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Cover and table of contents

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

Form 10-Q

(Mark One)

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

For the quarterly period ended September 30, 2025

☐ 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 (§ 232.405 of this chapter) 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 October 27, 2025
Voting common stock, $.01 par value	228,193,900 shares

HCA HEALTHCARE, INC.

Form 10-Q

September 30, 2025



		Page of Form 10-Q
Part I.	Financial Information

Item 1.	Financial Statements (Unaudited):

	Condensed Consolidated Income Statements — for the quarters and nine months ended September 30, 2025 and 2024	3

	Condensed Consolidated Comprehensive Income Statements — for the quarters and nine months ended September 30, 2025 and 2024	4

	Condensed Consolidated Balance Sheets — September 30, 2025 and December 31, 2024	5

	Condensed Consolidated Statements of Stockholders’ Equity (Deficit) — for the quarters and nine months ended September 30, 2025 and 2024	6

	Condensed Consolidated Statements of Cash Flows — for the nine months ended September 30, 2025 and 2024	7

	Notes to Condensed Consolidated Financial Statements	8

Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	17

Item 3.	Quantitative and Qualitative Disclosures About Market Risk	31

Item 4.	Controls and Procedures	31

Part II.	Other Information

Item 1.	Legal Proceedings	31

Item 1A.	Risk Factors	31

Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds	31

Item 5.	Other Information	32

Item 6.	Exhibits	32

Signatures		33

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED INCOME STATEMENTS

FOR THE QUARTERS AND NINE MONTHS ENDED SEPTEMBER 30, 2025 AND 2024

Unaudited

(Dollars in millions, except per share amounts)


	Quarter						Nine Months
	2025			2024			2025			2024
Revenues	$	19,161		$	17,487		$	56,087		$	52,318

Salaries and benefits		8,364			7,861			24,499			23,253
Supplies		2,782			2,657			8,390			7,962
Other operating expenses		4,161			3,717			11,799			10,946
Equity in earnings of affiliates		(16	)		(15	)		(53	)		(13	)
Depreciation and amortization		889			842			2,612			2,456
Interest expense		561			515			1,676			1,533
Losses (gains) on sales of facilities		2			4			4			(209	)
		16,743			15,581			48,927			45,928
Income before income taxes		2,418			1,906			7,160			6,390
Provision for income taxes		515			424			1,541			1,419
Net income		1,903			1,482			5,619			4,971
Net income attributable to noncontrolling interests		260			212			713			649
Net income attributable to HCA Healthcare, Inc.	$	1,643		$	1,270		$	4,906		$	4,322
Per share data:
Basic earnings	$	7.05		$	4.94		$	20.47		$	16.57
Diluted earnings	$	6.96		$	4.88		$	20.23		$	16.37
Shares used in earnings per share calculations (in millions):
Basic		232.891			256.763			239.615			260.770
Diluted		236.181			259.917			242.459			263.987

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

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED COMPREHENSIVE INCOME STATEMENTS

FOR THE QUARTERS AND NINE MONTHS ENDED SEPTEMBER 30, 2025 AND 2024

Unaudited

(Dollars in millions)


	Quarter						Nine Months
	2025			2024			2025		2024
Net income	$	1,903		$	1,482		$	5,619	$	4,971
Other comprehensive income (loss) before taxes:
Foreign currency translation		(14	)		55			71		48
Unrealized gains on available-for-sale securities		3			13			12		10

Defined benefit plans		—			—			—		—
Pension costs included in salaries and benefits		—			(1	)		—		(1	)
		—			(1	)		—		(1	)

Other comprehensive (loss) income before taxes		(11	)		67			83		57
Income taxes (benefits) related to other comprehensive income items		(3	)		12			13		10
Other comprehensive (loss) income		(8	)		55			70		47
Comprehensive income		1,895			1,537			5,689		5,018
Comprehensive income attributable to noncontrolling interests		260			212			713		649
Comprehensive income attributable to HCA Healthcare, Inc.	$	1,635		$	1,325		$	4,976	$	4,369

