HCA Healthcare, Inc. (HCA)

Business

Source: Annual Report on Form 10-K for the fiscal year ended December 31, 2025, accession 0001193125-26-044769, unless noted.

HCA Healthcare describes itself as one of the leading health care services companies in the United States. It owns and operates hospitals and the outpatient networks around them, and it is paid for patient care by commercial insurers and managed care plans, by Medicare and Medicaid (directly and through managed plans), and by patients. At December 31, 2025 it operated 190 hospitals (179 general acute care, seven behavioral and four rehabilitation hospitals, with 50,436 licensed beds in total), 121 freestanding ambulatory surgery centers and 31 freestanding endoscopy centers in 19 states and England. Its acute care hospitals provide inpatient, intensive, cardiac, surgical, diagnostic and emergency care; around them HCA runs freestanding emergency rooms, urgent care clinics, imaging and oncology centers, physician practices, home health, hospice and rehabilitation services. At September 30, 2026 it operated 189 hospitals, 117 freestanding surgery centers and 30 freestanding endoscopy centers (10-Q, accession 0001193125-26-437871), and the third-quarter earnings release counts approximately 2,600 ambulatory sites of care (accession 0001193125-26-432665).

Where the revenue comes from. Revenues were $75.600 billion in 2025. By payer, the mix was:

• Managed care and other insurers: $36.968 billion (48.9%)
• Managed Medicare: $13.435 billion (17.8%)
• Medicare: $11.273 billion (14.9%)
• Medicaid: $5.909 billion (7.8%)
• Managed Medicaid: $3.693 billion (4.9%)
• International managed care and insurers: $1.864 billion (2.5%)
• Other, including uninsured patients: $2.458 billion (3.2%)

Medicare and Medicaid programs together supplied 45.4% of 2025 revenues. Commercial payers usually reimburse at higher rates than government programs or uninsured patients, so the share of commercially insured patients drives margins. That share is the main issue of 2026 (see Current quarter). Medicaid revenue also includes state supplemental and state directed payment (SDP) programs, which brought in approximately $6.2 billion in 2025, against $5.5 billion in 2024 and $4.4 billion in 2023.

Operating structure. HCA reports one line of business, operating hospitals and related health care entities, managed through three geographic groups. Each one's 2025 revenue and adjusted segment EBITDA is shown below:

• National Group (53 hospitals at year-end 2025: Alaska, California, Idaho, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah, Virginia): revenues $21.278 billion; adjusted segment EBITDA $5.103 billion.
• Atlantic Group (63 hospitals: Florida, Georgia, Northern Kansas, Missouri, South Carolina): revenues $24.709 billion; adjusted segment EBITDA $5.642 billion.
• American Group (66 hospitals: Colorado, Central Kansas, Louisiana, Texas): revenues $26.445 billion; adjusted segment EBITDA $6.296 billion.
• Corporate and other, which includes the hospitals in England (eight at year-end 2025, seven at September 30, 2026): revenues $3.168 billion.

Concentration. Florida and Texas account for about half of the business. At year-end 2025 HCA had 47 hospitals and 27 surgery centers in Florida, with $17.856 billion of 2025 revenue, and 55 hospitals and 38 surgery centers in Texas, with $20.962 billion. Together the two states generated 51% of revenues, 59% of admissions and 73% of uninsured admissions. Neither state has adopted the Affordable Care Act Medicaid expansion.

Strategy and scale. HCA aims to deepen its existing markets rather than spread thinly. Its plan is to recruit physicians, build service lines such as cardiology, neurology, oncology, orthopedics and women's services, and add outpatient access points around its hospitals. It uses central purchasing, revenue-cycle, supply-chain and staffing platforms to run these networks at scale. It is also implementing a new electronic health record platform across its facilities and investing in digital and AI capabilities. The workforce was approximately 320,000 employees at December 31, 2025, including about 90,000 part-time and PRN staff. Certain employees at 35 domestic hospitals are represented by unions. The professional liability risk is mostly self-insured through a captive insurance subsidiary, which covers losses up to $120 million per occurrence (from January 1, 2026), subject in most cases to a $15 million per-occurrence self-insured retention. Affiliates of the founding Frist family held approximately 31% of the common stock as of January 31, 2026 and have board nomination rights under a stockholders' agreement.

