Document and Entity Information
Document and Entity Information - shares | 3 Months Ended | |
Mar. 31, 2019 | Apr. 30, 2019 | |
Document and Entity Information [Abstract] | ||
Amendment Flag | false | |
Document Type | 10-Q | |
Document Period End Date | Mar. 31, 2019 | |
Document Fiscal Year Focus | 2019 | |
Document Fiscal Period Focus | Q1 | |
Trading Symbol | HCA | |
Entity Registrant Name | HCA Healthcare, Inc. | |
Entity Central Index Key | 0000860730 | |
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 | 342,307,400 |
Condensed Consolidated Income S
Condensed Consolidated Income Statements - USD ($) shares in Thousands, $ in Millions | 3 Months Ended | |
Mar. 31, 2019 | Mar. 31, 2018 | |
Income Statement [Abstract] | ||
Revenues | $ 12,517 | $ 11,423 |
Salaries and benefits | 5,647 | 5,289 |
Supplies | 2,041 | 1,915 |
Other operating expenses | 2,299 | 2,110 |
Equity in earnings of affiliates | (11) | (9) |
Depreciation and amortization | 619 | 553 |
Interest expense | 461 | 431 |
Losses (gains) on sales of facilities | 1 | (405) |
Total expenses including equity in earnings of affiliates | 11,057 | 9,884 |
Income before income taxes | 1,460 | 1,539 |
Provision for income taxes | 279 | 257 |
Net income | 1,181 | 1,282 |
Net income attributable to noncontrolling interests | 142 | 138 |
Net income attributable to HCA Healthcare, Inc. | $ 1,039 | $ 1,144 |
Per share data: | ||
Basic earnings | $ 3.03 | $ 3.26 |
Diluted earnings | $ 2.97 | $ 3.18 |
Shares used in earnings per share calculations (in millions): | ||
Basic | 342,876 | 350,850 |
Diluted | 350,316 | 359,749 |
Condensed Consolidated Comprehe
Condensed Consolidated Comprehensive Income Statements - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2019 | Mar. 31, 2018 | |
Statement of Comprehensive Income [Abstract] | ||
Net income | $ 1,181 | $ 1,282 |
Other comprehensive income (loss) before taxes: | ||
Foreign currency translation | 20 | 54 |
Unrealized gains (losses) on available-for-salesecurities | 8 | (5) |
Defined benefit plans | 0 | |
Pension costs included in salaries and benefits | 3 | 5 |
Total defined benefit plans | 3 | 5 |
Change in fair value of derivative financial instruments | (18) | 35 |
Interest benefits included in interest expense | (5) | 0 |
Total change in fair value of derivative financial instruments | (23) | 35 |
Other comprehensive income before taxes | 8 | 89 |
Income taxes related to other comprehensive income items | 1 | 8 |
Other comprehensive income | 7 | 81 |
Comprehensive income | 1,188 | 1,363 |
Comprehensive income attributable to noncontrolling interests | 142 | 138 |
Comprehensive income attributable to HCA Healthcare, Inc. | $ 1,046 | $ 1,225 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Millions | Mar. 31, 2019 | Dec. 31, 2018 |
Current assets: | ||
Cash and cash equivalents | $ 531 | $ 502 |
Accounts receivable | 7,420 | 6,789 |
Inventories | 1,778 | 1,732 |
Other | 1,379 | 1,190 |
Total current assets | 11,108 | 10,213 |
Property and equipment, at cost | 44,583 | 42,965 |
Accumulated depreciation | (23,455) | (23,208) |
Property and equipment, net | 21,128 | 19,757 |
Investments of insurance subsidiaries | 338 | 362 |
Investments in and advances to affiliates | 246 | 232 |
Goodwill and other intangible assets | 8,159 | 7,953 |
Right-of-use operating lease assets | 1,812 | |
Other | 588 | 690 |
Total assets | 43,379 | 39,207 |
Current liabilities: | ||
Accounts payable | 2,693 | 2,577 |
Accrued salaries | 1,424 | 1,580 |
Other accrued expenses | 2,618 | 2,624 |
Long-term debt due within one year | 3,796 | 788 |
Total current liabilities | 10,531 | 7,569 |
Long-term debt, less net debt issuance costs of $170 and $157 | 31,019 | 32,033 |
Professional liability risks | 1,313 | 1,275 |
Right-of-use operating lease obligations | 1,494 | |
Income taxes and other liabilities | 1,277 | 1,248 |
Stockholders' deficit: | ||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 343,030,500 shares in 2019 and 342,895,200 shares in 2018 | 3 | 3 |
Accumulated other comprehensive loss | (374) | (381) |
Retained deficit | (3,983) | (4,572) |
Stockholders' deficit attributable to HCA Healthcare, Inc. | (4,354) | (4,950) |
Noncontrolling interests | 2,099 | 2,032 |
Total stockholders' deficit | (2,255) | (2,918) |
Total liabilities and stockholders' deficit | $ 43,379 | $ 39,207 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions | Mar. 31, 2019 | Dec. 31, 2018 |
Statement of Financial Position [Abstract] | ||
Debt issuance costs | $ 170 | $ 157 |
Common stock, par value | $ 0.01 | $ 0.01 |
Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 |
Common stock, shares outstanding | 343,030,500 | 342,895,200 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Stockholders' Deficit - USD ($) shares in Thousands, $ 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, 2017 | $ (4,995) | $ 4 | $ (278) | $ (6,532) | $ 1,811 | |
Balance, shares at Dec. 31, 2017 | 350,092 | |||||
Comprehensive income (loss) | 1,363 | 81 | 1,144 | 138 | ||
Repurchase of common stock | (423) | $ 114 | (537) | |||
Repurchase of common stock, shares | (4,370) | |||||
Share-based benefit plans | (114) | (114) | ||||
Share-based benefit plans, shares | 5,265 | |||||
Cash dividends declared | (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 | |||||
Comprehensive income (loss) | 902 | (64) | 820 | 146 | ||
Repurchase of common stock | (470) | $ (1) | (93) | (376) | ||
Repurchase of common stock, shares | (4,670) | |||||
Share-based benefit plans | 96 | 96 | ||||
Share-based benefit plans, shares | 443 | |||||
Cash dividends declared | (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 | |||||
Comprehensive income (loss) | 891 | (5) | 759 | 137 | ||
Repurchase of common stock | (302) | (55) | (247) | |||
Repurchase of common stock, shares | (2,518) | |||||
Share-based benefit plans | 54 | 54 | ||||
Share-based benefit plans, shares | 844 | |||||
Cash dividends declared | (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 | |||||
Comprehensive income (loss) | 1,225 | (20) | 1,064 | 181 | ||
Repurchase of common stock | (335) | (69) | (266) | |||
Repurchase of common stock, shares | (2,512) | |||||
Share-based benefit plans | 79 | 79 | ||||
Share-based benefit plans, shares | 321 | |||||
Cash dividends declared | (123) | (123) | ||||
Distributions | (126) | (126) | ||||
Reclassification of stranded tax effects | (95) | 95 | ||||
Other | 92 | (10) | 102 | |||
Balance at Dec. 31, 2018 | (2,918) | $ 3 | (381) | (4,572) | 2,032 | |
Balance, shares at Dec. 31, 2018 | 342,895 | |||||
Comprehensive income (loss) | 1,188 | 7 | 1,039 | 142 | ||
Repurchase of common stock | $ (278) | 32 | (310) | |||
Repurchase of common stock, shares | (2,106) | (2,106) | ||||
Share-based benefit plans | $ (29) | (29) | ||||
Share-based benefit plans, shares | 2,242 | |||||
Cash dividends declared | (140) | (140) | ||||
Distributions | (136) | (136) | ||||
Other | 58 | $ (3) | 61 | |||
Balance at Mar. 31, 2019 | $ (2,255) | $ 3 | $ (374) | $ (3,983) | $ 2,099 | |
Balance, shares at Mar. 31, 2019 | 343,031 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Stockholders' Deficit (Parenthetical) - $ / shares | 3 Months Ended | ||||
Mar. 31, 2019 | Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | |
Statement of Stockholders' Equity [Abstract] | |||||
Cash dividends declared, per share | $ 0.40 | $ 0.35 | $ 0.35 | $ 0.35 | $ 0.35 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2019 | Mar. 31, 2018 | |
Cash flows from operating activities: | ||
Net income | $ 1,181 | $ 1,282 |
Decrease in cash from operating assets and liabilities: | ||
Accounts receivable | (369) | (4) |
Inventories and other assets | (174) | (218) |
Accounts payable and accrued expenses | (651) | (263) |
Depreciation and amortization | 619 | 553 |
Income taxes | 269 | 246 |
Losses (gains) on sales of facilities | 1 | (405) |
Amortization of debt issuance costs | 8 | 8 |
Share-based compensation | 62 | 60 |
Other | 28 | 24 |
Net cash provided by (used in) operating activities | 974 | 1,283 |
Cash flows from investing activities: | ||
Purchase of property and equipment | (781) | (694) |
Acquisition of hospitals and health care entities | (1,474) | (379) |
Disposal of hospitals and health care entities | 30 | 767 |
Change in investments | 36 | 11 |
Other | 24 | (40) |
Net cash used in investing activities | (2,165) | (335) |
Cash flows from financing activities: | ||
Issuances of long-term debt | 1,500 | |
Net change in revolving bank credit facilities | 460 | 270 |
Repayment of long-term debt | (49) | (50) |
Distributions to noncontrolling interests | (136) | (92) |
Payment of debt issuance costs | (22) | (2) |
Payment of cash dividends | (141) | (123) |
Repurchases of common stock | (278) | (423) |
Other | (118) | (191) |
Net cash provided by (used in) financing activities | 1,216 | (611) |
Effect of exchange rate changes on cash and cash equivalents | 4 | 17 |
Change in cash and cash equivalents | 29 | 354 |
Cash and cash equivalents at beginning of period | 502 | 732 |
Cash and cash equivalents at end of period | 531 | 1,086 |
Interest payments | 580 | 549 |
Income tax payments, net | $ 10 | $ 11 |
Basis of Presentation and Signi
Basis of Presentation and Significant Accounting Policies | 3 Months Ended |
Mar. 31, 2019 | |
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 March 31, 2019, these affiliates owned and operated 185 hospitals, 124 freestanding surgery centers and provided extensive outpatient and ancillary services. HCA Healthcare, Inc.’s facilities are located in 21 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 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 $86 million and $81 million for the quarters ended March 31, 2019 and 2018, respectively. Operating results for the quarter ended March 31, 2019 are not necessarily indicative of the results that may be expected for the year ending December 31, 2019. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K Revenues 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 Our performance obligations for outpatient services are generally satisfied over a period of less than one day fee-for-service Revenues (continued) 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 2019 Ratio 2018 Ratio Medicare $ 2,770 22.1 % $ 2,524 22.1 % Managed Medicare 1,589 12.7 1,399 12.3 Medicaid 347 2.8 281 2.5 Managed Medicaid 613 4.9 561 4.9 Managed care and insurers 6,426 51.4 6,062 53.1 International (managed care and insurers) 297 2.4 305 2.7 Other 475 3.7 291 2.4 Revenues $ 12,517 100.0 % $ 11,423 100.0 % 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 ended March 31, 2019 and 2018 follows (dollars in millions): 2019 2018 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 10,606 $ 9,867 Cost-to-charges ratio (patient care costs as percentage of gross patient charges) 11.8 % 12.4 % Total uncompensated care $ 7,085 $ 6,252 Multiply by the cost-to-charges ratio 11.8 % 12.4 % Estimated cost of total uncompensated care $ 836 $ 775 Total uncompensated care as a percentage of the sum of revenues and total uncompensated care was 36.1% and 35.4% for the quarters ended March 31, 2019 and 2018, respectively. The total uncompensated care amounts include charity care of $2.905 billion and $1.879 billion, and the related estimated costs of charity care were $343 million and $233 million for the quarters ended March 31, 2019 and 2018, respectively. Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Acquisitions and Dispositions
