — — — — (366 ) Repurchases of common stock (1,195 ) — — — — (1,195 ) Changes in intercompany balances with affiliates, net 1,697 1,987 (3,167 ) (517 ) — — Other (242 ) — — 10 — (232 ) Net cash (used in) provided by financing activities (106 ) 2,067 (3,274 ) (801 ) — (2,114 ) Effect on exchange rate changes on cash and cash equivalents — — — (11 ) — (11 ) Change in cash and cash equivalents (1 ) — (7 ) (146 ) — (154 ) Cash and cash equivalents at beginning of period 1 — 112 619 — 732 Cash and cash equivalents at end of period $ — $ — $ 105 $ 473 $ — $ 578 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017 (Dollars in millions) HCA HCA Inc. Subsidiary (as adjusted) Subsidiary (as adjusted) Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,742 $ (1,463 ) $ 2,843 $ 682 $ (1,702 ) $ 2,102 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (15 ) (293 ) (191 ) 210 — (289 ) Depreciation and amortization — — 923 658 — 1,581 Income taxes (9 ) — — — — (9 ) Gains on sales of facilities — — (6 ) (4 ) — (10 ) Losses on retirement of debt — 39 — — — 39 Amortization of debt issuance costs — 23 — — — 23 Share-based compensation — — 195 — — 195 Equity in earnings of affiliates (1,702 ) — — — 1,702 — Other 58 — 2 — — 60 Net cash provided by (used in) operating activities 74 (1,694 ) 3,766 1,546 — 3,692 Cash flows from investing activities: Purchase of property and equipment — — (1,161 ) (872 ) — (2,033 ) Acquisition of hospitals and health care entities — — (9 ) (1,133 ) — (1,142 ) Disposition of hospitals and health care entities — — 12 12 — 24 Change in investments — — 1 (16 ) — (15 ) Other — — (7 ) 1 — (6 ) Net cash used in investing activities — — (1,164 ) (2,008 ) — (3,172 ) Cash flows from financing activities: Issuance of long-term debt — 1,500 — 2 — 1,502 Net change in revolving credit facilities — 650 — — — 650 Repayment of long-term debt — (604 ) (54 ) (42 ) — (700 ) Distributions to noncontrolling interests — — (105 ) (258 ) — (363 ) Payment of debt issuance costs — (25 ) — — — (25 ) Repurchases of common stock (1,475 ) — — — — (1,475 ) Changes in intercompany balances with affiliates, net 1,468 173 (2,439 ) 798 — — Other (66 ) — 1 28 — (37 ) Net cash (used in) provided by financing activities (73 ) 1,694 (2,597 ) 528 — (448 ) Change in cash and cash equivalents 1 — 5 66 — 72 Cash and cash equivalents at beginning of period — — 114 532 — 646 Cash and cash equivalents at end of period $ 1 $ — $ 119 $ 598 $ — $ 718 |
Summary of Restatement Adjustments to Financial Statements | The application of these adjustments to the consolidating information for the quarter and nine months ended September 30, 2017 is summarized as follows (dollars in millions): As Adjustment As Adjusted Quarter ended September 30, 2017 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 426 $ — $ 426 HCA Inc. Issuer (524 ) — (524 ) Subsidiary Guarantors 787 117 904 Subsidiary Non-Guarantors 173 (117 ) 56 Eliminations (436 ) — (436 ) Condensed Consolidated $ 426 $ — $ 426 As Adjustment As Adjusted Nine months ended September 30, 2017 Net income (loss) attributable to HCA Healthcare, Inc.: HCA Healthcare, Inc. Issuer $ 1,742 $ — $ 1,742 HCA Inc. Issuer (1,463 ) — (1,463 ) Subsidiary Guarantors 2,467 302 2,769 Subsidiary Non-Guarantors 698 (302 ) 396 Eliminations (1,702 ) — (1,702 ) Condensed Consolidated $ 1,742 $ — $ 1,742 As Adjustment As Adjusted Nine months ended September 30, 2017 Net cash provided (used in) operating activities: HCA Healthcare, Inc. Issuer $ 74 $ — $ 74 HCA Inc. Issuer (1,694 ) — (1,694 ) Subsidiary Guarantors 3,342 424 3,766 Subsidiary Non-Guarantors 1,970 (424 ) 1,546 Eliminations — — — Condensed Consolidated $ 3,692 $ — $ 3,692 |
Basis of Presentation and Sig_4
Basis of Presentation and Significant Accounting Policies - Additional Information (Detail) $ in Millions | Oct. 31, 2017 | Nov. 30, 2017 | Sep. 30, 2018USD ($)StateHospitalSurgery_Center | Sep. 30, 2017USD ($) | Sep. 30, 2018USD ($)StateHospitalSurgery_Center | Sep. 30, 2017USD ($) | Dec. 31, 2017USD ($) |
Summary Of Significant Accounting Policies [Line Items] | |||||||
Number of owned and operated hospitals | Hospital | 179 | 179 | |||||
Number of freestanding surgery centers | Surgery_Center | 122 | 122 | |||||
Number of facilities locations | State | 20 | 20 | |||||
General and administrative expense | $ 90 | $ 83 | $ 254 | $ 247 | |||
Estimated implicit price concessions recorded as reductions to revenues and accounts receivable | $ 5,781 | $ 5,488 | |||||
Percentage of sum of revenues and uncompensated care | 37.20% | 36.30% | 36.20% | 34.80% | |||
Charity care amount | $ 2,314 | $ 1,235 | $ 6,170 | $ 3,494 | |||
Estimated costs of charity care | $ 295 | $ 167 | $ 777 | $ 458 | |||
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 Sig_5
Basis of Presentation and Significant Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | |
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 11,451 | $ 10,696 | $ 34,403 | $ 32,052 |
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 | $ 2,404 | $ 2,298 | $ 7,353 | $ 6,931 |
Revenues from third party payers, Ratio | 21.00% | 21.50% | 21.40% | 21.60% |
Managed Medicare [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 1,344 | $ 1,122 | $ 4,088 | $ 3,463 |
Revenues from third party payers, Ratio | 11.70% | 10.50% | 11.90% | 10.80% |
