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HCA Healthcare, Inc. - Quarter Report: 2023 June (Form 10-Q)

10-Q

 

 

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 June 30, 2023

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)

Securities registered pursuant to Section 12(b) of the Act:

 

 

 

Title of each class

Trading Symbol(s)

Name of each exchange on which registered

Voting common stock, $.01 par value

HCA

New York Stock Exchange

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 every Interactive Data File required to be submitted 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 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

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 July 31, 2023

Voting common stock, $.01 par value

271,988,000 shares

 

 

 


 

HCA HEALTHCARE, INC.

Form 10-Q

June 30, 2023

 

 

 

Page of
Form 10-Q

Part I.

Financial Information

Item 1.

Financial Statements (Unaudited):

Condensed Consolidated Income Statements — for the quarters and six months ended June 30, 2023 and 2022

3

 

 

 

Condensed Consolidated Comprehensive Income Statements — for the quarters and six months ended June 30, 2023 and 2022

4

 

Condensed Consolidated Balance Sheets — June 30, 2023 and December 31, 2022

5

 

Condensed Consolidated Statements of Stockholders’ Equity (Deficit) — for the quarters and six months ended June 30, 2023 and 2022

6

 

Condensed Consolidated Statements of Cash Flows — for the six months ended June 30, 2023 and 2022

7

 

Notes to Condensed Consolidated Financial Statements

8

 

Item 2.

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

16

 

Item 3.

Quantitative and Qualitative Disclosures About Market Risk

29

 

Item 4.

Controls and Procedures

29

Part II.

Other Information

Item 1.

Legal Proceedings

29

 

Item 1A.

Risk Factors

29

 

Item 2.

Unregistered Sales of Equity Securities and Use of Proceeds

29

 

Item 5.

OOther Information

30

 

 

 

Item 6.

Exhibits

30

 

Signatures

31

2


 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED INCOME STATEMENTS

FOR THE QUARTERS AND SIX MONTHS ENDED JUNE 30, 2023 AND 2022

Unaudited

(Dollars in millions, except per share amounts)

 

 

 

Quarter

 

 

Six Months

 

 

2023

 

 

2022

 

 

2023

 

 

2022

 

Revenues

 

$

15,861

 

 

$

14,820

 

 

$

31,452

 

 

$

29,765

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,277

 

 

 

6,792

 

 

 

14,361

 

 

 

13,731

 

Supplies

 

 

2,478

 

 

 

2,301

 

 

 

4,901

 

 

 

4,622

 

Other operating expenses

 

 

3,043

 

 

 

2,693

 

 

 

5,937

 

 

 

5,445

 

Equity in losses (earnings) of affiliates

 

 

7

 

 

 

(8

)

 

 

25

 

 

 

(19

)

Depreciation and amortization

 

 

763

 

 

 

738

 

 

 

1,519

 

 

 

1,470

 

Interest expense

 

 

485

 

 

 

434

 

 

 

964

 

 

 

842

 

Losses (gains) on sales of facilities

 

 

(1

)

 

 

32

 

 

 

14

 

 

 

22

 

Losses on retirement of debt

 

 

 

 

 

78

 

 

 

 

 

 

78

 

 

 

14,052

 

 

 

13,060

 

 

 

27,721

 

 

 

26,191

 

Income before income taxes

 

 

1,809

 

 

 

1,760

 

 

 

3,731

 

 

 

3,574

 

Provision for income taxes

 

 

397

 

 

 

381

 

 

 

776

 

 

 

730

 

Net income

 

 

1,412

 

 

 

1,379

 

 

 

2,955

 

 

 

2,844

 

Net income attributable to noncontrolling interests

 

 

219

 

 

 

224

 

 

 

399

 

 

 

416

 

Net income attributable to HCA Healthcare, Inc.

 

$

1,193

 

 

$

1,155

 

 

$

2,556

 

 

$

2,428

 

Per share data:

 

 

 

 

 

 

 

 

 

 

 

 

Basic earnings

 

$

4.35

 

 

$

3.95

 

 

$

9.27

 

 

$

8.16

 

Diluted earnings

 

$

4.29

 

 

$

3.90

 

 

$

9.14

 

 

$

8.05

 

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

 

 

 

 

 

 

 

 

 

 

 

 

Basic

 

 

274.494

 

 

 

292.527

 

 

 

275.695

 

 

 

297.459

 

Diluted

 

 

278.198

 

 

 

296.061

 

 

 

279.573

 

 

 

301.690

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The accompanying notes are an integral part of the condensed consolidated financial statements.

3


 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED COMPREHENSIVE INCOME STATEMENTS

FOR THE QUARTERS AND SIX MONTHS ENDED JUNE 30, 2023 AND 2022

Unaudited

(Dollars in millions)

 

 

 

Quarter

 

 

Six Months

 

 

2023

 

 

2022

 

 

2023

 

 

2022

 

Net income

 

$

1,412

 

 

$

1,379

 

 

$

2,955

 

 

$

2,844

 

Other comprehensive income (loss) before taxes:

 

 

 

 

 

 

 

 

 

 

 

 

Foreign currency translation

 

 

20

 

 

 

(71

)

 

 

38

 

 

 

(105

)

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

(5

)

 

 

(16

)

 

 

2

 

 

 

(42

)

Losses included in other operating expenses

 

 

 

 

 

1

 

 

 

 

 

 

1

 

 

 

 

(5

)

 

 

(15

)

 

 

2

 

 

 

(41

)

 

 

 

 

 

 

 

 

 

 

 

 

 

Defined benefit plans

 

 

 

 

 

 

 

 

 

 

 

 

Pension costs included in salaries and benefits

 

 

 

 

 

3

 

 

 

 

 

 

5

 

 

 

 

 

 

3

 

 

 

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Change in fair value of derivative financial instruments

 

 

 

 

 

1

 

 

 

 

 

 

5

 

Interest costs included in interest expense

 

 

 

 

 

2

 

 

 

 

 

 

4

 

 

 

 

 

 

3

 

 

 

 

 

 

9

 

Other comprehensive income (loss) before taxes

 

 

15

 

 

 

(80

)

 

 

40

 

 

 

(132

)

Income taxes (benefits) related to other comprehensive income items

 

 

1

 

 

 

(12

)

 

 

6

 

 

 

(21

)

Other comprehensive income (loss)

 

 

14

 

 

 

(68

)

 

 

34

 

 

 

(111

)

Comprehensive income

 

 

1,426

 

 

 

1,311

 

 

 

2,989

 

 

 

2,733

 

Comprehensive income attributable to noncontrolling interests

 

 

219

 

 

 

224

 

 

 

399

 

 

 

416

 

Comprehensive income attributable to HCA Healthcare, Inc.

 

$

1,207

 

 

$

1,087

 

 

$

2,590

 

 

$

2,317

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The accompanying notes are an integral part of the condensed consolidated financial statements.

4


 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

Unaudited

(Dollars in millions)

 

 

June 30,
2023

 

 

December 31,
2022

 

ASSETS

 

 

 

 

 

 

Current assets:

 

 

 

 

 

 

Cash and cash equivalents

 

$

862

 

 

$

908

 

Accounts receivable

 

 

8,713

 

 

 

8,891

 

Inventories

 

 

2,050

 

 

 

2,068

 

Other

 

 

2,263

 

 

 

1,776

 

 

 

13,888

 

 

 

13,643

 

 

 

 

 

 

 

 

Property and equipment, at cost

 

 

56,667

 

 

 

54,757

 

Accumulated depreciation

 

 

(30,023

)

 

 

(29,182

)

 

 

26,644

 

 

 

25,575

 

 

 

 

 

 

 

 

Investments of insurance subsidiaries

 

 

384

 

 

 

381

 

Investments in and advances to affiliates

 

 

731

 

 

 

823

 

Goodwill and other intangible assets

 

 

9,641

 

 

 

9,653

 

Right-of-use operating lease assets

 

 

2,110

 

 

 

2,065

 

Other

 

 

196

 

 

 

298

 

 

$

53,594

 

 

$

52,438

 

LIABILITIES AND STOCKHOLDERS’ EQUITY (DEFICIT)

 

 

 

 

 

 

Current liabilities:

 

 

 

 

 

 

Accounts payable

 

$

3,823

 

 

$

4,239

 

Accrued salaries

 

 

1,776

 

 

 

1,712

 

Other accrued expenses

 

 

3,551

 

 

 

3,581

 

Long-term debt due within one year

 

 

2,395

 

 

 

370

 

 

 

11,545

 

 

 

9,902

 

 

 

 

 

 

 

 

Long-term debt, less debt issuance costs and discounts of $349 and $301

 

 

36,537

 

 

 

37,714

 

Professional liability risks

 

 

1,554

 

 

 

1,528

 

Right-of-use operating lease obligations

 

 

1,806

 

 

 

1,752

 

Income taxes and other liabilities

 

 

1,691

 

 

 

1,615

 

 

 

 

 

 

 

 

Stockholders’ equity (deficit):

 

 

 

 

 

 

Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 272,931,700 shares — 2023 and 277,378,300 shares — 2022

 

 

3

 

 

 

3

 

Accumulated other comprehensive loss

 

 

(456

)

 

 

(490

)

Retained deficit

 

 

(1,850

)

 

 

(2,280

)

Stockholders’ deficit attributable to HCA Healthcare, Inc.

 

 

(2,303

)

 

 

(2,767

)

Noncontrolling interests

 

 

2,764

 

 

 

2,694

 

 

 

461

 

 

 

(73

)

 

$

53,594

 

 

$

52,438

 

 

 

 

 

The accompanying notes are an integral part of the condensed consolidated financial statements.