Acquisitions and Dispositions | 3 Months Ended |
Mar. 31, 2019 | |
Business Combinations [Abstract] | |
Acquisitions and Dispositions | NOTE 2 — ACQUISITIONS AND DISPOSITIONS During the quarter ended March 31, 2019, we paid $1.398 billion to acquire a seven During the quarter ended March 31, 2019, we received proceeds of $25 million and recognized a net pretax loss of $ 1 |
Income Taxes
Income Taxes | 3 Months Ended |
Mar. 31, 2019 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | NOTE 3 — INCOME TAXES Our provision for income taxes for the quarters ended March 31, 2019 and 2018 was $279 million and $257 million, respectively, and the effective tax rates were 21.2% and 18.4%, respectively. Our provision for income taxes included tax benefits related to the settlement of employee equity awards of $49 million and $92 million for the quarters ended March 31, 2019 and 2018, respectively. Our liability for unrecognized tax benefits was $457 million, including accrued interest of $53 million, as of March 31, 2019 ($435 million and $48 million, respectively, as of December 31, 2018). Unrecognized tax benefits of $143 million ($137 million as of December 31, 2018) would affect the effective rate, if recognized. The Internal Revenue Service began an examination of the Company’s 2016 and 2017 federal income tax returns during 2019. We are also subject to examination by state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change. |
Earnings Per Share
Earnings Per Share | 3 Months Ended |
Mar. 31, 2019 | |
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 ended March 31, 2019 and 2018 (dollars and shares in millions, except per share amounts): 2019 2018 Net income attributable to HCA Healthcare, Inc. $ 1,039 $ 1,144 Weighted average common shares outstanding 342.876 350.850 Effect of dilutive incremental shares 7.440 8.899 Shares used for diluted earnings per share 350.316 359.749 Earnings per share: Basic earnings $ 3.03 $ 3.26 Diluted earnings $ 2.97 $ 3.18 |
Investments of Insurance Subsid
Investments of Insurance Subsidiaries | 3 Months Ended |
Mar. 31, 2019 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments of Insurance Subsidiaries | NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES A summary of our insurance subsidiaries’ investments at March 31, 2019 and December 31, 2018 follows (dollars in millions): March 31, 2019 Amortized Unrealized Fair Gains Losses Debt securities $ 336 $ 11 $ — $ 347 Money market funds and other 81 — — 81 $ 417 $ 11 $ — 428 Amounts classified as current assets (90 ) Investment carrying value $ 338 December 31, 2018 Amortized Cost Unrealized Amounts Fair Value Gains Losses Debt securities $ 338 $ 5 $ (2 ) $ 341 Money market funds and other 68 — — 68 $ 406 $ 5 $ (2 ) 409 Amounts classified as current assets (47 ) Investment carrying value $ 362 At March 31, 2019 and December 31, 2018, the investments of our insurance subsidiaries were classified as “available-for-sale.” Scheduled maturities of investments in debt securities at March 31, 2019 were as follows (dollars in millions): Amortized Cost Fair Value Due in one year or less $ 3 $ 3 Due after one year through five years 64 65 Due after five years through ten years 201 209 Due after ten years 68 70 $ 336 $ 347 The average expected maturity of the investments in debt securities at March 31, 2019 was 5.9 |
Financial Instruments
Financial Instruments | 3 Months Ended |
Mar. 31, 2019 | |
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 March 31, 2019 (dollars in millions): Notional Amount Maturity Date Fair Value Pay-fixed interest rate swaps $ 2,000 December 2021 $ 38 Pay-fixed interest rate swaps 500 December 2022 2 During the next 12 months, we estimate $20 million will be reclassified from other comprehensive income (“OCI”) and will reduce interest expense. Derivatives — Results of Operations The following table presents the effect of our interest rate swaps on our results of operations for the quarter ended March 31, 2019 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Loss Location of Gain Amount of Gain Interest rate swaps $ 14 Interest expense $ 5 |
Assets and Liabilities Measured
Assets and Liabilities Measured at Fair Value | 3 Months Ended |
Mar. 31, 2019 | |
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 March 31, 2019 and December 31, 2018, 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 March 31, 2019 and December 31, 2018, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): March 31, 2019 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 347 $ — $ 347 $ — Money market funds and other 81 81 — — Investments of insurance subsidiaries 428 81 347 — Less amounts classified as current assets (90 ) (80 ) (10 ) — $ 338 1 $ 337 $ — Interest rate swaps (Other) $ 40 $ — $ 40 $ — December 31, 2018 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 341 $ — $ 341 $ — Money market funds and other 68 68 — — Investments of insurance subsidiaries 409 68 341 — Less amounts classified as current assets (47 ) (47 ) — — $ 362 $ 21 $ 341 $ — Interest rate swaps (Other) $ 63 $ — $ 63 $ — The estimated fair value of our long-term debt was $36.602 billion and $32.887 billion at March 31, 2019 and December 31, 2018, respectively, compared to carrying amounts, excluding net debt issuance costs, aggregating $34.985 billion and $32.978 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 | 3 Months Ended |
Mar. 31, 2019 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | NOTE 8 — LONG-TERM DEBT A summary of long-term debt at March 31, 2019 and December 31, 2018, including related interest rates at March 31, 2019, follows (dollars in millions): March 31, December 31, Senior secured asset-based revolving credit facility (effective interest rate of 3.7%) $ 3,500 $ 3,040 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 3.7%) 3,776 3,801 Senior secured notes (effective interest rate of 5.6%) 13,800 13,800 Other senior secured debt (effective interest rate of 5.5%) 657 585 Senior secured debt 21,733 21,226 Senior unsecured notes (effective interest rate of 6.3%) 13,252 11,752 Net debt issuance costs (170 ) (157 ) Total debt (average life of 6.3 years, rates averaging 5.4%) 34,815 32,821 Less amounts due within one year 3,796 788 $ 31,019 $ 32,033 During January 2019, we issued $1.500 billion aggregate principal amount of senior unsecured notes comprised of $1.000 billion aggregate principal amount of 5.875% notes due 2029 and $500 million aggregate principal amount of 5.625% notes due 2028. We used the net proceeds to fund the purchase of a seven-hospital |
Leases
Leases | 3 Months Ended |
Mar. 31, 2019 | |
Leases [Abstract] | |
Leases | NOTE 9 — LEASES We adopted ASU No. 2016-02, Leases (Topic 842) We lease property and equipment under finance and operating leases. For leases with terms greater than 12 months, we record the related right-of-use right-of-use Generally, we use our estimated incremental borrowing rate to discount the lease payments based on information available at lease commencement, as most of our leases do not provide a readily determinable implicit interest rate. The following table presents our lease-related assets and liabilities at March 31, 2019 (dollars in millions): Balance Sheet Classification March 31, 2019 Assets: Operating leases Right-of-use $ 1,812 Finance leases Property and equipment 590 Total lease assets $ 2,402 Liabilities: Current: Operating leases Other accrued expenses $ 310 Finance leases Long-term 39 Noncurrent: Operating leases Right-of-use 1,494 Finance leases Long-term debt 519 Total lease liabilities $ 2,362 Weighted-average remaining term: Operating leases 12.3 years Finance leases 9.2 years Weighted-average discount rate: Operating leases(1) 5.6 % Finance leases 5.4 % (1) Upon adoption of the new lease standard, discount rates used for existing leases were established at January 1, 2019. The following table presents certain information related to lease expense for finance and operating leases for the quarter ended March 31, 2019 (dollars in millions): 2019 Finance lease expense: Amortization of leased assets $ 17 Interest of lease liabilities 6 Operating leases(2) 94 Short-term lease expense(2) 78 Variable lease expense(2) 39 Total lease expense $ 234 (2) Expenses are included in “other operating expenses” in our condensed consolidated income statement. Other Information The following table presents supplemental cash flow information for the quarter ended March 31, 2019 (dollars in millions): 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 144 Operating cash flows for finance leases 6 Financing cash flows for finance leases 17 Maturities of Lease Liabilities The following table reconciles the undiscounted cash flows to the finance lease liabilities and operating lease liabilities recorded on the balance sheet at March 31, 2019 (dollars in millions): Operating Finance 2019 $ 294 $ 72 2020 370 92 2021 315 71 2022 254 62 2023 198 52 Thereafter 1,265 318 Total minimum lease payments 2,696 667 Less: amount of lease payments representing interest (892 ) (109 ) Present value of future minimum lease payments 1,804 558 Less: current obligations under leases (310 ) (39 ) Long-term lease obligations $ 1,494 $ 519 |
Contingencies
Contingencies | 3 Months Ended |
Mar. 31, 2019 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | NOTE 10 — CONTINGENCIES We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity. Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our results of operations, financial position or liquidity. Texas operates a state Medicaid program pursuant to a waiver from CMS under Section 1115 of the Social Security Act (“Program”). The Program includes uncompensated-care pools; payments from these pools are intended to defray the uncompensated costs of services provided by our and other hospitals to Medicaid eligible or uninsured individuals. Separately, we and other hospitals provide charity care services in several communities in the state. The Civil Division of the U.S. Department of Justice and the U.S. Attorney’s Office for the Southern District of Texas have requested information about whether the Program as operated in Harris County complies with the laws and regulations applicable to provider related donations. The Company is cooperating with this request. We believe that our participation is and has been consistent with the requirements of the Program. However, at this time, we cannot predict what effect, if any, the request or resulting claims under the federal FCA, other statutes, regulations or laws, could have on the Company. |
Share Repurchases Transactions
Share Repurchases Transactions and Other Comprehensive Loss | 3 Months Ended |
Mar. 31, 2019 | |
Federal Home Loan Banks [Abstract] | |