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

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

Unaudited

(Dollars in millions)


	September 30, 2025			December 31, 2024
ASSETS
Current assets:
Cash and cash equivalents	$	997		$	1,933
Accounts receivable		10,428			10,751
Inventories		1,734			1,738
Other		2,126			1,992
		15,285			16,414

Property and equipment, at cost		65,489			62,514
Accumulated depreciation		(34,921	)		(33,100	)
		30,568			29,414

Investments of insurance subsidiaries		573			569
Investments in and advances to affiliates		654			662
Goodwill and other intangible assets		10,275			10,093
Right-of-use operating lease assets		2,115			2,131
Other		277			230
	$	59,747		$	59,513
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY
Current liabilities:
Accounts payable	$	4,552		$	4,276
Accrued salaries		2,294			2,304
Other accrued expenses		4,940			3,899
Short-term borrowings and long-term debt due within one year		6,110			4,698
		17,896			15,177

Long-term debt, less debt issuance costs and discounts of $416 and $369		38,401			38,333
Professional liability risks		1,462			1,544
Right-of-use operating lease obligations		1,838			1,863
Income taxes and other liabilities		2,309			2,041

Stockholders’ (deficit) equity:
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 229,845,100 shares — 2025 and 249,981,400 shares — 2024		2			3
Accumulated other comprehensive loss		(317	)		(387	)
Retained deficit		(5,020	)		(2,115	)
Stockholders’ deficit attributable to HCA Healthcare, Inc.		(5,335	)		(2,499	)
Noncontrolling interests		3,176			3,054
		(2,159	)		555
	$	59,747		$	59,513

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

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY (DEFICIT)

FOR THE QUARTERS AND NINE MONTHS ENDED SEPTEMBER 30, 2025 AND 2024

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, 2023		265.537		$	3		$	—		$	(425	)	$	(1,352	)	$	2,834		$	1,060
Comprehensive income (loss)											(8	)		1,591			211			1,794
Repurchase of common stock		(3.894	)											(1,187	)					(1,187	)
Share-based benefit plans		1.573												(68	)					(68	)
Cash dividends declared ($0.66 per share)														(176	)					(176	)
Distributions																	(152	)		(152	)
Other														7			(8	)		(1	)
Balances, March 31, 2024		263.216			3			—			(433	)		(1,185	)		2,885			1,270
Comprehensive income											—			1,461			226			1,687
Repurchase of common stock		(4.217	)					(68	)					(1,312	)					(1,380	)
Share-based benefit plans		0.239						68						68						136
Cash dividends declared ($0.66 per share)														(174	)					(174	)
Distributions																	(186	)		(186	)
Other														(28	)		14			(14	)
Balances, June 30, 2024		259.238			3			—			(433	)		(1,170	)		2,939			1,339
Comprehensive income											55			1,270			212			1,537
Repurchase of common stock		(4.948	)					(88	)					(1,724	)					(1,812	)
Share-based benefit plans		0.228						88												88
Cash dividends declared ($0.66 per share)														(170	)					(170	)
Distributions																	(192	)		(192	)
Other														(13	)		9			(4	)
Balances, September 30, 2024		254.518			3			—			(378	)		(1,807	)		2,968			786
Comprehensive income (loss)											(9	)		1,438			248			1,677
Repurchase of common stock		(4.739	)					(105	)					(1,580	)					(1,685	)
Share-based benefit plans		0.202						105												105
Cash dividends declared ($0.66 per share)														(168	)					(168	)
Distributions																	(181	)		(181	)
Other														2			19			21
Balances, December 31, 2024		249.981			3			—			(387	)		(2,115	)		3,054			555
Comprehensive income											30			1,610			215			1,855
Repurchase of common stock		(7.762	)		(1	)		(57	)					(2,470	)					(2,528	)
Share-based benefit plans		0.736						57												57
Cash dividends declared ($0.72 per share)														(178	)					(178	)
Distributions																	(220	)		(220	)
Other														(11	)		32			21
Balances, March 31, 2025		242.955			2			—			(357	)		(3,164	)		3,081			(438	)
Comprehensive income											48			1,653			238			1,939
Repurchase of common stock		(7.031	)					(126	)					(2,404	)					(2,530	)
Share-based benefit plans		0.220						126												126
Cash dividends declared ($0.72 per share)														(173	)					(173	)
Distributions																	(174	)		(174	)
Other														1			11			12
Balances, June 30, 2025		236.144			2			—			(309	)		(4,087	)		3,156			(1,238	)
Comprehensive income (loss)											(8	)		1,643			260			1,895
Repurchase of common stock		(6.514	)					(123	)					(2,399	)					(2,522	)
Share-based benefit plans		0.215						123												123
Cash dividends declared ($0.72 per share)														(169	)					(169	)
Distributions																	(237	)		(237	)
Other														(8	)		(3	)		(11	)
Balances, September 30, 2025		229.845		$	2		$	—		$	(317	)	$	(5,020	)	$	3,176		$	(2,159	)

