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HCA Healthcare, Inc. - Quarter Report: 2017 September (Form 10-Q)

Form 10-Q
Table of Contents

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

Form 10-Q

 

 

(Mark One)

QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2017

Or

 

TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from                    to                     

Commission file number 1-11239

 

 

HCA Healthcare, Inc.

(Exact name of registrant as specified in its charter)

 

 

 

Delaware   27-3865930

(State or other jurisdiction of

incorporation or organization)

 

(I.R.S. Employer

Identification No.)

One Park Plaza

Nashville, Tennessee

  37203
(Address of principal executive offices)   (Zip Code)

(615) 344-9551

(Registrant’s telephone number, including area code)

Not Applicable

(Former name, former address and former fiscal year, if changed since last report)

 

 

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    Yes  ☒    No  ☐

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).    Yes  ☒    No  ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

 

Large accelerated filer

 

  

Accelerated filer

 

Non-accelerated filer

 

☐  (Do not check if a smaller reporting company)

  

Smaller reporting company

 

Emerging growth company

 

    

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.  ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    Yes  ☐    No  ☒

Indicate the number of shares outstanding of each of the issuer’s classes of common stock as of the latest practicable date.

 

Class of Common Stock

  

Outstanding at October 31, 2017

Voting common stock, $.01 par value

   354,052,500 shares

 

 

 


Table of Contents

HCA HEALTHCARE, INC.

Form 10-Q

September 30, 2017

 

          Page of
Form 10-Q
 

Part I.

   Financial Information   

Item 1.

   Financial Statements (Unaudited):   
  

Condensed Consolidated Income Statements — for the quarters and nine months ended September  30, 2017 and 2016

     2  
  

Condensed Consolidated Comprehensive Income Statements — for the quarters and nine months ended September 30, 2017 and 2016

     3  
  

Condensed Consolidated Balance Sheets — September 30, 2017 and December 31, 2016

     4  
  

Condensed Consolidated Statements of Cash Flows — for the nine months ended September  30, 2017 and 2016

     5  
  

Notes to Condensed Consolidated Financial Statements

     6  

Item 2.

  

Management’s Discussion and Analysis of Financial Condition and Results of Operations

     26  

Item 3.

  

Quantitative and Qualitative Disclosures About Market Risk

     44  

Item 4.

  

Controls and Procedures

     44  

Part II.

   Other Information   

Item 1.

  

Legal Proceedings

     44  

Item 1A.

  

Risk Factors

     44  

Item 2.

  

Unregistered Sales of Equity Securities and Use of Proceeds

     45  

Item 6.

  

Exhibits

     46  

Signatures

     47  

 

1


Table of Contents

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED INCOME STATEMENTS

FOR THE QUARTERS AND NINE MONTHS ENDED SEPTEMBER 30, 2017 AND 2016

Unaudited

(Dollars in millions, except per share amounts)

 

     Quarter     Nine months  
     2017     2016     2017     2016  

Revenues before provision for doubtful accounts

   $ 11,967     $ 11,110     $ 35,156     $ 33,241  

Provision for doubtful accounts

     1,271       840       3,104       2,392  
  

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

     10,696       10,270       32,052       30,849  

Salaries and benefits

     5,081       4,740       14,878       14,133  

Supplies

     1,777       1,699       5,369       5,131  

Other operating expenses

     2,075       1,896       5,970       5,617  

Equity in earnings of affiliates

     (13     (22     (36     (44

Depreciation and amortization

     539       495       1,581       1,463  

Interest expense

     427       432       1,257       1,275  

Gains on sales of facilities

     (7     (3     (10     (8

Losses on retirement of debt

     39       4       39       4  

Legal claim costs

           11             33  
  

 

 

   

 

 

   

 

 

   

 

 

 
     9,918       9,252       29,048       27,604  
  

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     778       1,018       3,004       3,245  

Provision for income taxes

     248       273       902       898  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income

     530       745       2,102       2,347  

Net income attributable to noncontrolling interests

     104       127       360       377  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to HCA Healthcare, Inc.

   $ 426     $ 618     $ 1,742     $ 1,970  
  

 

 

   

 

 

   

 

 

   

 

 

 

Per share data:

        

Basic earnings per share

   $ 1.18     $ 1.63     $ 4.77     $ 5.09  

Diluted earnings per share

   $ 1.15     $ 1.59     $ 4.64     $ 4.93  

Shares used in earnings per share calculations (in millions):

        

Basic

     360.170       378.199       365.398       386.968  

Diluted

     369.834       389.592       375.013       399.577  

 

 

See accompanying notes.

 

2


Table of Contents

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED COMPREHENSIVE INCOME STATEMENTS

FOR THE QUARTERS AND NINE MONTHS ENDED SEPTEMBER 30, 2017 AND 2016

Unaudited

(Dollars in millions)

 

     Quarter     Nine months  
     2017     2016     2017     2016  

Net income

   $ 530     $ 745     $ 2,102     $ 2,347  

Other comprehensive income (loss) before taxes:

        

Foreign currency translation

     32       (40     87       (169

Unrealized gains (losses) on available-for-sale securities

           (2     5       3  

Defined benefit plans

                        

Pension costs included in salaries and benefits

     5       4       14       13  
  

 

 

   

 

 

   

 

 

   

 

 

 
     5       4       14       13  

Change in fair value of derivative financial instruments

     (1     13       (9     (57

Interest costs included in interest expense

     4       28       17       84  
  

 

 

   

 

 

   

 

 

   

 

 

 
     3       41       8       27  
  

 

 

   

 

 

   

 

 

   

 

 

 

Other comprehensive income (loss) before taxes

     40       3       114       (126

Income taxes (benefits) related to other comprehensive income items

     15             44       (50
  

 

 

   

 

 

   

 

 

   

 

 

 

Other comprehensive income (loss)

     25       3       70       (76
  

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income

     555       748       2,172       2,271  

Comprehensive income attributable to noncontrolling interests

     104       127       360       377  
  

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income attributable to HCA Healthcare, Inc.

   $ 451     $ 621     $ 1,812     $ 1,894  
  

 

 

   

 

 

   

 

 

   

 

 

 

 

 

See accompanying notes.

 

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Table of Contents

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

Unaudited

(Dollars in millions)

 

     September 30,
2017
    December 31,
2016
 
ASSETS     

Current assets:

    

Cash and cash equivalents

   $ 718     $ 646  

Accounts receivable, less allowance for doubtful accounts of $5,416 and $4,988

     5,980       5,826  

Inventories

     1,546       1,503  

Other

     1,204       1,111  
  

 

 

   

 

 

 
     9,448       9,086  

Property and equipment, at cost

     39,262       37,055  

Accumulated depreciation

     (21,933     (20,703
  

 

 

   

 

 

 
     17,329       16,352  

Investments of insurance subsidiaries

     368       336  

Investments in and advances to affiliates

     201       206  

Goodwill and other intangible assets

     7,357       6,704  

Other

     1,028       1,074  
  

 

 

   

 

 

 
   $ 35,731     $ 33,758  
  

 

 

   

 

 

 
LIABILITIES AND STOCKHOLDERS’ DEFICIT     

Current liabilities:

    

Accounts payable

   $ 2,314     $ 2,318  

Accrued salaries

     1,312       1,265  

Other accrued expenses

     1,783       2,035  

Long-term debt due within one year

     202       216  
  

 

 

   

 

 

 
     5,611       5,834  

Long-term debt, less net debt issuance costs of $171 and $170

     32,751       31,160  

Professional liability risks

     1,179       1,148  

Income taxes and other liabilities

     1,256       1,249  

Stockholders’ deficit:

    

Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 356,979,800 shares in 2017 and 370,535,900 shares in 2016

     4       4  

Accumulated other comprehensive loss

     (268     (338

Retained deficit

     (6,516     (6,968
  

 

 

   

 

 

 

Stockholders’ deficit attributable to HCA Healthcare, Inc.

     (6,780     (7,302

Noncontrolling interests

     1,714       1,669  
  

 

 

   

 

 

 
     (5,066     (5,633
  

 

 

   

 

 

 
   $ 35,731     $ 33,758  
  

 

 

   

 

 

 

 

See accompanying notes.

 

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Table of Contents

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017 AND 2016

Unaudited

(Dollars in millions)

 

     2017     2016  

Cash flows from operating activities:

    

Net income

   $ 2,102     $ 2,347  

Adjustments to reconcile net income to net cash provided by operating activities:

    

Increase (decrease) in cash from operating assets and liabilities:

    

Accounts receivable

     (3,174     (2,044

Provision for doubtful accounts

     3,104       2,392  
  

 

 

   

 

 

 

Accounts receivable, net

     (70     348  

Inventories and other assets

     (50     (161

Accounts payable and accrued expenses

     (169     (341

Depreciation and amortization

     1,581       1,463  

Income taxes

     (9     8  

Gains on sales of facilities

     (10     (8

Losses on retirement of debt

     39       4  

Legal claim costs

           33  

Amortization of debt issuance costs

     23       26  

Share-based compensation

     195       196  

Other

     60       39  
  

 

 

   

 

 

 

Net cash provided by operating activities

     3,692       3,954  
  

 

 

   

 

 

 

Cash flows from investing activities:

    

Purchase of property and equipment

     (2,033     (1,884

Acquisition of hospitals and health care entities

     (1,142     (468

Disposal of hospitals and health care entities

     24       23  

Change in investments

     (15     78  

Other

     (6     17  
  

 

 

   

 

 

 

Net cash used in investing activities

     (3,172     (2,234
  

 

 

   

 

 

 

Cash flows from financing activities:

    

Issuances of long-term debt

     1,502       5,400  

Net change in revolving bank credit facilities

     650       (70

Repayment of long-term debt

     (700     (4,424

Distributions to noncontrolling interests

     (363     (342

Payment of debt issuance costs

     (25     (40

Repurchases of common stock

     (1,475     (2,213

Other

     (37     (95
  

 

 

   

 

 

 

Net cash used in financing activities

     (448     (1,784
  

 

 

   

 

 

 

Change in cash and cash equivalents

     72       (64

Cash and cash equivalents at beginning of period

     646       741  
  

 

 

   

 

 

 

Cash and cash equivalents at end of period

   $ 718     $ 677  
  

 

 

   

 

 

 

Interest payments

   $ 1,383     $ 1,339  

Income tax payments, net

   $ 911     $ 890  

See accompanying notes.

 

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Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

Reporting Entity

HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At September 30, 2017, these affiliates owned and operated 177 hospitals, 119 freestanding surgery centers and provided extensive outpatient and ancillary services. HCA Healthcare, Inc.’s facilities are located in 20 states and England. The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicated by context, refer to HCA Healthcare, Inc. and its affiliates. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA.

Basis of Presentation

The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included and are of a normal and recurring nature.

The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $91 million and $94 million for the quarters ended September 30, 2017 and 2016, respectively, and $273 million and $272 million for the nine months ended September 30, 2017 and 2016, respectively. Operating results for the quarter and nine months ended September 30, 2017 are not necessarily indicative of the results that may be expected for the year ending December 31, 2017. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K for the year ended December 31, 2016.