Share Repurchases Transactions and Other Comprehensive Loss | NOTE 11 — SHARE REPURCHASES TRANSACTIONS AND OTHER COMPREHENSIVE LOSS During January 2019, our Board of Directors authorized a share repurchase program for up to $2 billion of our outstanding common stock. During the quarter ended March 31, 2019, we repurchased 2.106 million shares of our common stock at an average price of $131.92 per share through market purchases pursuant to the $2.0 billion share repurchase program authorized during October 2017 (which was completed during the first quarter of 2019) and the $2.0 billion share repurchase program authorized during January 2019. At March 31, 2019, we had $1.995 billion of repurchase authorization available under the January 2019 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, 2018 $ 3 $ (283 ) $ (148 ) $ 47 $ (381 ) Unrealized gains on available-for-sale 6 — — — 6 Foreign currency translation adjustments, net of $3 of income taxes — 17 — — 17 Change in fair value of derivative instruments, net of $4 income tax benefits — — — (14 ) (14 ) Expense (income) reclassified into operations from other comprehensive income, net of $1 income tax benefits and $1 of income taxes, respectively — — 2 (4 ) (2 ) Balances at March 31, 2019 $ 9 $ (266 ) $ (146 ) $ 29 $ (374 ) |
Segment and Geographic Informat
Segment and Geographic Information | 3 Months Ended |
Mar. 31, 2019 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | NOTE 12 — SEGMENT AND GEOGRAPHIC INFORMATION We operate in one line of business, which is operating hospitals and related health care entities. We operate in two hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Mississippi, Missouri, Tennessee and Texas. We also operate six Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses (gains) on sales of facilities, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters ended March 31, 2019 and 2018 are summarized in the following table (dollars in millions): 2019 2018 Revenues: National Group $ 6,317 $ 5,568 American Group 5,595 5,327 Corporate and other 605 528 $ 12,517 $ 11,423 Equity in earnings of affiliates: National Group $ (2 ) $ (2 ) American Group (11 ) (9 ) Corporate and other 2 2 $ (11 ) $ (9 ) Adjusted segment EBITDA: National Group $ 1,454 $ 1,182 American Group 1,141 1,031 Corporate and other (54 ) (95 ) $ 2,541 $ 2,118 Depreciation and amortization: National Group $ 265 $ 225 American Group 281 252 Corporate and other 73 76 $ 619 $ 553 Adjusted segment EBITDA $ 2,541 $ 2,118 Depreciation and amortization 619 553 Interest expense 461 431 Losses (gains) on sales of facilities 1 (405 ) Income before income taxes $ 1,460 $ 1,539 |
Supplemental Condensed Consolid
Supplemental Condensed Consolidating Financial Information | 3 Months Ended |
Mar. 31, 2019 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Supplemental Condensed Consolidating Financial Information And Other Collateral-related Information | NOTE 13 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION HCA Healthcare, Inc. has $1.000 billion aggregate principal amount of 6.250% senior unsecured notes due 2021 outstanding. 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 ended March 31, 2019 and 2018, condensed consolidating balance sheets at March 31, 2019 and December 31, 2018 and condensed consolidating statements of cash flows for the quarters ended March 31, 2019 and 2018, 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 MARCH 31, 2019 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 7,224 $ 5,293 $ — $ 12,517 Salaries and benefits — — 3,137 2,510 — 5,647 Supplies — — 1,177 864 — 2,041 Other operating expenses 2 — 1,146 1,151 — 2,299 Equity in earnings of affiliates (1,026 ) — (2 ) (9 ) 1,026 (11 ) Depreciation and amortization — — 355 264 — 619 Interest expense (income) 16 995 (473 ) (77 ) — 461 Losses on sales of facilities — — 1 — — 1 Management fees — — (171 ) 171 — — (1,008 ) 995 5,170 4,874 1,026 11,057 Income (loss) before income taxes 1,008 (995 ) 2,054 419 (1,026 ) 1,460 Provision (benefit) for income taxes (31 ) (231 ) 472 69 — 279 Net income (loss) 1,039 (764 ) 1,582 350 (1,026 ) 1,181 Net income attributable to noncontrolling interests — — 20 122 — 142 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,039 $ (764 ) $ 1,562 $ 228 $ (1,026 ) $ 1,039 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,046 $ (782 ) $ 1,564 $ 251 $ (1,033 ) $ 1,046 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE QUARTER ENDED MARCH 31, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 6,776 $ 4,647 $ — $ 11,423 Salaries and benefits — — 3,069 2,220 — 5,289 Supplies — — 1,141 774 — 1,915 Other operating expenses 1 — 1,128 981 — 2,110 Equity in earnings of affiliates (1,090 ) — (2 ) (7 ) 1,090 (9 ) Depreciation and amortization — — 323 230 — 553 Interest expense 16 837 (367 ) (55 ) — 431 Gains on sales of facilities — — (395 ) (10 ) — (405 ) Management fees — — (158 ) 158 — — (1,073 ) 837 4,739 4,291 1,090 9,884 Income (loss) before income taxes 1,073 (837 ) 2,037 356 (1,090 ) 1,539 Provision (benefit) for income taxes (71 ) (195 ) 467 56 — 257 Net income (loss) 1,144 (642 ) 1,570 300 (1,090 ) 1,282 Net income attributable to noncontrolling interests — — 28 110 — 138 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,144 $ (642 ) $ 1,542 $ 190 $ (1,090 ) $ 1,144 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,225 $ (615 ) $ 1,546 $ 240 $ (1,171 ) $ 1,225 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET MARCH 31, 2019 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 139 $ 392 $ — $ 531 Accounts receivable — — 4,200 3,220 — 7,420 Inventories — — 1,149 629 — 1,778 Other — — 699 680 — 1,379 — — 6,187 4,921 — 11,108 Property and equipment, net — — 12,587 8,541 — 21,128 Investments of insurance subsidiaries — — — 338 — 338 Investments in and advances to affiliates 34,199 — 29 217 (34,199 ) 246 Goodwill and other intangible assets — — 5,725 2,434 — 8,159 Right-of-use operating lease assets — — 438 1,374 — 1,812 Other 404 40 32 112 — 588 $ 34,603 $ 40 $ 24,998 $ 17,937 $ (34,199 ) $ 43,379 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY Current liabilities: Accounts payable $ — $ — $ 1,767 $ 926 $ — $ 2,693 Accrued salaries — — 851 573 — 1,424 Other accrued expenses 300 302 736 1,280 — 2,618 Long-term debt due within one year — 3,697 54 45 — 3,796 300 3,999 3,408 2,824 — 10,531 Long-term debt, net 997 29,464 231 327 — 31,019 Intercompany balances 37,135 (7,851 ) (29,293 ) 9 — — Professional liability risks — — — 1,313 — 1,313 Right-of-use operating lease obligations — — 336 1,158 — 1,494 Income taxes and other liabilities 525 — 233 519 — 1,277 38,957 25,612 (25,085 ) 6,150 — 45,634 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (4,354 ) (25,572 ) 50,001 9,770 (34,199 ) (4,354 ) Noncontrolling interests — — 82 2,017 — 2,099 (4,354 ) (25,572 ) 50,083 11,787 (34,199 ) (2,255 ) $ 34,603 $ 40 $ 24,998 $ 17,937 $ (34,199 ) $ 43,379 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET DECEMBER 31, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 174 $ 328 $ — $ 502 Accounts receivable, net — — 3,964 2,825 — 6,789 Inventories — — 1,178 554 — 1,732 Other — — 669 521 — 1,190 — — 5,985 4,228 — 10,213 Property and equipment, net — — 12,450 7,307 — 19,757 Investments of insurance subsidiaries — — — 362 — 362 Investments in and advances to affiliates 33,166 — 29 203 (33,166 ) 232 Goodwill and other intangible assets — — 5,724 2,229 — 7,953 Other 478 64 35 113 — 690 $ 33,644 $ 64 $ 24,223 $ 14,442 $ (33,166 ) $ 39,207 LIABILITIES AND Current liabilities: Accounts payable $ — $ — $ 1,721 $ 856 $ — $ 2,577 Accrued salaries — — 998 582 — 1,580 Other accrued expenses 142 403 905 1,174 — 2,624 Long-term debt due within one year — 696 55 37 — 788 142 1,099 3,679 2,649 — 7,569 Long-term debt, net 996 30,544 212 281 — 32,033 Intercompany balances 36,951 (6,789 ) (28,415 ) (1,747 ) — — Professional liability risks — — — 1,275 — 1,275 Income taxes and other liabilities 505 — 223 520 — 1,248 38,594 24,854 (24,301 ) 2,978 — 42,125 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (4,950 ) (24,790 ) 48,437 9,519 (33,166 ) (4,950 ) Noncontrolling interests — — 87 1,945 — 2,032 (4,950 ) (24,790 ) 48,524 11,464 (33,166 ) (2,918 ) $ 33,644 $ 64 $ 24,223 $ 14,442 $ (33,166 ) $ 39,207 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE QUARTER ENDED MARCH 31, 2019 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,039 $ (764 ) $ 1,582 $ 350 $ (1,026 ) $ 1,181 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (15 ) (101 ) (600 ) (478 ) — (1,194 ) Depreciation and amortization — — 355 264 — 619 Income taxes 269 — — — — 269 Losses on sales of facilities — — 1 — — 1 Amortization of debt issuance costs — 8 — — — 8 Share-based compensation — — 62 — — 62 Equity in earnings of affiliates (1,026 ) — — — 1,026 — Other 25 — 5 (2 ) — 28 Net cash provided by (used in) operating activities 292 (857 ) 1,405 134 — 974 Cash flows from investing activities: Purchase of property and equipment — — (471 ) (310 ) — (781 ) Acquisition of hospitals and health care entities — — (12 ) (1,462 ) — (1,474 ) Disposition of hospitals and health care entities — — 30 — — 30 Change in investments — — — 36 — 36 Other — — (5 ) 29 — 24 Net cash used in investing activities — — (458 ) (1,707 ) — (2,165 ) Cash flows from financing activities: Issuance of long-term debt — 1,500 — — — 1,500 Net change in revolving credit facilities — 460 — — — 460 Repayment of long-term debt — (23 ) (16 ) (10 ) — (49 ) Distributions to noncontrolling interests — — (25 ) (111 ) — (136 ) Payment of debt issuance costs — (22 ) — — — (22 ) Payment of cash dividends (141 ) — — — — (141 ) Repurchases of common stock (278 ) — — — — (278 ) Changes in intercompany balances with affiliates, net 243 (1,058 ) (941 ) 1,756 — — Other (116 ) — — (2 ) — (118 ) Net cash (used in) provided by financing activities (292 ) 857 (982 ) 1,633 — 1,216 Effect on exchange rate changes on cash and cash equivalents — — — 4 — 4 Change in cash and cash equivalents — — (35 ) 64 — 29 Cash and cash equivalents at beginning of period — — 174 328 — 502 Cash and cash equivalents at end of period $ — $ — $ 139 $ 392 $ — $ 531 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE QUARTER ENDED MARCH 31, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,144 $ (642 ) $ 1,570 $ 300 $ (1,090 ) $ 1,282 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (15 ) (99 ) (347 ) (24 ) — (485 ) Depreciation and amortization — — 323 230 — 553 Income taxes 246 — — — — 246 Gains on sales of facilities — — (395 ) (10 ) — (405 ) Amortization of debt issuance costs — 8 — — — 8 Share-based compensation — — 60 — — 60 Equity in earnings of affiliates (1,090 ) — — — 1,090 — Other 21 — — 3 — 24 Net cash provided by (used in) operating activities 306 (733 ) 1,211 499 — 1,283 Cash flows from investing activities: Purchase of property and equipment — — (413 ) (281 ) — (694 ) Acquisition of hospitals and health care entities — — (373 ) (6 ) — (379 ) Disposition of hospitals and health care entities — — 767 — — 767 Change in investments — — 13 (2 ) — 11 Other — — (48 ) 8 — (40 ) Net cash used in investing activities — — (54 ) (281 ) — (335 ) Cash flows from financing activities: Net change in revolving credit facilities — 270 — — — 270 Repayment of long-term debt — (18 ) (22 ) (10 ) — (50 ) Distributions to noncontrolling interests — — (24 ) (68 ) — (92 ) Payment of debt issuance costs — (2 ) — — — (2 ) Payment of cash dividends (123 ) — — — — (123 ) Repurchases of common stock (423 ) — — — — (423 ) Changes in intercompany balances with affiliates, net 434 483 (919 ) 2 — — Other (195 ) — — 4 — (191 ) Net cash (used in) provided by financing activities (307 ) 733 (965 ) (72 ) — (611 ) Effect on exchange rate changes on cash and cash equivalents — — — 17 — 17 Change in cash and cash equivalents (1 ) — 192 163 — 354 Cash and cash equivalents at beginning of period 1 — 112 619 — 732 Cash and cash equivalents at end of period $ — $ — $ 304 $ 782 $ — $ 1,086 |