5


 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY (DEFICIT)

FOR THE QUARTERS AND SIX MONTHS ENDED JUNE 30, 2023 AND 2022

Unaudited

(Dollars in millions)

 

 

Equity (Deficit) Attributable to HCA Healthcare, Inc.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Capital

 

 

Accumulated

 

 

 

 

 

Equity

 

 

 

 

 

Common Stock

 

 

in Excess

 

 

Other

 

 

 

 

 

Attributable to

 

 

 

 

 

Shares

 

 

Par

 

 

of Par

 

 

Comprehensive

 

 

Retained

 

 

Noncontrolling

 

 

 

 

 

(in millions)

 

 

Value

 

 

Value

 

 

Loss

 

 

Deficit

 

 

Interests

 

 

Total

 

Balances, December 31, 2021

 

 

305.477

 

 

$

3

 

 

$

 

 

$

(404

)

 

$

(532

)

 

$

2,422

 

 

$

1,489

 

Comprehensive income (loss)

 

 

 

 

 

 

 

 

 

 

 

(43

)

 

 

1,273

 

 

 

192

 

 

 

1,422

 

Repurchase of common stock

 

 

(8.375

)

 

 

 

 

 

 

 

 

 

 

 

(2,101

)

 

 

 

 

 

(2,101

)

Share-based benefit plans

 

 

1.879

 

 

 

 

 

 

 

 

 

 

 

 

(57

)

 

 

 

 

 

(57

)

Cash dividends declared
   ($
0.56 per share)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(171

)

 

 

 

 

 

(171

)

Distributions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(171

)

 

 

(171

)

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1

)

 

 

4

 

 

 

3

 

Balances, March 31, 2022

 

 

298.981

 

 

 

3

 

 

 

 

 

 

(447

)

 

 

(1,589

)

 

 

2,447

 

 

 

414

 

Comprehensive income (loss)

 

 

 

 

 

 

 

 

 

 

 

(68

)

 

 

1,155

 

 

 

224

 

 

 

1,311

 

Repurchase of common stock

 

 

(12.230

)

 

 

 

 

 

(111

)

 

 

 

 

 

(2,571

)

 

 

 

 

 

(2,682

)

Share-based benefit plans

 

 

0.253

 

 

 

 

 

 

118

 

 

 

 

 

 

 

 

 

 

 

 

118

 

Cash dividends declared
   ($
0.56 per share)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(163

)

 

 

 

 

 

(163

)

Distributions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(162

)

 

 

(162

)

Other

 

 

 

 

 

 

 

 

(7

)

 

 

 

 

 

 

 

 

29

 

 

 

22

 

Balances, June 30, 2022

 

 

287.004

 

 

 

3

 

 

 

 

 

 

(515

)

 

 

(3,168

)

 

 

2,538

 

 

 

(1,142

)

Comprehensive income (loss)

 

 

 

 

 

 

 

 

 

 

 

(77

)

 

 

1,134

 

 

 

210

 

 

 

1,267

 

Repurchase of common stock

 

 

(3.361

)

 

 

 

 

 

(113

)

 

 

 

 

 

(585

)

 

 

 

 

 

(698

)

Share-based benefit plans

 

 

0.261

 

 

 

 

 

 

116

 

 

 

 

 

 

 

 

 

 

 

 

116

 

Cash dividends declared
   ($
0.56 per share)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(162

)

 

 

 

 

 

(162

)

Distributions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(217

)

 

 

(217

)

Other

 

 

 

 

 

 

 

 

(3

)

 

 

 

 

 

 

 

 

61

 

 

 

58

 

Balances, September 30, 2022

 

 

283.904

 

 

 

3

 

 

 

 

 

 

(592

)

 

 

(2,781

)

 

 

2,592

 

 

 

(778

)

Comprehensive income

 

 

 

 

 

 

 

 

 

 

 

102

 

 

 

2,081

 

 

 

565

 

 

 

2,748

 

Repurchase of common stock

 

 

(6.781

)

 

 

 

 

 

(40

)

 

 

 

 

 

(1,479

)

 

 

 

 

 

(1,519

)

Share-based benefit plans

 

 

0.255

 

 

 

 

 

 

48

 

 

 

 

 

57

 

 

 

 

 

 

105

 

Cash dividends declared
   ($
0.56 per share)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(159

)

 

 

 

 

 

(159

)

Distributions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(475

)

 

 

(475

)

Other

 

 

 

 

 

 

 

 

(8

)

 

 

 

 

 

1

 

 

 

12

 

 

 

5

 

Balances, December 31, 2022

 

 

277.378

 

 

 

3

 

 

 

 

 

 

(490

)

 

 

(2,280

)

 

 

2,694

 

 

 

(73

)

Comprehensive income

 

 

 

 

 

 

 

 

 

 

 

20

 

 

 

1,363

 

 

 

180

 

 

 

1,563

 

Repurchase of common stock

 

 

(3.340

)

 

 

 

 

 

 

 

 

 

 

 

(849

)

 

 

 

 

 

(849

)

Share-based benefit plans

 

 

1.902

 

 

 

 

 

 

 

 

 

 

 

 

(87

)

 

 

 

 

 

(87

)

Cash dividends declared
   ($
0.60 per share)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(168

)

 

 

 

 

 

(168

)

Distributions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(187

)

 

 

(187

)

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(7

)

 

 

40

 

 

 

33

 

Balances, March 31, 2023

 

 

275.940

 

 

 

3

 

 

 

 

 

 

(470

)

 

 

(2,028

)

 

 

2,727

 

 

 

232

 

Comprehensive income

 

 

 

 

 

 

 

 

 

 

 

14

 

 

 

1,193

 

 

 

219

 

 

 

1,426

 

Repurchase of common stock

 

 

(3.311

)

 

 

 

 

 

(2

)

 

 

 

 

 

(922

)

 

 

 

 

 

(924

)

Share-based benefit plans

 

 

0.303

 

 

 

 

 

 

 

 

 

 

 

 

72

 

 

 

 

 

 

72

 

Cash dividends declared
   ($
0.60 per share)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(165

)

 

 

 

 

 

(165

)

Distributions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(155

)

 

 

(155

)

Other

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

(27

)

 

 

(25

)

Balances, June 30, 2023

 

 

272.932

 

 

$

3

 

 

$

 

 

$

(456

)

 

$

(1,850

)

 

$

2,764

 

 

$

461

 

 

 

The accompanying notes are an integral part of the condensed consolidated financial statements.

6


 

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

FOR THE SIX MONTHS ENDED JUNE 30, 2023 AND 2022

Unaudited

(Dollars in millions)

 

 

2023

 

 

2022

 

Cash flows from operating activities:

 

 

 

 

 

 

Net income

 

$

2,955

 

 

$

2,844

 

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

 

 

 

 

 

 

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

 

 

 

 

 

 

Accounts receivable

 

 

306

 

 

 

(547

)

Inventories and other assets

 

 

(301

)

 

 

(462

)

Accounts payable and accrued expenses

 

 

(505

)

 

 

(818

)

Depreciation and amortization

 

 

1,519

 

 

 

1,470

 

Income taxes

 

 

3

 

 

 

121

 

Losses on sales of facilities

 

 

14

 

 

 

22

 

Losses on retirement of debt

 

 

 

 

 

78

 

Amortization of debt issuance costs and discounts

 

 

17

 

 

 

15

 

Share-based compensation

 

 

133

 

 

 

171

 

Other

 

 

137

 

 

 

81

 

Net cash provided by operating activities

 

 

4,278

 

 

 

2,975

 

Cash flows from investing activities:

 

 

 

 

 

 

Purchase of property and equipment

 

 

(2,438

)

 

 

(1,941

)

Acquisition of hospitals and health care entities

 

 

(124

)

 

 

(116

)

Sales of hospitals and health care entities

 

 

172

 

 

 

20

 

Change in investments

 

 

(16

)

 

 

(2

)

Other

 

 

(2

)

 

 

(11

)

Net cash used in investing activities

 

 

(2,408

)

 

 

(2,050

)

Cash flows from financing activities:

 

 

 

 

 

 

Issuance of long-term debt

 

 

3,218

 

 

 

5,966

 

Net change in revolving credit facilities

 

 

(1,840

)

 

 

930

 

Repayment of long-term debt

 

 

(608

)

 

 

(2,690

)

Distributions to noncontrolling interests

 

 

(342

)

 

 

(333

)

Payment of debt issuance costs

 

 

(30

)

 

 

(53

)

Payment of dividends

 

 

(339

)

 

 

(337

)

Repurchase of common stock

 

 

(1,761

)

 

 

(4,783

)

Other

 

 

(221

)

 

 

(201

)

Net cash used in financing activities

 

 

(1,923

)

 

 

(1,501

)

Effect of exchange rate changes on cash and cash equivalents

 

 

7

 

 

 

(17

)

Change in cash and cash equivalents

 

 

(46

)

 

 

(593

)

Cash and cash equivalents at beginning of period

 

 

908

 

 

 

1,451

 

Cash and cash equivalents at end of period

 

$

862

 

 

$

858

 

Interest payments

 

$

925

 

 

$

777

 

Income tax payments, net

 

$

773

 

 

$

609

 

 

 

 

 

 

 

The accompanying notes are an integral part of the condensed consolidated financial statements.

7


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 June 30, 2023, these affiliates owned and operated 182 hospitals, 126 freestanding surgery centers, 22 freestanding endoscopy 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 $73 million and $77 million for the quarters ended June 30, 2023 and 2022, respectively, and $147 million and $154 million for the six months ended June 30, 2023 and 2022, respectively. Operating results for the quarter and six months ended June 30, 2023 are not necessarily indicative of the results that may be expected for the year ending December 31, 2023. 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, 2022.

COVID-19

We believe the extent of COVID-19’s impact on our operating results and financial condition has been and could continue to be driven by many factors, most of which are beyond our control and ability to forecast. Because of these uncertainties, we cannot estimate whether or to what extent COVID-19 will impact our operations.

Revenues

Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges), and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals.