Risk factors

Source: Form 10-K for fiscal 2025, Item 1A, accession 0001193125-26-044769. The Q3 2026 10-Q (accession 0001193125-26-437871) reports no material changes to these risk factors.

The risks that matter most for HCA are about who pays and how much. Federal policy changes in 2025–2026 bear on both.

• Loss of insured patients. The enhanced Exchange premium tax credits expired at the end of 2025. Together with the 2025 Federal Budget Act (FBA) and a June 2025 CMS rule tightening Exchange enrollment, HCA expects this to reduce Exchange enrollment and significantly raise the uninsured rate. Domestic private payers were 48.9% of 2025 revenues, and losing those patients lowers revenue per case. The FBA also imposes Medicaid work and community-engagement requirements in expansion states by December 31, 2026 and moves eligibility redeterminations for expansion adults to every six months.
• Medicaid financing and supplemental payments. The FBA restricts provider-tax arrangements, which states use to fund their share of Medicaid. New provider taxes, and increases in existing ones, are barred for state fiscal years beginning on or after October 1, 2026. The 6% safe harbor falls by 0.5 percentage points a year in expansion states from fiscal 2028 until it reaches 3.5%. The FBA also caps SDP rates at 100% (expansion states) or 110% (non-expansion states) of Medicare rates instead of average commercial rates. Grandfathered arrangements step down 10 percentage points a year from 2028. HCA expects these changes to affect payment rates in many of its states, including Texas. Its supplemental and SDP revenue, about $6.2 billion in 2025, depends on annual CMS approvals that it cannot time.
• Medicare rate pressure. Annual rate updates (about 2.6% for most payment systems in 2026) are reduced by productivity adjustments. Sequestration cuts Medicare payments by 2% through early federal fiscal 2033. Other pressures include site-neutral payment, a 0.5% annual outpatient offset for past 340B payments that began in 2026, and the three-year phase-out of the Medicare inpatient-only list, which moves procedures to outpatient and surgery-center settings.
• Payer utilization controls. Prior authorization, utilization review, downcoding and claim denials reduce admissions, surgical volume and reimbursement. CMS's WISeR model, which applies AI-assisted prior authorization to fee-for-service Medicare, begins in six states in 2026, including Texas.
• Uninsured volume and collectability. At December 31, 2025, implicit price concessions of $7.674 billion had been recorded against receivables. The estimated cost of total uncompensated care was $4.605 billion in 2025. Any rise in uninsured or patient-responsibility balances flows directly to results.
• Labor. HCA competes for nurses and other clinicians in short supply. Wage pressure, contract labor, union organizing, strikes and nurse-staffing ratio mandates could all raise costs that fixed or annually negotiated reimbursement may not cover. Recruiting and retaining physicians, most of whom are not HCA employees, also drives admissions.
• Leverage. Debt totaled $46.492 billion at December 31, 2025 and $50.493 billion at September 30, 2026. Debt service, refinancing on acceptable terms, a financial-ratio covenant in the unsecured credit facility and rising rates on variable-rate debt (mostly commercial paper) all limit flexibility.
• Florida and Texas concentration and weather. About half of revenues come from two hurricane-exposed states. Hurricanes Helene and Milton cost an estimated $250 million in 2024 expenses and lost revenue. Property insurance covers only claims above deductibles and self-insured retentions, and may not cover all losses.
• Cybersecurity and technology. HCA holds protected health information, and its care delivery depends on connected systems. Ransomware or a breach, at HCA or at a vendor, could disrupt care and create liability. The company-wide EHR conversion carries execution risk, and AI use brings new regulatory and accuracy risks.
• Regulatory and legal exposure. HCA is exposed to fraud-and-abuse laws (the Anti-kickback Statute, Stark Law and False Claims Act, including whistleblower suits), certificate-of-need limits on expansion, and antitrust scrutiny of acquisitions. Professional liability claims are mostly self-insured. In December 2023 HCA was notified that district attorneys in four California counties were investigating the waste-disposal practices of HCA's California facilities. HCA does not expect a material impact.
• Competition. HCA competes with not-for-profit and tax-supported hospitals, physician-owned specialty hospitals, freestanding surgery and emergency centers, and payers that use narrow or tiered networks. Price-transparency rules may also weaken its negotiating position.