Basis of Presentation and Sig_2
Basis of Presentation and Significant Accounting Policies (Policies) | 3 Months Ended |
Mar. 31, 2019 | |
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 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 $86 million and $81 million for the quarters ended March 31, 2019 and 2018, respectively. Operating results for the quarter ended March 31, 2019 are not necessarily indicative of the results that may be expected for the year ending December 31, 2019. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K |
Revenues | Revenues 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 Our performance obligations for outpatient services are generally satisfied over a period of less than one day fee-for-service Revenues (continued) 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 2019 Ratio 2018 Ratio Medicare $ 2,770 22.1 % $ 2,524 22.1 % Managed Medicare 1,589 12.7 1,399 12.3 Medicaid 347 2.8 281 2.5 Managed Medicaid 613 4.9 561 4.9 Managed care and insurers 6,426 51.4 6,062 53.1 International (managed care and insurers) 297 2.4 305 2.7 Other 475 3.7 291 2.4 Revenues $ 12,517 100.0 % $ 11,423 100.0 % 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 ended March 31, 2019 and 2018 follows (dollars in millions): 2019 2018 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 10,606 $ 9,867 Cost-to-charges ratio (patient care costs as percentage of gross patient charges) 11.8 % 12.4 % Total uncompensated care $ 7,085 $ 6,252 Multiply by the cost-to-charges ratio 11.8 % 12.4 % Estimated cost of total uncompensated care $ 836 $ 775 Total uncompensated care as a percentage of the sum of revenues and total uncompensated care was 36.1% and 35.4% for the quarters ended March 31, 2019 and 2018, respectively. The total uncompensated care amounts include charity care of $2.905 billion and $1.879 billion, and the related estimated costs of charity care were $343 million and $233 million for the quarters ended March 31, 2019 and 2018, respectively. |
Reclassifications | Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Basis of Presentation and Sig_3
Basis of Presentation and Significant Accounting Policies (Tables) | 3 Months Ended |
Mar. 31, 2019 | |
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 ended March 31, 2019 and 2018 are summarized in the following table (dollars in millions): 2019 Ratio 2018 Ratio Medicare $ 2,770 22.1 % $ 2,524 22.1 % Managed Medicare 1,589 12.7 1,399 12.3 Medicaid 347 2.8 281 2.5 Managed Medicaid 613 4.9 561 4.9 Managed care and insurers 6,426 51.4 6,062 53.1 International (managed care and insurers) 297 2.4 305 2.7 Other 475 3.7 291 2.4 Revenues $ 12,517 100.0 % $ 11,423 100.0 % |
Schedule of Estimated Cost of Uncompensated Care | A summary of the estimated cost of total uncompensated care for the quarters ended March 31, 2019 and 2018 follows (dollars in millions): 2019 2018 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 10,606 $ 9,867 Cost-to-charges ratio (patient care costs as percentage of gross patient charges) 11.8 % 12.4 % Total uncompensated care $ 7,085 $ 6,252 Multiply by the cost-to-charges ratio 11.8 % 12.4 % Estimated cost of total uncompensated care $ 836 $ 775 |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 3 Months Ended |
Mar. 31, 2019 | |
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 ended March 31, 2019 and 2018 (dollars and shares in millions, except per share amounts): 2019 2018 Net income attributable to HCA Healthcare, Inc. $ 1,039 $ 1,144 Weighted average common shares outstanding 342.876 350.850 Effect of dilutive incremental shares 7.440 8.899 Shares used for diluted earnings per share 350.316 359.749 Earnings per share: Basic earnings $ 3.03 $ 3.26 Diluted earnings $ 2.97 $ 3.18 |
Investments of Insurance Subs_2
Investments of Insurance Subsidiaries (Tables) | 3 Months Ended |
Mar. 31, 2019 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | A summary of our insurance subsidiaries’ investments at March 31, 2019 and December 31, 2018 follows (dollars in millions): March 31, 2019 Amortized Unrealized Fair Gains Losses Debt securities $ 336 $ 11 $ — $ 347 Money market funds and other 81 — — 81 $ 417 $ 11 $ — 428 Amounts classified as current assets (90 ) Investment carrying value $ 338 December 31, 2018 Amortized Cost Unrealized Amounts Fair Value Gains Losses Debt securities $ 338 $ 5 $ (2 ) $ 341 Money market funds and other 68 — — 68 $ 406 $ 5 $ (2 ) 409 Amounts classified as current assets (47 ) Investment carrying value $ 362 |
Schedule of Maturities of Investments | Scheduled maturities of investments in debt securities at March 31, 2019 were as follows (dollars in millions): Amortized Cost Fair Value Due in one year or less $ 3 $ 3 Due after one year through five years 64 65 Due after five years through ten years 201 209 Due after ten years 68 70 $ 336 $ 347 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 3 Months Ended |
Mar. 31, 2019 | |
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 March 31, 2019 (dollars in millions): Notional Amount Maturity Date Fair Value Pay-fixed interest rate swaps $ 2,000 December 2021 $ 38 Pay-fixed interest rate swaps 500 December 2022 2 |
Effect of Interest Rate on Results of Operations | The following table presents the effect of our interest rate swaps on our results of operations for the quarter ended March 31, 2019 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Loss Location of Gain Amount of Gain Interest rate swaps $ 14 Interest expense $ 5 |
Assets and Liabilities Measur_2
Assets and Liabilities Measured at Fair Value (Tables) | 3 Months Ended |
Mar. 31, 2019 | |
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 March 31, 2019 and December 31, 2018, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): March 31, 2019 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 347 $ — $ 347 $ — Money market funds and other 81 81 — — Investments of insurance subsidiaries 428 81 347 — Less amounts classified as current assets (90 ) (80 ) (10 ) — $ 338 1 $ 337 $ — Interest rate swaps (Other) $ 40 $ — $ 40 $ — December 31, 2018 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 341 $ — $ 341 $ — Money market funds and other 68 68 — — Investments of insurance subsidiaries 409 68 341 — Less amounts classified as current assets (47 ) (47 ) — — $ 362 $ 21 $ 341 $ — Interest rate swaps (Other) $ 63 $ — $ 63 $ — |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 3 Months Ended |
Mar. 31, 2019 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | A summary of long-term debt at March 31, 2019 and December 31, 2018, including related interest rates at March 31, 2019, follows (dollars in millions): March 31, December 31, Senior secured asset-based revolving credit facility (effective interest rate of 3.7%) $ 3,500 $ 3,040 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 3.7%) 3,776 3,801 Senior secured notes (effective interest rate of 5.6%) 13,800 13,800 Other senior secured debt (effective interest rate of 5.5%) 657 585 Senior secured debt 21,733 21,226 Senior unsecured notes (effective interest rate of 6.3%) 13,252 11,752 Net debt issuance costs (170 ) (157 ) Total debt (average life of 6.3 years, rates averaging 5.4%) 34,815 32,821 Less amounts due within one year 3,796 788 $ 31,019 $ 32,033 |
Leases (Tables)
Leases (Tables) | 3 Months Ended |
Mar. 31, 2019 | |
Leases [Abstract] | |
Schedule of lease-related assets and liabilities | The following table presents our lease-related assets and liabilities at March 31, 2019 (dollars in millions): Balance Sheet Classification March 31, 2019 Assets: Operating leases Right-of-use $ 1,812 Finance leases Property and equipment 590 Total lease assets $ 2,402 Liabilities: Current: Operating leases Other accrued expenses $ 310 Finance leases Long-term 39 Noncurrent: Operating leases Right-of-use 1,494 Finance leases Long-term debt 519 Total lease liabilities $ 2,362 Weighted-average remaining term: Operating leases 12.3 years Finance leases 9.2 years Weighted-average discount rate: Operating leases(1) 5.6 % Finance leases 5.4 % (1) Upon adoption of the new lease standard, discount rates used for existing leases were established at January 1, 2019. |
Schedule of lease expense for finance and operating leases | The following table presents certain information related to lease expense for finance and operating leases for the quarter ended March 31, 2019 (dollars in millions): 2019 Finance lease expense: Amortization of leased assets $ 17 Interest of lease liabilities 6 Operating leases(2) 94 Short-term lease expense(2) 78 Variable lease expense(2) 39 Total lease expense $ 234 (2) Expenses are included in “other operating expenses” in our condensed consolidated income statement. |
Schedule of supplemental cash flow information | The following table presents supplemental cash flow information for the quarter ended March 31, 2019 (dollars in millions): 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 144 Operating cash flows for finance leases 6 Financing cash flows for finance leases 17 |
Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities recorded on balance sheet | The following table reconciles the undiscounted cash flows to the finance lease liabilities and operating lease liabilities recorded on the balance sheet at March 31, 2019 (dollars in millions): Operating Finance 2019 $ 294 $ 72 2020 370 92 2021 315 71 2022 254 62 2023 198 52 Thereafter 1,265 318 Total minimum lease payments 2,696 667 Less: amount of lease payments representing interest (892 ) (109 ) Present value of future minimum lease payments 1,804 558 Less: current obligations under leases (310 ) (39 ) Long-term lease obligations $ 1,494 $ 519 |
Share Repurchases Transaction_2
Share Repurchases Transactions and Other Comprehensive Loss (Tables) | 3 Months Ended |
Mar. 31, 2019 | |
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, 2018 $ 3 $ (283 ) $ (148 ) $ 47 $ (381 ) Unrealized gains on available-for-sale 6 — — — 6 Foreign currency translation adjustments, net of $3 of income taxes — 17 — — 17 Change in fair value of derivative instruments, net of $4 income tax benefits — — — (14 ) (14 ) Expense (income) reclassified into operations from other comprehensive income, net of $1 income tax benefits and $1 of income taxes, respectively — — 2 (4 ) (2 ) Balances at March 31, 2019 $ 9 $ (266 ) $ (146 ) $ 29 $ (374 ) |
Segment and Geographic Inform_2
Segment and Geographic Information (Tables) | 3 Months Ended |
Mar. 31, 2019 | |
