In Q3 2024, **HCA's cash and cash equivalents** were significantly higher primarily due to **strong cash flows from operating activities**—the company generated markedly higher net cash inflows from operations. This robust operating performance, combined with **moderate cash outflows for investing activities** and **reduced outflows for financing activities**, helped boost the cash position. Additionally, a minor positive impact from **exchange rate changes** also contributed to the increase.  **[0000950170-24-119581_hca-20240930.htm:4]** **[0000950170-24-117215_hca-ex99_1.htm:8]** 

Why was Cash and cash equivalents so high in Q3 2024?

The spike in the short-term portion of long-term debt in Q2 2024 was primarily due to a **$2.150 billion increase** in long-term debt due within one year, which led to a significant impact on working capital, dropping from **$2.272 billion** at December 31, 2023, to **$872 million** at June 30, 2024.  **[0000950170-24-087322_hca-20240630.htm:2]** **[0000950170-24-087322_hca-20240630.htm:29]** 

Why did short-term long-term debt spike in Q2 2024?

The retained deficit worsened in Q3 2024 because the positive effects of **net income** were more than offset by the **share repurchases** and **dividend payments**. Although HCA Healthcare reported a net income of **$4,322 million** for the first nine months of 2024, which typically reduces a retained deficit, the company repurchased **13.059 million shares** and declared cash dividends of **$0.66 per share**. These outflows contributed to increasing the deficit from **$1,352 million** at the end of December 2023 to **$1,807 million** by September 2024.  **[0000950170-24-119581_hca-20240930.htm:2]** **[0000950170-24-119581_hca-20240930.htm:17]** **[0000950170-24-117215_hca-ex99_1.htm:7]** **[0000950170-24-119581_hca-20240930.htm:3]** 

What caused the retained deficit to worsen in Q3 2024?

a0e0855f74f20c5232098955982834f03e814e5c080fea8bad3907fb69376eba

The significant spike in Operating Cash Flow for Q3 2024 was primarily driven by a **$859 million improvement in working capital** due to a decline in accounts receivable, a **$285 million increase in net income** (excluding non-cash impacts), and **higher depreciation and amortization expenses**—rising from **$769 million in Q3 2023 to $842 million in Q3 2024**—which helped boost cash flows, despite a **$190 million increase in income tax payments** partially offsetting these gains.  **[0000950170-24-119581_hca-20240930.htm:17]** **[0000950170-24-117215_hca-ex99_1.htm:7]** 

Why did Operating Cash Flow spike in Q3 2024?

The turnaround was driven by **positive changes in working capital**, particularly a **decline in accounts receivable** that boosted cash flows by **$859 million** during the quarter.  **[0000950170-24-119581_hca-20240930.htm:17]** 

What drove the turnaround in Accounts Receivable cash impact in Q3 2024?

The reversal in Income Taxes adjustments in Q2 2024 was primarily caused by **significantly higher income tax payments**, which increased by **$232 million** compared to Q2 2023, reflecting higher taxable income and improved financial performance. This effect was compounded by negative changes in working capital, such as an increase in accounts receivable and a decrease in accounts payable, which further impacted the cash flow adjustments related to income taxes.  **[0000950170-24-087322_hca-20240630.htm:17]** 

What caused the reversal in Income Taxes adjustments in Q2 2024?

The surge in the change in cash for Q3 2024 was primarily driven by a robust increase in operating cash flows, which rose significantly due to positive shifts in working capital and a higher net income (excluding non-cash items). This strong operating performance was then offset by substantial investing outflows related to property, equipment purchases, and acquisitions, as well as sizable financing outflows resulting from share repurchases and dividend payments—although these were partially balanced by long-term debt issuances. Additionally, a minor positive effect from exchange rate changes also contributed to the overall improvement in cash and cash equivalents.  **[0000950170-24-119581_hca-20240930.htm:17]** **[0000950170-24-119581_hca-20240930.htm:4]** **[0000950170-24-117215_hca-ex99_1.htm:8]** 

What factors contributed to the surge in the Change in Cash in Q3 2024?

The **repayment of long-term debt** was significantly higher in Q1 2024 because the company repaid its **$2.000 billion aggregate principal amount of 5.000% senior notes**, which matured in March 2024, resulting in a repayment of **$2,066 million** compared to **$550 million** in Q1 2023.  **[0000950170-24-052195_hca-20240331.htm:10]** **[0001193125-24-115857_d799245dex991.htm:5]** 

Why was the Repayment of Long-Term Debt significantly higher in Q1 2024?