8


HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

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

Revenues (continued)

Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured and other discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective care, who have income at or below 400% of the federal poverty level, are eligible for charity care. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and six months ended June 30, 2023 and 2022 are summarized in the following table (dollars in millions):

 

 

Quarter

 

 

2023

 

 

Ratio

 

 

2022

 

 

Ratio

 

Medicare

 

$

2,567

 

 

 

16.2

%

 

$

2,495

 

 

 

16.8

%

Managed Medicare

 

 

2,541

 

 

 

16.0

 

 

 

2,260

 

 

 

15.2

 

Medicaid

 

 

742

 

 

 

4.7

 

 

 

611

 

 

 

4.1

 

Managed Medicaid

 

 

894

 

 

 

5.6

 

 

 

954

 

 

 

6.4

 

Managed care and insurers

 

 

7,830

 

 

 

49.4

 

 

 

7,144

 

 

 

48.4

 

International (managed care and insurers)

 

 

377

 

 

 

2.4

 

 

 

325

 

 

 

2.2

 

Other

 

 

910

 

 

 

5.7

 

 

 

1,031

 

 

 

6.9

 

Revenues

 

$

15,861

 

 

 

100.0

%

 

$

14,820

 

 

 

100.0

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Six Months

 

 

2023

 

 

Ratio

 

 

2022

 

 

Ratio

 

Medicare

 

$

5,305

 

 

 

16.9

%

 

$

5,221

 

 

 

17.5

%

Managed Medicare

 

 

5,100

 

 

 

16.2

 

 

 

4,584

 

 

 

15.4

 

Medicaid

 

 

1,477

 

 

 

4.7

 

 

 

1,190

 

 

 

4.0

 

Managed Medicaid

 

 

1,807

 

 

 

5.7

 

 

 

2,064

 

 

 

6.9

 

Managed care and insurers

 

 

15,453

 

 

 

49.2

 

 

 

14,296

 

 

 

48.1

 

International (managed care and insurers)

 

 

752

 

 

 

2.4

 

 

 

681

 

 

 

2.3

 

Other

 

 

1,558

 

 

 

4.9

 

 

 

1,729

 

 

 

5.8

 

Revenues

 

$

31,452

 

 

 

100.0

%

 

$

29,765

 

 

 

100.0

%

 

To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and six months ended June 30, 2023 and 2022 follows (dollars in millions):

 

 

Quarter

 

 

Six Months

 

 

2023

 

 

2022

 

 

2023

 

 

2022

 

Patient care costs (salaries and benefits, supplies, other
   operating expense and depreciation and amortization)

 

$

13,561

 

 

$

12,524

 

 

$

26,718

 

 

$

25,268

 

Cost-to-charges ratio (patient care costs as percentage of gross
   patient charges)

 

 

10.5

%

 

 

11.0

%

 

 

10.5

%

 

 

11.2

%

Total uncompensated care

 

$

8,483

 

 

$

8,457

 

 

$

16,474

 

 

$

15,462

 

Multiply by the cost-to-charges ratio

 

 

10.5

%

 

 

11.0

%

 

 

10.5

%

 

 

11.2

%

Estimated cost of total uncompensated care

 

$

899

 

 

$

940

 

 

$

1,730

 

 

$

1,732

 

 

9


HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

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

Revenues (continued)

The total uncompensated care amounts include charity care of $3.558 billion and $3.617 billion, respectively, and the related estimated costs of charity care were $377 million and $401 million, respectively, for the quarters ended June 30, 2023 and 2022. The total uncompensated care amounts include charity care of $7.153 billion and $7.075 billion, respectively, and the related estimated costs of charity care were $751 million and $792 million, respectively, for the six months ended June 30, 2023 and 2022.

Reclassifications

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

NOTE 2 — ACQUISITIONS AND DISPOSITIONS

During the six months ended June 30, 2023, we paid $83 million to acquire a hospital facility in Texas. During the six months ended June 30, 2023 and 2022, we paid $41 million and $116 million, respectively, to acquire nonhospital health care entities. Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values.

During the six months ended June 30, 2023, we received proceeds of $163 million for the sale of two hospital facilities in Louisiana. During the six months ended June 30, 2023 and 2022, we received proceeds of $9 million and $20 million, respectively, related to sales of real estate and other health care entity investments. We recognized pretax losses of $14 million and $22 million, respectively, for these transactions.

NOTE 3 — INCOME TAXES

Our provisions for income taxes for the quarters ended June 30, 2023 and 2022 were $397 million and $381 million, respectively, and the effective tax rates were 24.9% and 24.8%, respectively. Our provisions for income taxes for the six months ended June 30, 2023 and 2022 were $776 million and $730 million, respectively, and the effective tax rates were 23.3% and 23.1%, respectively. Our provisions for income taxes included tax benefits related to settlements of employee equity awards of $85 million and $67 million for the six months ended June 30, 2023 and 2022, respectively.

Our gross unrecognized tax benefits were $649 million, excluding accrued interest of $155 million, as of June 30, 2023 ($639 million and $129 million, respectively, as of December 31, 2022). Unrecognized tax benefits of $309 million ($278 million as of December 31, 2022) would affect the effective rate, if recognized.

At June 30, 2023, the Internal Revenue Service was conducting examinations of the Company’s 2016, 2017 and 2018 federal income tax returns and the 2019 returns of certain affiliates. We are also subject to examination by state, local and foreign taxing authorities. Depending on the resolution of any tax disputes, the completion of examinations by 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, computed using the treasury stock method.

10


HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 4 — EARNINGS PER SHARE (continued)

The following table sets forth the computation of basic and diluted earnings per share for the quarters and six months ended June 30, 2023 and 2022 (dollars and shares in millions, except per share amounts):

 

 

Quarter

 

 

Six Months

 

 

2023

 

 

2022

 

 

2023

 

 

2022

 

Net income attributable to HCA Healthcare, Inc.

 

$

1,193

 

 

$

1,155

 

 

$

2,556

 

 

$

2,428

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weighted average common shares outstanding

 

 

274.494

 

 

 

292.527

 

 

 

275.695

 

 

 

297.459

 

Effect of dilutive incremental shares

 

 

3.704

 

 

 

3.534

 

 

 

3.878

 

 

 

4.231

 

Shares used for diluted earnings per share

 

 

278.198

 

 

 

296.061

 

 

 

279.573

 

 

 

301.690

 

Earnings per share:

 

 

 

 

 

 

 

 

 

 

 

 

Basic earnings

 

$

4.35

 

 

$

3.95

 

 

$

9.27

 

 

$

8.16

 

Diluted earnings

 

$

4.29

 

 

$

3.90

 

 

$

9.14

 

 

$

8.05

 

 

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES

A summary of our insurance subsidiaries’ investments at June 30, 2023 and December 31, 2022 follows (dollars in millions):

 

 

June 30, 2023

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

413

 

 

$

 

 

$

(36

)

 

$

377

 

Money market funds and other

 

 

106

 

 

 

 

 

 

 

 

 

106

 

 

$

519

 

 

$

 

 

$

(36

)

 

 

483

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(99

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

384

 

 

 

December 31, 2022

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

415

 

 

$

 

 

$

(38

)

 

$

377

 

Money market funds and other

 

 

96

 

 

 

 

 

 

 

 

 

96

 

 

$

511

 

 

$

 

 

$

(38

)

 

 

473

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(92

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

381

 

 

At June 30, 2023 and December 31, 2022, the investments in debt securities of our insurance subsidiaries were classified as “available-for-sale.” Changes in unrealized gains and losses that are not credit-related are recorded as adjustments to other comprehensive income (loss).

 

 

11


HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued)

 

Scheduled maturities of investments in debt securities at June 30, 2023 were as follows (dollars in millions):

 

 

Amortized
Cost

 

 

Fair
Value

 

Due in one year or less

 

$

23

 

 

$

22

 

Due after one year through five years

 

 

138

 

 

 

131

 

Due after five years through ten years

 

 

166

 

 

 

146

 

Due after ten years

 

 

86

 

 

 

78

 

 

$

413

 

 

$

377

 

 

The average expected maturity of the investments in debt securities at June 30, 2023 was 5.8 years, compared to the average scheduled maturity of 8.8 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 — 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.

The investments of our insurance subsidiaries 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.

The following tables summarize our assets measured at fair value on a recurring basis as of June 30, 2023 and December 31, 2022, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

 

 

June 30, 2023

 

 

 

 

 

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

 

$

377

 

 

$

 

 

$

377

 

 

$

 

Money market funds and other

 

 

106

 

 

 

106

 

 

 

 

 

 

 

Investments of insurance subsidiaries

 

 

483

 

 

 

106

 

 

 

377

 

 

 

 

Less amounts classified as current assets

 

 

(99

)

 

 

(99

)

 

 

 

 

 

 

 

$

384

 

 

$

7

 

 

$

377

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12


HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 6 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

 

 

December 31, 2022

 

 

 

 

 

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)

 

Investments of insurance subsidiaries:

 

 

 

 

 

 

 

 

 

 

 

 

Debt securities

 

$

377

 

 

$

 

 

$

377

 

 

$

 

Money market funds and other

 

 

96

 

 

 

96

 

 

 

 

 

 

 

Investments of insurance subsidiaries

 

 

473

 

 

 

96

 

 

 

377

 

 

 

 

Less amounts classified as current assets

 

 

(92

)

 

 

(92

)

 

 

 

 

 

 

 

$

381

 

 

$

4

 

 

$

377

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The estimated fair value of our long-term debt was $36.742 billion and $35.555 billion at June 30, 2023 and December 31, 2022, respectively, compared to carrying amounts, excluding debt issuance costs and discounts, aggregating $39.281 billion and $38.385 billion, respectively. The estimates of fair value are generally based on Level 2 inputs, including quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities.

NOTE 7 — LONG-TERM DEBT

A summary of long-term debt at June 30, 2023 and December 31, 2022, including related interest rates at June 30, 2023, follows (dollars in millions):

 

 

 

June 30,
2023

 

 

December 31,
2022

 

Senior secured asset-based revolving credit facility (effective interest rate of 6.4%)

$

1,060

 

 

$

2,900

 

Senior secured revolving credit facility

 

 

 

 

 

Senior secured term loan facilities (effective interest rate of 6.6%)

 

1,350

 

 

 

1,880

 

Other senior secured debt (effective interest rate of 3.8%)

 

969

 

 

 

953

 

Senior secured debt

 

3,379

 

 

 

5,733

 

Senior unsecured notes (effective interest rate of 5.0%)

 

35,902

 

 

 

32,652

 

Debt issuance costs and discounts

 

(349

)

 

 

(301

)

Total debt (average life of 9.9 years, rates averaging 5.0%)

 

38,932

 

 

 

38,084

 

Less amounts due within one year

 

2,395

 

 

 

370

 

$

36,537

 

 

$

37,714

 

 

During January 2023, the availability under our senior secured revolving credit facility was increased by $1.500 billion to total $3.500 billion, the senior secured term loan B facility was fully retired and certain administrative updates were made to our credit agreements.