Management's discussion, fiscal 2025

Source: Form 10-K for fiscal 2025, Item 7, accession 0001193125-26-044769.

In 2025, volume growth, better pricing and some cost leverage raised earnings faster than revenue. Revenues rose 7.1% to $75.600 billion from $70.603 billion. Equivalent admissions grew 2.9% and revenue per equivalent admission 4.0%; on a same-facility basis revenue grew 6.6%. Admissions rose 2.7%, emergency room visits 1.6% and inpatient surgeries 0.9%, while outpatient surgeries slipped 0.2%. Net income attributable to HCA rose 17.8% to $6.784 billion, or $28.33 per diluted share, compared with $5.760 billion, or $22.00, in 2024. Per-share growth outpaced net income because diluted shares fell to 239.495 million from 261.806 million after 26.739 million shares were repurchased in the year. The 2024 comparison included about $250 million, or $0.73 per diluted share, of hurricane-related costs and lost revenue.

Costs. Salaries and benefits fell to 43.5% of revenues from 44.1%, and contract, overtime and other premium labor costs declined from 2024. Same-facility salaries and benefits per full-time equivalent rose 3.3%. Supplies fell to 15.0% of revenues from 15.2%: medical-device cost per equivalent admission rose 7.0%, mainly cardiovascular technology, while pharmacy cost fell 4.0%. Other operating expenses held at 21.0% of revenues. Interest expense rose to $2.248 billion from $2.061 billion because the average debt balance increased to $44.731 billion; the average effective rate was unchanged at 5.0%. The effective tax rate, excluding noncontrolling interests, fell to 23.2% from 24.5%.

Payer mix in 2025. Managed Medicare's share of admissions kept rising (27%, from 26% in 2024 and 25% in 2023), while traditional Medicare's share fell (19%, from 20% and 21%). Uninsured patients made up 7% of admissions in each of the three years. The estimated cost of uncompensated care rose by $239 million to $4.605 billion.

Cash and capital allocation. Operating cash flow rose to $12.636 billion from $10.514 billion. HCA spent $4.944 billion on capital expenditures and $397 million on acquisitions, including two hospitals in New Hampshire and Florida. It returned capital through $10.067 billion of share repurchases and $679 million of dividends ($0.72 per quarter). Indebtedness rose by a net $3.287 billion, and debt totaled $46.492 billion at year-end. During 2025 HCA moved to an unsecured capital structure. A new five-year $8.000 billion senior unsecured revolving credit facility replaced its secured asset-based revolver ($4.500 billion), its secured cash-flow revolver ($3.500 billion) and its $1.238 billion secured term loan. HCA issued $5.250 billion and then $3.250 billion of senior notes and started a commercial paper program, with $2.207 billion outstanding at year-end.

Outlook given with the annual report. Excluding any further CMS approvals, management expected SDP revenues to decline in 2026. It also expected Exchange administrative reforms and the expiration of the enhanced premium tax credits to hurt 2026 results, offset in part by resiliency (cost-efficiency) initiatives. Planned 2026 capital expenditures were $5.0–5.5 billion. At year-end 2025, projects under construction had about $7.1 billion of remaining cost to complete.

Current quarter, Q3 2026 (three months ended September 30, 2026)

Sources: Form 10-Q for the quarter ended September 30, 2026, accession 0001193125-26-437871; third-quarter earnings release (Form 8-K Exhibit 99.1), accession 0001193125-26-432665.

In Q3 2026, volume growth and cost control were outweighed by a shift toward uninsured patients. Revenues rose 3.6% to $19.849 billion, on a 2.8% increase in equivalent admissions (3.0% same-facility) but only a 0.7% rise in revenue per equivalent admission (6.1% in the year-earlier quarter). Net income attributable to HCA fell 3.9% to $1.579 billion. Diluted EPS still rose 4.5% to $7.27 from $6.96, because diluted shares fell to 217.212 million from 236.181 million. The quarter included $13 million ($0.05 per share) of gains on facility sales. Income before income taxes fell 2.0% to $2.370 billion, and the adjusted EBITDA margin (a non-GAAP measure) narrowed to 19.7% from 20.2%.