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 ended March 31, 2019 and 2018 are summarized in the following table (dollars in millions): 2019 2018 Revenues: National Group $ 6,317 $ 5,568 American Group 5,595 5,327 Corporate and other 605 528 $ 12,517 $ 11,423 Equity in earnings of affiliates: National Group $ (2 ) $ (2 ) American Group (11 ) (9 ) Corporate and other 2 2 $ (11 ) $ (9 ) Adjusted segment EBITDA: National Group $ 1,454 $ 1,182 American Group 1,141 1,031 Corporate and other (54 ) (95 ) $ 2,541 $ 2,118 Depreciation and amortization: National Group $ 265 $ 225 American Group 281 252 Corporate and other 73 76 $ 619 $ 553 Adjusted segment EBITDA $ 2,541 $ 2,118 Depreciation and amortization 619 553 Interest expense 461 431 Losses (gains) on sales of facilities 1 (405 ) Income before income taxes $ 1,460 $ 1,539 |
Supplemental Condensed Consol_2
Supplemental Condensed Consolidating Financial Information (Tables) | 3 Months Ended |
Mar. 31, 2019 | |
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 MARCH 31, 2019 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 7,224 $ 5,293 $ — $ 12,517 Salaries and benefits — — 3,137 2,510 — 5,647 Supplies — — 1,177 864 — 2,041 Other operating expenses 2 — 1,146 1,151 — 2,299 Equity in earnings of affiliates (1,026 ) — (2 ) (9 ) 1,026 (11 ) Depreciation and amortization — — 355 264 — 619 Interest expense (income) 16 995 (473 ) (77 ) — 461 Losses on sales of facilities — — 1 — — 1 Management fees — — (171 ) 171 — — (1,008 ) 995 5,170 4,874 1,026 11,057 Income (loss) before income taxes 1,008 (995 ) 2,054 419 (1,026 ) 1,460 Provision (benefit) for income taxes (31 ) (231 ) 472 69 — 279 Net income (loss) 1,039 (764 ) 1,582 350 (1,026 ) 1,181 Net income attributable to noncontrolling interests — — 20 122 — 142 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,039 $ (764 ) $ 1,562 $ 228 $ (1,026 ) $ 1,039 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,046 $ (782 ) $ 1,564 $ 251 $ (1,033 ) $ 1,046 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE QUARTER ENDED MARCH 31, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Revenues $ — $ — $ 6,776 $ 4,647 $ — $ 11,423 Salaries and benefits — — 3,069 2,220 — 5,289 Supplies — — 1,141 774 — 1,915 Other operating expenses 1 — 1,128 981 — 2,110 Equity in earnings of affiliates (1,090 ) — (2 ) (7 ) 1,090 (9 ) Depreciation and amortization — — 323 230 — 553 Interest expense 16 837 (367 ) (55 ) — 431 Gains on sales of facilities — — (395 ) (10 ) — (405 ) Management fees — — (158 ) 158 — — (1,073 ) 837 4,739 4,291 1,090 9,884 Income (loss) before income taxes 1,073 (837 ) 2,037 356 (1,090 ) 1,539 Provision (benefit) for income taxes (71 ) (195 ) 467 56 — 257 Net income (loss) 1,144 (642 ) 1,570 300 (1,090 ) 1,282 Net income attributable to noncontrolling interests — — 28 110 — 138 Net income (loss) attributable to HCA Healthcare, Inc. $ 1,144 $ (642 ) $ 1,542 $ 190 $ (1,090 ) $ 1,144 Comprehensive income (loss) attributable to HCA Healthcare, Inc. $ 1,225 $ (615 ) $ 1,546 $ 240 $ (1,171 ) $ 1,225 |
Schedule of Condensed Consolidating Balance Sheet | HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET MARCH 31, 2019 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 139 $ 392 $ — $ 531 Accounts receivable — — 4,200 3,220 — 7,420 Inventories — — 1,149 629 — 1,778 Other — — 699 680 — 1,379 — — 6,187 4,921 — 11,108 Property and equipment, net — — 12,587 8,541 — 21,128 Investments of insurance subsidiaries — — — 338 — 338 Investments in and advances to affiliates 34,199 — 29 217 (34,199 ) 246 Goodwill and other intangible assets — — 5,725 2,434 — 8,159 Right-of-use operating lease assets — — 438 1,374 — 1,812 Other 404 40 32 112 — 588 $ 34,603 $ 40 $ 24,998 $ 17,937 $ (34,199 ) $ 43,379 LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY Current liabilities: Accounts payable $ — $ — $ 1,767 $ 926 $ — $ 2,693 Accrued salaries — — 851 573 — 1,424 Other accrued expenses 300 302 736 1,280 — 2,618 Long-term debt due within one year — 3,697 54 45 — 3,796 300 3,999 3,408 2,824 — 10,531 Long-term debt, net 997 29,464 231 327 — 31,019 Intercompany balances 37,135 (7,851 ) (29,293 ) 9 — — Professional liability risks — — — 1,313 — 1,313 Right-of-use operating lease obligations — — 336 1,158 — 1,494 Income taxes and other liabilities 525 — 233 519 — 1,277 38,957 25,612 (25,085 ) 6,150 — 45,634 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (4,354 ) (25,572 ) 50,001 9,770 (34,199 ) (4,354 ) Noncontrolling interests — — 82 2,017 — 2,099 (4,354 ) (25,572 ) 50,083 11,787 (34,199 ) (2,255 ) $ 34,603 $ 40 $ 24,998 $ 17,937 $ (34,199 ) $ 43,379 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET DECEMBER 31, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed ASSETS Current assets: Cash and cash equivalents $ — $ — $ 174 $ 328 $ — $ 502 Accounts receivable, net — — 3,964 2,825 — 6,789 Inventories — — 1,178 554 — 1,732 Other — — 669 521 — 1,190 — — 5,985 4,228 — 10,213 Property and equipment, net — — 12,450 7,307 — 19,757 Investments of insurance subsidiaries — — — 362 — 362 Investments in and advances to affiliates 33,166 — 29 203 (33,166 ) 232 Goodwill and other intangible assets — — 5,724 2,229 — 7,953 Other 478 64 35 113 — 690 $ 33,644 $ 64 $ 24,223 $ 14,442 $ (33,166 ) $ 39,207 LIABILITIES AND Current liabilities: Accounts payable $ — $ — $ 1,721 $ 856 $ — $ 2,577 Accrued salaries — — 998 582 — 1,580 Other accrued expenses 142 403 905 1,174 — 2,624 Long-term debt due within one year — 696 55 37 — 788 142 1,099 3,679 2,649 — 7,569 Long-term debt, net 996 30,544 212 281 — 32,033 Intercompany balances 36,951 (6,789 ) (28,415 ) (1,747 ) — — Professional liability risks — — — 1,275 — 1,275 Income taxes and other liabilities 505 — 223 520 — 1,248 38,594 24,854 (24,301 ) 2,978 — 42,125 Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. (4,950 ) (24,790 ) 48,437 9,519 (33,166 ) (4,950 ) Noncontrolling interests — — 87 1,945 — 2,032 (4,950 ) (24,790 ) 48,524 11,464 (33,166 ) (2,918 ) $ 33,644 $ 64 $ 24,223 $ 14,442 $ (33,166 ) $ 39,207 |
Schedule of Condensed Consolidating Statement of Cash Flows | HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE QUARTER ENDED MARCH 31, 2019 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,039 $ (764 ) $ 1,582 $ 350 $ (1,026 ) $ 1,181 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (15 ) (101 ) (600 ) (478 ) — (1,194 ) Depreciation and amortization — — 355 264 — 619 Income taxes 269 — — — — 269 Losses on sales of facilities — — 1 — — 1 Amortization of debt issuance costs — 8 — — — 8 Share-based compensation — — 62 — — 62 Equity in earnings of affiliates (1,026 ) — — — 1,026 — Other 25 — 5 (2 ) — 28 Net cash provided by (used in) operating activities 292 (857 ) 1,405 134 — 974 Cash flows from investing activities: Purchase of property and equipment — — (471 ) (310 ) — (781 ) Acquisition of hospitals and health care entities — — (12 ) (1,462 ) — (1,474 ) Disposition of hospitals and health care entities — — 30 — — 30 Change in investments — — — 36 — 36 Other — — (5 ) 29 — 24 Net cash used in investing activities — — (458 ) (1,707 ) — (2,165 ) Cash flows from financing activities: Issuance of long-term debt — 1,500 — — — 1,500 Net change in revolving credit facilities — 460 — — — 460 Repayment of long-term debt — (23 ) (16 ) (10 ) — (49 ) Distributions to noncontrolling interests — — (25 ) (111 ) — (136 ) Payment of debt issuance costs — (22 ) — — — (22 ) Payment of cash dividends (141 ) — — — — (141 ) Repurchases of common stock (278 ) — — — — (278 ) Changes in intercompany balances with affiliates, net 243 (1,058 ) (941 ) 1,756 — — Other (116 ) — — (2 ) — (118 ) Net cash (used in) provided by financing activities (292 ) 857 (982 ) 1,633 — 1,216 Effect on exchange rate changes on cash and cash equivalents — — — 4 — 4 Change in cash and cash equivalents — — (35 ) 64 — 29 Cash and cash equivalents at beginning of period — — 174 328 — 502 Cash and cash equivalents at end of period $ — $ — $ 139 $ 392 $ — $ 531 HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE QUARTER ENDED MARCH 31, 2018 (Dollars in millions) HCA HCA Inc. Subsidiary Subsidiary Eliminations Condensed Cash flows from operating activities: Net income (loss) $ 1,144 $ (642 ) $ 1,570 $ 300 $ (1,090 ) $ 1,282 Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: Changes in operating assets and liabilities (15 ) (99 ) (347 ) (24 ) — (485 ) Depreciation and amortization — — 323 230 — 553 Income taxes 246 — — — — 246 Gains on sales of facilities — — (395 ) (10 ) — (405 ) Amortization of debt issuance costs — 8 — — — 8 Share-based compensation — — 60 — — 60 Equity in earnings of affiliates (1,090 ) — — — 1,090 — Other 21 — — 3 — 24 Net cash provided by (used in) operating activities 306 (733 ) 1,211 499 — 1,283 Cash flows from investing activities: Purchase of property and equipment — — (413 ) (281 ) — (694 ) Acquisition of hospitals and health care entities — — (373 ) (6 ) — (379 ) Disposition of hospitals and health care entities — — 767 — — 767 Change in investments — — 13 (2 ) — 11 Other — — (48 ) 8 — (40 ) Net cash used in investing activities — — (54 ) (281 ) — (335 ) Cash flows from financing activities: Net change in revolving credit facilities — 270 — — — 270 Repayment of long-term debt — (18 ) (22 ) (10 ) — (50 ) Distributions to noncontrolling interests — — (24 ) (68 ) — (92 ) Payment of debt issuance costs — (2 ) — — — (2 ) Payment of cash dividends (123 ) — — — — (123 ) Repurchases of common stock (423 ) — — — — (423 ) Changes in intercompany balances with affiliates, net 434 483 (919 ) 2 — — Other (195 ) — — 4 — (191 ) Net cash (used in) provided by financing activities (307 ) 733 (965 ) (72 ) — (611 ) Effect on exchange rate changes on cash and cash equivalents — — — 17 — 17 Change in cash and cash equivalents (1 ) — 192 163 — 354 Cash and cash equivalents at beginning of period 1 — 112 619 — 732 Cash and cash equivalents at end of period $ — $ — $ 304 $ 782 $ — $ 1,086 |
Basis of Presentation and Sig_4
Basis of Presentation and Significant Accounting Policies - Additional Information (Detail) $ in Millions | 3 Months Ended | |
Mar. 31, 2019USD ($)HospitalSurgery_CenterState | Mar. 31, 2018USD ($) | |
Summary Of Significant Accounting Policies [Line Items] | ||
Number of owned and operated hospitals | Hospital | 185 | |
Number of freestanding surgery centers | Surgery_Center | 124 | |
Number of facilities locations | State | 21 | |
General and administrative expense | $ 86 | $ 81 |
Percentage of sum of revenues and uncompensated care | 36.10% | 35.40% |
Charity care amount | $ 2,905 | $ 1,879 |
Estimated costs of charity care | $ 343 | $ 233 |
Inpatient Services [Member] | ||
Summary Of Significant Accounting Policies [Line Items] | ||
Performance obligations for inpatient/ outpatient services satisfied period | Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days | |
Out of Network Services [Member] | ||
Summary Of Significant Accounting Policies [Line Items] | ||
Revenues | $ 86 | |
Maximum [Member] | Outpatient Services [Member] | ||
Summary Of Significant Accounting Policies [Line Items] | ||
Performance obligations for inpatient/ outpatient services satisfied period | Our performance obligations for outpatient services are generally satisfied over a period of less than one day |