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

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2025 AND 2024

Unaudited

(Dollars in millions)


	2025			2024
Cash flows from operating activities:
Net income	$	5,619		$	4,971
Adjustments to reconcile net income to net cash provided by operating activities:
Increase (decrease) in cash from operating assets and liabilities:
Accounts receivable		345			55
Inventories and other assets		(125	)		184
Accounts payable and accrued expenses		29			77
Depreciation and amortization		2,612			2,456
Income taxes		1,314			(67	)
Losses (gains) on sales of facilities		4			(209	)
Amortization of debt issuance costs and discounts		32			26
Share-based compensation		301			275
Other		146			187
Net cash provided by operating activities		10,277			7,955
Cash flows from investing activities:
Purchase of property and equipment		(3,455	)		(3,590	)
Acquisition of hospitals and health care entities		(361	)		(224	)
Sales of hospitals and health care entities		177			312
Change in investments		(26	)		(85	)
Other		(6	)		—
Net cash used in investing activities		(3,671	)		(3,587	)
Cash flows from financing activities:
Issuance of long-term debt		5,233			7,495
Net change in short-term borrowings and revolving credit facilities		1,906			(1,880	)
Repayment of long-term debt		(5,834	)		(2,346	)
Distributions to noncontrolling interests		(631	)		(530	)
Payment of debt issuance costs		(57	)		(67	)
Payment of dividends		(517	)		(525	)
Repurchase of common stock		(7,509	)		(4,342	)
Other		(142	)		(224	)
Net cash used in financing activities		(7,551	)		(2,419	)
Effect of exchange rate changes on cash and cash equivalents		9			4
Change in cash and cash equivalents		(936	)		1,953
Cash and cash equivalents at beginning of period		1,933			935
Cash and cash equivalents at end of period	$	997		$	2,888
Interest payments	$	1,696		$	1,405
Income tax payments, net	$	227		$	1,486

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

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

NOTE 1 — BASIS OF PR****ESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

Reporting Entity

HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At September 30, 2025, these affiliates owned and operated 191 hospitals, 123 freestanding surgery centers, 29 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 $139 million and $111 million for the quarters ended September 30, 2025 and 2024, respectively, and $395 million and $301 million for the nine months ended September 30, 2025 and 2024, respectively. Operating results for the quarter and nine months ended September 30, 2025 are not necessarily indicative of the results that may be expected for the year ending December 31, 2025. 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, 2024.

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.