The payer-mix shift. HCA estimates that the move toward uninsured patients cut third-quarter income before income taxes by approximately $400 million, the same estimate it gave for the second quarter. It attributes the shift mainly to patients who lost Exchange coverage after the enhanced premium tax credits expired and administrative reforms took effect. Same-facility uninsured admissions rose 27.4% from a year earlier, after 15.5% in Q1 and 23.4% in Q2. The 10-Q also cites fewer Medicaid conversions. Uninsured patients made up 8% of admissions, against 6% a year earlier, while managed care and insurers fell to 31% from 33%. The estimated cost of uncompensated care rose to $1.477 billion from $1.188 billion, and charity care cost to $562 million from $408 million.

Volumes. Same-facility admissions rose 2.7% and emergency room visits 5.1%, but surgery declined: inpatient surgeries fell 1.4% and outpatient surgeries 3.7% on a same-facility basis. Average length of stay was 4.6 days, against 4.7. In Florida and Texas, HCA's 103 hospitals produced 58% of admissions, 51% of revenues and 73% of uninsured admissions.

Costs. Salaries and benefits fell to 43.2% of revenues from 43.6%. Salaries and benefits per equivalent admission fell 0.2%, while same-facility salaries per full-time equivalent rose 2.7%. Supplies fell to 14.2% from 14.5%, with supply cost per equivalent admission down 1.4%: medical devices -2.5%, pharmacy -2.3%, general medical and surgical -0.9%. Other operating expenses rose to 23.0% of revenues from 21.8%; for the nine months, HCA attributes the increase mainly to growth in Medicaid supplemental-program expenses and professional fees. Interest expense rose to $607 million from $561 million, as average debt rose to $49.743 billion from $44.400 billion while the average rate fell to 4.8% from 5.0%. The effective tax rate, excluding noncontrolling interests, rose to 24.8% from 23.9%, mainly because of lower deductible share-based compensation.

By group (adjusted segment EBITDA, Q3 2026 against Q3 2025). Results diverged across the three groups:

• National Group: $1.480 billion, up from $1.348 billion, on revenues of $5.738 billion (from $5.525 billion).
• Atlantic Group: $1.288 billion, down from $1.339 billion, on revenues of $6.421 billion (from $6.142 billion).
• American Group: $1.555 billion, down from $1.580 billion, on revenues of $6.848 billion (from $6.688 billion).

Nine months. Revenues rose 5.5% to $59.188 billion, and net income attributable to HCA was essentially flat at $4.898 billion ($22.05 per diluted share against $20.23). Medicaid revenue jumped to $5.998 billion from $4.413 billion. HCA cites the approval of certain Medicaid state directed and supplemental payment programs, primarily Florida's for the program year October 1, 2024 through September 30, 2025. Managed care and insurer revenue was nearly flat at $27.671 billion against $27.432 billion, falling to 46.7% of revenues from 48.8%. In the Atlantic Group, which includes Florida, nine-month adjusted segment EBITDA rose to $4.554 billion from $4.153 billion. In the American Group, which includes Texas, it fell to $4.338 billion from $4.576 billion.

Cash flow, capital and balance sheet. Nine-month operating cash flow fell to $8.810 billion from $10.277 billion. Most of the decline came from $1.190 billion more in income taxes paid: in 2025, an IRS deferral let Tennessee-based taxpayers postpone estimated tax payments to the fourth quarter. Working-capital changes also cost $472 million. Capital expenditures were $3.707 billion for the nine months and $1.357 billion in the quarter, and remaining spending on projects under construction rose to about $8.6 billion. HCA spent $942 million in the nine months acquiring non-hospital health care entities; the filing does not name them. It sold a hospital in Virginia for $26 million and received $81 million from sales of real estate and other investments, for $22 million of pretax gains. For the nine months it repurchased 15.139 million shares at an average price of $430.01.