During May 2023, we issued $3.250 billion aggregate principal amount of senior notes comprised of (i) $1.000 billion aggregate principal amount of 5.200% senior notes due 2028, (ii) $1.250 billion aggregate principal amount of 5.500% senior notes due 2033 and (iii) $1.000 billion aggregate principal amount of 5.900% senior notes due 2053. We used the net proceeds to repay borrowings under our asset-based revolving credit facility.

 

13


HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 8 — 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 routinely subject to investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), 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.

Texas operates a state Medicaid program pursuant to a waiver from the Centers for Medicare & Medicaid Services ("CMS") under Section 1115 of the Social Security Act (the “Program”). The Program includes uncompensated-care pools; payments from these pools are intended to defray the uncompensated costs of services provided by our and other hospitals to Medicaid eligible or uninsured individuals. Separately, we and other hospitals provide charity care services in several communities in the state. In 2018, the Civil Division of the U.S. Department of Justice and the U.S. Attorney’s Office for the Southern District of Texas requested information about whether the Program, as operated in Harris County, complied with the laws and regulations applicable to provider related donations, and the Company cooperated with that request. On May 21, 2019, a qui tam lawsuit asserting violations of the FCA and the Texas Medicaid Fraud Prevention Act related to the Program, as operated in Harris County, was unsealed by the U.S. District Court for the Southern District of Texas. Both the federal and state governments declined to intervene in the qui tam lawsuit. The Company believes that our participation is and has been consistent with the requirements of the Program and is vigorously defending against the lawsuit being pursued by the relator. We cannot predict what effect, if any, the qui tam lawsuit could have on the Company.

NOTE 9 — SHARE REPURCHASE TRANSACTIONS AND OTHER COMPREHENSIVE LOSS

During January 2023 and 2022, our Board of Directors authorized share repurchase programs for up to $3 billion and $8 billion, respectively, of our outstanding common stock. During the six months ended June 30, 2023, we repurchased 6.651 million shares of our common stock at an average price of $264.78 per share through market purchases pursuant to the January 2022 authorization (which was completed during the second quarter of 2023) and the January 2023 authorization. At June 30, 2023, we had $2.825 billion of repurchase authorization available under the January 2023 authorization.

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

 

 

Unrealized
Gains (Losses)
on Available-
for-Sale
Securities

 

 

Foreign
Currency
Translation
Adjustments

 

 

Defined
Benefit
Plans

 

 

Total

 

Balances at December 31, 2022

 

$

(30

)

 

$

(373

)

 

$

(87

)

 

$

(490

)

Unrealized gains on available-for-sale securities

 

 

2

 

 

 

 

 

 

 

 

 

2

 

Foreign currency translation adjustments, net of $6 of income
   taxes

 

 

 

 

 

32

 

 

 

 

 

 

32

 

Balances at June 30, 2023

 

$

(28

)

 

$

(341

)

 

$

(87

)

 

$

(456

)

 

 

14


HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 10 — SEGMENT AND GEOGRAPHIC INFORMATION

Effective January 1, 2023, we reorganized our operations from two geographically organized groups into three geographically organized groups: the National, American and Atlantic Groups. The National Group includes 57 hospitals located in Alaska, California, Idaho, Indiana, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah and Virginia, the American Group includes 56 hospitals located in Colorado, central Kansas, Louisiana and Texas, and the Atlantic Group includes 62 hospitals located in Florida, Georgia, northern Kansas, Missouri and South Carolina. The seven hospitals we operate in England remain in the Corporate and other group. Prior periods presented have been restated according to the new organizational structure.

Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, gains and losses on sales of facilities, losses on retirement of debt, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and six months ended June 30, 2023 and 2022 are summarized in the following table (dollars in millions):

 

Quarter

 

 

Six Months

 

 

2023

 

 

2022

 

 

2023

 

 

2022

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

4,372

 

 

$

4,088

 

 

$

8,988

 

 

$

8,290

 

Atlantic Group

 

 

5,038

 

 

 

4,700

 

 

 

10,147

 

 

 

9,386

 

American Group

 

 

5,536

 

 

 

5,205

 

 

 

10,735

 

 

 

10,411

 

Corporate and other

 

 

915

 

 

 

827

 

 

 

1,582

 

 

 

1,678

 

 

$

15,861

 

 

$

14,820

 

 

$

31,452

 

 

$

29,765

 

Equity in losses (earnings) of affiliates:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

(1

)

 

$

(1

)

 

$

(2

)

 

$

(1

)

Atlantic Group

 

 

(1

)

 

 

(1

)

 

 

(2

)

 

 

(1

)

American Group

 

 

(10

)

 

 

(9

)

 

 

(22

)

 

 

(18

)

Corporate and other

 

 

19

 

 

 

3

 

 

 

51

 

 

 

1

 

 

$

7

 

 

$

(8

)

 

$

25

 

 

$

(19

)

Adjusted segment EBITDA:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

878

 

 

$

867

 

 

$

2,027

 

 

$

1,822

 

Atlantic Group

 

 

975

 

 

 

969

 

 

 

2,061

 

 

 

1,819

 

American Group

 

 

1,319

 

 

 

1,338

 

 

 

2,452

 

 

 

2,654

 

Corporate and other

 

 

(116

)

 

 

(132

)

 

 

(312

)

 

 

(309

)

 

$

3,056

 

 

$

3,042

 

 

$

6,228

 

 

$

5,986

 

Depreciation and amortization:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

208

 

 

$

194

 

 

$

415

 

 

$

391

 

Atlantic Group

 

 

247

 

 

 

233

 

 

 

486

 

 

 

455

 

American Group

 

 

238

 

 

 

233

 

 

 

475

 

 

 

465

 

Corporate and other

 

 

70

 

 

 

78

 

 

 

143

 

 

 

159

 

 

$

763

 

 

$

738

 

 

$

1,519

 

 

$

1,470

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjusted segment EBITDA

 

$

3,056

 

 

$

3,042

 

 

$

6,228

 

 

$

5,986

 

Depreciation and amortization

 

 

763

 

 

 

738

 

 

 

1,519

 

 

 

1,470

 

Interest expense

 

 

485

 

 

 

434

 

 

 

964

 

 

 

842

 

Losses (gains) on sales of facilities

 

 

(1

)

 

 

32

 

 

 

14

 

 

 

22

 

Losses on retirement of debt

 

 

 

 

 

78

 

 

 

 

 

 

78

 

Income before income taxes

 

$

1,809

 

 

$

1,760

 

 

$

3,731

 

 

$

3,574

 

 

15


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” within the meaning of the federal securities laws, which involve risks and uncertainties. Forward-looking statements include statements regarding expected share-based compensation expense, expected capital expenditures, expected net claim payments, expected inflationary pressures, expected labor costs 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) changes in or related to general economic conditions nationally and regionally in our markets, including inflation and economic and business conditions (and the impact thereof on the economy, financial markets and banking industry); changes in revenues due to declining patient volumes; changes in payer mix (including increases in uninsured and underinsured patients); potential increased expenses related to labor, supply chain or other expenditures; workforce disruptions; and supply shortages and disruptions, (2) the impact of our substantial indebtedness and the ability to refinance such indebtedness on acceptable terms, (3) the impact of current and future federal and state health reform initiatives and possible changes to other federal, state or local laws and regulations affecting the health care industry, including, but not limited to, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the “Affordable Care Act”), additional changes to the Affordable Care Act, its implementation, or interpretation (including through executive orders and court challenges), and proposals to expand coverage of federally-funded insurance programs as an alternative to private insurance or establish a single-payer system (such reforms often referred to as “Medicare for All”), (4) the effects related to the implementation of sequestration spending reductions required under the Budget Control Act of 2011, related legislation extending these reductions and those required under the Pay-As-You-Go Act of 2010 as a result of the federal budget deficit impact of the American Rescue Plan Act of 2021, 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, (5) increases in the amount and risk of collectability of uninsured accounts and deductibles and copayment amounts for insured accounts, (6) the ability to achieve operating and financial targets, and attain expected levels of patient volumes and control the costs of providing services, (7) possible changes in Medicare, Medicaid and other state programs, including Medicaid supplemental payment programs or Medicaid waiver programs, that may impact reimbursements to health care providers and insurers and the size of the uninsured or underinsured population, (8) personnel-related capacity constraints, increases in wages and the ability to attract, utilize and retain qualified management and other personnel, including affiliated physicians, nurses and medical and technical support personnel, (9) the highly competitive nature of the health care business, (10) changes in service mix, revenue mix and surgical volumes, including potential declines in the population covered under third-party payer agreements, the ability to enter into and renew third-party payer provider agreements on acceptable terms and the impact of consumer-driven health plans and physician utilization trends and practices, (11) the efforts of health insurers, health care providers, large employer groups and others to contain health care costs, (12) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (13) the availability and terms of capital to fund the expansion of our business and improvements to our existing facilities, (14) changes in accounting practices, (15) developments related to COVID-19, including, without limitation, the length and severity of COVID-19-related impacts and the spread of virus strains with new epidemiological characteristics; the volume of canceled or rescheduled procedures and the volume and acuity of COVID-19 patients cared for across our health systems; and measures we are taking to respond to COVID-19, (16) the emergence of and effects related to pandemics, epidemics and infectious diseases, (17) future divestitures which may result in charges and possible impairments of long-lived assets, (18) changes in business strategy or development plans, (19) delays in receiving payments for services provided, (20) the outcome of pending and any future tax audits, disputes and litigation associated with our tax positions, (21) the impact of known and unknown government investigations, litigation and other claims that may be made against us, (22) the impact of actual and potential cybersecurity incidents or security breaches, including the data security incident disclosed in July 2023, (23) our ongoing ability to demonstrate meaningful use of certified electronic health record (“EHR”) technology and the impact of interoperability requirements, (24) the impact of natural disasters, such as hurricanes and floods, physical risks from climate change or similar events beyond our control, (25) changes in U.S. federal, state, or foreign tax laws including interpretive guidance that may be issued by taxing authorities or other standard setting bodies, and (26) other risk factors described in our annual report on Form 10-K for the year ended December 31, 2022 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.