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 nine months ended September 30, 2025 and 2024 are summarized in the following table (dollars in millions):


	Quarter
	2025		Ratio			2024		Ratio
Medicare	$	2,728		14.2	%	$	2,584		14.8	%
Managed Medicare		3,306		17.3			2,949		16.9
Medicaid		1,783		9.3			1,127		6.4
Managed Medicaid		949		4.9			1,031		5.9
Managed care and insurers		9,267		48.4			8,497		48.6
International (managed care and insurers)		484		2.5			424		2.4
Other		644		3.4			875		5.0
Revenues	$	19,161		100.0	%	$	17,487		100.0	%

	Nine Months
	2025		Ratio			2024		Ratio
Medicare	$	8,426		15.0	%	$	8,043		15.4	%
Managed Medicare		9,957		17.8			8,888		17.0
Medicaid		4,413		7.9			3,316		6.3
Managed Medicaid		2,727		4.9			3,042		5.8
Managed care and insurers		27,432		48.8			25,591		49.0
International (managed care and insurers)		1,390		2.5			1,252		2.4
Other		1,742		3.1			2,186		4.1
Revenues	$	56,087		100.0	%	$	52,318		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 nine months ended September 30, 2025 and 2024 follows (dollars in millions):


	Quarter						Nine Months
	2025			2024			2025			2024
Patient care costs (salaries and benefits, supplies, other operating expense and depreciation and amortization)	$	16,196		$	15,077		$	47,300		$	44,617
Cost-to-charges ratio (patient care costs as percentage of gross patient charges)		10.0	%		10.3	%		9.7	%		10.2	%
Total uncompensated care	$	12,015		$	10,958		$	34,633		$	31,571
Multiply by the cost-to-charges ratio		10.0	%		10.3	%		9.7	%		10.2	%
Estimated cost of total uncompensated care	$	1,188		$	1,138		$	3,359		$	3,220

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 $4.131 billion and $4.001 billion, respectively, and the related estimated costs of charity care were $408 million and $416 million, respectively, for the quarters ended September 30, 2025 and 2024. The total uncompensated care amounts include charity care of $11.887 billion and $12.091 billion, respectively, and the related estimated costs of charity care were $1.153 billion and $1.233 billion, respectively, for the nine months ended September 30, 2025 and 2024.

Reclassifications

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

NOTE 2 — ACQUISITIONS AND DISPOSITIONS

During the nine months ended September 30, 2025, we paid $190 million to acquire two hospital facilities in New Hampshire and Florida and $171 million to acquire nonhospital health care entities. During the nine months ended September 30, 2024, we paid $112 million to acquire three hospital facilities in Texas and $112 million 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 nine months ended September 30, 2025, we received proceeds of $155 million related to the sale of a hospital facility in California and $22 million related to sales of real estate and other health care entity investments. We recognized pretax losses of $4 million for these transactions. During the nine months ended September 30, 2024, we received proceeds of $295 million for the sale of a hospital facility in California and $17 million related to sales of real estate and other health care entity investments. We recognized pretax gains of $209 million for these transactions.

NOTE 3 — INCOME TAXES

Our provisions for income taxes for the quarters ended September 30, 2025 and 2024 were $515 million and $424 million, respectively, and the effective tax rates were 23.9% and 25.0%, respectively. Our provisions for income taxes for the nine months ended September 30, 2025 and 2024 were $1.541 billion and $1.419 billion, respectively, and the effective tax rates were 23.9% and 24.7%, respectively. The decline in the effective tax rate for the quarter and nine months ended September 30, 2025 is related primarily to adjustments to our liability for unrecognized tax benefits. Our provisions for income taxes included tax benefits related to settlements of employee equity awards of $45 million and $93 million for the nine months ended September 30, 2025 and 2024, respectively.

The One Big Beautiful Bill Act (the “OBBBA”), which was enacted on July 4, 2025, makes numerous tax changes, including reinstatement of 100% bonus depreciation for qualifying property placed in service after January 19, 2025, that we expect to change the timing of cash tax payments made in 2025 and future tax years. We do not expect the tax provisions of the OBBBA will have a material impact on our effective tax rate.

Our gross unrecognized tax benefits were $515 million, excluding accrued interest and penalties of $143 million, as of September 30, 2025 ($504 million and $115 million, respectively, as of December 31, 2024). Unrecognized tax benefits of $332 million ($295 million as of December 31, 2024) would affect the effective rate, if recognized.