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 | |
Mar. 31, 2019 | Mar. 31, 2018 | |
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 12,517 | $ 11,423 |
Revenues ratio from third party payers | 100.00% | 100.00% |
Medicare [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 2,770 | $ 2,524 |
Revenues from third party payers, Ratio | 22.10% | 22.10% |
Managed Medicare [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 1,589 | $ 1,399 |
Revenues from third party payers, Ratio | 12.70% | 12.30% |
Medicaid [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 347 | $ 281 |
Revenues from third party payers, Ratio | 2.80% | 2.50% |
Managed Medicaid [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 613 | $ 561 |
Revenues from third party payers, Ratio | 4.90% | 4.90% |
Managed Care and Other Insurers [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 6,426 | $ 6,062 |
Revenues from third party payers, Ratio | 51.40% | 53.10% |
International (Managed Care and Other Insurers) [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 297 | $ 305 |
Revenues from third party payers, Ratio | 2.40% | 2.70% |
Product and Service, Other [Member] | ||
Revenues From Third Party Payers [Line Items] | ||
Revenues from third party payers | $ 475 | $ 291 |
Other, Ratio | 3.70% | 2.40% |
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 | |
Mar. 31, 2019 | Mar. 31, 2018 | |
Accounting Policies [Abstract] | ||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ 10,606 | $ 9,867 |
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) | 11.80% | 12.40% |
Total uncompensated care | $ 7,085 | $ 6,252 |
Multiply by the cost-to-charges ratio | 11.80% | 12.40% |
Estimated cost of total uncompensated care | $ 836 | $ 775 |
Acquisitions and Dispositions -
Acquisitions and Dispositions - Additional Information (Detail) $ in Millions | 3 Months Ended | |
Mar. 31, 2019USD ($)Hospital | Mar. 31, 2018USD ($) | |
Business Acquisition [Line Items] | ||
Number of hospitals purchased | Hospital | 7 | |
Proceeds from sale of business | $ 30 | $ 767 |
Real Estate and Other Investments [Member] | ||
Business Acquisition [Line Items] | ||
Proceeds from sale of business | 5 | 9 |
Pretax gain (loss) on sales of business | 29 | |
Real Estate and Other Investments [Member] | Louisiana Markets [Member] | ||
Business Acquisition [Line Items] | ||
Pretax gain (loss) on sales of business | 1 | |
Discontinued Operations, Disposed of by Sale [Member] | Louisiana Markets [Member] | ||
Business Acquisition [Line Items] | ||
Proceeds from sale of business | 25 | |
Discontinued Operations, Disposed of by Sale [Member] | Oklahoma [Member] | ||
Business Acquisition [Line Items] | ||
Proceeds from sale of business | 758 | |
Pretax gain (loss) on sales of business | 376 | |
Hospitals [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | 1,398 | 360 |
Non hospital Health Care [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | 76 | $ 19 |
Other [Member] | ||
Business Acquisition [Line Items] | ||
Goodwill | $ 207 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | ||
Mar. 31, 2019 | Mar. 31, 2018 | Dec. 31, 2018 | |
Income Tax Contingency [Line Items] | |||
Effective tax rate | 21.20% | 18.40% | |
Provision for tax benefits related to settlement of employee awards | $ 49 | $ 92 | |
Liability for unrecognized tax benefits | 457 | $ 435 | |
Unrecognized tax benefits, accrued interest | 53 | 48 | |
Unrecognized tax benefits that would impact effective tax rate | 143 | $ 137 | |
Provision for income taxes | $ 279 | $ 257 |
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 | |
Mar. 31, 2019 | Mar. 31, 2018 | |
Earnings Per Share [Abstract] | ||
Net income attributable to HCA Healthcare, Inc. | $ 1,039 | $ 1,144 |
Weighted average common shares outstanding | 342,876 | 350,850 |
Effect of dilutive incremental shares | 7,440 | 8,899 |
Shares used for diluted earnings per share | 350,316 | 359,749 |
Basic earnings per share | $ 3.03 | $ 3.26 |
Diluted earnings per share | $ 2.97 | $ 3.18 |
Investments of Insurance Subs_3
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions | Mar. 31, 2019 | Dec. 31, 2018 |
Debt Securities, Available-for-sale [Line Items] | ||
Amounts classified as current assets | $ (90) | $ (47) |
Investment carrying value | 338 | 362 |
Amortized Cost | 417 | 406 |
Unrealized Amounts, Gains | 11 | 5 |
Unrealized Amounts, Losses | (2) | |
Fair Value | 428 | 409 |
Money Market Funds and Other [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 81 | 68 |
Fair Value | 81 | 68 |
Debt Securities [Member] | States and Municipalities [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 336 | 338 |
Unrealized Amounts, Gains | 11 | 5 |
Unrealized Amounts, Losses | (2) | |
Fair Value | $ 347 | $ 341 |
Investments of Insurance Subs_4
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions | Mar. 31, 2019USD ($) |
Investments, Debt and Equity Securities [Abstract] | |
Due in one year or less, Amortized Cost | $ 3 |
Due after one year through five years, Amortized Cost | 64 |
Due after five years through ten years, Amortized Cost | 201 |
Due after ten years, Amortized Cost | 68 |
Amortized Cost, Total | 336 |
Due in one year or less, Fair Value | 3 |
Due after one year through five years, Fair Value | 65 |
Due after five years through ten years, Fair Value | 209 |
Due after ten years, Fair Value | 70 |
Fair Value, Total | $ 347 |
Investments of Insurance Subs_5
Investments of Insurance Subsidiaries - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2019 | |
Investments, Debt and Equity Securities [Abstract] | |
Available for sale securities expected maturity of debt securities | 5 years 10 months 24 days |
Available for sale securities average scheduled maturity | 10 years 2 months 12 days |
Financial Instruments - Schedul
Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) - Pay-Fixed Interest Rate Swaps [Member] | 3 Months Ended |
Mar. 31, 2019USD ($) | |
Maturity Date, 2021 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 2,000 |
Fair Value | $ 38 |
Maturity Date | Dec. 31, 2021 |
Maturity Date, 2022 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 500 |
Fair Value | $ 2 |
Maturity Date | Dec. 31, 2022 |
Financial Instruments - Additio
Financial Instruments - Additional Information (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2019USD ($) | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Estimated amount reclassified from other comprehensive income and reduce interest expense | $ 20 |
Financial Instruments - Effect
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2019USD ($) | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | $ (14) |
Interest Rate Swaps [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Amount of Gain Recognized in OCI on Derivatives, Net of Tax | 14 |
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 | Mar. 31, 2019 | Dec. 31, 2018 |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | $ 428 | $ 409 |
Less amounts classified as current assets | (90) | (47) |
Investments of insurance subsidiaries, noncurrent | 338 | 362 |
Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Derivative Asset | 40 | 63 |
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 | 81 | 68 |
Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Securities, Available-for-sale Securities | 347 | 341 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 81 | 68 |
Less amounts classified as current assets | (80) | (47) |
Investments of insurance subsidiaries, noncurrent | 1 | 21 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Money Market Funds and Other [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 81 | 68 |
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 | 347 | 341 |
Less amounts classified as current assets | (10) | |
Investments of insurance subsidiaries, noncurrent | 337 | 341 |
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 | 40 | 63 |
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Securities, Available-for-sale Securities | $ 347 | $ 341 |
Assets and Liabilities Measur_4
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions | Mar. 31, 2019 | Dec. 31, 2018 |
Fair Value Disclosures [Abstract] | ||
Estimated fair value of long-term debt | $ 36,602 | $ 32,887 |
Carrying amounts of long-term debt | $ 34,985 | $ 32,978 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions | Mar. 31, 2019 | Dec. 31, 2018 |
Debt Instrument [Line Items] | ||
Senior secured debt | $ 21,733 | $ 21,226 |
Net debt issuance costs | (170) | (157) |
Total debt (average life of 6.4 years, rates averaging 5.5%) | 34,815 | 32,821 |
Less amounts due within one year | 3,796 | 788 |
Long-term debt | 31,019 | 32,033 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 3,500 | 3,040 |
Senior Secured Term Loan Facilities [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 3,776 | 3,801 |
Senior Secured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 13,800 | 13,800 |
Other Senior Secured Debt [Member] | ||
Debt Instrument [Line Items] | ||
Other senior secured debt | 657 | 585 |
Senior Unsecured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior unsecured notes | $ 13,252 | $ 11,752 |
Long-Term Debt - Schedule of _2
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | 3 Months Ended |
Mar. 31, 2019 | |
Debt Instrument [Line Items] | |
Total debt average term | 6 years 3 months 18 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 | 3.70% |
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 | 5.50% |
Senior Unsecured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 6.30% |
Long-Term Debt - Additional Inf
Long-Term Debt - Additional Information (Detail) $ in Millions | Jan. 31, 2019USD ($) |
5.625% Senior Notes Due 2028 [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, principal amount | $ 500 |
Debt instrument, stated interest | 5.625% |
5.875% Senior Notes Due 2029 [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, principal amount | $ 1,000 |
Debt instrument, stated interest | 5.875% |
Senior Unsecured Notes [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, principal amount | $ 1,500 |
Leases - Schedule Of Lease-Rel
Leases - Schedule Of Lease-Related Assets And Liabilities (Detail) $ in Millions | Mar. 31, 2019USD ($) | |
Assets: | ||
Operating leases | $ 1,812 | |
Finance leases | 590 | |
Total lease assets | 2,402 | |
Liabilities | ||
Operating leases | 310 | |
Finance leases | 39 | |
Operating leases | 1,494 | |
Finance leases | 519 | |
Total lease liabilities | $ 2,362 | |
Weighted-average remaining term: | ||
Operating leases | 12 years 3 months 18 days | |
Finance leases | 9 years 2 months 12 days | |
Weighted-average discount rate: | ||
Operating leases | 5.60% | [1] |
Finance leases | 5.40% | |
[1] | Upon adoption of the new lease standard, discount rates used for existing leases were established at January 1, 2019. |
Leases - Schedule Of Lease Expe
Leases - Schedule Of Lease Expense For Finance And Operating Leases (Detail) $ in Millions | 3 Months Ended | |
Mar. 31, 2019USD ($) | ||
Finance lease expense: | ||
Amortization of leased assets | $ 17 | |