 

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Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (Continued)

 

Revenues

Revenues are recorded during the period the health care services are provided, based upon the estimated amounts due from the patients and third-party payers. Third-party payers include federal and state agencies (under the Medicare and Medicaid programs), managed care health plans and commercial insurance companies (including plans offered through the health insurance exchanges), and employers. Estimates of contractual allowances under managed care health plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record a provision for doubtful accounts (based primarily on historical collection experience) related to uninsured accounts to record net self-pay revenues at the estimated amounts we expect to collect. Our revenues from third-party payers, the uninsured and other for the quarters and nine months ended September 30, 2017 and 2016 are summarized in the following table (dollars in millions):

 

     Quarter  
     2017      Ratio     2016      Ratio  

Medicare

   $ 2,354        22.0   $ 2,158        21.0

Managed Medicare

     1,156        10.8       1,068        10.4  

Medicaid

     362        3.4       405        3.9  

Managed Medicaid

     582        5.4       611        6.0  

Managed care and other insurers

     6,039        56.4       5,863        57.1  

International (managed care and other insurers)

     276        2.6       285        2.8  
  

 

 

    

 

 

   

 

 

    

 

 

 
     10,769        100.6       10,390        101.2  

Uninsured

     849        7.9       336        3.3  

Other

     349        3.3       384        3.7  
  

 

 

    

 

 

   

 

 

    

 

 

 

Revenues before provision for doubtful accounts

     11,967        111.8       11,110        108.2  

Provision for doubtful accounts

     (1,271      (11.8     (840      (8.2
  

 

 

    

 

 

   

 

 

    

 

 

 

Revenues

   $ 10,696        100.0   $ 10,270        100.0
  

 

 

    

 

 

   

 

 

    

 

 

 

 

     Nine Months  
     2017      Ratio     2016      Ratio  

Medicare

   $ 7,080        22.1   $ 6,641        21.5

Managed Medicare

     3,546        11.1       3,250        10.5  

Medicaid

     1,188        3.7       1,248        4.0  

Managed Medicaid

     1,798        5.6       1,816        5.9  

Managed care and other insurers

     18,071        56.4       17,324        56.2  

International (managed care and other insurers)

     814        2.5       926        3.0  
  

 

 

    

 

 

   

 

 

    

 

 

 
     32,497        101.4       31,205        101.1  

Uninsured

     1,593        5.0       750        2.4  

Other

     1,066        3.3       1,286        4.2  
  

 

 

    

 

 

   

 

 

    

 

 

 

Revenues before provision for doubtful accounts

     35,156        109.7       33,241        107.7  

Provision for doubtful accounts

     (3,104      (9.7     (2,392      (7.7
  

 

 

    

 

 

   

 

 

    

 

 

 

Revenues

   $ 32,052        100.0   $ 30,849        100.0
  

 

 

    

 

 

   

 

 

    

 

 

 

 

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Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (Continued)

 

Recent Pronouncements

In May 2014, the Financial Accounting Standards Board (“FASB”) and the International Accounting Standards Board issued a final, converged, principles-based standard on revenue recognition. Companies across all industries will use a five-step model to recognize revenue from customer contracts. The new standard, which replaces nearly all existing revenue recognition guidance, will require significant management judgments and change the way many companies recognize revenue in their financial statements. In July 2015, the FASB decided to defer the effective date of the new revenue standard by one year to annual and interim periods beginning after December 15, 2017 for public entities and permit entities to adopt one year earlier if they choose. The FASB decided, based on its outreach to various stakeholders and continuing amendments to the new revenue standard, that a deferral was necessary to provide adequate time to effectively implement the new standard. We are continuing to evaluate the effects the adoption of this standard will have on our financial statements and financial disclosures. We believe the most significant impact will be to the presentation of our income statement where the provision for doubtful accounts will be recorded as a direct reduction to revenues and will not be presented as a separate line item. We expect to adopt the new standard using the full retrospective application, and we do not currently believe the adoption will have a significant impact on our recognition of net revenues or related disclosures for any period.

In February 2016, the FASB issued Accounting Standards Update 2016-02, Leases (“ASU 2016-02”), which requires lessees to recognize assets and liabilities for most leases. ASU 2016-02 is effective for public business entities for annual and interim periods beginning after December 15, 2018. Early adoption is permitted. ASU 2016-02’s transition provisions will be applied using a modified retrospective approach at the beginning of the earliest comparative period presented in the financial statements. We are currently evaluating the provisions of ASU 2016-02 to determine how our financial statements will be affected, and we believe the primary effect of adopting the new standard will be to record right-of-use assets and obligations for our leases currently classified as operating leases.

Reclassifications

Certain prior year amounts have been reclassified to conform to the current year presentation.

NOTE 2 — ACQUISITIONS AND DISPOSITIONS

During the nine months ended September 30, 2017, we paid $1.000 billion to acquire seven hospital facilities (one of the acquired hospital facilities has an effective acquisition date of October 1, 2017) and $142 million to acquire other nonhospital health care entities. During the nine months ended September 30, 2016, we paid $343 million to acquire three hospital facilities and $125 million to acquire other nonhospital health care entities.

During the nine months ended September 30, 2017, we received proceeds of $24 million and recognized a net pretax gain of $10 million related to sales of real estate and other investments. During the nine months ended September 30, 2016, we received proceeds of $23 million and recognized a net pretax gain of $8 million related to sales of real estate and other investments.

 

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HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 3 — INCOME TAXES

Our liability for unrecognized tax benefits was $429 million, including accrued interest of $40 million, as of September 30, 2017 ($418 million and $45 million, respectively, as of December 31, 2016). Unrecognized tax benefits of $136 million ($137 million as of December 31, 2016) would affect the effective rate, if recognized.

Our provision for income taxes for the quarters ended September 30, 2017 and 2016, included tax benefits of $4 million and $11 million, respectively, and for the nine months ended September 30, 2017 and 2016, included tax benefits of $80 million and $129 million, respectively, related to the settlement of employee equity awards. Our provision for income taxes for the quarter and nine months ended September 30, 2017 also included $4 million and $16 million, respectively, of reductions in interest expense (net of tax). We also reduced our provision for income taxes for the quarter and nine months ended September 30, 2016 by $51 million, including interest of $17 million (net of tax) primarily related to the completion of IRS examinations which resolved all outstanding federal tax issues for our 2011 and 2012 tax years.

We are subject to examination by federal, state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change.

NOTE 4 — EARNINGS PER SHARE

We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards and potential shares, computed using the treasury stock method.

The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2017 and 2016 (dollars and shares in millions, except per share amounts):

 

     Quarter      Nine months  
     2017      2016      2017      2016  

Net income attributable to HCA Healthcare, Inc.

   $ 426      $ 618      $ 1,742      $ 1,970  

Weighted average common shares outstanding

     360.170        378.199        365.398        386.968  

Effect of dilutive incremental shares

     9.664        11.393        9.615        12.609  
  

 

 

    

 

 

    

 

 

    

 

 

 

Shares used for diluted earnings per share

     369.834        389.592        375.013        399.577  
  

 

 

    

 

 

    

 

 

    

 

 

 

Earnings per share:

           

Basic earnings per share

   $ 1.18      $ 1.63      $ 4.77      $ 5.09  

Diluted earnings per share

   $ 1.15      $ 1.59      $ 4.64      $ 4.93  

 

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HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES

A summary of our insurance subsidiaries’ investments at September 30, 2017 and December 31, 2016 follows (dollars in millions):

 

     September 30, 2017  
     Amortized
Cost
     Unrealized
Amounts
     Fair
Value
 
        Gains      Losses     

Debt securities:

           

States and municipalities

   $ 352        $14        $—      $ 366  

Money market funds

     52                      52  
  

 

 

    

 

 

    

 

 

    

 

 

 
     404        14               418  

Equity securities

     1        2               3  
  

 

 

    

 

 

    

 

 

    

 

 

 
   $ 405        $16        $—        421  
  

 

 

    

 

 

    

 

 

    

Amounts classified as current assets

              (53
           

 

 

 

Investment carrying value

            $ 368  
           

 

 

 

 

     December 31, 2016  
     Amortized
Cost
     Unrealized
Amounts
     Fair
Value
 
        Gains      Losses     

Debt securities:

           

States and municipalities

   $ 345        $9        $(1)      $ 353  

Money market funds

     28                      28  
  

 

 

    

 

 

    

 

 

    

 

 

 
     373        9        (1)        381  

Equity securities

     1        3               4  
  

 

 

    

 

 

    

 

 

    

 

 

 
   $ 374        $12        $(1)        385  
  

 

 

    

 

 

    

 

 

    

Amounts classified as current assets

              (49
           

 

 

 

Investment carrying value

            $ 336  
           

 

 

 

At September 30, 2017 and December 31, 2016, the investments of our insurance subsidiaries were classified as “available-for-sale.” Changes in temporary unrealized gains and losses are recorded as adjustments to other comprehensive income (loss).

Scheduled maturities of investments in debt securities at September 30, 2017 were as follows (dollars in millions):

 

     Amortized
Cost
     Fair
Value
 

Due in one year or less

   $ 100      $ 100  

Due after one year through five years

     76        80  

Due after five years through ten years

     178        187  

Due after ten years

     50        51  
  

 

 

    

 

 

 
   $ 404      $ 418  
  

 

 

    

 

 

 

 

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Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES (Continued)

 

The average expected maturity of the investments in debt securities at September 30, 2017 was 4.0 years, compared to the average scheduled maturity of 5.5 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to their scheduled maturity date.

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 interest rate swaps effectively convert LIBOR indexed variable rate obligations to fixed interest rate obligations. The interest payments under these agreements are settled on a net basis. The net interest payments, based on the notional amounts in these agreements, generally match the timing of the related liabilities for the interest rate swap agreements which have been designated as cash flow hedges. The notional amounts of the swap agreements represent amounts used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions.

The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at September 30, 2017 (dollars in millions):

 

     Notional
Amount
     Maturity Date      Fair
Value
 

Pay-fixed interest rate swaps

   $ 1,000        December 2017      $ (3

Pay-fixed interest rate swaps

     2,000        December 2021        30  

During the next 12 months, we estimate $3 million will be reclassified from other comprehensive income (“OCI”) to interest expense.

Derivatives — Results of Operations

The following table presents the effect of our interest rate swaps on our results of operations for the nine months ended September 30, 2017 (dollars in millions):

 

Derivatives in Cash Flow Hedging Relationships

   Amount of Loss
Recognized in OCI on
Derivatives, Net of  Tax
     Location of Loss
Reclassified from
Accumulated OCI
into Operations
     Amount of Loss
Reclassified from
Accumulated OCI
into Operations
 

Interest rate swaps

   $ 6        Interest expense      $ 17  

 

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Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE

Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”) emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).

Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment.

Cash Traded Investments

Our cash traded investments are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. Certain types of cash traded instruments are classified within Level 3 of the fair value hierarchy because they trade infrequently and therefore have little or no price transparency. The valuation of these securities involves the consideration of market factors and management’s judgment.

Derivative Financial Instruments

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments.

Although we determined the majority of the inputs used to value our derivatives fall within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with our derivatives utilize Level 3 inputs, such as estimates of current credit spreads to evaluate the likelihood of default by us and our counterparties. We assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions, and at September 30, 2017 and December 31, 2016, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives.

 

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Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (Continued)

 

The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of September 30, 2017 and December 31, 2016, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

 

     September 30, 2017  
           Fair Value Measurements Using  
     Fair Value     Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
    Significant Other
Observable Inputs
(Level 2)
    Significant
Unobservable Inputs
(Level 3)
 

Assets:

        

Investments of insurance subsidiaries:

        

Debt securities:

        

States and municipalities

   $ 366     $     $ 366     $  

Money market funds

     52       52              
  

 

 

   

 

 

   

 

 

   

 

 

 
     418       52       366        

Equity securities

     3       3              
  

 

 

   

 

 

   

 

 

   

 

 

 

Investments of insurance subsidiaries

     421       55       366        

Less amounts classified as current assets

     (53     (52     (1      
  

 

 

   

 

 

   

 

 

   

 

 

 
   $ 368     $ 3     $ 365     $  
  

 

 

   

 

 

   

 

 

   

 

 

 

Interest rate swaps (Other)

   $ 30     $     $ 30     $  

Liabilities:

        

Interest rate swaps (Income taxes and other liabilities)

   $ 3     $     $ 3     $  
     December 31, 2016  
           Fair Value Measurements Using  
     Fair Value     Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
    Significant Other
Observable Inputs
(Level 2)
    Significant
Unobservable Inputs
(Level 3)
 

Assets:

        

Investments of insurance subsidiaries:

        

Debt securities:

        

States and municipalities

   $ 353     $     $ 347     $ 6  

Money market funds

     28       28              
  

 

 

   

 

 

   

 

 

   

 

 

 
     381       28       347       6  

Equity securities

     4       4              
  

 

 

   

 

 

   

 

 

   

 

 

 

Investments of insurance subsidiaries

     385       32       347       6  

Less amounts classified as current assets

     (49     (28     (21      
  

 

 

   

 

 

   

 

 

   

 

 

 
   $ 336     $ 4     $ 326     $ 6  
  

 

 

   

 

 

   

 

 

   

 

 

 

Interest rate swaps (Other)

   $ 31     $     $ 31     $  

Liabilities:

        

Interest rate swaps (Income taxes and other liabilities)

   $ 12     $     $ 12     $  

 

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Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (Continued)

 

The $6 million reduction in the Level 3 investments of our insurance subsidiaries resulted from settlements. The estimated fair value of our long-term debt was $34.998 billion and $32.833 billion at September 30, 2017 and December 31, 2016, respectively, compared to carrying amounts, excluding net debt issuance costs, aggregating $33.124 billion and $31.546 billion, respectively. The estimates of fair value are generally based upon the quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities.