The Internal Revenue Service (“IRS”) concluded its examination of the Company's 2022 and 2023 income tax returns during the quarter ended September 30, 2025, resolving all federal income tax matters for those years. Completion of the examination had no material impact on our results of operations or financial position. At September 30, 2025, the IRS was examining the 2019 income tax returns of certain affiliates. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change.

NOTE 4 — EARNINGS PER SHARE

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

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 nine months ended September 30, 2025 and 2024 (dollars and shares in millions, except per share amounts):


	Quarter				Nine Months
	2025		2024		2025		2024
Net income attributable to HCA Healthcare, Inc.	$	1,643	$	1,270	$	4,906	$	4,322

Weighted average common shares outstanding		232.891		256.763		239.615		260.770
Effect of dilutive incremental shares		3.290		3.154		2.844		3.217
Shares used for diluted earnings per share		236.181		259.917		242.459		263.987
Earnings per share:
Basic earnings	$	7.05	$	4.94	$	20.47	$	16.57
Diluted earnings	$	6.96	$	4.88	$	20.23	$	16.37

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES

A summary of our insurance subsidiaries’ investments at September 30, 2025 and December 31, 2024 follows (dollars in millions):


	September 30, 2025
			Unrealized Amounts
	Amortized Cost		Gains		Losses			Fair Value
Debt securities	$	343	$	1	$	(16	)	$	328
Money market funds and other		339		—		—			339
	$	682	$	1	$	(16	)		667
Amounts classified as current assets									(94	)
Investment carrying value								$	573


	December 31, 2024
			Unrealized Amounts
	Amortized Cost		Gains		Losses			Fair Value
Debt securities	$	388	$	—	$	(27	)	$	361
Money market funds and other		296		—		—			296
	$	684	$	—	$	(27	)		657
Amounts classified as current assets									(88	)
Investment carrying value								$	569

At September 30, 2025 and December 31, 2024, 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 or loss.

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 September 30, 2025 were as follows (dollars in millions):


	Amortized Cost		Fair Value
Due in one year or less	$	18	$	17
Due after one year through five years		151		147
Due after five years through ten years		114		107
Due after ten years		60		57
	$	343	$	328

The average expected maturity of the investments in debt securities at September 30, 2025 was 4.0 years, compared to the average scheduled maturity of 8.1 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 the investments of our insurance subsidiaries measured at fair value on a recurring basis as of September 30, 2025 and December 31, 2024, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):


	September 30, 2025
				Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Debt securities	$	328		$	1		$	327	$	—
Money market funds and other		339			339			—		—
Investments of insurance subsidiaries		667			340			327		—
Less amounts classified as current assets		(94	)		(94	)		—		—
	$	573		$	246		$	327	$	—

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

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


	December 31, 2024
				Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Debt securities	$	361		$	—		$	361	$	—
Money market funds and other		296			296			—		—
Investments of insurance subsidiaries		657			296			361		—
Less amounts classified as current assets		(88	)		(88	)		—		—
	$	569		$	208		$	361	$	—

The estimated fair value of our debt was $43.898 billion and $40.845 billion at September 30, 2025 and December 31, 2024, respectively, compared to carrying amounts, excluding debt issuance costs and discounts, aggregating $44.927 billion and $43.400 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 — DEBT

A summary of our debt at September 30, 2025 and December 31, 2024, including related interest rates at September 30, 2025, follows (dollars in millions):


	September 30, 2025			December 31, 2024
Short-term borrowings:
Commercial paper (average life of 17 days, weighted average rate of 4.7%)	$	1,910		$	—
Long-term debt:
Senior secured term loan facility		—			1,238
Other senior secured debt (effective interest rate of 4.4%)		1,067			1,046
Senior unsecured credit facilities		—			—
Senior unsecured notes payable through 2095 (effective interest rate of 5.1%)		41,950			41,116
Debt issuance costs and discounts		(416	)		(369	)
Total long-term debt (average life of 11.7 years, rates averaging 5.1%)		42,601			43,031
Total debt		44,511			43,031
Less amounts due within one year		6,110			4,698
	$	38,401		$	38,333