Interest of lease liabilities | 6 | |
Operating leases | 94 | [1] |
Short-term lease expense | 78 | [1] |
Variable lease expense | 39 | [1] |
Total lease expense | $ 234 | |
[1] | Expenses are included in “other operating expenses” in our condensed consolidated income statement. |
Leases - Schedule Of Supplement
Leases - Schedule Of Supplemental Cash Flow Information (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2019USD ($) | |
Cash Paid For Amounts Included In Measurement Of Lease Liabilities [Abstract] | |
Operating cash flows for operating leases | $ 144 |
Operating cash flows for finance leases | 6 |
Financing cash flows for finance leases | $ 17 |
Leases - Schedule of undiscount
Leases - Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities (Detail) $ in Millions | Mar. 31, 2019USD ($) |
Operating Lease Liabilities, Payments Due [Abstract] | |
2019 | $ 294 |
2020 | 370 |
2021 | 315 |
2022 | 254 |
2023 | 198 |
Thereafter | 1,265 |
Total minimum lease payments | 2,696 |
Less: amount of lease payments representing interest | (892) |
Present value of future minimum lease payments | 1,804 |
Less: current obligations under leases | (310) |
Long-term lease obligations | 1,494 |
Finance Lease Liabilities, Payments, Due [Abstract] | |
2019 | 72 |
2020 | 92 |
2021 | 71 |
2022 | 62 |
2023 | 52 |
Thereafter | 318 |
Total minimum lease payments | 667 |
Less: amount of lease payments representing interest | (109) |
Present value of future minimum lease payments | 558 |
Less: current obligations under leases | (39) |
Long-term lease obligations | $ 519 |
Share Repurchases Transaction_3
Share Repurchases Transactions and Other Comprehensive Loss - Additional Information (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions | 3 Months Ended | ||
Mar. 31, 2019 | Jan. 31, 2019 | Oct. 31, 2017 | |
Repurchase of common stock, shares | 2,106 | ||
Repurchase price of common stock, per share | $ 131.92 | ||
Share repurchase program, remaining authorized repurchase amount | $ 1,995 | ||
Share repurchase program authorized amount | $ 2,000 | $ 2,000 | |
Board of Directors Chairman [Member] | |||
Share repurchase program, remaining authorized repurchase amount | $ 2,000 |
Share Repurchases Transaction_4
Share Repurchases Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2019USD ($) | |
Equity [Abstract] | |
Unrealized gains on available-for-sale securities, beginning balances | $ 3 |
Unrealized gains on available-for-sale securities, net of income tax benefit | 6 |
Unrealized gains on available-for-sale securities, ending balances | 9 |
Foreign currency translation adjustments, beginning balances | (283) |
Foreign currency translation adjustments | 17 |
Foreign currency translation adjustments, ending balances | (266) |
Defined benefit plans, beginning balances | (148) |
Defined benefit plans, (income) expense reclassified into operations from other comprehensive income | 2 |
Defined benefit plans, ending balances | (146) |
Change in fair value of derivative instruments, beginning balances | 47 |
Change in fair value of derivative instruments | (14) |
Change in fair value of derivative instruments, (income) expense reclassified into operations from other comprehensive income | (4) |
Change in fair value of derivative instruments, ending balances | 29 |
Accumulated other comprehensive income (loss), net of tax, beginning balances | (381) |
Unrealized losses on available-for-sale securities, net of income taxes | 6 |
Foreign currency translation adjustments | 17 |
Change in fair value of derivative instruments | (14) |
Expense (income) reclassified into operations from other comprehensive income, Total | (2) |
Accumulated other comprehensive income (loss), net of tax, ending balances | $ (374) |
Share Repurchases Transaction_5
Share Repurchases Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2019USD ($) | |
Equity [Abstract] | |
Unrealized losses on available-for-sale securities, tax benefit portion | $ 2 |
Foreign currency translation adjustments, income tax benefit | 3 |
Change in fair value of derivative instruments, income tax expense (benefit) | 4 |
Defined benefit plans, Expense reclassified into operations from other comprehensive income, Income tax benefits | 1 |
Change in fair value of derivative instruments, Expense reclassified into operations from other comprehensive income, Income tax benefits | $ 1 |
Segment and Geographic Inform_3
Segment and Geographic Information - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2019Hospital | |
Segment Reporting Information [Line Items] | |
Number of geographically organized groups | 2 |
Number of owned and operated hospitals | 185 |
Reorganization Group [Member] | National Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 95 |
Reorganization Group [Member] | American Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 84 |
Reorganization Group [Member] | Corporate and Other [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 6 |
Segment and Geographic 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 | |
Mar. 31, 2019 | Mar. 31, 2018 | |
Segment Reporting Information [Line Items] | ||
Revenues | $ 12,517 | $ 11,423 |
Equity in earnings of affiliates | (11) | (9) |
Adjusted segment EBITDA | 2,541 | 2,118 |
Depreciation and amortization | 619 | 553 |
Interest expense | 461 | 431 |
Gains on sales of facilities | 1 | (405) |
Income before income taxes | 1,460 | 1,539 |
National Group [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 6,317 | 5,568 |
Equity in earnings of affiliates | (2) | (2) |
Adjusted segment EBITDA | 1,454 | 1,182 |
Depreciation and amortization | 265 | 225 |
American Group [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 5,595 | 5,327 |
Equity in earnings of affiliates | (11) | (9) |
Adjusted segment EBITDA | 1,141 | 1,031 |
Depreciation and amortization | 281 | 252 |
Corporate and Other [Member] | ||
Segment Reporting Information [Line Items] | ||
Revenues | 605 | 528 |
Equity in earnings of affiliates | 2 | 2 |
Adjusted segment EBITDA | (54) | (95) |
Depreciation and amortization | $ 73 | $ 76 |
Supplemental Condensed Consol_3
Supplemental Condensed Consolidating Financial Information - Additional Information (Detail) | Mar. 31, 2019USD ($) |
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 - Schedule of Condensed Consolidating Comprehensive Income Statement (Detail) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2019 | Mar. 31, 2018 | |
Condensed Statement of Income Captions [Line Items] | ||
Revenues | $ 12,517 | $ 11,423 |
Salaries and benefits | 5,647 | 5,289 |
Supplies | 2,041 | 1,915 |
Other operating expenses | 2,299 | 2,110 |
Equity in earnings of affiliates | (11) | (9) |
Depreciation and amortization | 619 | 553 |
Interest expense (income) | 461 | 431 |
Losses (gains) on sales of facilities | 1 | (405) |
Total expenses including equity in earnings of affiliates | 11,057 | 9,884 |
Income (loss) before income taxes | 1,460 | 1,539 |
Provision (benefit) for income taxes | 279 | 257 |
Net income (loss) | 1,181 | 1,282 |
Net income attributable to noncontrolling interests | 142 | 138 |
Net income (loss) attributable to HCA Healthcare, Inc. | 1,039 | 1,144 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 1,046 | 1,225 |
HCA Healthcare, Inc. Issuer [Member] | ||
Condensed Statement of Income Captions [Line Items] | ||
Other operating expenses | 2 | 1 |
Equity in earnings of affiliates | (1,026) | (1,090) |
Interest expense (income) | 16 | 16 |
Total expenses including equity in earnings of affiliates | (1,008) | (1,073) |
Income (loss) before income taxes | 1,008 | 1,073 |
Provision (benefit) for income taxes | (31) | (71) |
Net income (loss) | 1,039 | 1,144 |
Net income (loss) attributable to HCA Healthcare, Inc. | 1,039 | 1,144 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 1,046 | 1,225 |
HCA Inc. Issuer [Member] | ||
Condensed Statement of Income Captions [Line Items] | ||
Interest expense (income) | 995 | 837 |
Total expenses including equity in earnings of affiliates | 995 | 837 |
Income (loss) before income taxes | (995) | (837) |
Provision (benefit) for income taxes | (231) | (195) |
Net income (loss) | (764) | (642) |
Net income (loss) attributable to HCA Healthcare, Inc. | (764) | (642) |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | (782) | (615) |
Subsidiary Guarantors [Member] | ||
Condensed Statement of Income Captions [Line Items] | ||
Revenues | 7,224 | 6,776 |
Salaries and benefits | 3,137 | 3,069 |
Supplies | 1,177 | 1,141 |
Other operating expenses | 1,146 | 1,128 |
Equity in earnings of affiliates | (2) | (2) |
Depreciation and amortization | 355 | 323 |
Interest expense (income) | (473) | (367) |
Losses (gains) on sales of facilities | 1 | (395) |
Management fees | (171) | (158) |
Total expenses including equity in earnings of affiliates | 5,170 | 4,739 |
Income (loss) before income taxes | 2,054 | 2,037 |
Provision (benefit) for income taxes | 472 | 467 |
Net income (loss) | 1,582 | 1,570 |
Net income attributable to noncontrolling interests | 20 | 28 |
Net income (loss) attributable to HCA Healthcare, Inc. | 1,562 | 1,542 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 1,564 | 1,546 |
Subsidiary Non-Guarantors [Member] | ||
Condensed Statement of Income Captions [Line Items] | ||
Revenues | 5,293 | 4,647 |
Salaries and benefits | 2,510 | 2,220 |
Supplies | 864 | 774 |
Other operating expenses | 1,151 | 981 |
Equity in earnings of affiliates | (9) | (7) |
Depreciation and amortization | 264 | 230 |
Interest expense (income) | (77) | (55) |
Losses (gains) on sales of facilities | (10) | |
Management fees | 171 | 158 |
Total expenses including equity in earnings of affiliates | 4,874 | 4,291 |
Income (loss) before income taxes | 419 | 356 |
Provision (benefit) for income taxes | 69 | 56 |
Net income (loss) | 350 | 300 |
Net income attributable to noncontrolling interests | 122 | 110 |
Net income (loss) attributable to HCA Healthcare, Inc. | 228 | 190 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | 251 | 240 |
Eliminations [Member] | ||
Condensed Statement of Income Captions [Line Items] | ||
Equity in earnings of affiliates | 1,026 | 1,090 |
Total expenses including equity in earnings of affiliates | 1,026 | 1,090 |
Income (loss) before income taxes | (1,026) | (1,090) |
Net income (loss) | (1,026) | (1,090) |
Net income (loss) attributable to HCA Healthcare, Inc. | (1,026) | (1,090) |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. | $ (1,033) | $ (1,171) |
Supplemental Condensed Consol_5
Supplemental Condensed Consolidating Financial Information - Schedule of Condensed Consolidating Balance Sheet (Detail) - USD ($) $ in Millions | Mar. 31, 2019 | Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 |
Current assets: | ||||||
Cash and cash equivalents | $ 531 | $ 502 | ||||
Accounts receivable, net | 7,420 | 6,789 | ||||
Inventories | 1,778 | 1,732 | ||||
Other | 1,379 | 1,190 | ||||
Total current assets | 11,108 | 10,213 | ||||
Property and equipment, net | 21,128 | 19,757 | ||||
Investments of insurance subsidiaries | 338 | 362 | ||||
Investments in and advances to affiliates | 246 | 232 | ||||
Goodwill and other intangible assets | 8,159 | 7,953 | ||||