 

16


ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Second Quarter 2023 Operations Summary

Revenues increased to $15.861 billion in the second quarter of 2023 from $14.820 billion in the second quarter of 2022. Net income attributable to HCA Healthcare, Inc. totaled $1.193 billion, or $4.29 per diluted share, for the quarter ended June 30, 2023, compared to $1.155 billion, or $3.90 per diluted share, for the quarter ended June 30, 2022. Second quarter results for 2022 include losses on sales of facilities of $32 million, or $0.11 per diluted share, and losses on retirement of debt of $78 million, or $0.20 per diluted share. During the quarter ended June 30, 2023, we acquired for an immaterial amount of consideration a controlling interest in a physician management and staffing joint venture in which we previously had an equity investment. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 278.198 million shares for the quarter ended June 30, 2023 and 296.061 million shares for the quarter ended June 30, 2022. During 2022 and the first six months of 2023, we repurchased 30.747 million shares and 6.651 million shares, respectively, of our common stock.

Revenues increased 7.0% on a consolidated basis and 6.2% on a same facility basis for the quarter ended June 30, 2023, compared to the quarter ended June 30, 2022. The increase in consolidated revenues can be primarily attributed to the combined impact of a 2.9% increase in revenue per equivalent admission and a 4.0% increase in equivalent admissions. The same facility revenues increase primarily resulted from the combined impact of a 2.4% increase in same facility revenue per equivalent admission and a 3.7% increase in same facility equivalent admissions.

During the quarter ended June 30, 2023, consolidated admissions increased 1.5% and same facility admissions increased 2.2% compared to the quarter ended June 30, 2022. Surgeries increased 1.8% on a consolidated basis and 2.8% on a same facility basis during the quarter ended June 30, 2023, compared to the quarter ended June 30, 2022. Emergency department visits increased 3.2% on a consolidated basis and 3.7% on a same facility basis during the quarter ended June 30, 2023, compared to the quarter ended June 30, 2022. Consolidated and same facility uninsured admissions declined 6.7% and 6.6%, respectively, for the quarter ended June 30, 2023, compared to the quarter ended June 30, 2022.

Cash flows from operating activities increased $845 million, from $1.630 billion for the second quarter of 2022 to $2.475 billion for the second quarter of 2023. The increase in cash provided by operating activities was primarily related to positive changes in working capital items of $1.050 billion, mainly from an increase in accounts payable and accrued expenses, partially offset by negative changes in income taxes of $144 million.

We believe the extent of COVID-19’s impact on our operating results and financial condition has been and could continue to be driven by many factors, most of which are beyond our control and ability to forecast. Because of these uncertainties, we cannot estimate whether or to what extent COVID-19 will impact our operations.

Results of Operations

Revenue/Volume Trends

Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges), and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals.

 

17


ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Results of Operations (continued)

Revenue/Volume Trends (continued)

Revenues increased 7.0% from $14.820 billion in the second quarter of 2022 to $15.861 billion in the second quarter of 2023. Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured and other discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record self-pay revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective care, who have income at or below 400% of the federal poverty level, are eligible for charity care. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and six months ended June 30, 2023 and 2022 are summarized in the following table (dollars in millions):

 

 

Quarter

 

 

2023

 

 

Ratio

 

 

2022

 

 

Ratio

 

Medicare

 

$

2,567

 

 

 

16.2

%

 

$

2,495

 

 

 

16.8

%

Managed Medicare

 

 

2,541

 

 

 

16.0

 

 

 

2,260

 

 

 

15.2

 

Medicaid

 

 

742

 

 

 

4.7

 

 

 

611

 

 

 

4.1

 

Managed Medicaid

 

 

894

 

 

 

5.6

 

 

 

954

 

 

 

6.4

 

Managed care and insurers

 

 

7,830

 

 

 

49.4

 

 

 

7,144

 

 

 

48.4

 

International (managed care and insurers)

 

 

377

 

 

 

2.4

 

 

 

325

 

 

 

2.2

 

Other

 

 

910

 

 

 

5.7

 

 

 

1,031

 

 

 

6.9

 

Revenues

 

$

15,861

 

 

 

100.0

%

 

$

14,820

 

 

 

100.0

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Six Months

 

 

2023

 

 

Ratio

 

 

2022

 

 

Ratio

 

Medicare

 

$

5,305

 

 

 

16.9

%

 

$

5,221

 

 

 

17.5

%

Managed Medicare

 

 

5,100

 

 

 

16.2

 

 

 

4,584

 

 

 

15.4

 

Medicaid

 

 

1,477

 

 

 

4.7

 

 

 

1,190

 

 

 

4.0

 

Managed Medicaid

 

 

1,807

 

 

 

5.7

 

 

 

2,064

 

 

 

6.9

 

Managed care and insurers

 

 

15,453

 

 

 

49.2

 

 

 

14,296

 

 

 

48.1

 

International (managed care and insurers)

 

 

752

 

 

 

2.4

 

 

 

681

 

 

 

2.3

 

Other

 

 

1,558

 

 

 

4.9

 

 

 

1,729

 

 

 

5.8

 

Revenues

 

$

31,452

 

 

 

100.0

%

 

$

29,765

 

 

 

100.0

%

 

Consolidated and same facility revenue per equivalent admission increased 2.9% and 2.4%, respectively, in the second quarter of 2023, compared to the second quarter of 2022. Consolidated and same facility equivalent admissions increased 4.0% and 3.7%, respectively, in the second quarter of 2023, compared to the second quarter of 2022. Consolidated and same facility outpatient surgeries increased 2.1% and 3.3%, respectively, in the second quarter of 2023, compared to the second quarter of 2022. Consolidated and same facility inpatient surgeries increased 1.1% and 1.8%, respectively, in the second quarter of 2023, compared to the second quarter of 2022. Consolidated and same facility emergency department visits increased 3.2% and 3.7%, respectively, in the second quarter of 2023, compared to the second quarter of 2022.

 

18


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 the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and six months ended June 30, 2023 and 2022 follows (dollars in millions):

 

Quarter

 

 

Six Months

 

 

2023

 

 

2022

 

 

2023

 

 

2022

 

Patient care costs (salaries and benefits, supplies, other
   operating expense and depreciation and amortization)

 

$

13,561

 

 

$

12,524

 

 

$

26,718

 

 

$

25,268

 

Cost-to-charges ratio (patient care costs as percentage of gross
   patient charges)

 

 

10.5

%

 

 

11.0

%

 

 

10.5

%

 

 

11.2

%

Total uncompensated care

 

$

8,483

 

 

$

8,457

 

 

$

16,474

 

 

$

15,462

 

Multiply by the cost-to-charges ratio

 

 

10.5

%

 

 

11.0

%

 

 

10.5

%

 

 

11.2

%

Estimated cost of total uncompensated care

 

$

899

 

 

$

940

 

 

$

1,730

 

 

$

1,732

 

Same facility uninsured admissions declined 6.6%, in the second quarter of 2023, compared to the second quarter of 2022. Same facility uninsured admissions declined 1.1% in the first quarter of 2023, compared to the first quarter of 2022. Same facility uninsured admissions declined in 2022, compared to 2021, 5.5% in the fourth quarter, 4.5% in the third quarter, 5.1% in the second quarter and 3.0% in the first quarter.

The approximate percentages of our admissions related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and insurers and the uninsured for the quarters and six months ended June 30, 2023 and 2022 are set forth in the following table.

 

 

Quarter

 

 

Six Months

 

 

2023

 

 

2022

 

 

2023

 

 

2022

 

Medicare

 

 

21

%

 

 

22

%

 

 

21

%

 

 

22

%

Managed Medicare

 

 

25

 

 

 

23

 

 

 

25

 

 

 

23

 

Medicaid

 

 

4

 

 

 

5

 

 

 

4

 

 

 

5

 

Managed Medicaid

 

 

13

 

 

 

13

 

 

 

13

 

 

 

13

 

Managed care and insurers

 

 

30

 

 

 

30

 

 

 

30

 

 

 

30

 

Uninsured

 

 

7

 

 

 

7

 

 

 

7

 

 

 

7

 

 

 

100

%

 

 

100

%

 

 

100

%

 

 

100

%

 

The approximate percentages of our inpatient revenues related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and insurers for the quarters and six months ended June 30, 2023 and 2022 are set forth in the following table.

 

Quarter

 

 

Six Months

 

 

2023

 

 

2022

 

 

2023

 

 

2022

 

Medicare

 

 

23

%

 

 

23

%

 

 

23

%

 

 

24

%

Managed Medicare

 

 

18

 

 

 

18

 

 

 

18

 

 

 

18

 

Medicaid

 

 

8

 

 

 

7

 

 

 

8

 

 

 

6

 

Managed Medicaid

 

 

6

 

 

 

7

 

 

 

6

 

 

 

8

 

Managed care and insurers

 

 

45

 

 

 

45

 

 

 

45

 

 

 

44

 

 

 

100

%

 

 

100

%

 

 

100

%

 

 

100

%

 

At June 30, 2023, we had 92 hospitals in the states of Texas and Florida. During the quarter ended June 30, 2023, 58% of our admissions and 50% of our revenues were generated by these hospitals. Uninsured admissions in Texas and Florida represented 73% of our uninsured admissions during the quarter ended June 30, 2023.

 

19


ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Results of Operations (continued)

Revenue/Volume Trends (continued)

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. Some state Medicaid programs use, or have applied to use, waivers granted by the Centers for Medicare & Medicaid Services ("CMS") to implement Medicaid expansion, impose different eligibility or enrollment restrictions, or otherwise implement programs that vary from federal standards. We receive supplemental payments in several states. We are aware these supplemental payment programs are currently being reviewed by certain government agencies and some states have made requests to CMS to replace their existing supplemental payment programs. It is possible these reviews and 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.

Key Performance Indicators

We present certain metrics and statistical information that management uses when assessing our results of operations. We believe this information is useful to investors as it provides insight to how management evaluates operational performance and trends between reporting periods. Information on how these metrics and statistical information are defined is provided in the following tables summarizing operating results and operating data.