NOTE 8 — LONG-TERM DEBT

A summary of long-term debt at September 30, 2017 and December 31, 2016, including related interest rates at September 30, 2017, follows (dollars in millions):

 

     September 30,
2017
    December 31,
2016
 

Senior secured asset-based revolving credit facility (effective interest rate of 2.7%)

   $ 3,570     $ 2,920  

Senior secured revolving credit facility

            

Senior secured term loan facilities (effective interest rate of 3.6%)

     3,915       3,981  

Senior secured notes (effective interest rate of 5.4%)

     15,300       13,800  

Other senior secured debt (effective interest rate of 5.8%)

     587       593  
  

 

 

   

 

 

 

Senior secured debt

     23,372       21,294  

Senior unsecured notes (effective interest rate of 6.4%)

     9,752       10,252  

Net debt issuance costs

     (171     (170
  

 

 

   

 

 

 

Total debt (average life of 7.1 years, rates averaging 5.2%)

     32,953       31,376  

Less amounts due within one year

     202       216  
  

 

 

   

 

 

 
   $ 32,751     $ 31,160  
  

 

 

   

 

 

 

2017 Activity

During June 2017, we issued $1.500 billion aggregate principal amount of 5.500% senior secured notes due 2047. We used the net proceeds for general corporate purposes, including funding the purchase of certain hospital acquisitions, and the redemption, during July 2017, of all $500 million aggregate principal amount of our existing 8.000% senior notes maturing in October 2018. The pretax loss on retirement of debt was $39 million.

During June 2017, we amended our senior secured revolving credit facilities by (i) increasing the commitments under the senior secured asset-based revolving credit facility to $3.750 billion, (ii) extending the maturity date of the revolving credit commitments to June 28, 2022, (iii) amending the incremental facility provisions to permit the incurrence of additional incremental credit facilities in an aggregate principal amount of $1.5 billion and (iv) providing that the commitment fee for unutilized commitments under the senior secured asset-based revolving credit facility shall be 0.250% per annum.

 

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Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 9 — CONTINGENCIES

We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity.

Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act, private parties have the right to bring qui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying 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.

NOTE 10 — CAPITAL STRUCTURE

The changes in stockholders’ deficit, including changes in stockholders’ deficit attributable to HCA Healthcare, Inc. and changes in equity attributable to noncontrolling interests, are as follows (dollars and shares in millions):

 

    Equity (Deficit) Attributable to HCA Healthcare, Inc.     Equity
Attributable to
Noncontrolling
Interests
    Total  
    Common Stock     Capital in
Excess of
Par
Value
    Accumulated
Other
Comprehensive
Loss
    Retained
Deficit
     
    Shares     Par Value            

Balances at December 31, 2016

    370.536     $ 4     $     $ (338   $ (6,968   $ 1,669     $ (5,633

Comprehensive income

                      70       1,742       360       2,172  

Repurchase of common stock

    (17.847           (185           (1,290           (1,475

Distributions

                                  (363     (363

Share-based benefit plans

    4.291             188                         188  

Other

                (3                 48       45  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Balances at September 30, 2017

    356.980     $ 4     $     $ (268   $ (6,516   $ 1,714     $ (5,066
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

During the nine months ended September 30, 2017, we repurchased 17.847 million shares of our common stock at an average price of $82.62 per share through market purchases pursuant to the $2.0 billion share repurchase program authorized during November 2016. At September 30, 2017, we had $379 million of repurchase authorization available under the November 2016 authorization. During October 2017, our board of directors authorized a share repurchase program for up to $2 billion of our outstanding common stock.

 

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Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 10 — CAPITAL STRUCTURE (Continued)

 

The components of accumulated other comprehensive loss are as follows (dollars in millions):

 

     Unrealized
Gains on
Available-
for-Sale
Securities
     Foreign
Currency
Translation
Adjustments
    Defined
Benefit
Plans
    Change
in Fair
Value of
Derivative
Instruments
    Total  

Balances at December 31, 2016

   $ 7      $ (211   $ (146   $ 12     $ (338

Unrealized gains on available-for-sale securities, net of $2 of income taxes

     3                          3  

Foreign currency translation adjustments, net of $34 of income taxes

            53                   53  

Change in fair value of derivative instruments, net of $3 income tax benefits

                        (6     (6

Expense reclassified into operations from other comprehensive income, net of $5 and $6, respectively, income tax benefits

                  9       11       20  
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Balances at September 30, 2017

   $ 10      $ (158   $ (137   $ 17     $ (268
  

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION

We operate in one line of business, which is operating hospitals and related health care entities. We operate in two geographically organized groups: the National and American Groups. The National Group includes 86 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, South Carolina, Utah and Virginia, and the American Group includes 85 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and Texas. We also operate six hospitals in England, and these facilities are included in the Corporate and other group.

Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, gains on sales of facilities, losses on retirement of debt, legal claim costs, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues,

 

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Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION (Continued)

 

equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2017 and 2016 are summarized in the following table (dollars in millions):

 

     Quarter      Nine months  
     2017      2016      2017      2016  

Revenues:

           

National Group

   $ 5,036      $ 4,882      $ 15,344      $ 14,780  

American Group

     5,180        4,908        15,268        14,554  

Corporate and other

     480        480        1,440        1,515  
  

 

 

    

 

 

    

 

 

    

 

 

 
   $ 10,696      $ 10,270      $ 32,052      $ 30,849  
  

 

 

    

 

 

    

 

 

    

 

 

 

Equity in earnings of affiliates:

           

National Group

   $ (8    $ (13    $ (17    $ (17

American Group

     (9      (9      (27      (26

Corporate and other

     4               8        (1
  

 

 

    

 

 

    

 

 

    

 

 

 
   $ (13    $ (22    $ (36    $ (44
  

 

 

    

 

 

    

 

 

    

 

 

 

Adjusted segment EBITDA:

           

National Group

   $ 975      $ 1,073      $ 3,268      $ 3,342  

American Group

     930        1,016        2,977        3,002  

Corporate and other

     (129      (132      (374      (332
  

 

 

    

 

 

    

 

 

    

 

 

 
   $ 1,776      $ 1,957      $ 5,871      $ 6,012  
  

 

 

    

 

 

    

 

 

    

 

 

 

Depreciation and amortization:

           

National Group

   $ 219      $ 204      $ 650      $ 602  

American Group

     251        231        727        675  

Corporate and other

     69        60        204        186  
  

 

 

    

 

 

    

 

 

    

 

 

 
   $ 539      $ 495      $ 1,581      $ 1,463  
  

 

 

    

 

 

    

 

 

    

 

 

 

Adjusted segment EBITDA

   $ 1,776      $ 1,957      $ 5,871      $ 6,012  

Depreciation and amortization

     539        495        1,581        1,463  

Interest expense

     427        432        1,257        1,275  

Gains on sales of facilities

     (7      (3      (10      (8

Losses on retirement of debt

     39        4        39        4  

Legal claim costs

            11               33  
  

 

 

    

 

 

    

 

 

    

 

 

 

Income before income taxes

   $ 778      $ 1,018      $ 3,004      $ 3,245  
  

 

 

    

 

 

    

 

 

    

 

 

 

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION

During December 2012, HCA Healthcare, Inc. issued $1.000 billion aggregate principal amount of 6.250% senior unsecured notes due 2021. These notes are senior unsecured obligations and are not guaranteed by any of our subsidiaries.

HCA Inc., a direct wholly-owned subsidiary of HCA Healthcare, Inc., is the obligor under a significant portion of our other indebtedness, including our senior secured credit facilities, senior secured notes and senior unsecured notes (other than the senior unsecured notes issued by HCA Healthcare, Inc.). The senior secured notes and senior unsecured notes issued by HCA Inc. are fully and unconditionally guaranteed

 

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Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (Continued)

 

by HCA Healthcare, Inc. The senior secured credit facilities and senior secured notes are fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, 100% owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our senior secured asset-based revolving credit facility).

Our summarized condensed consolidating comprehensive income statements for the quarters and nine months ended September 30, 2017 and 2016, condensed consolidating balance sheets at September 30, 2017 and December 31, 2016 and condensed consolidating statements of cash flows for the nine months ended September 30, 2017 and 2016, segregating HCA Healthcare, Inc. issuer, HCA Inc. issuer, the subsidiary guarantors, the subsidiary non-guarantors and eliminations, follow:

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE QUARTER ENDED SEPTEMBER 30, 2017

(Dollars in millions)

 

    HCA
Healthcare, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues before provision for doubtful accounts

  $     $     $ 5,897     $ 6,070     $     $ 11,967  

Provision for doubtful accounts

                636       635             1,271  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

                5,261       5,435             10,696  

Salaries and benefits

                2,427       2,654             5,081  

Supplies

                889       888             1,777  

Other operating expenses

                963       1,112             2,075  

Equity in earnings of affiliates

    (436           (1     (12     436       (13

Depreciation and amortization

                249       290             539  

Interest expense

    16       792       (318     (63           427  

Gains on sales of facilities

                (4     (3           (7

Losses on retirement of debt

          39                         39  

Management fees

                (215     215              
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    (420     831       3,990       5,081       436       9,918  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

    420       (831     1,271       354       (436     778  

Provision (benefit) for income taxes

    (6     (307     460       101             248  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss)

    426       (524     811       253       (436     530  

Net income attributable to noncontrolling interests

                24       80             104  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss) attributable to HCA Healthcare, Inc.

  $ 426     $ (524   $ 787     $ 173     $ (436   $ 426  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income (loss) attributable to HCA Healthcare, Inc.

  $ 451     $ (522   $ 790     $ 193     $ (461   $ 451  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

18


Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (Continued)

 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE QUARTER ENDED SEPTEMBER 30, 2016

(Dollars in millions)

 

     HCA
Healthcare, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues before provision for doubtful accounts

   $     $     $ 5,591     $ 5,519     $     $ 11,110  

Provision for doubtful accounts

                 391       449             840  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

                 5,200       5,070             10,270  

Salaries and benefits

                 2,373       2,367             4,740  

Supplies

                 888       811             1,699  

Other operating expenses

     1             904       991             1,896  

Equity in earnings of affiliates

     (573           (1     (21     573       (22

Depreciation and amortization

                 242       253             495  

Interest expense

     16       711       (235     (60           432  

Gains on sales of facilities

                       (3           (3

Losses on retirement of debt

           4                         4  

Legal claim costs

           11                         11  

Management fees

                 (206     206              
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
     (556     726       3,965       4,544       573       9,252  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

     556       (726     1,235       526       (573     1,018  

Provision (benefit) for income taxes

     (62     (268     447       156             273  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss)

     618       (458     788       370       (573     745  

Net income attributable to noncontrolling interests

                 24       103             127  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss) attributable to HCA Healthcare, Inc.

   $ 618     $ (458   $ 764     $ 267     $ (573   $ 618  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income (loss) attributable to HCA Healthcare, Inc.

   $ 621     $ (432   $ 766     $ 242     $ (576   $ 621  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

19


Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (Continued)

 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017

(Dollars in millions)

 

     HCA
Healthcare, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues before provision for doubtful accounts

   $     $     $ 17,799       17,357     $     $ 35,156  

Provision for doubtful accounts

                 1,648       1,456             3,104  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

                 16,151       15,901             32,052  

Salaries and benefits

                 7,330       7,548             14,878  

Supplies

                 2,771       2,598             5,369  

Other operating expenses

     5             2,841       3,124             5,970  

Equity in earnings of affiliates

     (1,702           (3     (33     1,702       (36

Depreciation and amortization

                 748       833             1,581  

Interest expense

     48       2,280       (878     (193           1,257  

Gains on sales of facilities

                 (5     (5           (10

Losses on retirement of debt

           39                         39  

Management fees

                 (637     637              
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
     (1,649     2,319       12,167       14,509       1,702       29,048  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

     1,649       (2,319     3,984       1,392       (1,702     3,004  

Provision (benefit) for income taxes

     (93     (856     1,443       408             902  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss)

     1,742       (1,463     2,541       984       (1,702     2,102  

Net income attributable to noncontrolling interests

                 74       286             360  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss) attributable to HCA Healthcare, Inc.

   $ 1,742     $ (1,463   $ 2,467     $ 698     $ (1,702   $ 1,742  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income (loss) attributable to HCA Healthcare, Inc.