During February 2025, we repaid all $2.600 billion aggregate principal amount of 5.375% senior notes due 2025 at maturity. We entered into a new credit agreement that provides for $8.000 billion of senior unsecured revolving credit commitments with a term of five years (“senior unsecured credit facility”). Borrowings under the senior unsecured credit facility bear interest at a rate equal to the Secured Overnight Financing Rate plus 1.250% (plus, until October 23, 2025, a 0.10% credit spread adjustment, as the unsecured credit facility was amended on that date to remove the credit spread adjustment). We concurrently borrowed funds from the senior unsecured credit facility and repaid outstanding borrowings under our $4.500 billion senior secured asset-based revolving credit facility and our senior secured term loan facility of $1.238 billion. We terminated these senior secured credit facilities along with our $3.500 billion senior secured revolving cash flow credit facility.

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 7 — DEBT (continued)

During February 2025, we also issued $5.250 billion aggregate principal amount of senior notes comprised of (i) $700 million aggregate principal amount of 5.000% senior notes due 2028, (ii) $300 million aggregate principal amount of floating rate senior notes due 2028, (iii) $750 million aggregate principal amount of 5.250% senior notes due 2030, (iv) $750 million aggregate principal amount of 5.500% senior notes due 2032, (v) $1.500 billion aggregate principal amount of 5.750% senior notes due 2035 and (vi) $1.250 billion aggregate principal amount of 6.200% senior notes due 2055. We used the net proceeds to repay borrowings under the senior unsecured credit facility and for general corporate purposes.

During June 2025, we established a commercial paper program under which we may issue unsecured commercial paper notes from time to time up to a maximum aggregate face or principal amount of $4.000 billion outstanding at any time. Amounts available under the program may be borrowed, repaid and reborrowed from time to time. The maturities of the commercial paper notes borrowings may vary, but will not exceed 397 days from the date of issue, and the proceeds from the program will be used for general corporate purposes. In connection with the commercial paper program, we intend to maintain a minimum available borrowing capacity under our $8.000 billion senior unsecured credit facility equal to the aggregate amount outstanding under the commercial paper program. At September 30, 2025, we had $1.910 billion of commercial paper outstanding, and there were no borrowings outstanding under our senior unsecured credit facility.

During April 2025, June 2025 and September 2025, we repaid at maturity, utilizing our senior unsecured credit facility or commercial paper program, as applicable, all $1.400 billion aggregate principal amount of 5.25% senior notes, $291 million aggregate principal amount of 7.69% senior notes and $125 million aggregate principal amount of 7.58% medium-term notes, respectively.

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 subject to numerous 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.

We accrue for such contingencies to the extent that it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. If we are a party to any proceeding that, either individually or in the aggregate, is probable or reasonably possible of having a material, adverse effect on the business, our results of operations, financial position or liquidity, we disclose a summary of such contingencies and the amount or range of reasonably possible losses in excess of recorded amounts or that we are unable to reasonably estimate the amount or range of losses.

NOTE 9 — SHARE REPURCHASE TRANSACTIONS AND OTHER COMPREHENSIVE LOSS

During January 2025 and 2024, our Board of Directors authorized share repurchase programs for up to $10 billion and $6 billion, respectively, of our outstanding common stock. During the nine months ended September 30, 2025, we repurchased 21.307 million shares of our common stock at an average price of $352.40 per share through market purchases pursuant to the January 2024 authorization (which was completed during the first quarter of 2025) and the January 2025 authorization. At September 30, 2025, we had $3.256 billion of repurchase authorization available under the January 2025 authorization.