Operating Results Summary

The following is a comparative summary of results of operations for the quarters and six months ended June 30, 2023 and 2022 (dollars in millions):

 

 

Quarter

 

 

2023

 

 

2022

 

 

Amount

 

 

Ratio

 

 

Amount

 

 

Ratio

 

Revenues

 

$

15,861

 

 

 

100.0

 

 

$

14,820

 

 

 

100.0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,277

 

 

 

45.9

 

 

 

6,792

 

 

 

45.8

 

Supplies

 

 

2,478

 

 

 

15.6

 

 

 

2,301

 

 

 

15.5

 

Other operating expenses

 

 

3,043

 

 

 

19.2

 

 

 

2,693

 

 

 

18.3

 

Equity in losses (earnings) of affiliates

 

 

7

 

 

 

 

 

 

(8

)

 

 

(0.1

)

Depreciation and amortization

 

 

763

 

 

 

4.8

 

 

 

738

 

 

 

5.0

 

Interest expense

 

 

485

 

 

 

3.1

 

 

 

434

 

 

 

2.9

 

Losses (gains) on sales of facilities

 

 

(1

)

 

 

 

 

 

32

 

 

 

0.2

 

Losses on retirement of debt

 

 

 

 

 

 

 

 

78

 

 

 

0.5

 

 

 

14,052

 

 

 

88.6

 

 

 

13,060

 

 

 

88.1

 

Income before income taxes

 

 

1,809

 

 

 

11.4

 

 

 

1,760

 

 

 

11.9

 

Provision for income taxes

 

 

397

 

 

 

2.5

 

 

 

381

 

 

 

2.6

 

Net income

 

 

1,412

 

 

 

8.9

 

 

 

1,379

 

 

 

9.3

 

Net income attributable to noncontrolling interests

 

 

219

 

 

 

1.4

 

 

 

224

 

 

 

1.5

 

Net income attributable to HCA Healthcare, Inc.

 

$

1,193

 

 

 

7.5

 

 

$

1,155

 

 

 

7.8

 

% changes from prior year:

 

 

 

 

 

 

 

 

 

 

 

 

Revenues

 

 

7.0

%

 

 

 

 

 

2.7

%

 

 

 

Income before income taxes

 

 

2.8

 

 

 

 

 

 

(16.9

)

 

 

 

Net income attributable to HCA Healthcare, Inc.

 

 

3.3

 

 

 

 

 

 

(20.3

)

 

 

 

Admissions(a)

 

 

1.5

 

 

 

 

 

 

(3.2

)

 

 

 

Equivalent admissions(b)

 

 

4.0

 

 

 

 

 

 

(1.5

)

 

 

 

Revenue per equivalent admission

 

 

2.9

 

 

 

 

 

 

4.2

 

 

 

 

Same facility % changes from prior year(c):

 

 

 

 

 

 

 

 

 

 

 

 

Revenues

 

 

6.2

 

 

 

 

 

 

4.0

 

 

 

 

Admissions(a)

 

 

2.2

 

 

 

 

 

 

(1.2

)

 

 

 

Equivalent admissions(b)

 

 

3.7

 

 

 

 

 

 

0.5

 

 

 

 

Revenue per equivalent admission

 

 

2.4

 

 

 

 

 

 

3.5

 

 

 

 

 

20


ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

 

Results of Operations (continued)

Operating Results Summary (continued)

 

 

Six Months

 

 

2023

 

 

2022

 

 

Amount

 

 

Ratio

 

 

Amount

 

 

Ratio

 

Revenues

 

$

31,452

 

 

 

100.0

 

 

$

29,765

 

 

 

100.0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

14,361

 

 

 

45.7

 

 

 

13,731

 

 

 

46.1

 

Supplies

 

 

4,901

 

 

 

15.6

 

 

 

4,622

 

 

 

15.5

 

Other operating expenses

 

 

5,937

 

 

 

18.8

 

 

 

5,445

 

 

 

18.4

 

Equity in losses (earnings) of affiliates

 

 

25

 

 

 

0.1

 

 

 

(19

)

 

 

(0.1

)

Depreciation and amortization

 

 

1,519

 

 

 

4.8

 

 

 

1,470

 

 

 

4.9

 

Interest expense

 

 

964

 

 

 

3.1

 

 

 

842

 

 

 

2.8

 

Losses on sales of facilities

 

 

14

 

 

 

 

 

 

22

 

 

 

0.1

 

Losses on retirement of debt

 

 

 

 

 

 

 

 

78

 

 

 

0.3

 

 

 

27,721

 

 

 

88.1

 

 

 

26,191

 

 

 

88.0

 

Income before income taxes

 

 

3,731

 

 

 

11.9

 

 

 

3,574

 

 

 

12.0

 

Provision for income taxes

 

 

776

 

 

 

2.5

 

 

 

730

 

 

 

2.4

 

Net income

 

 

2,955

 

 

 

9.4

 

 

 

2,844

 

 

 

9.6

 

Net income attributable to noncontrolling interests

 

 

399

 

 

 

1.3

 

 

 

416

 

 

 

1.4

 

Net income attributable to HCA Healthcare, Inc.

 

$

2,556

 

 

 

8.1

 

 

$

2,428

 

 

 

8.2

 

% changes from prior year:

 

 

 

 

 

 

 

 

 

 

 

 

Revenues

 

 

5.7

%

 

 

 

 

 

4.8

%

 

 

 

Income before income taxes

 

 

4.4

 

 

 

 

 

 

(12.6

)

 

 

 

Net income attributable to HCA Healthcare, Inc.

 

 

5.3

 

 

 

 

 

 

(15.5

)

 

 

 

Admissions(a)

 

 

2.6

 

 

 

 

 

 

(1.6

)

 

 

 

Equivalent admissions(b)

 

 

5.3

 

 

 

 

 

 

0.8

 

 

 

 

Revenue per equivalent admission

 

 

0.4

 

 

 

 

 

 

4.0

 

 

 

 

Same facility % changes from prior year(c):

 

 

 

 

 

 

 

 

 

 

 

 

Revenues

 

 

5.6

 

 

 

 

 

 

5.9

 

 

 

 

Admissions(a)

 

 

3.3

 

 

 

 

 

 

0.4

 

 

 

 

Equivalent admissions(b)

 

 

5.6

 

 

 

 

 

 

2.7

 

 

 

 

Revenue per equivalent admission

 

 

 

 

 

 

 

 

3.1

 

 

 

 

 

(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.

 

21


ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Results of Operations (continued)

Quarters Ended June 30, 2023 and 2022

Revenues increased to $15.861 billion in the second quarter of 2023 from $14.820 billion in the second quarter of 2022. Net income attributable to HCA Healthcare, Inc. totaled $1.193 billion, or $4.29 per diluted share, for the quarter ended June 30, 2023, compared to $1.155 billion, or $3.90 per diluted share, for the quarter ended June 30, 2022. Second quarter results for 2022 include losses on sales of facilities of $32 million, or $0.11 per diluted share, and losses on retirement of debt of $78 million, or $0.20 per diluted share. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 278.198 million shares for the quarter ended June 30, 2023 and 296.061 million shares for the quarter ended June 30, 2022. During 2022 and the first six months of 2023, we repurchased 30.747 million shares and 6.651 million shares, respectively, of our common stock.

Revenues increased 7.0% on a consolidated basis and 6.2% on a same facility basis for the quarter ended June 30, 2023, compared to the quarter ended June 30, 2022. The increase in consolidated revenues can be primarily attributed to the combined impact of a 2.9% increase in revenue per equivalent admission and a 4.0% increase in equivalent admissions. The same facility revenues increase primarily resulted from the combined impact of a 2.4% increase in same facility revenue per equivalent admission and a 3.7% increase in same facility equivalent admissions.

Salaries and benefits, as a percentage of revenues, were 45.9% in the second quarter of 2023 and 45.8% in the second quarter of 2022. Salaries and benefits per equivalent admission increased 3.0% in the second quarter of 2023, compared to the second quarter of 2022. Same facility salaries and benefits per full time equivalent increased 1.7% for the second quarter of 2023, compared to the second quarter of 2022. We continue to utilize certain contract, overtime and other premium rate labor costs to support our clinical staff and patients. These costs declined compared to the prior year period and were in line with the three month period ended March 31, 2023; however, any expected future declines may be affected by labor market conditions and other factors.

Supplies, as a percentage of revenues, were 15.6% in the second quarter of 2023 and 15.5% in the second quarter of 2022. Supply costs per equivalent admission increased 3.6% in the second quarter of 2023, compared to the second quarter of 2022. Supply costs per equivalent admission increased 5.0% for medical devices and 3.1% for general medical and surgical items and declined 0.5% for pharmacy supplies in the second quarter of 2023, compared to the second quarter of 2022.

Other operating expenses, as a percentage of revenues, were 19.2% in the second quarter of 2023 and 18.3% in the second quarter of 2022. 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 largest component of the 90 basis points increase for the second quarter of 2023, compared to the second quarter of 2022, was a 70 basis points increase in professional fees. We have seen inflation have a negative impact on certain of these expenses and expect inflationary pressures will continue to impact operating expenses in the future. Provisions for losses related to professional liability risks were $144 million and $142 million for the second quarters of 2023 and 2022, respectively.

Equity in losses of affiliates was $7 million and equity in earnings of affiliates was $8 million in the second quarters of 2023 and 2022, respectively.

Depreciation and amortization increased $25 million, from $738 million in the second quarter of 2022 to $763 million in the second quarter of 2023. The increase in depreciation relates primarily to capital expenditures at our existing facilities.

Interest expense was $485 million in the second quarter of 2023 and $434 million in the second quarter of 2022. Our average debt balance was $38.790 billion for the second quarter of 2023, compared to $38.264 billion for the second quarter of 2022. The average effective interest rate for our debt was 5.0% and 4.5%, respectively, for the quarters ended June 30, 2023 and 2022.

During the second quarter of 2022, we recorded losses on sales of facilities of $32 million.

During March 2022, we issued $6.000 billion aggregate principal amount of senior notes and used a portion of the net proceeds to pay down our revolving credit facilities. During April 2022, we redeemed all $1.250 billion outstanding aggregate principal amount of our 4.75% senior notes due 2023. During May 2022, we redeemed all $1.250 billion outstanding aggregate principal amount of our 5.875% senior notes due 2023. The aggregate pretax loss on retirement of debt for these two redemptions was $78 million.

 

22


ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Results of Operations (continued)

Quarters Ended June 30, 2023 and 2022 (continued)

The effective tax rates were 24.9% and 24.8% for the second quarters of 2023 and 2022, respectively. The effective tax rate computations exclude net income attributable to noncontrolling interests as it relates to consolidated partnerships.

Net income attributable to noncontrolling interests declined from $224 million for the second quarter of 2022 to $219 million for the second quarter of 2023.