Over the nine months, repurchases ($6.605 billion), dividends ($519 million) and distributions to noncontrolling interests ($574 million) exceeded operating cash flow less investing outflows, and indebtedness rose by a net $3.788 billion. Total debt reached $50.493 billion at September 30, 2026, against $46.492 billion at year-end, including $5.727 billion of commercial paper (from $2.207 billion). Debt due within one year rose to $8.093 billion, leaving negative working capital of $3.560 billion. Excluding commercial paper, which HCA says it can refinance through its credit facility, working capital would have been $2.167 billion. HCA intends to keep unused capacity under its $8.000 billion credit facility at least equal to commercial paper outstanding, so the larger commercial paper balance also reduces available credit. Variable-rate debt rose to about $6.027 billion (from $2.507 billion at year-end), and HCA estimates a 1% rate rise would now reduce annual pretax earnings by about $60 million. Stockholders' deficit attributable to HCA widened to $8.077 billion from $6.027 billion at year-end, as repurchases and dividends exceeded net income.

2026 guidance

Sources: earnings releases of July 14, 2026 (accession 0001193125-26-302539) and October 27, 2026 (accession 0001193125-26-432665).

The Exchange problem has shaped HCA's 2026 outlook. On July 14 HCA lowered its 2026 earnings guidance. It raised its estimate of the full-year pretax drag from Exchange-related payer-mix shifts and changed its Medicaid supplemental-payment assumption from a net reduction to a net benefit. On October 27 it said it now expects results in the upper half of the July ranges. The guidance excludes gains or losses on facility sales, debt retirement losses, legal claim costs, impairments and the effect of any future state directed or supplemental payment approvals.

Subsequent events

Source: Form 10-Q for the quarter ended September 30, 2026, accession 0001193125-26-437871.

The quarterly report has no separate subsequent-events note. Apart from the quarterly dividend declared on October 26, 2026, it discloses two developments after September 30, 2026. No acquisition, divestiture, debt offering or litigation outcome is disclosed after the quarter end.

• Short-term borrowing and liquidity. Commercial paper outstanding rose to $6.245 billion at October 26, 2026 from $5.727 billion at September 30. Availability under the senior unsecured credit facility, after letters of credit and the commercial paper backstop, fell to $1.709 billion from $2.226 billion.
• Share count. Common shares outstanding were 208,892,500 at October 26, 2026, against 210,880,500 at September 30, 2026.

Filings that contain financial statements

HCA is a domestic filer. The earnings press releases furnished as Exhibit 99.1 to Form 8-K carry condensed income statements, balance sheet and cash flow tables, plus non-GAAP reconciliations:

• Form 8-K filed October 27, 2026, accession 0001193125-26-432665: third quarter and nine months ended September 30, 2026.
• Form 8-K filed July 24, 2026, accession 0001193125-26-315151: second quarter and six months ended June 30, 2026.
• Form 8-K filed July 14, 2026, accession 0001193125-26-302539: preliminary second quarter 2026 results and revised guidance (summary figures and an Adjusted EBITDA reconciliation, not full statements).
• Form 8-K filed April 24, 2026, accession 0001193125-26-174933: first quarter ended March 31, 2026.
• Form 8-K filed January 27, 2026, accession 0001193125-26-023323: fourth quarter and year ended December 31, 2025.

Earnings and guidance

2026 guidance path.

• January 27, 2026 (0001193125-26-023323): initial 2026 guidance of revenues $76.500 to $80.000 billion, net income attributable to HCA $6.495 to $7.035 billion, Adjusted EBITDA $15.550 to $16.450 billion and diluted EPS $29.10 to $31.50. Capital expenditures, excluding acquisitions, were guided to $5.0 to $5.5 billion.
• April 24, 2026 (0001193125-26-174933): guidance reaffirmed.
• July 14, 2026 (0001193125-26-302539): guidance cut, with the second-quarter preview. Revised ranges were revenues $77.000 to $79.500 billion, net income $6.300 to $6.700 billion, Adjusted EBITDA $15.400 to $16.100 billion and diluted EPS $28.70 to $30.50. The revenue range narrowed and moved up at the low end; the other three ranges were lowered. The estimated 2026 pre-tax drag from health insurance exchange payer mix shifts widened from $600 to $900 million to $1.000 to $1.200 billion. The estimated net benefit from Medicaid supplemental payment programs moved from a $50 to $250 million headwind to a $300 to $500 million benefit. The capital expenditure estimate was unchanged.
• October 27, 2026 (0001193125-26-432665): the company said it now expects full-year operating results in the upper half of the ranges issued July 14, 2026.