   $ 1,812     $ (1,458   $ 2,476     $ 754     $ (1,772   $ 1,812  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

20


Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (Continued)

 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2016

(Dollars in millions)

 

     HCA
Healthcare, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues before provision for doubtful accounts

   $     $     $ 16,957     $ 16,284     $     $ 33,241  

Provision for doubtful accounts

                 1,383       1,009             2,392  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

                 15,574       15,275             30,849  

Salaries and benefits

                 7,074       7,059             14,133  

Supplies

                 2,672       2,459             5,131  

Other operating expenses

     5             2,654       2,958             5,617  

Equity in earnings of affiliates

     (1,843           (4     (40     1,843       (44

Depreciation and amortization

                 707       756             1,463  

Interest expense

     48       2,031       (646     (158           1,275  

Gains on sales of facilities

                       (8           (8

Losses on retirement of debt

           4                         4  

Legal claim costs

           33                         33  

Management fees

                 (601     601              
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
     (1,790     2,068       11,856       13,627       1,843       27,604  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

     1,790       (2,068     3,718       1,648       (1,843     3,245  

Provision (benefit) for income taxes

     (180     (763     1,347       494             898  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss)

     1,970       (1,305     2,371       1,154       (1,843     2,347  

Net income attributable to noncontrolling interests

                 67       310             377  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss) attributable to HCA Healthcare, Inc.

   $ 1,970     $ (1,305   $ 2,304     $ 844     $ (1,843   $ 1,970  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income (loss) attributable to HCA Healthcare, Inc.

   $ 1,894     $ (1,288   $ 2,312     $ 743     $ (1,767   $ 1,894  
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

21


Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (Continued)

 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

SEPTEMBER 30, 2017

(Dollars in millions)

 

    HCA
Healthcare, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 
ASSETS            

Current assets:

           

Cash and cash equivalents

  $ 1     $     $ 117     $ 600     $     $ 718  

Accounts receivable, net

                3,003       2,977             5,980  

Inventories

                899       647             1,546  

Other

    33             438       733             1,204  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    34             4,457       4,957             9,448  

Property and equipment, net

                8,670       8,659             17,329  

Investments of insurance subsidiaries

                      368             368  

Investments in and advances to affiliates

    28,817             15       186       (28,817     201  

Goodwill and other intangible assets

                1,728       5,629             7,357  

Other

    783       29       35       181             1,028  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
  $ 29,634     $ 29     $ 14,905     $ 19,980     $ (28,817   $ 35,731  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

LIABILITIES AND

STOCKHOLDERS’ (DEFICIT)

EQUITY

           

Current liabilities:

           

Accounts payable

  $     $     $ 1,288     $ 1,026     $     $ 2,314  

Accrued salaries

                704       608             1,312  

Other accrued expenses

    8       279       475       1,021             1,783  

Long-term debt due within one year

          97       54       51             202  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    8       376       2,521       2,706             5,611  

Long-term debt, net

    994       31,275       192       290             32,751  

Intercompany balances

    34,983       (10,069     (28,514     3,600              

Professional liability risks

                      1,179             1,179  

Income taxes and other liabilities

    429       2       353       472             1,256  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    36,414       21,584       (25,448)       8,247             40,797  

Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc.

    (6,780     (21,555     40,228       10,144       (28,817     (6,780

Noncontrolling interests

                125       1,589             1,714  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    (6,780     (21,555     40,353       11,733       (28,817     (5,066
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
  $ 29,634     $ 29     $ 14,905     $ 19,980     $ (28,817   $ 35,731  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

22


Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (Continued)

 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

DECEMBER 31, 2016

(Dollars in millions)

 

    HCA
Healthcare, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 
ASSETS            

Current assets:

           

Cash and cash equivalents

  $     $     $ 110     $ 536     $     $ 646  

Accounts receivable, net

                3,028       2,798             5,826  

Inventories

                890       613             1,503  

Other

                445       666             1,111  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
                4,473       4,613             9,086  

Property and equipment, net

                8,463       7,889             16,352  

Investments of insurance subsidiaries

                      336             336  

Investments in and advances to affiliates

    27,045             16       190       (27,045     206  

Goodwill and other intangible assets

                1,728       4,976             6,704  

Other

    877             34       163             1,074  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
  $ 27,922     $     $ 14,714     $ 18,167     $ (27,045   $ 33,758  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

LIABILITIES AND

STOCKHOLDERS’ (DEFICIT)

EQUITY

           

Current liabilities:

           

Accounts payable

  $     $     $ 1,439     $ 879     $     $ 2,318  

Accrued salaries

                704       561             1,265  

Other accrued expenses

    29       572       464       970             2,035  

Long-term debt due within one year

          97       60       59             216  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    29       669       2,667       2,469             5,834  

Long-term debt, net

    993       29,693       199       275             31,160  

Intercompany balances

    33,784       (10,277     (26,447     2,940              

Professional liability risks

                      1,148             1,148  

Income taxes and other liabilities

    418       12       387       432             1,249  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    35,224       20,097       (23,194     7,264             39,391  

Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc.

    (7,302     (20,097     37,752       9,390       (27,045     (7,302

Noncontrolling interests

                156       1,513             1,669  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    (7,302     (20,097     37,908       10,903       (27,045     (5,633
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
  $ 27,922     $     $ 14,714     $ 18,167     $ (27,045   $ 33,758  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

23


Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (Continued)

 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017

(Dollars in millions)

 

    HCA
Healthcare, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Cash flows from operating activities:

           

Net income (loss)

  $ 1,742     $ (1,463   $ 2,541     $ 984     $ (1,702   $ 2,102  

Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:

           

Changes in operating assets and liabilities

    (15     (293     (1,785     (1,300           (3,393

Provision for doubtful accounts

                1,648       1,456             3,104  

Depreciation and amortization

                748       833             1,581  

Income taxes

    (9                             (9

Gains on sales of facilities

                (5     (5           (10

Losses on retirement of debt

          39                         39  

Amortization of debt issuance costs

          23                         23  

Share-based compensation

                195                   195  

Equity in earnings of affiliates

    (1,702                       1,702        

Other

    58                   2             60  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) operating activities

    74       (1,694     3,342       1,970             3,692  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from investing activities:

           

Purchase of property and equipment

                (912     (1,121           (2,033

Acquisition of hospitals and health care entities

                (9     (1,133           (1,142

Disposition of hospitals and health care entities

                12       12             24  

Change in investments

                      (15           (15

Other

                (2     (4           (6
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash used in investing activities

                (911     (2,261           (3,172
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from financing activities:

           

Issuance of long-term debt

          1,500             2             1,502  

Net change in revolving credit facilities

          650                         650  

Repayment of long-term debt

          (604     (52     (44           (700

Distributions to noncontrolling interests

                (105     (258           (363

Payment of debt issuance costs

          (25                       (25

Repurchases of common stock

    (1,475                             (1,475

Changes in intercompany balances with affiliates, net

    1,468       173       (2,267     626              

Other

    (66                 29             (37
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash (used in) provided by financing activities

    (73     1,694       (2,424     355             (448
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Change in cash and cash equivalents

    1             7       64             72  

Cash and cash equivalents at beginning of period

                110       536             646  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash and cash equivalents at end of period

  $ 1     $     $ 117     $ 600     $     $ 718  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

24


Table of Contents

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (Continued)

 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2016

(Dollars in millions)

 

    HCA
Healthcare, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Cash flows from operating activities:

           

Net income (loss)

  $ 1,970     $ (1,305   $ 2,371     $ 1,154     $ (1,843   $ 2,347  

Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:

           

Changes in operating assets and liabilities

    (40     (49     (1,628     (829           (2,546

Provision for doubtful accounts

                1,383       1,009             2,392  

Depreciation and amortization

                707       756             1,463  

Income taxes

    8                               8  

Gains on sales of facilities

                      (8           (8

Losses on retirement of debt

          4                         4  

Legal claim costs

          33                         33  

Amortization of debt issuance costs

          26                         26  

Share-based compensation

                196                   196  

Equity in earnings of affiliates

    (1,843                       1,843        

Other

    53             (3     (11           39  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) operating activities

    148       (1,291     3,026       2,071             3,954  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from investing activities:

           

Purchase of property and equipment

                (892     (992           (1,884

Acquisition of hospitals and health care entities

                (164     (304           (468

Disposition of hospitals and health care entities

                10       13             23  

Change in investments

                (2     80             78  

Other

                      17             17  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash used in investing activities

                (1,048     (1,186           (2,234
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from financing activities:

           

Issuance of long-term debt

          5,400                         5,400  

Net change in revolving credit facilities

          (70                       (70

Repayment of long-term debt

          (4,334     (54     (36           (4,424

Distributions to noncontrolling interests

                (46     (296           (342

Payment of debt issuance costs

          (40                       (40

Repurchases of common stock

    (2,213                             (2,213

Changes in intercompany balances with affiliates, net

    2,171       335       (1,895     (611            

Other

    (105                 10             (95
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash (used in) provided by financing activities

    (147     1,291       (1,995     (933           (1,784
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Change in cash and cash equivalents

    1             (17     (48           (64

Cash and cash equivalents at beginning of period

                155       586             741  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash and cash equivalents at end of period

  $ 1     $     $ 138     $ 538     $     $ 677  
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

25


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS

Forward-Looking Statements

This quarterly report on Form 10-Q includes certain disclosures which contain “forward-looking statements.” Forward-looking statements include statements regarding expected share-based compensation expense, expected capital expenditures and expected net claim payments and all other statements that do not relate solely to historical or current facts, and can be identified by the use of words like “may,” “believe,” “will,” “expect,” “project,” “estimate,” “anticipate,” “plan,” “initiative” or “continue.” These forward-looking statements are based on our current plans and expectations and are subject to a number of known and unknown uncertainties and risks, many of which are beyond our control, which could significantly affect current plans and expectations and our future financial position and results of operations. These factors include, but are not limited to, (1) the impact of our substantial indebtedness and the ability to refinance such indebtedness on acceptable terms, (2) the impact of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the “Health Reform Law”), including the effects of any repeal of, or changes to, the Health Reform Law or changes to its implementation, the possible enactment of additional federal or state health care reforms and possible changes to other federal, state or local laws or regulations affecting the health care industry, (3) the effects related to the continued implementation of the sequestration spending reductions required under the Budget Control Act of 2011, and related legislation extending these reductions, and the potential for future deficit reduction legislation that may alter these spending reductions, which include cuts to Medicare payments, or create additional spending reductions, (4) increases in the amount and risk of collectability of uninsured accounts and deductibles and copayment amounts for insured accounts, (5) the ability to achieve operating and financial targets, and attain expected levels of patient volumes and control the costs of providing services, (6) possible changes in Medicare, Medicaid and other state programs, including Medicaid upper payment limit programs or Waiver Programs, that may impact reimbursements to health care providers and insurers, (7) the highly competitive nature of the health care business, (8) changes in service mix, revenue mix and surgical volumes, including potential declines in the population covered under managed care agreements, the ability to enter into and renew managed care provider agreements on acceptable terms and the impact of consumer-driven health plans and physician utilization trends and practices, (9) the efforts of insurers, health care providers and others to contain health care costs, (10) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (11) increases in wages and the ability to attract and retain qualified management and personnel, including affiliated physicians, nurses and medical and technical support personnel, (12) the availability and terms of capital to fund the expansion of our business and improvements to our existing facilities, (13) changes in accounting practices, (14) changes in general economic conditions nationally and regionally in our markets, (15) the emergence and effects related to infectious diseases, (16) future divestitures which may result in charges and possible impairments of long-lived assets, (17) changes in business strategy or development plans, (18) delays in receiving payments for services provided, (19) the outcome of pending and any future tax audits, disputes and litigation associated with our tax positions, (20) potential adverse impact of known and unknown government investigations, litigation and other claims that may be made against us, (21) the impact of potential cybersecurity incidents or security breaches, (22) our ongoing ability to demonstrate meaningful use of certified electronic health record (“EHR”) technology, and (23) other risk factors described in our annual report on Form 10-K for the year ended December 31, 2016 and our other filings with the Securities and Exchange Commission. As a consequence, current plans, anticipated actions and future financial position and results of operations may differ from those expressed in any forward-looking statements made by or on behalf of HCA. You are cautioned not to unduly rely on such forward-looking statements when evaluating the information presented in this report, which forward-looking statements reflect management’s views only as of the date of this report. We undertake no obligation to revise or update any forward-looking statements, whether as a result of new information, future events or otherwise.