Six Months Ended June 30, 2023 and 2022

Revenues increased to $31.452 billion in the first six months of 2023 from $29.765 billion in the first six months of 2022. Net income attributable to HCA Healthcare, Inc. totaled $2.556 billion, or $9.14 per diluted share, for the six months ended June 30, 2023, compared to $2.428 billion, or $8.05 per diluted share, for the six months ended June 30, 2022. Results for the first six months of 2023 and 2022 include losses on sales of facilities of $14 million, or $0.08 per diluted share, and $22 million, or $0.08 per diluted share, respectively. Results for the first six months of 2022 also include losses on retirement of debt of $78 million, or $0.20 per diluted share. Our provision for income taxes for the first six months of 2023 and 2022 included tax benefits of $85 million, or $0.30 per diluted share, and $67 million, or $0.22 per diluted share, respectively, related to employee equity award settlements. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 279.573 million shares for the six months ended June 30, 2023 and 301.690 million shares for the six months ended June 30, 2022. During 2022 and the first six months of 2023, we repurchased 30.747 million shares and 6.651 million shares, respectively, of our common stock.

Revenues increased 5.7% on a consolidated basis and 5.6% on a same facility basis for the six months ended June 30, 2023, compared to the six months ended June 30, 2022. The increase in consolidated revenues can be attributed to the combined impact of a 0.4% increase in revenue per equivalent admission and a 5.3% increase in equivalent admissions. The same facility revenues increase resulted from a 5.6% increase in same facility equivalent admissions.

Salaries and benefits, as a percentage of revenues, were 45.7% in the first six months of 2023 and 46.1% in the first six months of 2022. Salaries and benefits per equivalent admission declined 0.7% in the first six months of 2023, compared to the first six months of 2022. Same facility salaries and benefits per full time equivalent increased 1.4% for the first six months of 2023, compared to the first six months of 2022. We continue to utilize certain contract, overtime and other premium rate labor costs to support our clinical staff and patients. These costs declined compared to the prior year period; however, any expected future declines may be affected by labor market conditions and other factors.

Supplies, as a percentage of revenues, were 15.6% in the first six months of 2023 and 15.5% in the first six months of 2022. Supply costs per equivalent admission increased 0.7% in the first six months of 2023, compared to the first six months of 2022. Supply costs per equivalent admission increased 3.5% for medical devices and 1.1% for general medical and surgical items and declined 8.3% for pharmacy supplies in the first six months of 2023, compared to the first six months of 2022. The decline in pharmacy supplies is primarily related to certain COVID-19 therapies during the first six months of 2022.

Other operating expenses, as a percentage of revenues, were 18.8% in the first six months of 2023 and 18.4% in the first six months of 2022. 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. We have seen inflation have a negative impact on certain of these expenses and expect inflationary pressures will continue to impact operating expenses in the future. Provisions for losses related to professional liability risks were $288 million and $285 million for the first six months of 2023 and 2022, respectively.

Equity in losses of affiliates was $25 million and equity in earnings of affiliates was $19 million in the first six months of 2023 and 2022, respectively.

Depreciation and amortization increased $49 million, from $1.470 billion in the first six months of 2022 to $1.519 billion in the first six months of 2023. The increase in depreciation relates primarily to capital expenditures at our existing facilities.

 

23


ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Results of Operations (continued)

Six Months Ended June 30, 2023 and 2022 (continued)

Interest expense was $964 million in the first six months of 2023 and $842 million in the first six months of 2022. Our average debt balance was $38.622 billion for the first six months of 2023 compared to $36.936 billion for the first six months of 2022. The average effective interest rate for our debt was 5.0% and 4.6%, respectively, for the six months ended June 30, 2023 and 2022.

During the first six months of 2023 and 2022, we recorded losses on sales of facilities of $14 million and $22 million, respectively.

During March 2022, we issued $6.000 billion aggregate principal amount of senior notes and used a portion of the net proceeds to pay down our revolving credit facilities. During April 2022, we redeemed all $1.250 billion outstanding aggregate principal amount of our 4.75% senior notes due 2023. During May 2022, we redeemed all $1.250 billion outstanding aggregate principal amount of our 5.875% senior notes due 2023. The aggregate pretax loss on retirement of debt for these two redemptions was $78 million.

The effective tax rates were 23.3% and 23.1% for the first six months of 2023 and 2022, 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 first six months of 2023 and 2022 included tax benefits of $85 million and $67 million, respectively, related to employee equity award settlements.

Net income attributable to noncontrolling interests declined from $416 million for the first six months of 2022 to $399 million for the first six months 2023. The decline in net income attributable to noncontrolling interests related primarily to the operations of two of our Texas markets and our group purchasing organization, partially offset by an increase from our surgery centers.

 

Liquidity and Capital Resources

Cash provided by operating activities totaled $4.278 billion for the first six months of 2023 compared to $2.975 billion for the first six months of 2022. The $1.303 billion increase in cash provided by operating activities, for the first six months of 2023 compared to the first six months of 2022, related primarily to positive changes in working capital items of $1.327 billion, mainly from a decline in accounts receivable. The combination of interest payments and net income tax payments in the first six months of 2023 and 2022 totaled $1.698 billion and $1.386 billion, respectively. Working capital totaled $2.343 billion at June 30, 2023 and $3.741 billion at December 31, 2022 (decline due primarily to the $2.025 billion increase in long-term debt due within one year).

Cash used in investing activities was $2.408 billion in the first six months of 2023 compared to $2.050 billion in the first six months of 2022. Excluding acquisitions, capital expenditures were $2.438 billion in the first six months of 2023 and $1.941 billion in the first six months of 2022. Planned capital expenditures are expected to approximate $4.7 billion in 2023. At June 30, 2023, there were projects under construction which had estimated additional costs to complete and equip over the next five years of approximately $4.8 billion. We expect to finance capital expenditures with internally generated and borrowed funds.

Cash used in financing activities totaled $1.923 billion in the first six months of 2023, compared to $1.501 billion in the first six months of 2022. During the first six months of 2023, net cash flows used in financing activities included a net increase of $770 million in our indebtedness, payment of dividends of $339 million, repurchase of common stock of $1.761 billion and distributions to noncontrolling interests of $342 million. During the first six months of 2022, net cash flows used in financing activities included a net increase of $4.206 billion in our indebtedness, payment of dividends of $337 million, repurchase of common stock of $4.783 billion and distributions to noncontrolling interests of $333 million.

We are a highly leveraged company with significant debt service requirements. Our debt totaled $38.932 billion at June 30, 2023. Our interest expense was $964 million for the first six months of 2023 and $842 million for the first six months of 2022.

In addition to cash flows from operations, available sources of capital include amounts available under our senior secured credit facilities ($6.875 billion and $7.005 billion available as of June 30, 2023 and July 31, 2023, respectively) and anticipated access to public and private debt markets.

 

24


ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Liquidity and Capital Resources (continued)

Investments of our insurance subsidiaries, held to maintain statutory equity levels and to provide liquidity to pay claims, totaled $483 million and $473 million at June 30, 2023 and December 31, 2022, respectively. An insurance subsidiary maintained net reserves for professional liability risks of $124 million and $147 million at June 30, 2023 and December 31, 2022, respectively. Our facilities are insured by our insurance subsidiary for losses up to $80 million per occurrence; however, this coverage is generally subject, in most cases, to a $15 million per occurrence self-insured retention. Additionally, the insurance subsidiary has entered into reinsurance contracts providing reimbursement for a certain portion of losses in excess of self-insured retentions. Net reserves for the self-insured professional liability risks retained were $1.897 billion and $1.836 billion at June 30, 2023 and December 31, 2022, respectively. Claims payments, net of reinsurance recoveries, during the next 12 months are expected to approximate $518 million. We estimate that approximately $479 million of the expected net claim payments during the next 12 months will relate to claims subject to the self-insured retention.

During May 2023, we issued $3.250 billion aggregate principal amount of senior notes comprised of (i) $1.000 billion aggregate principal amount of 5.200% senior notes due 2028, (ii) $1.250 billion aggregate principal amount of 5.500% senior notes due 2033 and (iii) $1.000 billion aggregate principal amount of 5.900% senior notes due 2053. We used the net proceeds to repay borrowings under our asset-based revolving credit facility.

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 for the foreseeable future.

Market Risk

We are exposed to market risk related to changes in market values of securities. The investment securities held by our insurance subsidiaries were recorded at $483 million at June 30, 2023. These investments are carried at fair value, with changes in unrealized gains and losses that are not credit-related being recorded as adjustments to other comprehensive income. At June 30, 2023, we had net unrealized losses of $36 million on the insurance subsidiaries’ investments.

We are exposed to market risk related to market illiquidity. Investment securities held by our insurance subsidiaries could be impaired by the inability to access the capital markets. Should the 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 credit-related 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. With respect to our interest-bearing liabilities, approximately $2.410 billion of our debt at June 30, 2023 was subject to variable rates of interest, while the remaining debt balance of $36.522 billion at June 30, 2023 was subject to fixed rates of interest. Both the general level of interest rates and our leverage affect our variable interest rates. Our variable debt is comprised primarily of amounts outstanding under the senior secured credit facilities. The average effective interest rate for our debt was 5.0% and 4.6% for the six months ended June 30, 2023 and 2022, respectively.

The estimated fair value of our long-term debt was $36.742 billion at June 30, 2023. 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 $24 million. To mitigate the impact of fluctuations in interest rates, we generally target a majority of our debt portfolio to be maintained at fixed rates.

We are exposed to currency translation risk related to our foreign operations. We currently do not consider the market risk related to foreign currency translation to be material to our consolidated financial statements or our liquidity.

Tax Examinations

At June 30, 2023, the Internal Revenue Service was conducting examinations of the Company’s 2016, 2017 and 2018 federal income tax returns and the 2019 returns of certain affiliates. We are also subject to examination by state, local 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 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.

 

25


ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Data Security Incident

On July 10, 2023, we announced that we had recently discovered that a list of certain information with respect to some of our patients was made available by an unknown and unauthorized party on an online forum. We believe the list may include information for approximately 11 million patients. The list includes:

Patient name, city, state, and zip code;
Patient email, telephone number, date of birth, gender; and
Patient service date, location and next appointment date.

The list does not include:

Clinical information, such as treatment, diagnosis, or condition;
Payment information, such as credit card or account numbers; and
Sensitive information, such as passwords, driver’s license or social security numbers.