Third quarter 2026 (reported October 27, 2026; 0001193125-26-432665).

• Revenues rose 3.6 percent to $19.849 billion.
• Net income attributable to HCA fell 3.9 percent to $1.579 billion.
• Diluted EPS rose 4.5 percent to $7.27 ($7.22 as adjusted).
• Adjusted EBITDA rose 1.2 percent to $3.918 billion.
• Operating cash flow was $4.461 billion, against $4.416 billion a year earlier.
• Same facility admissions rose 2.7 percent and equivalent admissions 3.0 percent.
• The company said a payer mix shift toward uninsured volume, mainly patients who lost exchange coverage, reduced pre-tax income by about $400 million in the quarter.
• Nine-month revenues were $59.188 billion and net income attributable to HCA $4.898 billion ($22.05 per diluted share).
• At September 30, 2026: cash $908 million, total debt $50.493 billion, total assets $63.452 billion.
• In the quarter HCA repurchased 7.230 million shares for $2.970 billion; $4.240 billion remained under authorization.

Second quarter 2026 (previewed July 14 and reported July 24, 2026; 0001193125-26-302539, 0001193125-26-315151).

• Revenues rose 8.7 percent to $20.230 billion.
• Net income attributable to HCA rose 2.8 percent to $1.699 billion.
• Diluted EPS was $7.62.
• Adjusted EBITDA was $4.027 billion.
• Operating cash flow was $2.335 billion, against $4.210 billion a year earlier.
• The quarter included about $400 million of incremental net benefit from Medicaid supplemental payment programs, mainly the Florida state directed payment program, which Medicare and Medicaid regulators approved during the quarter and which covers October 1, 2024 through June 30, 2026. An exchange payer mix shift offset it with an unfavorable pre-tax effect of about $400 million, which included roughly $75 million of upward revision to the first-quarter estimate.

First quarter 2026 (reported April 24, 2026; 0001193125-26-174933).

• Revenues rose 4.3 percent to $19.109 billion.
• Net income attributable to HCA was $1.620 billion.
• Diluted EPS was $7.15.
• Adjusted EBITDA was $3.802 billion.
• Operating cash flow was $2.014 billion.
• Respiratory-related admissions were down 42 percent. The company said Medicaid supplemental programs not in initial guidance mostly offset the volume shortfall.
• HCA repurchased 3.157 million shares for $1.571 billion.

Fourth quarter and full year 2025 (reported January 27, 2026; 0001193125-26-023323).

• Fourth-quarter revenues rose 6.7 percent to $19.513 billion.
• Net income attributable to HCA rose 30.6 percent to $1.878 billion.
• Diluted EPS was $8.14.
• Adjusted EBITDA was $4.114 billion.

Capital actions

• Share repurchase authorization. January 27, 2026 (0001193125-26-023323): the board authorized an additional repurchase program of up to $10 billion.
• Dividend. The quarterly dividend was $0.78 per share in each declaration this year: January 27 (paid March 31), April 24 (paid June 30), July 24 (paid September 30) and October 26, 2026 (announced October 27, 2026; payable December 29, 2026 to holders of record December 15). The January, April and July dates are the dates of the earnings-release announcements. Accessions 0001193125-26-023323, 0001193125-26-174933, 0001193125-26-315151, 0001193125-26-432665. The prior-year declarations in July and October 2025 were $0.72 per share.
• Senior notes, April 2026. April 27, 2026 (0001193125-26-182265): HCA Inc., a wholly owned subsidiary, launched a senior notes offering and gave notice to redeem all $1.500 billion of 5.250% notes due June 2026 and all $1.000 billion of 5.375% notes due September 2026, conditioned on receiving offering proceeds. On April 30, 2026 (0001193125-26-197278) it completed the sale of $3.000 billion of senior notes: $1.000 billion of 4.700% notes due 2031, $750 million of 5.000% notes due 2033 and $1.250 billion of 5.300% notes due 2036, guaranteed by HCA Healthcare, Inc. The September 2026 10-Q states the proceeds repaid commercial paper and went to general corporate purposes, and that both series of 2026 notes were redeemed in May 2026.
• Commercial paper program. July 29, 2026 (0001193125-26-323731): HCA Inc. increased its commercial paper program capacity from $4.0 billion to $8.0 billion outstanding at any time.
• Prior-year senior notes. October 31, 2025 (0001193125-25-260809): HCA Inc. completed $3.250 billion of senior notes (4.300% due 2030, 4.600% due 2032, 4.900% due 2035, 5.700% due 2055), after an October 27, 2025 notice to redeem $1.500 billion of 5.875% notes due 2026 (0001193125-25-251612).

Management and governance

• Chief Clinical Officer transition. June 18, 2026 (0001193125-26-275086): the company reported that Dr. Michael Cuffe and HCA agreed on June 15 that he will step down as Executive Vice President and Chief Clinical Officer effective August 31, 2026, then continue in a transitional role until February 2027.
• Board. February 25, 2026 (0001193125-26-071880): Robert J. Dennis informed the company he would not stand for re-election and would retire from the board effective at the April 23, 2026 annual meeting. The same filing adopted the 2026 Executive Officer Performance Excellence Program (80 percent EBITDA targets, 20 percent quality metrics; cash-settled).
• Annual meeting. April 28, 2026 (0001193125-26-187155): all nine nominees were elected at the April 23, 2026 meeting, and Ernst & Young LLP was ratified as auditor for 2026.

M&A and portfolio

No signed or pending acquisition or divestiture appears in the 8-Ks reviewed. The September 2026 Form 10-Q (accession 0001193125-26-437871, Note 2) reports completed activity in the nine months ended September 30, 2026: $942 million paid to acquire nonhospital health care entities, and proceeds of $26 million from the sale of a hospital facility in Virginia and $81 million from sales of real estate and other investments, with pretax gains of $22 million.

About this file

HCA annual income statement, balance sheet and cash flow

Taken from the SEC filings and normalized to actual dollars.

HCA quarterly income statement, balance sheet and cash flow

Taken from the SEC filings and normalized to actual dollars.

HCA year-to-date income statement and cash flow

Taken from the SEC filings and normalized to actual dollars.

HCA trailing twelve month income statement and cash flow

Derived by AI from the figures the filings report. No filing prints these, so none of them is linked.