 

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Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Third Quarter 2017 Operations Summary

Revenues increased to $10.696 billion in the third quarter of 2017 from $10.270 billion in the third quarter of 2016. Net income attributable to HCA Healthcare, Inc. totaled $426 million, or $1.15 per diluted share, for the quarter ended September 30, 2017, compared to $618 million, or $1.59 per diluted share, for the quarter ended September 30, 2016. Third quarter 2017 results include additional expenses and losses of revenues estimated at approximately $140 million, or $0.24 per diluted share, associated with the impact of hurricanes Harvey and Irma on our Texas, Florida, Georgia and South Carolina facilities, and a negative impact to operating results related to the Texas Medicaid Waiver program of approximately $50 million, or $0.08 per diluted share, related to final settlement amounts for the program year ended September 30, 2017. The amount associated with the hurricanes is prior to any insurance recoveries which we may receive. Third quarter 2017 results also include net gains on sales of facilities of $7 million, or $0.01 per diluted share, and losses on retirement of debt of $39 million, or $0.07 per diluted share. Third quarter 2016 results include legal claim costs of $11 million, or $0.02 per diluted share, losses on retirement of debt of $4 million, or $0.01 per diluted share, and net gains on sales of facilities of $3 million, or $0.01 per diluted share. Our provisions for income taxes for the third quarters of 2017 and 2016 included tax benefits of $4 million, or $0.01 per diluted share, and $11 million, or $0.03 per diluted share, respectively, related to excess tax benefits from employee equity award settlements. Our provision for income taxes for the third quarter of 2016 also included tax benefits of $51 million, or $0.13 per diluted share, primarily related to the resolution of federal income tax issues for our 2011 and 2012 tax years. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 369.834 million shares for the quarter ended September 30, 2017 and 389.592 million shares for the quarter ended September 30, 2016. During 2016 and the first nine months of 2017, we repurchased 36.325 million shares and 17.847 million shares of our common stock, respectively.

Revenues increased 4.2% on a consolidated basis and increased 2.3% on a same facility basis for the quarter ended September 30, 2017, compared to the quarter ended September 30, 2016. The increase in consolidated revenues can be attributed to the combined impact of a 1.6% increase in revenue per equivalent admission and a 2.5% increase in equivalent admissions. The same facility revenues increase resulted from the combined impact of a 2.0% increase in same facility revenue per equivalent admission and a 0.3% increase in same facility equivalent admissions.

During the quarters ended September 30, 2017 and 2016, consolidated admissions and same facility admissions increased 2.7% and 0.6%, respectively. Surgeries declined 0.7% on a consolidated basis and declined 2.9% on a same facility basis during the quarter ended September 30, 2017, compared to the quarter ended September 30, 2016. Emergency department visits increased 2.5% on a consolidated basis and increased 0.3% on a same facility basis during the quarter ended September 30, 2017, compared to the quarter ended September 30, 2016.

For the quarter ended September 30, 2017, the provision for doubtful accounts increased $431 million, compared to the quarter ended September 30, 2016. The self-pay revenue deductions for charity care and uninsured discounts increased $189 million and $256 million, respectively, during the third quarter of 2017, compared to the third quarter of 2016. The sum of the provision for doubtful accounts, uninsured discounts and charity care, as a percentage of the sum of revenues, provision for doubtful accounts, uninsured discounts and charity care, was 36.3% for the third quarter of 2017, compared to 33.7% for the third quarter of 2016. Same facility uninsured admissions increased 6.4% for the quarter ended September 30, 2017, compared to the quarter ended September 30, 2016.

Cash flows from operating activities declined $198 million from $1.206 billion for the third quarter of 2016 to $1.008 billion for the third quarter of 2017. The decline relates primarily to the decline in net income of $215 million.

 

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Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Results of Operations

Revenue/Volume Trends

Our revenues depend upon inpatient occupancy levels, the ancillary services and therapy programs ordered by physicians and provided to patients, the volume of outpatient procedures and the charge and negotiated payment rates for such services. Gross charges typically do not reflect what our facilities are actually paid. Our facilities have entered into agreements with third-party payers, including government programs and managed care health plans, under which the facilities are paid based upon the cost of providing services, predetermined rates per diagnosis, fixed per diem rates or discounts from gross charges. We do not pursue collection of amounts related to patients who meet our guidelines to qualify for charity care; therefore, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. After the discounts are applied, we are still unable to collect a significant portion of uninsured patients’ accounts, and we record provisions for doubtful accounts (based upon our historical collection experience) related to uninsured patients in the period the services are provided to record the net self-pay revenues at the estimated amounts we expect to collect.

Revenues increased 4.2% from $10.270 billion in the third quarter of 2016 to $10.696 billion in the third quarter of 2017. Revenues are recorded during the period the health care services are provided, based upon the estimated amounts due from the patients and third-party payers. Third-party payers include federal and state agencies (under the Medicare and Medicaid programs), managed care health plans and commercial insurance companies (including plans offered through the health insurance exchanges), and employers. Estimates of contractual allowances under managed care health plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). Our revenues from our third-party payers, the uninsured and other payers for the quarters and nine months ended September 30, 2017 and 2016 are summarized in the following table (dollars in millions):

 

     Quarter  
     2017      Ratio     2016      Ratio  

Medicare

   $ 2,354        22.0   $ 2,158        21.0

Managed Medicare

     1,156        10.8       1,068        10.4  

Medicaid

     362        3.4       405        3.9  

Managed Medicaid

     582        5.4       611        6.0  

Managed care and other insurers

     6,039        56.4       5,863        57.1  

International (managed care and other insurers)

     276        2.6       285        2.8  
  

 

 

    

 

 

   

 

 

    

 

 

 
     10,769        100.6       10,390        101.2  

Uninsured

     849        7.9       336        3.3  

Other

     349        3.3       384        3.7  
  

 

 

    

 

 

   

 

 

    

 

 

 

Revenues before provision for doubtful accounts

     11,967        111.8       11,110        108.2  

Provision for doubtful accounts

     (1,271      (11.8     (840      (8.2
  

 

 

    

 

 

   

 

 

    

 

 

 

Revenues

   $ 10,696        100.0   $ 10,270        100.0
  

 

 

    

 

 

   

 

 

    

 

 

 

 

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Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (Continued)

Revenue/Volume Trends (Continued)

 

     Nine Months  
     2017      Ratio     2016      Ratio  

Medicare

   $ 7,080        22.1   $ 6,641        21.5

Managed Medicare

     3,546        11.1       3,250        10.5  

Medicaid

     1,188        3.7       1,248        4.0  

Managed Medicaid

     1,798        5.6       1,816        5.9  

Managed care and other insurers

     18,071        56.4       17,324        56.2  

International (managed care and other insurers)

     814        2.5       926        3.0  
  

 

 

    

 

 

   

 

 

    

 

 

 
     32,497        101.4       31,205        101.1  

Uninsured

     1,593        5.0       750        2.4  

Other

     1,066        3.3       1,286        4.2  
  

 

 

    

 

 

   

 

 

    

 

 

 

Revenues before provision for doubtful accounts

     35,156        109.7       33,241        107.7  

Provision for doubtful accounts

     (3,104      (9.7     (2,392      (7.7
  

 

 

    

 

 

   

 

 

    

 

 

 

Revenues

   $ 32,052        100.0   $ 30,849        100.0
  

 

 

    

 

 

   

 

 

    

 

 

 

Consolidated and same facility revenue per equivalent admission increased 1.6% and 2.0%, respectively, in the third quarter of 2017, compared to the third quarter of 2016. Consolidated and same facility equivalent admissions increased 2.5% and 0.3%, respectively, in the third quarter of 2017, compared to the third quarter of 2016. Consolidated and same facility outpatient surgeries declined 2.1% and 4.2%, respectively, in the third quarter of 2017, compared to the third quarter of 2016. Consolidated inpatient surgeries increased 1.6% and same facility inpatient surgeries declined 0.7% in the third quarter of 2017, compared to the third quarter of 2016. Consolidated and same facility emergency department visits increased 2.5% and 0.3%, respectively, in the third quarter of 2017, compared to the third quarter of 2016.

Our uninsured revenues increased $513 million and $843 million, respectively, for the quarter and nine months ended September 30, 2017 compared to the quarter and nine months ended September 30, 2016. The provision for doubtful accounts increased $431 million and $712 million, respectively, for the quarter and nine months ended September 30, 2017, which offset the majority of the increases in uninsured revenues during the same periods. During these periods we also experienced declines in the percentages of our total uncompensated care that related to uninsured discounts, with uninsured discounts comprising 59% and 64%, respectively, of total uncompensated care for the quarters ended September 30, 2017 and 2016, and 62% and 63%, respectively, of total uncompensated care for the nine months ended September 30, 2017 and 2016.

 

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Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (Continued)

Revenue/Volume Trends (Continued)

 

To quantify the total impact of and trends related to uninsured accounts, we believe it is beneficial to view the direct uninsured revenue deductions (charity care and uninsured discounts) and provision for doubtful accounts in combination, rather than each separately. At September 30, 2017, our allowance for doubtful accounts represented 99.1% of the $5.465 billion total patient due accounts receivable balance. The patient due accounts receivable balance represents the estimated uninsured portion of our accounts receivable. A summary of these adjustments to revenues amounts, related to uninsured accounts, for the quarters and nine months ended September 30, 2017 and 2016 follows (dollars in millions):

 

     Quarter     Nine Months  
     2017      Ratio     2016      Ratio     2017      Ratio     2016      Ratio  

Charity care

   $ 1,235        20   $ 1,046        20   $ 3,494        20   $ 3,100        21

Uninsured discounts

     3,583        59       3,327        64       10,539        62       9,539        63  

Provision for doubtful accounts

     1,271        21       840        16       3,104        18       2,392        16  
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

 

Totals

   $ 6,089        100   $ 5,213        100   $ 17,137        100   $ 15,031        100
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

 

Same facility uninsured admissions increased by 2,354 admissions, or 6.4%, in the third quarter of 2017, compared to the third quarter of 2016. Same facility uninsured admissions increased by 4.9%, in the second quarter of 2017, compared to the second quarter of 2016. Same facility uninsured admissions increased by 3.2%, in the first quarter of 2017, compared to the first quarter of 2016. Same facility uninsured admissions in 2016, compared to 2015, declined 0.3% in the fourth quarter of 2016, increased 0.7% in the third quarter of 2016, increased 5.7% in the second quarter of 2016 and increased 10.6% in the first quarter of 2016.

The approximate percentages of our admissions related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and other insurers and the uninsured for the quarters and nine months ended September 30, 2017 and 2016 are set forth in the following table.

 

     Quarter     Nine Months  
     2017     2016     2017     2016  

Medicare

     30     30     31     31

Managed Medicare

     15       15       16       15  

Medicaid

     5       6       5       6  

Managed Medicaid

     13       12       12       12  

Managed care and other insurers

     28       29       28       29  

Uninsured

     9       8       8       7  
  

 

 

   

 

 

   

 

 

   

 

 

 
     100     100     100     100
  

 

 

   

 

 

   

 

 

   

 

 

 

 

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Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (Continued)

Revenue/Volume Trends (Continued)

 

The approximate percentages of our inpatient revenues, before provision for doubtful accounts, related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and other insurers and the uninsured for the quarters and nine months ended September 30, 2017 and 2016 are set forth in the following table.

 

     Quarter     Nine Months  
     2017     2016     2017     2016  

Medicare

     27     27     27     28

Managed Medicare

     12       12       12       12  

Medicaid

     4       6       5       6  

Managed Medicaid

     5       6       6       6  

Managed care and other insurers

     47       49       47       48  

Uninsured

     5             3        
  

 

 

   

 

 

   

 

 

   

 

 

 
     100     100     100     100
  

 

 

   

 

 

   

 

 

   

 

 

 

At September 30, 2017, we had 89 hospitals in the states of Texas and Florida. During the third quarter of 2017, 56% of our admissions and 48% of our revenues were generated by these hospitals. Uninsured admissions in Texas and Florida represented 70% of our uninsured admissions during the third quarter of 2017.

We receive a significant portion of our revenues from government health programs, principally Medicare and Medicaid, which are highly regulated and subject to frequent and substantial changes. In 2011, the Centers for Medicare & Medicaid Services (“CMS”) approved a Medicaid waiver that allows Texas to continue receiving supplemental Medicaid reimbursement while expanding its Medicaid managed care program. Texas currently operates its Medicaid Waiver Program pursuant to this waiver, which CMS has agreed to extend through December 2017. We cannot predict whether the Texas Medicaid Waiver Program will be further extended, be revised or that revenues recognized from the program will not decline.