0034076f53c1145f9ec5c44208e94e693c50672a9bbd7439d03a4c4c754b9cb2

The revenue jump was driven primarily by **increases in same facility admissions and service intensity**. Specifically, there was a **3.0% rise in same facility admissions** and a **3.1% rise in same facility equivalent admissions**, along with a **2.9% increase in revenue per equivalent admission**. Additionally, **emergency room visits increased by 2.4%** and **inpatient surgeries by 2.8%**, which outweighed a **1.3% decline in outpatient surgeries**. These operational improvements were key to the revenue growth in Q4 2024 despite other challenges.  **[0000950170-25-008608_hca-ex99_1.htm:0]** **[0000950170-25-008608_hca-ex99_1.htm:5]** 

What factors drove the revenue jump in Q4 2024?

The decline in net income attributable to HCA Healthcare in Q4 2024 was primarily due to **significant losses on sales of facilities**, which shifted from a gain of **$7 million in Q4 2023** to a loss of **$195 million in Q4 2024**. Additionally, the company faced **hurricane-related impacts** that resulted in extra expenses and revenue losses estimated at **$200 million**, and rising **operating expenses** further compressed margins despite a revenue increase. These factors combined to reduce net income by **$169 million** in the quarter.  **[0000950170-25-008608_hca-ex99_1.htm:0]** **[0000950170-25-008608_hca-ex99_1.htm:5]** 

Why did net income attributable to HCA Healthcare decline in Q4 2024?

The significant change in losses (gains) on sales of facilities in Q1 2024 was primarily due to a **gain of $201 million**, which resulted from the **sale of a hospital facility in California**.  **[0000950170-24-052195_hca-20240331.htm:17]** **[0000950170-24-052195_hca-20240331.htm:23]** 

Why were losses on sales of facilities so negative in Q1 2024?

The higher tax provision in Q2 2024 was primarily driven by **two key factors**. First, there was a **notable increase in Income Before Income Taxes**, which rose from **$1,809 million in Q2 2023** to **$2,237 million in Q2 2024**. Second, the **Effective Tax Rate increased from 24.9% to 27.4%**, a change largely attributed to adjustments related to the company’s liability for unrecognized tax benefits.  **[0000950170-24-087322_hca-20240630.htm:1]** **[0000950170-24-087322_hca-20240630.htm:7]** 

What contributed to the higher tax provision in Q2 2024?

HCA Healthcare’s increased income before income taxes in Q1 2024 was driven by several factors. **Revenue growth** played a major role, as revenues increased by **11.2%** due to a **7.1% increase in equivalent admissions** and a **3.9% increase in revenue per equivalent admission**. Additionally, there was a significant shift in the gains on sales of facilities, with a **$201 million gain** in Q1 2024 replacing a **$15 million loss** in Q1 2023. Improved operating metrics, such as a decrease in salaries and benefits from **45.4%** to **44.4%** of revenues, along with volume growth (admissions increased by **6.8%** and emergency room visits by **7.8%**), further supported the increase in income before income taxes.  **[0000950170-24-052195_hca-20240331.htm:21]** **[0000950170-24-052195_hca-20240331.htm:1]** **[0000950170-24-052195_hca-20240331.htm:17]** **[0000950170-24-052195_hca-20240331.htm:22]** **[0001193125-24-115857_d799245dex991.htm:0]** 

What drove the increase in income before income taxes in Q1 2024?

85f34134c2dc00f382d6936d7996bbeaade24edfe851cce190e25f55a1702bd1

Cash and cash equivalents (USD, millions)

Accounts receivable (USD, millions)

Inventories (USD, millions)

Other Current assets (USD, millions)

Total Current assets (USD, millions)

Land (USD, millions)

Buildings (USD, millions)

Equipment (USD, millions)

Construction in progress (USD, millions)

Total Property and equipment, at cost (USD, millions)

Accumulated depreciation (USD, millions)

Net Property and equipment (USD, millions)

Investments of insurance subsidiaries (USD, millions)

Investments in and advances to affiliates (USD, millions)

Goodwill and other intangible assets (USD, millions)

Right-of-use operating lease assets (USD, millions)

Other Assets (USD, millions)

Total Assets (USD, millions)

Accounts payable (USD, millions)

Accrued salaries (USD, millions)

Other accrued expenses (USD, millions)

Long-term debt due within one year (USD, millions)

Total Current liabilities (USD, millions)

Long-term debt, less debt issuance costs and discounts (USD, millions)

Professional liability risks (USD, millions)

Right-of-use operating lease obligations (USD, millions)

Income taxes and other liabilities (USD, millions)

Common stock (USD, millions)

Accumulated other comprehensive loss (USD, millions)

Retained deficit (USD, millions)