Adjustments

Definitions

Notes

• Annual figures come from HCA Healthcare's FY2025 Form 10-K (accession 0001193125-26-044769): income statements and cash flow statements for 2025, 2024 and 2023, and balance sheets at December 31, 2025 and 2024. FY2023 therefore carries no balance sheet, because this 10-K does not print one for that date.
• Third-quarter, nine-month and September 30, 2026 balance-sheet figures come from the Q3 2026 Form 10-Q (accession 0001193125-26-437871), which presents the quarters and nine months ended September 30, 2026 and 2025. Its December 31, 2025 balance-sheet column matches the 10-K line for line.
• The 10-Q's cash flow statement covers only the nine-month periods. The three-month operating cash flow and capital expenditures are therefore taken from the earnings releases. For Q3 FY2026, operating cash flow of $4.461 billion and capital expenditures of $1.357 billion are stated in the Q3 2026 earnings release furnished as Exhibit 99.1 to the 8-K filed October 27, 2026 (accession 0001193125-26-432665). For Q3 FY2025, operating cash flow of $4.416 billion and capital expenditures of $1.288 billion are stated in the Q3 2025 earnings release (accession 0001193125-25-249345). Each figure also equals the nine-month amount less the six-month amount the second-quarter release of the same year prints: 8,810 less 4,349 and 3,707 less 2,350 for 2026 (accession 0001193125-26-315151), and 10,277 less 5,861 and 3,455 less 2,167 for 2025 (accession 0000950170-25-098578), in millions.
• HCA does not print a gross profit or operating income line. Its costs and expenses include interest expense, so income before income taxes is the first profit subtotal. The 10-Q notes that most of its expenses are costs of revenues; corporate office costs, which could be classified as general and administrative, were $146 million in Q3 FY2026 against $139 million a year earlier.
• Revenues rose 3.6% in Q3 FY2026 to $19,849 million from $19,161 million, while net income attributable to HCA Healthcare, Inc. fell to $1,579 million from $1,643 million. Diluted EPS still rose, to $7.27 from $6.96, because diluted weighted shares fell to 217.212 million from 236.181 million. Other operating expenses rose to $4,548 million from $4,161 million. The earnings release estimates that a shift in payer mix toward uninsured patients, primarily patients who lost coverage on the health insurance exchanges, reduced the quarter's income before income taxes by approximately $400 million.
• Non-GAAP measures (Adjusted EBITDA, Adjusted EBITDA margin, and net income and diluted EPS as adjusted) and the operating statistics are as HCA reports them in the Q3 2026 earnings release (accession 0001193125-26-432665), which prints both the 2026 and 2025 columns. Adjusted EBITDA was $3,918 million in Q3 FY2026 against $3,870 million a year earlier.
• HCA reports a stockholders' deficit. Total equity, including noncontrolling interests, was a deficit of $4,599 million at September 30, 2026, against a deficit of $2,771 million at December 31, 2025 and positive equity of $555 million at December 31, 2024. The deficit attributable to HCA Healthcare, Inc. alone was $8,077 million at September 30, 2026. The statements of stockholders' equity charge most of each period's share repurchases to the retained deficit (for 2025, $9,692 million of $10,110 million).
• Total debt is the debt note's 'Total debt' line: $50,493 million at September 30, 2026, $46,492 million at December 31, 2025 and $43,031 million at December 31, 2024. At September 30, 2026 it included $5,727 million of commercial paper, against $2,207 million at December 31, 2025.
• Share repurchases: the statement of stockholders' equity (deficit) records 7.230 million shares repurchased in Q3 FY2026 for $2,999 million. The 10-Q's Part II reports 7,229,310 shares bought in the quarter at an average price of $410.85, and the earnings release states a cost of $2.970 billion. The filing does not itemize the difference between the two amounts. For the nine months, the 10-Q reports 15.139 million shares repurchased at an average price of $430.01.
• Nine-month operating cash flow was $8,810 million in 2026 against $10,277 million in 2025. The cash flow statement shows net income tax payments of $1,417 million in the 2026 nine months against $227 million in the 2025 nine months, and a $635 million increase in accounts receivable against a $345 million decrease a year earlier.
• Common shares outstanding were 210,880,500 at September 30, 2026, 224,605,100 at December 31, 2025 and 249,981,400 at December 31, 2024. The 10-Q cover reports 208,892,500 shares outstanding at October 26, 2026.
• Dividends declared per share come from the statements of stockholders' equity (deficit): $0.78 for Q3 FY2026, $0.72 for Q3 FY2025, and $2.88, $2.64 and $2.40 for 2025, 2024 and 2023.
• The trailing twelve months to September 30, 2026 are computed here as FY2025 plus the nine months ended September 30, 2026 less the nine months ended September 30, 2025. No EPS is computed for that period, because EPS is not additive across periods.

Uncertainties

• The three-month cash flow figures for Q3 FY2026 and Q3 FY2025 come from the earnings releases rather than a filed cash flow statement, because the 10-Q's cash flow statement covers only nine months. Each agrees with the difference between the nine-month and six-month statements the releases print, but no three-month cash flow statement exists to confirm them against.
• The Q3 FY2025 quarter carries no balance sheet, because the Q3 2026 10-Q compares the September 30, 2026 balance sheet with December 31, 2025, not with September 30, 2025.
• The Q3 FY2026 share repurchase amount differs between the statement of stockholders' equity ($2,999 million) and the average-price disclosure and earnings release (about $2.970 billion). Both are recorded as printed; the filing does not explain the $29 million gap.

Company details

Fiscal period

Source filings