The Texas Medicaid Waiver Program includes two primary components: an indigent care component and a Delivery System Reform Incentive Payment (“DSRIP”) component. Initiatives under the DSRIP program are designed to provide incentive payments to hospitals and other providers for their investments in delivery system reforms that increase access to health care, improve the quality of care and enhance the health of patients and families they serve. We provide indigent care services in several communities in the state of Texas, in affiliation with other hospitals. The state of Texas has been involved in efforts to increase the indigent care provided by private hospitals. As a result of additional indigent care being provided by private hospitals, public hospital districts or counties in Texas have available funds that were previously devoted to indigent care. The public hospital districts or counties are under no contractual or legal obligation to provide such indigent care. The public hospital districts or counties have elected to transfer some portion of these available funds to the state’s Medicaid program. Such action is at the sole discretion of the public hospital districts or counties. It is anticipated that these contributions to the state will be matched with federal Medicaid funds. The state then may make supplemental payments to hospitals in the state for Medicaid services rendered. Hospitals receiving Medicaid supplemental payments may include those that are providing additional indigent care services. Our Texas Medicaid revenues included Medicaid supplemental payments of $60 million ($26 million DSRIP related and $34 million indigent care related) and $109 million ($25 million DSRIP related and $84 million indigent care related) during the third quarters of 2017 and 2016, respectively, and $261 million ($82 million DSRIP related and $179 million indigent care related) and $293 million ($78 million DSRIP related and $215 million indigent care related) during the first nine months of 2017 and 2016, respectively.

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (Continued)

Revenue/Volume Trends (Continued)

 

In addition, we receive supplemental payments in several other states. We are aware these supplemental payment programs are currently being reviewed by certain state agencies and CMS, and some states have made waiver requests to CMS to replace their existing supplemental payment programs. It is possible these reviews and waiver requests will result in the restructuring of such supplemental payment programs and could result in the payment programs being reduced or eliminated. Because deliberations about these programs are ongoing, we are unable to estimate the financial impact the program structure modifications, if any, may have on our results of operations.

Operating Results Summary

The following is a comparative summary of results of operations for the quarters and nine months ended September 30, 2017 and 2016 (dollars in millions):

 

     Quarter  
     2017     2016  
     Amount     Ratio     Amount     Ratio  

Revenues before provision for doubtful accounts

   $ 11,967       $ 11,110    

Provision for doubtful accounts

     1,271         840    
  

 

 

     

 

 

   

Revenues

     10,696       100.0       10,270       100.0  

Salaries and benefits

     5,081       47.5       4,740       46.1  

Supplies

     1,777       16.6       1,699       16.5  

Other operating expenses

     2,075       19.4       1,896       18.5  

Equity in earnings of affiliates

     (13     (0.1     (22     (0.2

Depreciation and amortization

     539       5.0       495       4.9  

Interest expense

     427       4.0       432       4.2  

Gains on sales of facilities

     (7     (0.1     (3      

Losses on retirement of debt

     39       0.4       4        

Legal claim costs

                 11       0.1  
  

 

 

   

 

 

   

 

 

   

 

 

 
     9,918       92.7       9,252       90.1  
  

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     778       7.3       1,018       9.9  

Provision for income taxes

     248       2.3       273       2.6  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income

     530       5.0       745       7.3  

Net income attributable to noncontrolling interests

     104       1.0       127       1.3  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to HCA Healthcare, Inc.

   $ 426       4.0     $ 618       6.0  
  

 

 

   

 

 

   

 

 

   

 

 

 

% changes from prior year:

        

Revenues

     4.2       4.2  

Income before income taxes

     (23.6       20.6    

Net income attributable to HCA Healthcare, Inc.

     (31.1       37.7    

Admissions(a)

     2.7         0.7    

Equivalent admissions(b)

     2.5         1.5    

Revenue per equivalent admission

     1.6         2.7    

Same facility % changes from prior year(c):

        

Revenues

     2.3         4.0    

Admissions(a)

     0.6         0.7    

Equivalent admissions(b)

     0.3         1.3    

Revenue per equivalent admission

     2.0         2.7    

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (Continued)

Operating Results Summary (Continued)

 

     Nine Months  
     2017     2016  
     Amount     Ratio     Amount     Ratio  

Revenues before provision for doubtful accounts

   $ 35,156       $ 33,241    

Provision for doubtful accounts

     3,104         2,392    
  

 

 

     

 

 

   

Revenues

     32,052       100.0       30,849       100.0  

Salaries and benefits

     14,878       46.4       14,133       45.8  

Supplies

     5,369       16.8       5,131       16.6  

Other operating expenses

     5,970       18.6       5,617       18.2  

Equity in earnings of affiliates

     (36     (0.1     (44     (0.1

Depreciation and amortization

     1,581       4.9       1,463       4.8  

Interest expense

     1,257       3.9       1,275       4.1  

Gains on sales of facilities

     (10           (8      

Losses on retirement of debt

     39       0.1       4        

Legal claim costs

                 33       0.1  
  

 

 

   

 

 

   

 

 

   

 

 

 
     29,048       90.6       27,604       89.5  
  

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     3,004       9.4       3,245       10.5  

Provision for income taxes

     902       2.8       898       2.9  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income

     2,102       6.6       2,347       7.6  

Net income attributable to noncontrolling interests

     360       1.2       377       1.2  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to HCA Healthcare, Inc.

   $ 1,742       5.4     $ 1,970       6.4  
  

 

 

   

 

 

   

 

 

   

 

 

 

% changes from prior year:

        

Revenues

     3.9       4.8  

Income before income taxes

     (7.4       11.7    

Net income attributable to HCA Healthcare, Inc.

     (11.6       27.3    

Admissions(a)

     1.8         1.1    

Equivalent admissions(b)

     2.1         2.3    

Revenue per equivalent admission

     1.7         2.4    

Same facility % changes from prior year(c):

        

Revenues

     3.0         4.4    

Admissions(a)

     1.0         1.0    

Equivalent admissions(b)

     1.2         2.0    

Revenue per equivalent admission

     1.8         2.3    

 

(a) Represents the total number of patients admitted to our hospitals and is used by management and certain investors as a general measure of inpatient volume.
(b) Equivalent admissions are used by management and certain investors as a general measure of combined inpatient and outpatient volume. Equivalent admissions are computed by multiplying admissions (inpatient volume) by the sum of gross inpatient revenues and gross outpatient revenues and then dividing the resulting amount by gross inpatient revenues. The equivalent admissions computation “equates” outpatient revenues to the volume measure (admissions) used to measure inpatient volume, resulting in a general measure of combined inpatient and outpatient volume.
(c) Same facility information excludes the operations of hospitals and their related facilities which were either acquired or divested during the current and prior period.

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (Continued)

 

Quarters Ended September 30, 2017 and 2016

Net income attributable to HCA Healthcare, Inc. totaled $426 million, or $1.15 per diluted share, for the third quarter of 2017, compared to $618 million, or $1.59 per diluted share, for the third quarter of 2016. Third quarter 2017 results include additional expenses and losses of revenues estimated at approximately $140 million, or $0.24 per diluted share, associated with the impact of hurricanes Harvey and Irma on our Texas, Florida, Georgia and South Carolina facilities, and a negative impact to operating results related to the Texas Medicaid Waiver program of approximately $50 million, or $0.08 per diluted share, related to final settlement amounts for the program year ended September 30, 2017. The amount associated with the hurricanes is prior to any insurance recoveries which we may receive. Third quarter 2017 results also include net gains on sales of facilities of $7 million, or $0.01 per diluted share, and losses on retirement of debt of $39 million, or $0.07 per diluted share. Third quarter 2016 results include legal claim costs of $11 million, or $0.02 per diluted share, losses on retirement of debt of $4 million, or $0.01 per diluted share, and net gains on sales of facilities of $3 million, or $0.01 per diluted share. Our provision for income taxes for the third quarter of 2016 also included tax benefits of $51 million, or $0.13 per diluted share, primarily related to the resolution of federal income tax issues for our 2011 and 2012 tax years. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 369.834 million shares for the quarter ended September 30, 2017 and 389.592 million shares for the quarter ended September 30, 2016. During 2016 and the first nine months of 2017, we repurchased 36.325 million and 17.847 million shares of our common stock, respectively.

Revenues before provision for doubtful accounts increased 7.7% for the third quarter of 2017 compared to the third quarter of 2016. The provision for doubtful accounts increased $431 million, from $840 million in the third quarter of 2016 to $1.271 billion in the third quarter of 2017. The provision for doubtful accounts relates primarily to uninsured amounts due directly from patients, including copayment and deductible amounts for patients who have health care coverage. The self-pay revenue deductions for charity care and uninsured discounts increased $189 million and $256 million, respectively, during the third quarter of 2017, compared to the third quarter of 2016. The sum of the provision for doubtful accounts, uninsured discounts and charity care, as a percentage of the sum of revenues, the provision for doubtful accounts, uninsured discounts and charity care, was 36.3% for the third quarter of 2017, compared to 33.7% for the third quarter of 2016. At September 30, 2017, our allowance for doubtful accounts represented 99.1% of the $5.465 billion total patient due accounts receivable balance, including accounts, net of estimated contractual discounts, related to patients for which eligibility for Medicaid coverage or uninsured discounts was being evaluated.

Revenues increased 4.2% due to the combined impact of revenue per equivalent admission growth of 1.6% and a 2.5% increase in equivalent admissions for the third quarter of 2017 compared to the third quarter of 2016. Same facility revenues increased 2.3% due to the combined impact of a 2.0% increase in same facility revenue per equivalent admission and a 0.3% increase in same facility equivalent admissions for the third quarter of 2017 compared to the third quarter of 2016.

Salaries and benefits, as a percentage of revenues, were 47.5% in the third quarter of 2017 and 46.1% in the third quarter of 2016. Salaries and benefits per equivalent admission increased 4.6% in the third quarter of 2017 compared to the third quarter of 2016. Same facility labor rate increases averaged 3.3% for the third quarter of 2017 compared to the third quarter of 2016.

Supplies, as a percentage of revenues, were 16.6% in the third quarter of 2017 and 16.5% in the third quarter of 2016. Supply costs per equivalent admission increased 2.1% in the third quarter of 2017 compared to the third quarter of 2016. Supply costs per equivalent admission increased 2.9% for medical devices, 0.8% for pharmacy supplies and 1.8% for general medical and surgical items in the third quarter of 2017 compared to the third quarter of 2016.

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Quarters Ended September 30, 2017 and 2016 (continued)

 

Other operating expenses, as a percentage of revenues, were 19.4% in the third quarter of 2017 and 18.5% in the third quarter of 2016. Other operating expenses is primarily comprised of contract services, professional fees, repairs and maintenance, rents and leases, utilities, insurance (including professional liability insurance) and nonincome taxes. The increase in other operating expenses, as a percentage of revenues, for the third quarter of 2017 compared to the third quarter of 2016 was due to small increases in many of the other operating expense components. Provisions for losses related to professional liability risks were $116 million and $106 million for the third quarters of 2017 and 2016, respectively.

Equity in earnings of affiliates was $13 million and $22 million in the third quarters of 2017 and 2016, respectively.

Depreciation and amortization increased $44 million, from $495 million in the third quarter of 2016 to $539 million in the third quarter of 2017. The increase in depreciation relates to both acquired facilities and increased routine capital expenditures.

Interest expense was $427 million in the third quarter of 2017 and $432 million in the third quarter of 2016. Our average debt balance was $32.337 billion for the third quarter of 2017 compared to $31.358 billion for the third quarter of 2016. The average effective interest rate for our long-term debt declined to 5.2% from 5.5% for the quarters ended September 30, 2017 and 2016, respectively.

During the third quarters of 2017 and 2016, we recorded net gains on sales of facilities of $7 million and $3 million, respectively.

During June 2017, we issued $1.500 billion aggregate principal amount of 5.500% senior secured notes due 2047. We used the net proceeds for general corporate purposes, including funding the purchase of certain hospital acquisitions, and the redemption, during July 2017, of all $500 million aggregate principal amount of our existing 8.000% senior notes maturing in October 2018. The pretax loss on retirement of debt was $39 million. During August 2016, we issued $1.200 billion aggregate principal amount of 4.500% senior secured notes due 2027. We used the net proceeds for general corporate purposes and to retire a portion of one of our senior secured term loans. We also entered into a joinder agreement to retire the remaining portion of this senior secured term loan using proceeds from a new $1.200 billion senior secured term loan facility maturing in February 2024. The pretax loss on retirement of debt was $4 million.

We recorded $11 million of legal claim costs during the third quarter of 2016 related to the Health Midwest litigation.

The effective tax rates were 36.7% and 30.6% for the third quarters of 2017 and 2016, respectively. The effective tax rate computations exclude net income attributable to noncontrolling interests as it relates to consolidated partnerships. Our provisions for income taxes for the third quarters of 2017 and 2016 included tax benefits of $4 million and $11 million, respectively, related to excess tax benefits from employee equity award settlements. Our provision for income taxes for the third quarter of 2016 also included a tax benefit of $51 million primarily related to the resolution of federal income tax issues for our 2011 and 2012 tax years. Our provision for income taxes for the third quarter of 2017 also included $4 million of reductions in interest expense (net of tax). Excluding the effect of these adjustments, the effective tax rate for the third quarters of 2017 and 2016 would have been 37.8% and 37.6%, respectively.