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

Noncontrolling interests (USD, millions)

Total Stockholders’ Equity (USD, millions)

Total Liabilities and Stockholders’ Equity (USD, millions)

978766dfb8cce0d1fa95d8fa530fa2c448eff4c12d7331a2f0682d44003f1e2b

Revenues (USD, millions)

Salaries and benefits (USD, millions)

Supplies (USD, millions)

Other operating expenses (USD, millions)

Equity in earnings of affiliates (USD, millions)

Depreciation and amortization (USD, millions)

Interest expense (USD, millions)

Losses (gains) on sales of facilities (USD, millions)

Losses on retirement of debt (USD, millions)

Income before income taxes (USD, millions)

Provision for income taxes (USD, millions)

Net income (USD, millions)

Net income attributable to noncontrolling interests (USD, millions)

Net income attributable to HCA Healthcare, Inc. (USD, millions)

d2599978ee6978ab517b897d359812778b44ffe817c87171899a0b0cac6235f2

Net Income [USD, millions]

Accounts Receivable - Increase (Decrease) in Cash from Operating Assets and Liabilities [USD, millions]

Inventories and Other Assets - Increase (Decrease) in Cash from Operating Assets and Liabilities [USD, millions]

Accounts Payable and Accrued Expenses - Increase (Decrease) in Cash from Operating Assets and Liabilities [USD, millions]

Depreciation and Amortization [USD, millions]

Income Taxes - Adjustments to Reconcile Net Income [USD, millions]

Losses (Gains) on Sales of Facilities [USD, millions]

Losses on Retirement of Debt [USD, millions]

Amortization of Debt Issuance Costs and Discounts [USD, millions]

Share-Based Compensation [USD, millions]

Other - Adjustments to Reconcile Net Income [USD, millions]

Net Cash Provided by Operating Activities [USD, millions]

Purchase of Property and Equipment [USD, millions]

Acquisition of Hospitals and Health Care Entities [USD, millions]

Sales of Hospitals and Health Care Entities [USD, millions]

Change in Investments [USD, millions]

Other - Investing Activities [USD, millions]

Net Cash Used in Investing Activities [USD, millions]

Issuances of Long-Term Debt [USD, millions]

Net Change in Revolving Credit Facilities [USD, millions]

Repayment of Long-Term Debt [USD, millions]

Distributions to Noncontrolling Interests [USD, millions]

Payment of Debt Issuance Costs [USD, millions]

Payment of Dividends [USD, millions]

Repurchase of Common Stock [USD, millions]

Other - Financing Activities [USD, millions]

Net Cash Used in Financing Activities [USD, millions]

Effect of Exchange Rate Changes on Cash and Cash Equivalents [USD, millions]

Change in Cash and Cash Equivalents [USD, millions]

Interest Payments [USD, millions]

Income Tax Payments, Net [USD, millions]

Cash and Cash Equivalents at Beginning of Period [USD, millions]

Cash and Cash Equivalents at End of Period [USD, millions]

6e87779bf8f22986dfc555e201d0f909a3465f8c0ab836593cf65c358b4597db

Adjustments for Non-Cash Items

Stock-Based Compensation

Changes in Working Capital

Capital Expenditures (CapEx)

Proceeds from / Repayments of Debt

Share Repurchases

Dividend Payments

Net Change in Cash

255a4749b8cdc10a410bfcff3ce14863b8a85082768cca03aba5fc287cfec228

23962ac8b158976793355afcdc3c60f70cd20a13d22db89e8b5a0badb53ce8ef

Total Revenue [USD, Millions]

Cost of Goods Sold (COGS) [USD, Millions]

SG&A [USD, Millions]

R&D [USD, Millions]

D&A [USD, Millions]

Interest Expense [USD, Millions]

Operating Income (EBIT) [USD, Millions]

Net Income [USD, Millions]

EPS - Basic [USD, Per Share]

EPS - Diluted [USD, Per Share]

9a73afd8e65740e36bf3f67997d13c98665de40be06f333be20cb5400a85aa7f

0aa02e36a8a08796faaf814db869232561462f5d392bc585cfcabe79fea8b926

National Group

Atlantic Group

American Group

Corporate and Other

- Medicare

- Managed Medicare

- Medicaid

- Managed Medicaid

- Managed care and insurers

- International (managed care and insurers)

- Uninsured

- Other

Total Revenue

1e4dac20c7acf3888e51ceeb6d7652fe1ffbfd3c9096eed414aaea09c8ba0302

2e4078a9ca5c6fdec181dcad534bc1ee6eba7831ba6600b92b44d16cdbc06e23

HCA Healthcare (HCA)

Financials