Medicaid [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 338 | $ 286 | $ 976 | $ 956 |
Revenues from third party payers, Ratio | 3.00% | 2.70% | 2.80% | 3.00% |
Managed Medicaid [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 622 | $ 537 | $ 1,769 | $ 1,653 |
Revenues from third party payers, Ratio | 5.40% | 5.00% | 5.10% | 5.20% |
Managed Care and Insurers [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 6,026 | $ 5,605 | $ 18,081 | $ 16,957 |
Revenues from third party payers, Ratio | 52.60% | 52.40% | 52.60% | 52.90% |
International (Managed Care and Other Insurers) [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 273 | $ 276 | $ 873 | $ 814 |
Revenues from third party payers, Ratio | 2.40% | 2.60% | 2.50% | 2.50% |
Product and Service, Other [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 444 | $ 572 | $ 1,263 | $ 1,278 |
Other, Ratio | 3.90% | 5.30% | 3.70% | 4.00% |
Health Care, Patient Service [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 11,451 | $ 10,696 | $ 34,403 | $ 32,052 |
Basis of Presentation and Sig_6
Basis of Presentation and Significant Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | |
Accounting Policies [Abstract] | ||||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ 9,946 | $ 9,472 | $ 29,684 | $ 27,798 |
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) | 12.70% | 13.40% | 12.60% | 13.10% |
Total uncompensated care | $ 6,786 | $ 6,089 | $ 19,524 | $ 17,137 |
Multiply by the cost-to-charges ratio | 12.70% | 13.40% | 12.60% | 13.10% |
Estimated cost of total uncompensated care | $ 862 | $ 816 | $ 2,460 | $ 2,245 |
Acquisitions and Dispositions -
Acquisitions and Dispositions - Additional Information (Detail) $ in Thousands | 9 Months Ended | |
Sep. 30, 2018USD ($)Hospital | Sep. 30, 2017USD ($)Hospital | |
Business Acquisition [Line Items] | ||
Number of hospitals purchased | Hospital | 2 | 7 |
Proceeds from sale of business | $ 802,000 | $ 24,000 |
Real Estate and Other Investments [Member] | ||
Business Acquisition [Line Items] | ||
Pretax gain (loss) on sales of business | 48,000 | 10,000 |
Proceeds from sale of business | 44,000 | 24,000 |
Discontinued Operations, Disposed of by Sale [Member] | Oklahoma [Member] | ||
Business Acquisition [Line Items] | ||
Pretax gain (loss) on sales of business | 372,000 | |
Proceeds from sale of business | $ 758,000 | |
Number of hospitals sold | Hospital | 2 | |
Hospitals [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | $ 788,000 | 1,000,000 |
Nonhospital Health Care [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | 268,000 | 142,000 |
Other [Member] | ||
Business Acquisition [Line Items] | ||
Fair value of identifiable net assets of acquired entities | $ 433,000 | $ 655,000 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | 12 Months Ended | ||
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | Dec. 31, 2017 | |
Income Tax Disclosure [Abstract] | |||||
Provision for income taxes | $ 173 | $ 248 | $ 702 | $ 902 | |
Effective tax rates | 18.60% | 36.70% | 20.50% | 34.10% | |
Provision for income tax benefit excluding gains on sale | $ 132 | $ 377 | |||
Provision for tax benefits related to settlement of employee awards | 23 | $ 4 | $ 119 | $ 80 | |
Reduction to provision for income taxes for tax credits | 28 | ||||
Effective tax rate | 21.00% | 35.00% | |||
Liability for unrecognized tax benefits | 440 | $ 440 | $ 439 | ||
Unrecognized tax benefits, accrued interest | 45 | 45 | 44 | ||
Unrecognized tax benefits that would impact effective tax rate | $ 145 | $ 145 | $ 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 | 9 Months Ended | ||
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | |
Earnings Per Share [Abstract] | ||||
Net income attributable to HCA Healthcare, Inc. | $ 759 | $ 426 | $ 2,723 | $ 1,742 |
Weighted average common shares outstanding | 345,823 | 360,170 | 348,411 | 365,398 |
Effect of dilutive incremental shares | 7,816 | 9,664 | 7,713 | 9,615 |
Shares used for diluted earnings per share | 353,639 | 369,834 | 356,124 | 375,013 |
Basic earnings | $ 2.20 | $ 1.18 | $ 7.82 | $ 4.77 |
Diluted earnings | $ 2.15 | $ 1.15 | $ 7.65 | $ 4.64 |
Investments of Insurance Subs_3
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions | Sep. 30, 2018 | Dec. 31, 2017 |
Debt Securities, Available-for-sale [Line Items] | ||
Amounts classified as current assets | $ (46) | $ (54) |
Investment carrying value | 367 | 418 |
Amortized Cost | 411 | 462 |
Unrealized Amounts, Gains | 4 | 10 |
Unrealized Amounts, Losses | (2) | |
Fair Value | 413 | 472 |
Money Market Funds and Other [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 68 | 101 |
Fair Value | 68 | 101 |
Debt Securities [Member] | States and Municipalities [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 343 | 361 |
Unrealized Amounts, Gains | 4 | 10 |
Unrealized Amounts, Losses | (2) | |
Fair Value | $ 345 | $ 371 |
Investments of Insurance Subs_4
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions | Sep. 30, 2018USD ($) |
Investments, Debt and Equity Securities [Abstract] | |
Due in one year or less, Amortized Cost | $ 9 |
Due after one year through five years, Amortized Cost | 57 |
Due after five years through ten years, Amortized Cost | 210 |
Due after ten years, Amortized Cost | 67 |
Amortized Cost, Total | 343 |
Due in one year or less, Fair Value | 9 |