Net income attributable to noncontrolling interests declined from $127 million for the third quarter of 2016 to $104 million for the third quarter of 2017. The decline in net income attributable to noncontrolling interests related primarily to one of our Texas markets.

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

 

Nine months Ended September 30, 2017 and 2016

Net income attributable to HCA Healthcare, Inc. totaled $1.742 billion, or $4.64 per diluted share, in the nine months ended September 30, 2017 compared to $1.970 billion, or $4.93 per diluted share, in the nine months ended September 30, 2016. The first nine months of 2017 results include additional expenses and losses of revenues estimated at approximately $140 million, or $0.24 per diluted share, associated with the impact of hurricanes Harvey and Irma on our Texas, Florida, Georgia and South Carolina facilities, and a negative impact to operating results related to the Texas Medicaid Waiver program of approximately $50 million, or $0.08 per diluted share, related to final settlement amounts for the program year ended September 30, 2017. The amount associated with the hurricanes is prior to any insurance recoveries which we may receive. The first nine months of 2017 results also include net gains on sales of facilities of $10 million, or $0.02 per diluted share, and losses on retirement of debt of $39 million, or $0.07 per diluted share. The first nine months of 2016 results include legal claim costs of $33 million, or $0.05 per diluted share, losses on retirement of debt of $4 million, or $0.01 per diluted share, and net gains on sales of facilities of $8 million, or $0.01 per diluted share. Our provision for income taxes for the first nine months of 2016 also included tax benefits of $51 million, or $0.13 per diluted share, primarily related to the resolution of federal income tax issues for our 2011 and 2012 tax years. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 375.013 million shares and 399.577 million shares for the nine months ended September 30, 2017 and 2016, respectively. During 2016 and the first nine months of 2017, we repurchased 36.325 million and 17.847 million shares of our common stock, respectively.

For the first nine months of 2017, consolidated and same facility admissions increased 1.8% and 1.0%, respectively, compared to the first nine months of 2016. Consolidated and same facility outpatient surgical volumes declined 0.8% and 2.0%, respectively, during the first nine months of 2017, compared to the first nine months of 2016. Consolidated and same facility inpatient surgeries increased 1.0% and 0.1%, respectively, in the first nine months of 2017, compared to the first nine months of 2016. Consolidated and same facility emergency department visits increased 1.7% and 0.7%, respectively, during the nine months ended September 30, 2017, compared to the nine months ended September 30, 2016.

Revenues before provision for doubtful accounts increased 5.8% for the first nine months of 2017 compared to the first nine months of 2016. Provision for doubtful accounts increased $712 million from $2.392 billion in the first nine months of 2016 to $3.104 billion in the first nine months of 2017. The provision for doubtful accounts relates primarily to uninsured amounts due directly from patients, including copayment and deductible amounts for patients who have health care coverage. The self-pay revenue deductions for charity care and uninsured discounts increased $394 million and $1.000 billion, respectively, during the first nine months of 2017, compared to the first nine months of 2016. The sum of the provision for doubtful accounts, uninsured discounts and charity care, as a percentage of the sum of revenues, the provision for doubtful accounts, uninsured discounts and charity care, was 34.8% for the first nine months of 2017, compared to 32.8% for the first nine months of 2016. At September 30, 2017, our allowance for doubtful accounts represented approximately 99.1% of the $5.465 billion total patient due accounts receivable balance, including accounts, net of estimated contractual discounts, related to patients for which eligibility for Medicaid coverage or uninsured discounts was being evaluated.

Revenues increased 3.9% primarily due to the combined impact of revenue per equivalent admission growth of 1.7% and an increase of 2.1% in equivalent admissions for the first nine months of 2017 compared to the first nine months of 2016. Same facility revenues increased 3.0% due to the combined impact of a 1.8% increase in same facility revenue per equivalent admission and a 1.2% increase in same facility equivalent admissions for the first nine months of 2017 compared to the first nine months of 2016.

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Nine months Ended September 30, 2017 and 2016 (continued)

 

Salaries and benefits, as a percentage of revenues, were 46.4% in the first nine months of 2017 and 45.8% in the first nine months of 2016. Salaries and benefits per equivalent admission increased 3.1% in the first nine months of 2017 compared to the first nine months of 2016. Same facility labor rate increases averaged 2.7% for the first nine months of 2017 compared to the first nine months of 2016.

Supplies, as a percentage of revenues, were 16.8% in the first nine months of 2017 and 16.6% in the first nine months of 2016. Supply costs per equivalent admission increased 2.5% in the first nine months of 2017 compared to the first nine months of 2016. Supply costs per equivalent admission increased 5.1% for medical devices and 1.6% for general medical and surgical items, and were flat for pharmacy supplies in the first nine months of 2017 compared to the first nine months of 2016.

Other operating expenses, as a percentage of revenues, increased to 18.6% in the first nine months of 2017 from 18.2% in the first nine months of 2016. Other operating expenses is primarily comprised of contract services, professional fees, repairs and maintenance, rents and leases, utilities, insurance (including professional liability insurance) and nonincome taxes. Provisions for losses related to professional liability risks were $353 million and $329 million for the first nine months of 2017 and 2016, respectively.

Equity in earnings of affiliates was $36 million and $44 million in the first nine months of 2017 and 2016, respectively.

Depreciation and amortization increased $118 million, from $1.463 billion in the first nine months of 2016 to $1.581 billion in the first nine months of 2017. The increase in depreciation relates to both acquired facilities and increased routine capital expenditures.

Interest expense was $1.257 billion for the first nine months of 2017 and $1.275 billion for the first nine months of 2016. Our average debt balance was $31.846 billion for the first nine months of 2017 compared to $31.002 billion for the first nine months of 2016. The average effective interest rate for our long-term debt declined from 5.5% for the nine months ended September 30, 2016 to 5.3% for the nine months ended September 30, 2017.

During the first nine months of 2017 and 2016, we recorded net gains on sales of facilities of $10 million and $8 million, respectively.

During June 2017, we issued $1.500 billion aggregate principal amount of 5.500% senior secured notes due 2047. We used the net proceeds for general corporate purposes, including funding the purchase of certain hospital acquisitions, and the redemption, during July 2017, of all $500 million aggregate principal amount of our existing 8.000% senior notes maturing in October 2018. The pretax loss on retirement of debt was $39 million. During August 2016, we issued $1.200 billion aggregate principal amount of 4.500% senior secured notes due 2027. We used the net proceeds for general corporate purposes and to retire a portion of one of our senior secured term loans. We also entered into a joinder agreement to retire the remaining portion of this senior secured term loan using proceeds from a new $1.200 billion senior secured term loan facility maturing in February 2024. The pretax loss on retirement of debt was $4 million.

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Nine months Ended September 30, 2017 and 2016 (continued)

 

We recorded $33 million of legal claim costs during the first nine months of 2016 related to the Health Midwest litigation.

The effective tax rates were 34.1% and 31.3% for the first nine months of 2017 and 2016, respectively. The effective tax rate computations exclude net income attributable to noncontrolling interests as it relates to consolidated partnerships. Our provision for income taxes for the first nine months of 2017 and 2016 included tax benefits of $80 million and $129 million, respectively, related to excess tax benefits from employee equity award settlements. Our provision for income taxes for the first nine months of 2016 also included a tax benefit of $51 million primarily related to the resolution of federal income tax issues for our 2011 and 2012 tax years. Our provision for income taxes for the first nine months of 2017 also included $16 million of reductions in interest expense (net of tax). Excluding the effect of these adjustments, the effective tax rate for the first nine months of 2017 and 2016 would have been 37.7% and 37.6%, respectively.

Net income attributable to noncontrolling interests declined from $377 million for the first nine months of 2016 to $360 million for the first nine months of 2017. The decline in net income attributable to noncontrolling interests related primarily to one of our Texas markets.

Liquidity and Capital Resources

Cash provided by operating activities totaled $3.692 billion in the first nine months of 2017 compared to $3.954 billion in the first nine months of 2016. The $262 million decline in cash provided by operating activities in the first nine months of 2017 compared to the first nine months of 2016 primarily related to the $245 million decline in net income. The combined interest payments and net tax payments in the first nine months of 2017 and 2016 were $2.294 billion and $2.229 billion, respectively. Working capital totaled $3.837 billion at September 30, 2017 and $3.252 billion at December 31, 2016.

Cash used in investing activities was $3.172 billion in the first nine months of 2017 compared to $2.234 billion in the first nine months of 2016. Acquisitions of hospitals and health care entities increased from $468 million in the first nine months of 2016 to $1.142 billion in the first nine months of 2017. Excluding acquisitions, capital expenditures were $2.033 billion in the first nine months of 2017 and $1.884 billion in the first nine months of 2016. Capital expenditures, excluding acquisitions, are expected to approximate $3.0 billion in 2017. At September 30, 2017, there were projects under construction which had estimated additional costs to complete and equip over the next five years of approximately $3.5 billion. We expect to finance capital expenditures with internally generated and borrowed funds.

Cash used in financing activities totaled $448 million in the first nine months of 2017 compared to $1.784 billion in the first nine months of 2016. During the first nine months of 2017, net cash flows used in financing activities included a net increase of $1.452 billion in our indebtedness, repurchases of common stock of $1.475 billion, distributions to noncontrolling interests of $363 million and payments of debt issuance costs of $25 million. During the first nine months of 2016, net cash flows used in financing activities included a net increase of $906 million in our indebtedness, repurchases of common stock of $2.213 billion, distributions to noncontrolling interests of $342 million and payments of debt issuance costs of $40 million.

We are a highly leveraged company with significant debt service requirements. Our debt totaled $32.953 billion at September 30, 2017. Our interest expense was $1.257 billion for the first nine months of 2017 and $1.275 billion for the first nine months of 2016.

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Liquidity and Capital Resources (continued)

 

In addition to cash flows from operations, available sources of capital include amounts available under our senior secured credit facilities ($2.037 billion and $2.154 billion available as of September 30, 2017 and October 31, 2017, respectively) and anticipated access to public and private debt markets.

During June 2017, we issued $1.500 billion aggregate principal amount of 5.500% senior secured notes due 2047. We used the net proceeds for general corporate purposes, including funding the purchase of certain hospital acquisitions, and the redemption, during July 2017, of all $500 million aggregate principal amount of our existing 8.000% senior notes maturing in October 2018. The pretax loss on retirement of debt was $39 million.

During June 2017, we amended our senior secured revolving credit facilities by (i) increasing the commitments under the senior secured asset-based revolving credit facility to $3.750 billion, (ii) extending the maturity date of the revolving credit commitments to June 28, 2022, (iii) amending the incremental facility provisions to permit the incurrence of additional incremental credit facilities in an aggregate principal amount of $1.5 billion and (iv) providing that the commitment fee for unutilized commitments under the senior secured asset-based revolving credit facility shall be 0.250% per annum.

During August 2016, we issued $1.200 billion aggregate principal amount of 4.500% senior secured notes due 2027. We used the net proceeds for general corporate purposes and to retire a portion of one of our senior secured term loans. We also entered into a joinder agreement to retire the remaining portion of this senior secured term loan using proceeds from a new $1.200 billion senior secured term loan facility maturing in February 2024. The pretax loss on retirement of debt was $4 million.

During March 2016, we issued $1.500 billion aggregate principal amount of 5.250% senior secured notes due 2026. We used the net proceeds for general corporate purposes and to retire a portion of one of our senior secured term loans. We also entered into a joinder agreement to retire the remaining portion of this senior secured term loan using proceeds from a new $1.500 billion senior secured term loan facility maturing in March 2023.

Investments of our professional liability insurance subsidiaries, to maintain statutory equity and pay claims, totaled $421 million and $385 million at September 30, 2017 and December 31, 2016, respectively. An insurance subsidiary maintained net reserves for professional liability risks of $202 million and $215 million at September 30, 2017 and December 31, 2016, respectively. Our facilities are insured by a 100% owned insurance subsidiary for losses up to $50 million per occurrence; however, this coverage is subject to a $15 million per occurrence self-insured retention. Net reserves for the self-insured professional liability risks retained were $1.378 billion and $1.279 billion at September 30, 2017 and December 31, 2016, respectively. Claims payments, net of reinsurance recoveries, during the next 12 months are expected to approximate $419 million. We estimate that approximately $372 million of the expected net claim payments during the next 12 months will relate to claims subject to the self-insured retention.