Right-of-use operating lease assets | 1,812 | |||||
Other | 588 | 690 | ||||
Total assets | 43,379 | 39,207 | ||||
Current liabilities: | ||||||
Accounts payable | 2,693 | 2,577 | ||||
Accrued salaries | 1,424 | 1,580 | ||||
Other accrued expenses | 2,618 | 2,624 | ||||
Long-term debt due within one year | 3,796 | 788 | ||||
Total current liabilities | 10,531 | 7,569 | ||||
Long-term debt, net | 31,019 | 32,033 | ||||
Professional liability risks | 1,313 | 1,275 | ||||
Right-of-use operating lease obligations | 1,494 | |||||
Income taxes and other liabilities | 1,277 | 1,248 | ||||
Total liabilities | 45,634 | 42,125 | ||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (4,354) | (4,950) | ||||
Noncontrolling interests | 2,099 | 2,032 | ||||
Total stockholders' deficit | (2,255) | (2,918) | $ (3,730) | $ (4,125) | $ (4,434) | $ (4,995) |
Total liabilities and stockholders' deficit | 43,379 | 39,207 | ||||
HCA Healthcare, Inc. Issuer [Member] | ||||||
Current assets: | ||||||
Investments in and advances to affiliates | 34,199 | 33,166 | ||||
Other | 404 | 478 | ||||
Total assets | 34,603 | 33,644 | ||||
Current liabilities: | ||||||
Other accrued expenses | 300 | 142 | ||||
Total current liabilities | 300 | 142 | ||||
Long-term debt, net | 997 | 996 | ||||
Intercompany balances | 37,135 | 36,951 | ||||
Income taxes and other liabilities | 525 | 505 | ||||
Total liabilities | 38,957 | 38,594 | ||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (4,354) | (4,950) | ||||
Total stockholders' deficit | (4,354) | (4,950) | ||||
Total liabilities and stockholders' deficit | 34,603 | 33,644 | ||||
HCA Inc. Issuer [Member] | ||||||
Current assets: | ||||||
Other | 40 | 64 | ||||
Total assets | 40 | 64 | ||||
Current liabilities: | ||||||
Other accrued expenses | 302 | 403 | ||||
Long-term debt due within one year | 3,697 | 696 | ||||
Total current liabilities | 3,999 | 1,099 | ||||
Long-term debt, net | 29,464 | 30,544 | ||||
Intercompany balances | (7,851) | (6,789) | ||||
Total liabilities | 25,612 | 24,854 | ||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (25,572) | (24,790) | ||||
Total stockholders' deficit | (25,572) | (24,790) | ||||
Total liabilities and stockholders' deficit | 40 | 64 | ||||
Subsidiary Guarantors [Member] | ||||||
Current assets: | ||||||
Cash and cash equivalents | 139 | 174 | ||||
Accounts receivable, net | 4,200 | 3,964 | ||||
Inventories | 1,149 | 1,178 | ||||
Other | 699 | 669 | ||||
Total current assets | 6,187 | 5,985 | ||||
Property and equipment, net | 12,587 | 12,450 | ||||
Investments in and advances to affiliates | 29 | 29 | ||||
Goodwill and other intangible assets | 5,725 | 5,724 | ||||
Right-of-use operating lease assets | 438 | |||||
Other | 32 | 35 | ||||
Total assets | 24,998 | 24,223 | ||||
Current liabilities: | ||||||
Accounts payable | 1,767 | 1,721 | ||||
Accrued salaries | 851 | 998 | ||||
Other accrued expenses | 736 | 905 | ||||
Long-term debt due within one year | 54 | 55 | ||||
Total current liabilities | 3,408 | 3,679 | ||||
Long-term debt, net | 231 | 212 | ||||
Intercompany balances | (29,293) | (28,415) | ||||
Right-of-use operating lease obligations | 336 | |||||
Income taxes and other liabilities | 233 | 223 | ||||
Total liabilities | (25,085) | (24,301) | ||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 50,001 | 48,437 | ||||
Noncontrolling interests | 82 | 87 | ||||
Total stockholders' deficit | 50,083 | 48,524 | ||||
Total liabilities and stockholders' deficit | 24,998 | 24,223 | ||||
Subsidiary Non-Guarantors [Member] | ||||||
Current assets: | ||||||
Cash and cash equivalents | 392 | 328 | ||||
Accounts receivable, net | 3,220 | 2,825 | ||||
Inventories | 629 | 554 | ||||
Other | 680 | 521 | ||||
Total current assets | 4,921 | 4,228 | ||||
Property and equipment, net | 8,541 | 7,307 | ||||
Investments of insurance subsidiaries | 338 | 362 | ||||
Investments in and advances to affiliates | 217 | 203 | ||||
Goodwill and other intangible assets | 2,434 | 2,229 | ||||
Right-of-use operating lease assets | 1,374 | |||||
Other | 112 | 113 | ||||
Total assets | 17,937 | 14,442 | ||||
Current liabilities: | ||||||
Accounts payable | 926 | 856 | ||||
Accrued salaries | 573 | 582 | ||||
Other accrued expenses | 1,280 | 1,174 | ||||
Long-term debt due within one year | 45 | 37 | ||||
Total current liabilities | 2,824 | 2,649 | ||||
Long-term debt, net | 327 | 281 | ||||
Intercompany balances | 9 | (1,747) | ||||
Professional liability risks | 1,313 | 1,275 | ||||
Right-of-use operating lease obligations | 1,158 | |||||
Income taxes and other liabilities | 519 | 520 | ||||
Total liabilities | 6,150 | 2,978 | ||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | 9,770 | 9,519 | ||||
Noncontrolling interests | 2,017 | 1,945 | ||||
Total stockholders' deficit | 11,787 | 11,464 | ||||
Total liabilities and stockholders' deficit | 17,937 | 14,442 | ||||
Eliminations [Member] | ||||||
Current assets: | ||||||
Investments in and advances to affiliates | (34,199) | (33,166) | ||||
Total assets | (34,199) | (33,166) | ||||
Current liabilities: | ||||||
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc. | (34,199) | (33,166) | ||||
Total stockholders' deficit | (34,199) | (33,166) | ||||
Total liabilities and stockholders' deficit | $ (34,199) | $ (33,166) |
Supplemental Condensed Consol_6
Supplemental Condensed Consolidating Financial Information - Schedule of Condensed Consolidating Statement of Cash Flows (Detail) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2019 | Mar. 31, 2018 | |
Cash flows from operating activities: | ||
Net income (loss) | $ 1,181 | $ 1,282 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||
Changes in operating assets and liabilities | (1,194) | (485) |
Depreciation and amortization | 619 | 553 |
Income taxes | 269 | 246 |
Losses (gains) on sales of facilities | 1 | (405) |
Amortization of debt issuance costs | 8 | 8 |
Share-based compensation | 62 | 60 |
Other | 28 | 24 |
Net cash provided by (used in) operating activities | 974 | 1,283 |
Cash flows from investing activities: | ||
Purchase of property and equipment | (781) | (694) |
Acquisition of hospitals and health care entities | (1,474) | (379) |
Disposition of hospitals and health care entities | 30 | 767 |
Change in investments | 36 | 11 |
Other | 24 | (40) |
Net cash used in investing activities | (2,165) | (335) |
Cash flows from financing activities: | ||
Issuance of long-term debt | 1,500 | |
Net change in revolving credit facilities | 460 | 270 |
Repayment of long-term debt | (49) | (50) |
Distributions to noncontrolling interests | (136) | (92) |
Payment of debt issuance costs | (22) | (2) |
Payment of cash dividends | (141) | (123) |
Repurchases of common stock | (278) | (423) |
Other | (118) | (191) |
Net cash provided by (used in) financing activities | 1,216 | (611) |
Effect on exchange rate changes on cash and cash equivalents | 4 | 17 |
Change in cash and cash equivalents | 29 | 354 |
Cash and cash equivalents at beginning of period | 502 | 732 |
Cash and cash equivalents at end of period | 531 | 1,086 |
HCA Healthcare, Inc. Issuer [Member] | ||
Cash flows from operating activities: | ||
Net income (loss) | 1,039 | 1,144 |
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 | 269 | 246 |
Equity in earnings of affiliates | (1,026) | (1,090) |
Other | 25 | 21 |
Net cash provided by (used in) operating activities | 292 | 306 |
Cash flows from financing activities: | ||
Payment of cash dividends | (141) | (123) |
Repurchases of common stock | (278) | (423) |
Changes in intercompany balances with affiliates, net | 243 | 434 |
Other | (116) | (195) |
Net cash provided by (used in) financing activities | (292) | (307) |
Change in cash and cash equivalents | (1) | |
Cash and cash equivalents at beginning of period | 1 | |
HCA Inc. Issuer [Member] | ||
Cash flows from operating activities: | ||
Net income (loss) | (764) | (642) |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||
Changes in operating assets and liabilities | (101) | (99) |
Amortization of debt issuance costs | 8 | 8 |
Net cash provided by (used in) operating activities | (857) | (733) |
Cash flows from financing activities: | ||
Issuance of long-term debt | 1,500 | |
Net change in revolving credit facilities | 460 | 270 |
Repayment of long-term debt | (23) | (18) |
Payment of debt issuance costs | (22) | (2) |
Changes in intercompany balances with affiliates, net | (1,058) | 483 |
Net cash provided by (used in) financing activities | 857 | 733 |
Subsidiary Guarantors [Member] | ||
Cash flows from operating activities: | ||
Net income (loss) | 1,582 | 1,570 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||
Changes in operating assets and liabilities | (600) | (347) |
Depreciation and amortization | 355 | 323 |
Losses (gains) on sales of facilities | 1 | (395) |
Share-based compensation | 62 | 60 |
Other | 5 | |
Net cash provided by (used in) operating activities | 1,405 | 1,211 |
Cash flows from investing activities: | ||
Purchase of property and equipment | (471) | (413) |
Acquisition of hospitals and health care entities | (12) | (373) |
Disposition of hospitals and health care entities | 30 | 767 |
Change in investments | 13 | |
Other | (5) | (48) |
Net cash used in investing activities | (458) | (54) |
Cash flows from financing activities: | ||
Repayment of long-term debt | (16) | (22) |
Distributions to noncontrolling interests | (25) | (24) |
Changes in intercompany balances with affiliates, net | (941) | (919) |
Net cash provided by (used in) financing activities | (982) | (965) |
Change in cash and cash equivalents | (35) | 192 |
Cash and cash equivalents at beginning of period | 174 | 112 |
Cash and cash equivalents at end of period | 139 | 304 |
Subsidiary Non-Guarantors [Member] | ||
Cash flows from operating activities: | ||
Net income (loss) | 350 | 300 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||
Changes in operating assets and liabilities | (478) | (24) |
Depreciation and amortization | 264 | 230 |
Losses (gains) on sales of facilities | (10) | |
Other | (2) | 3 |
Net cash provided by (used in) operating activities | 134 | 499 |
Cash flows from investing activities: | ||
Purchase of property and equipment | (310) | (281) |
Acquisition of hospitals and health care entities | (1,462) | (6) |
Change in investments | 36 | (2) |
Other | 29 | 8 |
Net cash used in investing activities | (1,707) | (281) |
Cash flows from financing activities: | ||
Repayment of long-term debt | (10) | (10) |
Distributions to noncontrolling interests | (111) | (68) |
Changes in intercompany balances with affiliates, net | 1,756 | 2 |
Other | (2) | 4 |
Net cash provided by (used in) financing activities | 1,633 | (72) |
Effect on exchange rate changes on cash and cash equivalents | 4 | 17 |
Change in cash and cash equivalents | 64 | 163 |
Cash and cash equivalents at beginning of period | 328 | 619 |
Cash and cash equivalents at end of period | 392 | 782 |
Eliminations [Member] | ||
Cash flows from operating activities: | ||
Net income (loss) | (1,026) | (1,090) |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: | ||
Equity in earnings of affiliates | $ 1,026 | $ 1,090 |