Due after one year through five years, Fair Value | 58 |
Due after five years through ten years, Fair Value | 212 |
Due after ten years, Fair Value | 66 |
Fair Value, Total | $ 345 |
Investments of Insurance Subs_5
Investments of Insurance Subsidiaries - Additional Information (Detail) | 9 Months Ended |
Sep. 30, 2018 | |
Investments, Debt and Equity Securities [Abstract] | |
Available for sale securities expected maturity of debt securities | 5 years 8 months 12 days |
Available for sale securities average scheduled maturity | 10 years 1 month 6 days |
Financial Instruments - Schedul
Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) - Pay-Fixed Interest Rate Swaps [Member] | 9 Months Ended |
Sep. 30, 2018USD ($) | |
Maturity Date, 2021 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 2,000,000,000 |
Fair Value | $ 88,000,000 |
Maturity Date | Dec. 31, 2021 |
Maturity Date, 2022 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 500,000,000 |
Fair Value | $ 17,000,000 |
Maturity Date | Dec. 31, 2022 |
Financial Instruments - Additio
Financial Instruments - Additional Information (Detail) $ in Millions | 9 Months Ended |
Sep. 30, 2018USD ($) | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Estimated amount reclassified from other comprehensive income and reduce interest expense | $ 26 |
Financial Instruments - Effect
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | |
Derivative Instruments, Gain (Loss) [Line Items] | ||||
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | $ 10 | $ (1) | $ 60 | $ (9) |
Interest Rate Swaps [Member] | ||||
Derivative Instruments, Gain (Loss) [Line Items] | ||||
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | 46 | |||
Interest Rate Swaps [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | ||||
Derivative Instruments, Gain (Loss) [Line Items] | ||||
Interest rate swaps | $ 5 |
Assets and Liabilities Measur_3
Assets and Liabilities Measured at Fair Value - Schedule of Assets Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Millions | Sep. 30, 2018 | Dec. 31, 2017 |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | $ 413 | $ 472 |
Less amounts classified as current assets | (46) | (54) |
Investments of insurance subsidiaries, noncurrent | 367 | 418 |
Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Derivative Asset | 105 | 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 | 345 | 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 | 68 | 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 | 68 | 101 |
Less amounts classified as current assets | (46) | (54) |
Investments of insurance subsidiaries, noncurrent | 22 | 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 | 68 | 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 | 345 | 371 |
Investments of insurance subsidiaries, noncurrent | 345 | 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 | 105 | 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 | $ 345 | $ 371 |
Assets and Liabilities Measur_4
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions | Sep. 30, 2018 | Dec. 31, 2017 |
Fair Value Disclosures [Abstract] | ||
Estimated fair value of long-term debt | $ 34,125 | $ 34,689 |
Carrying amounts of long-term debt | $ 33,270 | $ 33,222 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions | Sep. 30, 2018 | Dec. 31, 2017 |
Debt Instrument [Line Items] | ||
Senior secured debt | $ 21,518 | $ 23,470 |
Net debt issuance costs | (163) | (164) |
Total debt (average life of 6.6 years, rates averaging 5.4%) | 33,107 | 33,058 |
Less amounts due within one year | 191 | 200 |
Long-term debt | 32,916 | 32,858 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 3,350 | 3,680 |
Senior Secured Term Loan Facilities [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 3,825 | 3,891 |
Senior Secured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 13,800 | 15,300 |
Other Senior Secured Debt [Member] | ||
Debt Instrument [Line Items] | ||
Other senior secured debt | 543 | 599 |
Senior Unsecured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior unsecured notes | $ 11,752 | $ 9,752 |
Long-Term Debt - Schedule of _2
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | 9 Months Ended |
Sep. 30, 2018 | |
Debt Instrument [Line Items] | |
Total debt average term | 6 years 7 months 6 days |
Total debt average rate | 5.40% |
Senior Secured Asset-Based Revolving Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 3.70% |
Senior Secured Term Loan Facilities [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 3.60% |
Senior Secured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5.60% |
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 | 6.30% |
Long-Term Debt - Additional Inf
Long-Term Debt - Additional Information (Detail) - USD ($) | 1 Months Ended | 3 Months Ended | 9 Months Ended | ||
Aug. 31, 2018 | Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | |
Debt Instrument [Line Items] | |||||
Pretax loss on retirement of debt | $ (9,000,000) | $ (39,000,000) | $ (9,000,000) | $ (39,000,000) | |
Senior Notes [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 2,000,000,000 | ||||
Senior Notes [Member] | 5.375% Senior Notes Due 2026 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 1,000,000,000 | ||||
Debt instrument, stated interest | 5.375% | ||||
Senior Notes [Member] | 5.625% Senior Notes Due 2028 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, principal amount | $ 1,000,000,000 | ||||
Debt instrument, stated interest | 5.625% | ||||
Senior Notes [Member] | Senior Notes Due2019 [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, stated interest | 3.75% | ||||
Proceeds from new term loan | $ 1,500,000,000 | ||||
Pretax loss on retirement of debt | $ 9,000,000 |
Share Repurchases Transaction_3
Share Repurchases Transactions and Other Comprehensive Loss - Additional Information (Detail) - USD ($) | 9 Months Ended | |
Sep. 30, 2018 | Oct. 31, 2017 | |
Equity [Abstract] | ||
Repurchase of common stock, shares | 11,558,000 | |
Repurchase price of common stock, per share | $ 103.42 | |
Share repurchase program, remaining authorized repurchase amount | $ 607,000,000 | |
Share repurchase program authorized amount | $ 2,000,000,000 |
Share Repurchases Transaction_4
Share Repurchases Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) $ in Millions | 9 Months Ended |
Sep. 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 | (7) |
Foreign currency translation adjustments, beginning balances | (149) |
Foreign currency translation adjustments | (35) |
Foreign currency translation adjustments, ending balances | (184) |
Defined benefit plans, beginning balances | (168) |
Defined benefit plans, (income) expense reclassified into operations from other comprehensive income | 12 |
Defined benefit plans, ending balances | (156) |
Change in fair value of derivative instruments, beginning balances | 32 |
Change in fair value of derivative instruments net of income taxes | 46 |
Change in fair value of derivative instruments, ending balances | 74 |
Accumulated other comprehensive income, net of tax, beginning balances | (278) |
Unrealized losses on available-for-sale securities, net of income tax benefit | (7) |
Foreign currency translation adjustments | (35) |
Change in fair value of derivative instruments | 46 |
Expense (income) reclassified into operations from other comprehensive income, Total | 8 |
Accumulated other comprehensive income (loss), net of tax, ending balances | $ (266) |
Share Repurchases Transaction_5
Share Repurchases Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) $ in Millions | 9 Months Ended |
Sep. 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 |
Defined benefit plans, Expense (income) reclassified into operations from other comprehensive income, net of Income taxes | 1 |
Change in fair value of derivative instruments, change in fair value of derivative instruments, income taxes | $ 4 |
Segment and Geographic Inform_3
Segment and Geographic Information - Additional Information (Detail) | 9 Months Ended |
Sep. 30, 2018Hospital | |
Segment Reporting Information [Line Items] | |
Number of geographically organized groups | 2 |
Number of owned and operated hospitals | 179 |
Reorganization Group [Member] | National Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 88 |
Reorganization Group [Member] | American Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 85 |
Reorganization Group [Member] | Corporate and Other [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 6 |
Segment and Geographic Inform_4
Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization and Assets (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | |
Segment Reporting Information [Line Items] | ||||
Revenues | $ 11,451 | $ 10,696 | $ 34,403 | $ 32,052 |
Equity in earnings of affiliates | 9 | 13 | 25 | 36 |
Adjusted segment EBITDA | 2,096 | 1,776 | 6,441 | 5,871 |
Depreciation and amortization | 582 | 539 | 1,697 | 1,581 |
Interest expense | 442 | 427 | 1,309 | 1,257 |
Gain on sales of facilities | (6) | (7) | (420) | (10) |
Losses on retirement of debt | 9 | 39 | 9 | 39 |
Income before income taxes | 1,069 | 778 | 3,846 | 3,004 |
National Group [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 5,542 | 5,036 | 16,719 | 15,344 |
Equity in earnings of affiliates | (1) | (8) | (5) | (17) |
Adjusted segment EBITDA | 1,127 | 975 | 3,593 | 3,268 |
Depreciation and amortization | 245 | 219 | 702 | 650 |
American Group [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 5,396 | 5,180 | 16,113 | 15,268 |
Equity in earnings of affiliates | (10) | (9) | (29) | (27) |
Adjusted segment EBITDA | 1,072 | 930 | 3,250 | 2,977 |
Depreciation and amortization | 258 | 251 | 765 | 727 |
Corporate and Other [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 513 | 480 | 1,571 | 1,440 |
Equity in earnings of affiliates | 2 | 4 | 9 | 8 |
Adjusted segment EBITDA | (103) | (129) | (402) | (374) |
Depreciation and amortization | $ 79 | $ 69 | $ 230 | $ 204 |
Supplemental Condensed Consol_3
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Additional Information (Detail) - USD ($) | Sep. 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 Consol_4
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Comprehensive Income Statement (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | |
Condensed Statement of Income Captions [Line Items] | ||||
Revenues | $ 11,451 | $ 10,696 | $ 34,403 | $ 32,052 |
Salaries and benefits | 5,377 | 5,081 | 15,940 | 14,878 |
Supplies | 1,890 | 1,777 | 5,722 | 5,369 |
Other operating expenses | 2,097 | 2,075 | 6,325 | 5,970 |
Equity in earnings of affiliates | (9) | (13) | (25) | (36) |
Depreciation and amortization | 582 | 539 | 1,697 | 1,581 |
Interest expense (income) | 442 | 427 | 1,309 | 1,257 |
Losses (gains) on sales of facilities | (6) | (7) | (420) | (10) |
Losses on retirement of debt | 9 | 39 | 9 | 39 |
Total expenses including equity in earnings of affiliates | 10,382 | 9,918 | 30,557 | 29,048 |
Income (loss) before income taxes | 1,069 | 778 | 3,846 | 3,004 |
Provision (benefit) for income taxes | 173 | 248 | 702 | 902 |
Net income (loss) | 896 | 530 | 3,144 | 2,102 |
Net income attributable to noncontrolling interests | 137 | 104 | 421 | 360 |
Net income (loss) attributable to HCA Healthcare, Inc. | 759 | 426 | 2,723 | 1,742 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 754 | 451 | 2,735 | 1,812 |
Health Care, Patient Service [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Revenues | 11,451 | 10,696 | 34,403 | 32,052 |
HCA Healthcare, Inc. Issuer [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Other operating expenses | 2 | 7 | 5 | |
Equity in earnings of affiliates | (728) | (436) | (2,670) | (1,702) |
Interest expense (income) | 16 | 16 | 48 | 48 |
Total expenses including equity in earnings of affiliates | (710) | (420) | (2,615) | (1,649) |
Income (loss) before income taxes | 710 | 420 | 2,615 | 1,649 |
Provision (benefit) for income taxes | (49) | (6) | (108) | (93) |
Net income (loss) | 759 | 426 | 2,723 | 1,742 |
Net income (loss) attributable to HCA Healthcare, Inc. | 759 | 426 | 2,723 | 1,742 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 754 | 451 | 2,735 | 1,812 |
HCA Inc. Issuer [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Interest expense (income) | 913 | 792 | 2,617 | 2,280 |
Losses on retirement of debt | 9 | 39 | 9 | 39 |
Total expenses including equity in earnings of affiliates | 922 | 831 | 2,626 | 2,319 |
Income (loss) before income taxes | (922) | (831) | (2,626) | (2,319) |
Provision (benefit) for income taxes | (214) | (307) | (610) | (856) |
Net income (loss) | (708) | (524) | (2,016) | (1,463) |
Net income (loss) attributable to HCA Healthcare, Inc. | (708) | (524) | (2,016) | (1,463) |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | (703) | (522) | (1,974) | (1,458) |
Subsidiary Guarantors [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Salaries and benefits | 3,090 | 2,915 | 9,184 | 8,689 |
Supplies | 1,115 | 1,033 | 3,383 | 3,163 |
Other operating expenses | 1,137 | 1,093 | 3,387 | 3,207 |
Equity in earnings of affiliates | (2) | (1) | (5) | (4) |
Depreciation and amortization | 340 | 311 | 992 | 923 |
Interest expense (income) | (423) | (342) | (1,179) | (947) |
Losses (gains) on sales of facilities | (6) | (3) | (378) | (6) |
Management fees | (158) | (159) | (473) | (479) |
Total expenses including equity in earnings of affiliates | 5,093 | 4,847 | 14,911 | 14,546 |
Income (loss) before income taxes | 1,654 | 1,456 | 5,386 | 4,462 |
Provision (benefit) for income taxes | 379 | 528 | 1,235 | 1,619 |
Net income (loss) | 1,275 | 928 | 4,151 | 2,843 |
Net income attributable to noncontrolling interests | 22 | 24 | 72 | 74 |
Net income (loss) attributable to HCA Healthcare, Inc. | 1,253 | 904 | 4,079 | 2,769 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 1,258 | 907 | 4,091 | 2,778 |
Subsidiary Guarantors [Member] | Health Care, Patient Service [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Revenues | 6,747 | 6,303 | 20,297 | 19,008 |
Subsidiary Non-Guarantors [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Salaries and benefits | 2,287 | 2,166 | 6,756 | 6,189 |
Supplies | 775 | 744 | 2,339 | 2,206 |
Other operating expenses | 958 | 982 | 2,931 | 2,758 |
Equity in earnings of affiliates | (7) | (12) | (20) | (32) |
Depreciation and amortization | 242 | 228 | 705 | 658 |
Interest expense (income) | (64) | (39) | (177) | (124) |
Losses (gains) on sales of facilities | (4) | (42) | (4) | |
Management fees | 158 | 159 | 473 | 479 |
Total expenses including equity in earnings of affiliates | 4,349 | 4,224 | 12,965 | 12,130 |
Income (loss) before income taxes | 355 | 169 | 1,141 | 914 |
Provision (benefit) for income taxes | 57 | 33 | 185 | 232 |
Net income (loss) | 298 | 136 | 956 | 682 |
Net income attributable to noncontrolling interests | 115 | 80 | 349 | 286 |
Net income (loss) attributable to HCA Healthcare, Inc. | 183 | 56 | 607 | 396 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 168 | 76 | 565 | 452 |
Subsidiary Non-Guarantors [Member] | Health Care, Patient Service [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Revenues | 4,704 | 4,393 | 14,106 | 13,044 |
Eliminations [Member] | ||||
Condensed Statement of Income Captions [Line Items] | ||||
Equity in earnings of affiliates | 728 | 436 | 2,670 | 1,702 |
Total expenses including equity in earnings of affiliates | 728 | 436 | 2,670 | 1,702 |
Income (loss) before income taxes | (728) | (436) | (2,670) | (1,702) |
Net income (loss) | (728) | (436) | (2,670) | (1,702) |
Net income (loss) attributable to HCA Healthcare, Inc. | (728) | (436) | (2,670) | (1,702) |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | $ (723) | $ (461) | $ (2,682) | $ (1,772) |
Supplemental Condensed Consol_5
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Balance Sheet (Detail) - USD ($) $ in Millions | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2016 |
Current assets: | ||||||||
Cash and cash equivalents | $ 578 | $ 732 | ||||||
Accounts receivable | 6,532 | 6,501 | ||||||
Inventories | 1,634 | 1,573 | ||||||
Other | 1,266 | 1,171 | ||||||
Total current assets | 10,010 | 9,977 | ||||||
Property and equipment, net | 19,041 | 17,895 | ||||||
Investments of insurance subsidiaries | 367 | 418 | ||||||
Investments in and advances to affiliates | 238 | 199 | ||||||
Goodwill and other intangible assets | 7,759 | 7,394 | ||||||
Other | 629 | 710 | ||||||
Total assets | 38,044 | 36,593 | ||||||
Current liabilities: | ||||||||
Accounts payable | 2,414 | 2,606 | ||||||
Accrued salaries | 1,456 | 1,369 | ||||||
Other accrued expenses | 2,170 | 1,983 | ||||||
Long-term debt due within one year | 191 | 200 | ||||||
Total current liabilities | 6,231 | 6,158 | ||||||
Long-term debt, net | 32,916 | 32,858 | ||||||
Professional liability risks | 1,239 | 1,198 | ||||||
Income taxes and other liabilities | 1,388 | 1,374 | ||||||
Total liabilities | 41,774 | 41,588 | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (5,605) | (6,806) | ||||||
Noncontrolling interests | 1,875 | 1,811 | ||||||
Total stockholders' deficit | (3,730) | $ (4,125) | $ (4,434) | (4,995) | $ (5,066) | $ (5,079) | $ (5,357) | $ (5,633) |
Total liabilities and stockholders' deficit | 38,044 | 36,593 | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (5,605) | (6,806) | ||||||
Noncontrolling interests | 1,875 | 1,811 | ||||||
Total stockholders' deficit | (3,730) | $ (4,125) | $ (4,434) | (4,995) | $ (5,066) | $ (5,079) | $ (5,357) | $ (5,633) |
Total liabilities and stockholders' deficit | 38,044 | 36,593 | ||||||
HCA Healthcare, Inc. Issuer [Member] | ||||||||
Current assets: | ||||||||
Cash and cash equivalents | 1 | |||||||
Other | 47 | |||||||
Total current assets | 47 | 1 | ||||||
Investments in and advances to affiliates | 32,263 | 29,581 | ||||||
Other | 389 | 510 | ||||||
Total assets | 32,699 | 30,092 | ||||||
Current liabilities: | ||||||||
Other accrued expenses | 10 | 29 | ||||||
Total current liabilities | 10 | 29 | ||||||
Long-term debt, net | 996 | 995 | ||||||
Intercompany balances | 36,790 | 35,322 | ||||||
Income taxes and other liabilities | 508 | 552 | ||||||
Total liabilities | 38,304 | 36,898 | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (5,605) | (6,806) | ||||||
Total stockholders' deficit | (5,605) | (6,806) | ||||||
Total liabilities and stockholders' deficit | 32,699 | 30,092 | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (5,605) | (6,806) | ||||||
Total stockholders' deficit | (5,605) | (6,806) | ||||||
Total liabilities and stockholders' deficit | 32,699 | 30,092 | ||||||
HCA Inc. Issuer [Member] | ||||||||
Current assets: | ||||||||
Other | 106 | 50 | ||||||
Total assets | 106 | 50 | ||||||
Current liabilities: | ||||||||
Other accrued expenses | 296 | 378 | ||||||
Long-term debt due within one year | 97 | 97 | ||||||
Total current liabilities | 393 | 475 | ||||||
Long-term debt, net | 31,471 | 31,367 | ||||||
Intercompany balances | (7,734) | (9,742) | ||||||
Total liabilities | 24,130 | 22,100 | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (24,024) | (22,050) | ||||||
Total stockholders' deficit | (24,024) | (22,050) | ||||||
Total liabilities and stockholders' deficit | 106 | 50 | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (24,024) | (22,050) | ||||||
Total stockholders' deficit | (24,024) | (22,050) | ||||||
Total liabilities and stockholders' deficit | 106 | 50 | ||||||
Subsidiary Guarantors [Member] | ||||||||
Current assets: | ||||||||
Cash and cash equivalents | 105 | 112 | ||||||
Accounts receivable | 3,854 | 3,693 | ||||||
Inventories | 1,088 | 1,030 | ||||||
Other | 667 | 663 | ||||||
Total current assets | 5,714 | 5,498 | ||||||
Property and equipment, net | 12,192 | 11,110 | ||||||
Investments in and advances to affiliates | 29 | 22 | ||||||
Goodwill and other intangible assets | 5,736 | 4,893 | ||||||
Other | 29 | 47 | ||||||
Total assets | 23,700 | 21,570 | ||||||
Current liabilities: | ||||||||
Accounts payable | 1,627 | 1,793 | ||||||
Accrued salaries | 914 | 862 | ||||||
Other accrued expenses | 790 | 536 | ||||||
Long-term debt due within one year | 61 | 64 | ||||||
Total current liabilities | 3,392 | 3,255 | ||||||
Long-term debt, net | 281 | 307 | ||||||
Intercompany balances | (27,263) | (25,228) | ||||||
Income taxes and other liabilities | 364 | 357 | ||||||
Total liabilities | (23,226) | (21,309) | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 46,846 | 42,755 | ||||||
Noncontrolling interests | 80 | 124 | ||||||
Total stockholders' deficit | 46,926 | 42,879 | ||||||
Total liabilities and stockholders' deficit | 23,700 | 21,570 | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 46,846 | 42,755 | ||||||
Noncontrolling interests | 80 | 124 | ||||||
Total stockholders' deficit | 46,926 | 42,879 | ||||||
Total liabilities and stockholders' deficit | 23,700 | 21,570 | ||||||
Subsidiary Non-Guarantors [Member] | ||||||||
Current assets: | ||||||||
Cash and cash equivalents | 473 | 619 | ||||||
Accounts receivable | 2,678 | 2,808 | ||||||
Inventories | 546 | 543 | ||||||
Other | 552 | 508 | ||||||
Total current assets | 4,249 | 4,478 | ||||||
Property and equipment, net | 6,849 | 6,785 | ||||||
Investments of insurance subsidiaries | 367 | 418 | ||||||
Investments in and advances to affiliates | 209 | 177 | ||||||
Goodwill and other intangible assets | 2,023 | 2,501 | ||||||
Other | 105 | 103 | ||||||
Total assets | 13,802 | 14,462 | ||||||
Current liabilities: | ||||||||
Accounts payable | 787 | 813 | ||||||
Accrued salaries | 542 | 507 | ||||||
Other accrued expenses | 1,074 | 1,040 | ||||||
Long-term debt due within one year | 33 | 39 | ||||||
Total current liabilities | 2,436 | 2,399 | ||||||
Long-term debt, net | 168 | 189 | ||||||
Intercompany balances | (1,793) | (352) | ||||||
Professional liability risks | 1,239 | 1,198 | ||||||
Income taxes and other liabilities | 516 | 465 | ||||||
Total liabilities | 2,566 | 3,899 | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 9,441 | 8,876 | ||||||
Noncontrolling interests | 1,795 | 1,687 | ||||||
Total stockholders' deficit | 11,236 | 10,563 | ||||||
Total liabilities and stockholders' deficit | 13,802 | 14,462 | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 9,441 | 8,876 | ||||||
Noncontrolling interests | 1,795 | 1,687 | ||||||
Total stockholders' deficit | 11,236 | 10,563 | ||||||
Total liabilities and stockholders' deficit | 13,802 | 14,462 | ||||||
Eliminations [Member] | ||||||||
Current assets: | ||||||||
Investments in and advances to affiliates | (32,263) | (29,581) | ||||||
Total assets | (32,263) | (29,581) | ||||||
Current liabilities: | ||||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (32,263) | (29,581) | ||||||
Total stockholders' deficit | (32,263) | (29,581) | ||||||
Total liabilities and stockholders' deficit | (32,263) | (29,581) | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (32,263) | (29,581) | ||||||
Total stockholders' deficit | (32,263) | (29,581) | ||||||
Total liabilities and stockholders' deficit | $ (32,263) | $ (29,581) |
Supplemental Condensed Consol_6
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Statement of Cash Flows (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | |
Cash flows from operating activities: | ||||
Net income (loss) | $ 896 | $ 530 | $ 3,144 | $ 2,102 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (147) | (289) | ||
Depreciation and amortization | 582 | 539 | 1,697 | 1,581 |
Income taxes | (9) | |||
Gain on sales of facilities | (6) | (7) | (420) | (10) |
Losses on retirement of debt | 9 | 39 | 9 | 39 |
Amortization of debt issuance costs | 23 | 23 | ||
Share-based compensation | 204 | 195 | ||
Other | 76 | 60 | ||
Net cash provided by (used in) operating activities | 4,586 | 3,692 | ||
Cash flows from investing activities: | ||||
Purchase of property and equipment | (2,420) | (2,033) | ||
Acquisition of hospitals and health care entities | (1,056) | (1,142) | ||
Disposition of hospitals and health care entities | 802 | 24 | ||
Change in investments | 65 | (15) | ||
Other | (6) | (6) | ||
Net cash used in investing activities | (2,615) | (3,172) | ||
Cash flows from financing activities: | ||||
Issuance of long-term debt | 2,000 | 1,502 | ||
Net change in revolving credit facilities | (330) | 650 | ||
Repayment of long-term debt | (1,652) | (700) | ||
Distributions to noncontrolling interests | (315) | (363) | ||
Payment of debt issuance costs | (24) | (25) | ||
Payment of cash dividends | (366) | |||
Repurchases of common stock | (1,195) | (1,475) | ||
Other | (232) | (37) | ||
Net cash (used in) provided by financing activities | (2,114) | (448) | ||
Effect on exchange rate changes on cash and cash equivalents | (11) | |||
Change in cash and cash equivalents | (154) | 72 | ||
Cash and cash equivalents at beginning of period | 732 | 646 | ||
Cash and cash equivalents at end of period | 578 | 718 | 578 | 718 |
Eliminations [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | (728) | (436) | (2,670) | (1,702) |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Equity in earnings of affiliates | 2,670 | 1,702 | ||
HCA Healthcare, Inc. Issuer [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | 759 | 426 | 2,723 | 1,742 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (15) | (15) | ||
Income taxes | (9) | |||
Equity in earnings of affiliates | (2,670) | (1,702) | ||
Other | 67 | 58 | ||
Net cash provided by (used in) operating activities | 105 | 74 | ||
Cash flows from financing activities: | ||||
Payment of cash dividends | (366) | |||
Repurchases of common stock | (1,195) | (1,475) | ||
Changes in intercompany balances with affiliates, net | 1,697 | 1,468 | ||
Other | (242) | (66) | ||
Net cash (used in) provided by financing activities | (106) | (73) | ||
Change in cash and cash equivalents | (1) | 1 | ||
Cash and cash equivalents at beginning of period | 1 | |||
Cash and cash equivalents at end of period | 1 | 1 | ||
HCA Inc. Issuer [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | (708) | (524) | (2,016) | (1,463) |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (83) | (293) | ||
Losses on retirement of debt | 9 | 39 | 9 | 39 |
Amortization of debt issuance costs | 23 | 23 | ||
Net cash provided by (used in) operating activities | (2,067) | (1,694) | ||
Cash flows from financing activities: | ||||
Issuance of long-term debt | 2,000 | 1,500 | ||
Net change in revolving credit facilities | (330) | 650 | ||
Repayment of long-term debt | (1,566) | (604) | ||
Payment of debt issuance costs | (24) | (25) | ||
Changes in intercompany balances with affiliates, net | 1,987 | 173 | ||
Net cash (used in) provided by financing activities | 2,067 | 1,694 | ||
Subsidiary Guarantors [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | 1,275 | 928 | 4,151 | 2,843 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | (154) | (191) | ||
Depreciation and amortization | 340 | 311 | 992 | 923 |
Gain on sales of facilities | (6) | (3) | (378) | (6) |
Share-based compensation | 204 | 195 | ||
Other | 2 | |||
Net cash provided by (used in) operating activities | 4,815 | 3,766 | ||
Cash flows from investing activities: | ||||
Purchase of property and equipment | (1,425) | (1,161) | ||
Acquisition of hospitals and health care entities | (894) | (9) | ||
Disposition of hospitals and health care entities | 770 | 12 | ||
Change in investments | 19 | 1 | ||
Other | (18) | (7) | ||
Net cash used in investing activities | (1,548) | (1,164) | ||
Cash flows from financing activities: | ||||
Repayment of long-term debt | (44) | (54) | ||
Distributions to noncontrolling interests | (63) | (105) | ||
Changes in intercompany balances with affiliates, net | (3,167) | (2,439) | ||
Other | 1 | |||
Net cash (used in) provided by financing activities | (3,274) | (2,597) | ||
Change in cash and cash equivalents | (7) | 5 | ||
Cash and cash equivalents at beginning of period | 112 | 114 | ||
Cash and cash equivalents at end of period | 105 | 119 | 105 | 119 |
Subsidiary Non-Guarantors [Member] | ||||
Cash flows from operating activities: | ||||
Net income (loss) | 298 | 136 | 956 | 682 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||||
Changes in operating assets and liabilities | 105 | 210 | ||
Depreciation and amortization | 242 | 228 | 705 | 658 |
Gain on sales of facilities | (4) | (42) | (4) | |
Other | 9 | |||
Net cash provided by (used in) operating activities | 1,733 | 1,546 | ||
Cash flows from investing activities: | ||||
Purchase of property and equipment | (995) | (872) | ||
Acquisition of hospitals and health care entities | (162) | (1,133) | ||
Disposition of hospitals and health care entities | 32 | 12 | ||
Change in investments | 46 | (16) | ||
Other | 12 | 1 | ||
Net cash used in investing activities | (1,067) | (2,008) | ||
Cash flows from financing activities: | ||||
Issuance of long-term debt | 2 | |||
Repayment of long-term debt | (42) | (42) | ||
Distributions to noncontrolling interests | (252) | (258) | ||
Changes in intercompany balances with affiliates, net | (517) | 798 | ||
Other | 10 | 28 | ||
Net cash (used in) provided by financing activities | (801) | 528 | ||
Effect on exchange rate changes on cash and cash equivalents | (11) | |||
Change in cash and cash equivalents | (146) | 66 | ||
Cash and cash equivalents at beginning of period | 619 | 532 | ||
Cash and cash equivalents at end of period | $ 473 | $ 598 | $ 473 | $ 598 |
Supplemental Condensed Consol_7
Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Summary of Restatement Adjustments to Financial Statements (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2018 | Sep. 30, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | |
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | $ 759 | $ 426 | $ 2,723 | $ 1,742 |
Net cash provided by operating activities | 3,692 | |||
HCA Healthcare, Inc. Issuer [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 759 | 426 | 2,723 | 1,742 |
Net cash provided by operating activities | 74 | |||
HCA Inc. Issuer [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | (708) | (524) | (2,016) | (1,463) |
Net cash provided by operating activities | (1,694) | |||
Subsidiary Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 1,253 | 904 | 4,079 | 2,769 |
Net cash provided by operating activities | 3,766 | |||
Subsidiary Non-Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 183 | 56 | 607 | 396 |
Net cash provided by operating activities | 1,546 | |||
Eliminations [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | $ (728) | (436) | $ (2,670) | (1,702) |
As Previously Reported [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 426 | 1,742 | ||
Net cash provided by operating activities | 3,692 | |||
As Previously Reported [Member] | HCA Healthcare, Inc. Issuer [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 426 | 1,742 | ||
Net cash provided by operating activities | 74 | |||
As Previously Reported [Member] | HCA Inc. Issuer [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | (524) | (1,463) | ||
Net cash provided by operating activities | (1,694) | |||
As Previously Reported [Member] | Subsidiary Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 787 | 2,467 | ||
Net cash provided by operating activities | 3,342 | |||
As Previously Reported [Member] | Subsidiary Non-Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 173 | 698 | ||
Net cash provided by operating activities | 1,970 | |||
As Previously Reported [Member] | Eliminations [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | (436) | (1,702) | ||
Adjustment [Member] | Subsidiary Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | 117 | 302 | ||
Net cash provided by operating activities | 424 | |||
Adjustment [Member] | Subsidiary Non-Guarantors [Member] | ||||
Adjustments or Reclassifications [Line Items] | ||||
Net income attributable to HCA Healthcare, Inc. | $ (117) | (302) | ||
Net cash provided by operating activities | $ (424) |