Management believes that cash flows from operations, amounts available under our senior secured credit facilities and our anticipated access to public and private debt markets will be sufficient to meet expected liquidity needs during the next 12 months.

Market Risk

We are exposed to market risk related to changes in market values of securities. The investments in debt and equity securities of our 100% owned insurance subsidiaries were $418 million and $3 million, respectively, at

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Liquidity and Capital Resources (continued)

Market Risk (continued)

 

September 30, 2017. These investments are carried at fair value, with changes in unrealized gains and losses being recorded as adjustments to other comprehensive income. At September 30, 2017, we had a net unrealized gain of $16 million on the insurance subsidiaries’ investment securities.

We are exposed to market risk related to market illiquidity. Investments in debt and equity securities of our 100% owned insurance subsidiaries could be impaired by the inability to access the capital markets. Should the 100% owned insurance subsidiaries require significant amounts of cash in excess of normal cash requirements to pay claims and other expenses on short notice, we may have difficulty selling these investments in a timely manner or be forced to sell them at a price less than what we might otherwise have been able to in a normal market environment. We may be required to recognize other-than-temporary impairments on our investment securities in future periods should issuers default on interest payments or should the fair market valuations of the securities deteriorate due to ratings downgrades or other issue-specific factors.

We are also exposed to market risk related to changes in interest rates, and we periodically enter into interest rate swap agreements to manage our exposure to these fluctuations. Our interest rate swap agreements involve the exchange of fixed and variable rate interest payments between two parties, based on common notional principal amounts and maturity dates. The notional amounts of the swap agreements represent balances used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions. The interest payments under these agreements are settled on a net basis. These derivatives have been recognized in the financial statements at their respective fair values. Changes in the fair value of these derivatives, which are designated as cash flow hedges, are included in other comprehensive income, and changes in the fair value of derivatives which have not been designated as hedges are recorded in operations.

With respect to our interest-bearing liabilities, approximately $4.486 billion of long-term debt at September 30, 2017 was subject to variable rates of interest, while the remaining balance in long-term debt of $28.467 billion at September 30, 2017 was subject to fixed rates of interest. Both the general level of interest rates and, for the senior secured credit facilities, our leverage affect our variable interest rates. Our variable debt is comprised primarily of amounts outstanding under the senior secured credit facilities. Borrowings under the senior secured credit facilities bear interest at a rate equal to an applicable margin plus, at our option, either (a) a base rate determined by reference to the higher of (1) the federal funds rate plus 0.50% and (2) the prime rate of Bank of America or (b) a LIBOR rate for the currency of such borrowing for the relevant interest period. The applicable margin for borrowings under the senior secured credit facilities may fluctuate according to a leverage ratio. The average effective interest rate for our long-term debt declined from 5.5% for the nine months ended September 30, 2016 to 5.3% for the nine months ended September 30, 2017.

The estimated fair value of our total long-term debt was $34.998 billion at September 30, 2017. The estimates of fair value are based upon the quoted market prices for the same or similar issues of long-term debt with the same maturities. Based on a hypothetical 1% increase in interest rates, the potential annualized reduction to future pretax earnings would be approximately $45 million. To mitigate the impact of fluctuations in interest rates, we generally target a portion of our debt portfolio to be maintained at fixed rates.

We are exposed to currency translation risk related to our foreign operations. Our international operations represented 2.6% and 2.5%, respectively, of our consolidated revenues for the quarter and nine months ended September 30, 2017. The United Kingdom’s vote to exit the European Union in June 2016 contributed to a 16.8% decline in the Great British pound (GBP) to US dollar (USD) translation ratio during 2016. However, the GBP/USD translation ratio has stabilized (6.6% increase) during the first nine months of 2017. We currently do not consider the market risk related to GBP/USD translation to be material to our consolidated financial statements or our liquidity.

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Tax Examinations

We are subject to examination by federal, state and foreign taxing authorities. Management believes HCA Healthcare, Inc. and its predecessors, subsidiaries and affiliates properly reported taxable income and paid taxes in accordance with applicable laws and agreements established with IRS, state and foreign taxing authorities and final resolution of any disputes will not have a material, adverse effect on our results of operations or financial position. However, if payments due upon final resolution of any issues exceed our recorded estimates, such resolutions could have a material, adverse effect on our results of operations or financial position.

Operating Data

 

     2017      2016  

Number of hospitals in operation at:

     

March 31

     171        168  

June 30

     172        169  

September 30

     177        169  

December 31

        170  

Number of freestanding outpatient surgical centers in operation at:

     

March 31

     118        116  

June 30

     119        116  

September 30

     119        117  

December 31

        118  

Licensed hospital beds at(a):

     

March 31

     44,374        43,817  

June 30

     44,727        44,127  

September 30

     46,250        44,226  

December 31

        44,290  

Weighted average licensed beds(b):

     

Quarter:

     

First

     44,362        43,780  

Second

     44,605        44,064  

Third

     45,887        44,188  

Fourth

        44,274  

Year

        44,077  

Average daily census(c):

     

Quarter:

     

First

     26,699        26,325  

Second

     25,353        25,199  

Third

     25,653        24,748  

Fourth

        25,096  

Year

        25,340  

Admissions(d):

     

Quarter:

     

First

     485,761        479,568  

Second

     473,174        467,218  

Third

     482,557        469,764  

Fourth

        475,281  

Year

        1,891,831  

Equivalent admissions(e):

     

Quarter:

     

First

     812,192        798,001  

Second

     809,367        792,599  

Third

     818,887        799,120  

Fourth

        801,799  

Year

        3,191,519  

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Operating Data (Continued)

 

     2017     2016  

Average length of stay (days)(f):

    

Quarter:

    

First

     4.9       5.0  

Second

     4.9       4.9  

Third

     4.9       4.8  

Fourth

       4.9  

Emergency room visits(g):

    

Quarter:

    

First

     2,163,138       2,133,289  

Second

     2,116,123       2,093,039  

Third

     2,130,460       2,077,938  

Fourth

       2,074,074  

Year

       8,378,340  

Outpatient surgeries(h):

    

Quarter:

    

First

     225,915       226,486  

Second

     234,215       234,578  

Third

     224,252       229,054  

Fourth

       242,095  

Year

       932,213  

Inpatient surgeries(i):

    

Quarter:

    

First

     133,341       131,840  

Second

     134,553       134,068  

Third

     137,187       135,013  

Fourth

       136,385  

Year

       537,306  

Days revenues in accounts receivable(j):

    

Quarter:

    

First

     48       52  

Second

     49       50  

Third

     51       49  

Fourth

       50  

Outpatient revenues as a % of patient revenues(k):

    

Quarter:

    

First

     37     38

Second

     38     38

Third

     38     39

Fourth

       39

Year

       38

 

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Operating Data (Continued)

 

BALANCE SHEET DATA

 

     % of Accounts Receivable  
     Under 91 Days     91 – 180 Days     Over 180 Days  

Accounts receivable aging at September 30, 2017(l):

      

Medicare and Medicaid

     11     1     1

Managed care and other discounted

     29       5       5  

Uninsured

     21       6       21  
  

 

 

   

 

 

   

 

 

 

Total

     61     12     27
  

 

 

   

 

 

   

 

 

 

 

(a) Licensed beds are those beds for which a facility has been granted approval to operate from the applicable state licensing agency.
(b) Represents the average number of licensed beds, weighted based on periods owned.
(c) Represents the average number of patients in our hospital beds each day.
(d) Represents the total number of patients admitted to our hospitals and is used by management and certain investors as a general measure of inpatient volume.
(e) Equivalent admissions are used by management and certain investors as a general measure of combined inpatient and outpatient volume. Equivalent admissions are computed by multiplying admissions (inpatient volume) by the sum of gross inpatient revenues and gross outpatient revenues and then dividing the resulting amount by gross inpatient revenues. The equivalent admissions computation “equates” outpatient revenues to the volume measure (admissions) used to measure inpatient volume resulting in a general measure of combined inpatient and outpatient volume.
(f) Represents the average number of days admitted patients stay in our hospitals.
(g) Represents the number of patients treated in our emergency rooms.
(h) Represents the number of surgeries performed on patients who were not admitted to our hospitals. Pain management and endoscopy procedures are not included in outpatient surgeries.
(i) Represents the number of surgeries performed on patients who have been admitted to our hospitals. Pain management and endoscopy procedures are not included in inpatient surgeries.
(j) Revenues per day is calculated by dividing the revenues for the quarter by the days in the quarter. Days revenues in accounts receivable is then calculated as accounts receivable, net of allowance for doubtful accounts, at the end of the quarter divided by the revenues per day. “Revenues” used in this computation are net of the provision for doubtful accounts.
(k) Represents the percentage of patient revenues related to patients who are not admitted to our hospitals.
(l) Accounts receivable aging data is based upon consolidated gross accounts receivable of $11.396 billion (each 1% is equivalent to approximately $114 million of gross accounts receivable).

 

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ITEM 3.

    QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

The information called for by this item is provided under the caption “Market Risk” under Item 2, “Management’s Discussion and Analysis of Financial Condition and Results of Operations.”

ITEM 4.    CONTROLS AND PROCEDURES

Evaluation of Disclosure Controls and Procedures

HCA’s chief executive officer and chief financial officer have reviewed and evaluated the effectiveness of HCA’s disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) promulgated under the Securities Exchange Act of 1934) as of the end of the period covered by this quarterly report. Based on that evaluation, the chief executive officer and chief financial officer have concluded HCA’s disclosure controls and procedures were effective.

Changes in Internal Control Over Financial Reporting

During the period covered by this report, there have been no changes in our internal control over financial reporting that have materially affected or are reasonably likely to materially affect our internal control over financial reporting.

PART II. OTHER INFORMATION

ITEM 1.    LEGAL PROCEEDINGS

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. Further, under the federal False Claims Act, private parties have the right to bring qui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying 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.

ITEM 1A.    RISK FACTORS

Reference is made to the factors set forth under the caption “Forward-Looking Statements” in Part I, Item 2 of this quarterly report on Form 10-Q and other risk factors described in our annual report on Form 10-K for the year ended December 31, 2016, which are incorporated herein by reference. There have not been any material changes to the risk factors previously disclosed in our annual report on Form 10-K for the year ended December 31, 2016.

 

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ITEM 2.    UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

During the quarter ended September 30, 2017, we repurchased 6,321,873 shares of our common stock at an average price of $80.44 per share through market purchases pursuant to the $2 billion share repurchase program authorized during November 2016. At September 30, 2017, we had $379 million of repurchase authorization available under the November 2016 authorization. During October 2017, our board of directors authorized a share repurchase program for up to $2 billion of our outstanding common stock.

The following table provides certain information with respect to our repurchases of common stock from July 1, 2017 through September 30, 2017 (dollars in millions, except per share amounts).

 

Period

   Total Number
of Shares
Purchased
     Average Price
Paid per Share
     Total Number
of Shares
Purchased as
Part  of
Publicly
Announced
Plans or
Programs
     Approximate
Dollar Value of
Shares That
May Yet  Be
Purchased
Under Publicly
Announced
Plans or
Programs
 

July 1, 2017 through July 31, 2017

     1,663,241      $ 86.05        1,663,241      $ 744  

August 1, 2017 through August 31, 2017

     2,001,470      $ 79.22        2,001,470      $ 585  

September 1, 2017 through September 30, 2017

     2,657,162      $ 77.85        2,657,162      $ 379  
  

 

 

       

 

 

    

Total for third quarter 2017

     6,321,873      $ 80.44        6,321,873      $ 379  
  

 

 

       

 

 

    

 

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ITEM 6.

    EXHIBITS

(a) List of Exhibits:

 

    31.1     

Certification of Chief Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

    31.2     

Certification of Chief Financial Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

    32     

Certification Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section  906 of the Sarbanes-Oxley Act of 2002.

  101     

The following financial information from our quarterly report on Form 10-Q for the quarters and the nine months ended September 30, 2017 and 2016, filed with the SEC on November 7, 2017, formatted in Extensible Business Reporting Language: (i) the condensed consolidated balance sheets at September 30, 2017 and December 31, 2016, (ii) the condensed consolidated income statements for the quarters and nine months ended September 30, 2017 and 2016, (iii) the condensed consolidated comprehensive income statements for the quarters and nine months ended September 30, 2017 and 2016, (iv) the condensed consolidated statements of cash flows for the nine months ended September 30, 2017 and 2016 and (v) the notes to condensed consolidated financial statements.

 

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SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

 

HCA Healthcare, Inc.

By:

 

/S/ WILLIAM B. RUTHERFORD

  William B. Rutherford
  Executive Vice President and Chief Financial Officer

Date: November 7, 2017

 

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