Our forensic investigation is ongoing, but we believe the incident is a theft from an external storage location exclusively used to automate the formatting of email messages. There has been no disruption to the care and services we provide to patients and communities. This incident has not caused any disruption to our day-to-day operations. We have been named as defendant in multiple purported class action lawsuits related to the data security incident. Based on the information known at this time, we do not believe the incident will materially impact our business, operations or financial results.

We reported this event to law enforcement and retained third-party forensic and threat intelligence advisors. While our investigation is ongoing, we have not identified evidence of any malicious activity on HCA networks or systems related to this incident. We disabled user access to the storage location as an immediate containment measure, are in the process of notifying any impacted patients to provide additional information and support, in accordance with our legal and regulatory obligations, and are offering credit monitoring and identity protection services.

 

 

26


ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

Operating Data

 

 

 

 

 

 

 

 

 

2023

 

 

2022

 

Number of hospitals in operation at:

 

 

 

 

 

 

March 31

 

 

180

 

 

 

182

 

June 30

 

 

182

 

 

 

182

 

September 30

 

 

 

 

 

182

 

December 31

 

 

 

 

 

182

 

Number of freestanding outpatient surgical centers in operation at:

 

 

 

 

 

 

March 31

 

 

126

 

 

 

124

 

June 30

 

 

126

 

 

 

126

 

September 30

 

 

 

 

 

125

 

December 31

 

 

 

 

 

126

 

Licensed hospital beds at(a):

 

 

 

 

 

 

March 31

 

 

48,891

 

 

 

48,892

 

June 30

 

 

49,063

 

 

 

48,979

 

September 30

 

 

 

 

 

49,179

 

December 31

 

 

 

 

 

49,281

 

Weighted average beds in service(b):

 

 

 

 

 

 

Quarter:

 

 

 

 

 

 

First

 

 

41,684

 

 

 

41,818

 

Second

 

 

41,802

 

 

 

41,930

 

Third

 

 

 

 

 

42,056

 

Fourth

 

 

 

 

 

42,119

 

Year

 

 

 

 

 

41,982

 

Average daily census(c):

 

 

 

 

 

 

Quarter:

 

 

 

 

 

 

First

 

 

29,310

 

 

 

29,797

 

Second

 

 

28,116

 

 

 

28,256

 

Third

 

 

 

 

 

28,287

 

Fourth

 

 

 

 

 

28,790

 

Year

 

 

 

 

 

28,778

 

Admissions(d):

 

 

 

 

 

 

Quarter:

 

 

 

 

 

 

First

 

 

525,235

 

 

 

506,956

 

Second

 

 

522,996

 

 

 

515,113

 

Third

 

 

 

 

 

523,092

 

Fourth

 

 

 

 

 

530,298

 

Year

 

 

 

 

 

2,075,459

 

Equivalent admissions(e):

 

 

 

 

 

 

Quarter:

 

 

 

 

 

 

First

 

 

916,535

 

 

 

859,290

 

Second

 

 

938,834

 

 

 

902,757

 

Third

 

 

 

 

 

917,262

 

Fourth

 

 

 

 

 

931,990

 

Year

 

 

 

 

 

3,611,299

 

Average length of stay (days)(f):

 

 

 

 

 

 

Quarter:

 

 

 

 

 

 

First

 

 

5.0

 

 

 

5.3

 

Second

 

 

4.9

 

 

 

5.0

 

Third

 

 

 

 

 

5.0

 

Fourth

 

 

 

 

 

5.0

 

Year

 

 

 

 

 

5.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27


ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

 

 

 

 

 

 

 

 

 

 

2023

 

 

2022

 

Emergency room visits(g):

 

 

 

 

 

 

Quarter:

 

 

 

 

 

 

First

 

 

2,252,669

 

 

 

2,056,389

 

Second

 

 

2,294,205

 

 

 

2,223,999

 

Third

 

 

 

 

 

2,278,782

 

Fourth

 

 

 

 

 

2,412,781

 

Year

 

 

 

 

 

8,971,951

 

Outpatient surgeries(h):

 

 

 

 

 

 

Quarter:

 

 

 

 

 

 

First

 

 

255,971

 

 

 

247,421

 

Second

 

 

263,601

 

 

 

258,182

 

Third

 

 

 

 

 

252,026

 

Fourth

 

 

 

 

 

265,610

 

Year

 

 

 

 

 

1,023,239

 

Inpatient surgeries(i):

 

 

 

 

 

 

Quarter:

 

 

 

 

 

 

First

 

 

130,460

 

 

 

126,880

 

Second

 

 

132,447

 

 

 

130,961

 

Third

 

 

 

 

 

132,470

 

Fourth

 

 

 

 

 

131,840

 

Year

 

 

 

 

 

522,151

 

Days revenues in accounts receivable(j):

 

 

 

 

 

 

Quarter:

 

 

 

 

 

 

First

 

 

50

 

 

 

51

 

Second

 

 

50

 

 

 

53

 

Third

 

 

 

 

 

53

 

Fourth

 

 

 

 

 

53

 

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

 

 

 

 

 

 

Quarter:

 

 

 

 

 

 

First

 

 

38

%

 

 

37

%

Second

 

 

40

%

 

 

39

%

Third

 

 

 

 

 

37

%

Fourth

 

 

 

 

 

38

%

Year

 

 

 

 

 

38

%

(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 beds in service, 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 revenues for the quarter by the days in the quarter. Days revenues in accounts receivable is then calculated as accounts receivable at the end of the quarter divided by revenues per day.
(k)
Represents the percentage of patient revenues related to patients who are not admitted to our hospitals.

28


 

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 management, with the participation of HCA’s chief executive officer and chief financial officer, has evaluated the effectiveness of HCA’s disclosure controls and procedures as of June 30, 2023. Based on that evaluation, HCA’s chief executive officer and chief financial officer concluded that HCA’s disclosure controls and procedures were effective as of June 30, 2023.

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

The information set forth in “Note 8 – Contingencies” in the notes to condensed consolidated financial statements is incorporated herein by reference.

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, 2022, 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, 2022.

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

During January 2023 and 2022, our Board of Directors authorized share repurchase programs for up to $3 billion and $8 billion, respectively, of our outstanding common stock. During the quarter ended June 30, 2023, we repurchased 3,310,445 shares of our common stock at an average price of $276.40 per share through market purchases pursuant to the January 2022 authorization (which was completed during the second quarter of 2023) and the January 2023 authorization. At June 30, 2023, we had $2.825 billion of repurchase authorization available under the January 2023 authorization.

The following table provides certain information with respect to our repurchases of common stock from April 1, 2023 through June 30, 2023 (dollars in billions, 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

 

April 2023

 

 

994,596

 

 

$

271.47

 

 

 

994,596

 

 

$

3.470

 

May 2023

 

 

1,192,663

 

 

$

276.70

 

 

 

1,192,663

 

 

$

3.140

 

June 2023

 

 

1,123,186

 

 

$

280.46

 

 

 

1,123,186

 

 

$

2.825

 

Total for second quarter 2023

 

 

3,310,445

 

 

$

276.40

 

 

 

3,310,445

 

 

$

2.825

 

On July 26, 2023, our Board of Directors declared a quarterly dividend of $0.60 per share on our common stock, payable on September 29, 2023 to stockholders of record at the close of business on September 15, 2023. Future declarations of quarterly dividends and the establishment of future record and payment dates are subject to the final determination of our Board of Directors. Our ability to declare future dividends may also from time to time be limited by the terms of our debt agreements.

 

29


 

ITEM 5. OTHER INFORMATION

(c) During the three months ended June 30, 2023, no director or officer (as defined in Rule 16a-1(f) of the Exchange Act) of the Company adopted or terminated a “Rule 10b5-1 trading arrangement” or “non-Rule 10b5-1 trading arrangement,” as each term is defined in Item 408(a) of Regulation S-K.

 

ITEM 6. EXHIBITS

(a) List of Exhibits:

 

4.1

Supplemental Indenture No. 34, dated as of May 4, 2023, among HCA Inc., HCA Healthcare, Inc., Delaware Trust Company, as trustee, and Deutsche Bank Trust Company Americas, as paying agent, registrar and transfer agent (filed as Exhibit 4.2 to the Company’s Current Report on Form 8-K filed on May 4, 2023, and incorporated herein by reference).

 

 

 

4.2

Supplemental Indenture No. 35, dated as of May 4, 2023, among HCA Inc., HCA Healthcare, Inc., Delaware Trust Company, as trustee, and Deutsche Bank Trust Company Americas, as paying agent, registrar and transfer agent (filed as Exhibit 4.3 to the Company’s Current Report on Form 8-K filed on May 4, 2023, and incorporated herein by reference).

 

 

 

4.3

Supplemental Indenture No. 36, dated as of May 4, 2023, among HCA Inc., HCA Healthcare, Inc., Delaware Trust Company, as trustee, and Deutsche Bank Trust Company Americas, as paying agent, registrar and transfer agent (filed as Exhibit 4.4 to the Company’s Current Report on Form 8-K filed on May 4, 2023, and incorporated herein by reference).

 

 

 

4.4

Form of 5.200% Senior Notes due 2028 (included in Exhibit 4.1)

 

 

 

4.5

Form of 5.500% Senior Notes due 2033 (included in Exhibit 4.2)

 

 

 

4.6

Form of 5.900% Senior Notes due 2053 (included in Exhibit 4.3)

 

 

 

   22

List of Subsidiary Guarantors and Pledged Securities.

 

   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 quarter ended June 30, 2023 filed with the SEC on August 2, 2023, formatted in Inline Extensible Business Reporting Language: (i) the condensed consolidated balance sheets at June 30, 2023 and December 31, 2022, (ii) the condensed consolidated income statements for the quarters and six months ended June 30, 2023 and 2022, (iii) the condensed consolidated comprehensive income statements for the quarters and six months ended June 30, 2023 and 2022, (iv) the condensed consolidated statements of stockholders’ equity (deficit) for the quarters and six months ended June 30, 2023 and 2022, (v) the condensed consolidated statements of cash flows for the six months ended June 30, 2023 and 2022 and (vi) the notes to condensed consolidated financial statements. The instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.

 

  104

The cover page from the Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2023, formatted in Inline XBRL (included in Exhibit 101).

 

30


 

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: August 2, 2023

 

31