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 9 — SHARE REPURCHASE TRANSACTIONS AND OTHER COMPREHENSIVE LOSS (continued)

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, 2024	$	(21	)	$	(353	)	$	(13	)	$	(387	)
Unrealized gains on available-for-sale securities, net of $3 of income taxes		9									9
Foreign currency translation adjustments, net of $10 of income taxes					61						61
Balances at September 30, 2025	$	(12	)	$	(292	)	$	(13	)	$	(317	)

NOTE 10 — SEGMENT AND GEOGRAPHIC INFORMATION

We operate in one line of business, which is operating hospitals and related health care entities. We operate in three geographically organized groups: the National, Atlantic and American Groups. At September 30, 2025, the National Group included 54 hospitals located in Alaska, California, Idaho, Indiana, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah and Virginia, the Atlantic Group included 63 hospitals located in Florida, Georgia, Northern Kansas, Missouri and South Carolina, and the American Group included 66 hospitals located in Colorado, Central Kansas, Louisiana and Texas. The eight hospitals we operate in England are included in the Corporate and other group.

Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses and gains 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, salaries and benefits, supplies, other operating expenses, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization and assets that are provided to the Chief Operating Decision Maker, which is the Chief Executive Officer, are summarized in the following tables (dollars in millions) and represent the operating segments for the quarters and nine months ended September 30, 2025 and 2024 and assets at September 30, 2025 and December 31, 2024:


	Quarter									Nine Months
	2025
	National Group			Atlantic Group			American Group			National Group			Atlantic Group			American Group
Revenues	$	5,525		$	6,142		$	6,688		$	15,790		$	18,431		$	19,512

Salaries and benefits		1,970			2,288			2,275			5,848			6,750			6,687
Supplies		742			889			1,053			2,238			2,738			3,140
Other operating expenses		1,466			1,627			1,796			3,954			4,793			5,156
Equity in earnings of affiliates		(1	)		(1	)		(16	)		(1	)		(3	)		(47	)
		4,177			4,803			5,108			12,039			14,278			14,936
Adjusted segment EBITDA	$	1,348		$	1,339		$	1,580		$	3,751		$	4,153		$	4,576

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 10 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)


	Quarter							Nine Months
	2024
	National Group		Atlantic Group		American Group			National Group		Atlantic Group			American Group
Revenues	$	4,931	$	5,738	$	6,078		$	14,622	$	17,429		$	18,105

Salaries and benefits		1,897		2,190		2,176			5,656		6,500			6,405
Supplies		696		858		1,007			2,094		2,651			2,965
Other operating expenses		1,270		1,555		1,549			3,668		4,581			4,689
Equity in (earnings) losses of affiliates		—		—		(18	)		2		(2	)		(49	)
		3,863		4,603		4,714			11,420		13,730			14,010
Adjusted segment EBITDA	$	1,068	$	1,135	$	1,364		$	3,202	$	3,699		$	4,095


	Quarter				Nine Months
	2025		2024		2025		2024
Adjusted segment EBITDA:
National Group	$	1,348	$	1,068	$	3,751	$	3,202
Atlantic Group		1,339		1,135		4,153		3,699
American Group		1,580		1,364		4,576		4,095
		4,267		3,567		12,480		10,996
Adjustments to reconcile Total Adjusted segment EBITDA to consolidated Income before income taxes:
Corporate and Other		397		300		1,028		826
Depreciation and amortization		889		842		2,612		2,456
Interest expense		561		515		1,676		1,533
Losses (gains) on sales of facilities		2		4		4		(209	)
Income before income taxes	$	2,418	$	1,906	$	7,160	$	6,390


	Quarter				Nine Months
	2025		2024		2025		2024
Revenues:
National Group	$	5,525	$	4,931	$	15,790	$	14,622
Atlantic Group		6,142		5,738		18,431		17,429
American Group		6,688		6,078		19,512		18,105
Corporate and other		806		740		2,354		2,162
	$	19,161	$	17,487	$	56,087	$	52,318
Depreciation and amortization:
National Group	$	226	$	214	$	675	$	637
Atlantic Group		281		271		830		790
American Group		283		277		839		799
Corporate and other		99		80		268		230
	$	889	$	842	$	2,612	$	2,456


	September 30, 2025		December 31, 2024
Assets:
National Group	$	13,274	$	12,855
Atlantic Group		17,573		17,168
American Group		20,889		20,714
Corporate and other		8,011		8,776
	$	59,747	$	59,513

Next: Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF