HCA Healthcare, Inc. (HCA)

HCA Healthcare reported third-quarter 2026 revenue of $19.849 billion on 27 October, up 3.6 percent from a year earlier 1. Net income attributable to the company fell 3.9 percent to $1.579 billion 1. Diluted earnings per share came to $7.27, a 4.5 percent increase 1.

A shift toward patients with no insurance was the main drag 1. The company estimated that the shift cut income before income taxes by about $400 million in the quarter, mostly from patients who lost coverage on the health insurance exchanges 1. Same facility uninsured admissions rose 27.4 percent 2.

The 10-Q ties the rise to the expiration of the enhanced premium tax credits at the end of 2025, which had helped people buy plans on those exchanges 2. The company also says approvals of Medicaid supplemental payment programs, mainly in Florida, helped revenue 2.

The company now believes its full year 2026 results will land in the upper half of the guidance ranges it issued on 14 July 1. Those ranges are revenue of $77.0 billion to $79.5 billion and net income attributable to the company of $6.3 billion to $6.7 billion 1.

On 2 November a subsidiary, HCA Inc., proposed a public offering of senior notes and said it would redeem all $1.200 billion of its 4.500% senior notes due February 2027 on 2 December 5. The redemption depends on the offering's proceeds arriving first, and the release says the money may also repay commercial paper and credit facility borrowings 54.

Through its predecessors, HCA began operating in 1968, and HCA Healthcare, Inc. was incorporated in Delaware in October 2010 3. On 17 November 2006 a private investor group that included affiliates of founder Thomas Frist Jr bought HCA Inc 3. Some Frist-affiliated investors still hold about 31 percent of the common stock, as of 31 January 2026 3.

In 2019 revenue rose 10.0 percent to $51.336 billion from $46.677 billion 8. The company credited a 3.2 percent rise in revenue per equivalent admission and a 6.6 percent rise in equivalent admissions 8. Equivalent admissions is its volume measure that counts outpatient visits alongside hospital stays 3.

The year before, 2018 revenue rose 7.0 percent to $46.677 billion from $43.614 billion, credited to a 2.8 percent rise in revenue per equivalent admission and a 4.1 percent rise in equivalent admissions 8.

The pandemic year 2020 barely moved revenue, which rose 0.4 percent to $51.533 billion 7. Revenue per equivalent admission rose 10.5 percent, but equivalent admissions fell 9.2 percent 7. The company believed the drop came mainly from restrictions on services and general concerns about exposure to the virus 7.

Revenue jumped 14.0 percent in 2021 to $58.752 billion, then grew 2.5 percent in 2022 to $60.233 billion 6. Salaries and benefits took 46.0 percent of 2022 revenue, against 45.6 percent a year earlier, as inflation and premium-rate contract labor raised labor costs 6.

Growth sped up in 2023 and 2024 9. Revenue rose 7.9 percent in 2023 to $64.968 billion and 8.7 percent in 2024 to $70.603 billion, helped by 4.9 percent and 5.3 percent gains in equivalent admissions 9. Medicaid state directed and supplemental payment programs brought in about $4.9 billion in 2024, up from $3.9 billion 9.

Revenue reached $75.600 billion in 2025, up 7.1 percent, from a 2.9 percent rise in equivalent admissions and a 4.0 percent rise in revenue per equivalent admission 3. Net income attributable to the company was $6.784 billion, against $5.760 billion in 2024, a year that included about $250 million of hurricane costs 3.

Medicaid supplemental payment programs became a bigger revenue source 3. Payments from state directed and supplemental programs totaled about $6.2 billion in 2025, $5.5 billion in 2024 and $4.4 billion in 2023 3. The company says it cannot estimate the financial effect of changes to those programs 3.

The company spent heavily on its own stock and facilities 3. It repurchased 26.739 million shares in 2025 for $10.067 billion and spent $4.944 billion on capital projects excluding acquisitions 3. Its debt grew to $46.492 billion from $43.031 billion, and interest expense rose to $2.248 billion 3.

What it runs

At the end of 2025 the company operated 190 hospitals: 179 general acute care hospitals, seven behavioral hospitals and four rehabilitation hospitals 3. It also ran 121 freestanding surgery centers and 31 freestanding endoscopy centers, in 19 states and England 3. By 30 September 2026 it counted 189 hospitals and about 2,600 sites of care 1.

General acute care hospitals

These hospitals handle everything from surgery and cardiology to emergency care, and the 179 of them held 50,436 licensed beds 3. Most are run by a local board of community members and an organized medical staff 3. In the latest quarter same facility emergency room visits rose 5.1 percent, while inpatient surgeries fell 1.4 percent 1.

Outpatient and surgery centers

The company also runs surgery centers, urgent care, freestanding emergency rooms, imaging, physician practices, home health and hospice 3. Most surgery centers are partnerships with a company affiliate holding the majority 3. Same facility outpatient surgeries fell 3.7 percent in the latest quarter 1.

Behavioral and rehabilitation hospitals

The seven behavioral hospitals held 714 licensed beds and offer psychiatric care and treatment for alcohol and drug abuse 3.

Who pays the bills

Managed care and other insurers were the largest payer group, at 48.9 percent of 2025 revenue 3. Managed Medicare supplied 17.8 percent, Medicare 14.9 percent and Medicaid 7.8 percent 3. Medicare and Medicaid pay set rates that are generally far below hospital charges 3.

Florida, Texas and the rest

Florida and Texas matter most 3. Florida has 47 hospitals and Texas 55, and the two states made 51 percent of 2025 revenue 3. The other hospitals sit in groups the company calls National, Atlantic and American, with eight hospitals in England 3.

People

Sam Hazen has been chief executive since January 2019 3. Mike Marks became chief financial officer on 1 May 2024, Jon Foster chief operating officer on 1 January 2023 and Michael McAlevey chief legal and administrative officer on 1 April 2024 3. The company counted about 320,000 employees at the end of 2025, about 90,000 of them part-time or PRN 3.

Rivals

Rivals include other hospitals, specialty hospitals, surgery centers, urgent care and imaging centers in the same towns 3. Some are not-for-profit or tax-supported, and the company notes they can have a funding advantage because they are exempt from certain taxes 3. The filing names no single rival 3.

Current problems

Revenue from managed care insurers fell short because enhanced premium tax credits expired at the end of 2025 2. The company has also said a federal budget law is expected to cut federal Medicaid spending 3. Rolling out a new electronic health record system across its facilities is complex and time-intensive, the 10-K says 3.

In December 2023 an affiliate learned that district attorneys in four counties in California were investigating its waste disposal practices 3. The company does not believe the matter will materially affect it 3.

The umbrella, in words

HCA Healthcare is a holding company whose affiliates own and operate the hospitals and related entities 3. Exhibit 21 lists its subsidiaries state by state, from hospital corporations to urgent care sites and the Bermuda insurer Parthenon Insurance Company, Limited 10. The list does not mark which are listed on an exchange 10.

The January 2026 board authorization lets the company repurchase up to $10 billion of its common stock 3. Dividends declared in 2025 were four payments of $0.72 per share, or $2.88 in all 3.

Its facilities are insured by one of its own insurance subsidiaries for losses up to $110 million per occurrence 3. The headquarters take up about 2,002,000 square feet in the Nashville area 3.

Control sits with a founder's family: Frist-affiliated investors hold about 31 percent of the stock as of 31 January 2026 and may nominate certain directors under a stockholders' agreement 3. On 6 February 2026 the company exchanged 36,629,188 of its shares held by an entity controlled by Dr Thomas Frist Jr for 36,557,141 new shares, cutting outstanding shares by 72,047 3.

For the year ending 31 December 2026 the company's guidance puts revenue at $77.0 billion to $79.5 billion 1. It puts adjusted EBITDA, earnings before interest, taxes, depreciation and amortization with some items removed, at $15.4 billion to $16.1 billion 1. Diluted earnings per share are guided at $28.70 to $30.50 1.

The company now believes full year results will fall in the upper half of those ranges 1. The guidance leaves out gains or losses on sales of facilities, losses on retirement of debt, legal claims costs and impairment of long-lived assets 1. It also assumes a diluted share count of 219.500 million 1.

The guidance assumes mostly stable conditions and excludes the effect of future approvals of certain state Medicaid directed and supplemental payments 1. It counts on resiliency initiatives, which are efficiency and cost steps meant to offset policy changes 12.

Planned capital spending for 2026 is between $5.0 billion and $5.5 billion, excluding acquisitions, and projects under construction need about $8.6 billion more over the next five years 2. The company expects to pay for this with internally generated and borrowed funds 2.

The board declared a quarterly dividend of $0.78 per share, payable on 29 December 2026 to holders of record on 15 December 1. At 30 September 2026 the company had $4.240 billion left under its share repurchase authorization 1.

Medicaid supplemental payment programs continue to evolve, and the 10-K says changes to them could reduce or reshape the revenue the company gets from the programs 3. The 10-K says the company cannot estimate the financial effect of such changes 3.

The 2 November notes offering is pending 5. The redemption of the 4.500% notes is set for 2 December, conditioned on receiving its proceeds 5. The 10-K lists growth aims including more presence in existing markets, a disciplined development strategy and advancing digital and AI capabilities 3.

Past

HCA Healthcare's revenue rose from $51 billion in fiscal 2019 to $76 billion in fiscal 2025, up 6.7% a year, and rose in 6 of 6 years with no fall from a peak; net income was positive in all 7 of those years. Over the three fiscal years to 2025, the diluted share count shrank about 6.7% a year, and dividends and buybacks returned about 67% of its operating cash flow. Dividends declared per share rose from $1.40 in fiscal 2018 to $2.88 in fiscal 2025. The company's filings since 2017 show no bankruptcy or receivership notice, no debt default notice, no exchange listing notice, no restatement warning, no auditor change, no material cyber incident and no late-report notice. 12

Present

For the fiscal year ended 2025-12-31, HCA Healthcare reported revenue of $76 billion and a profit of $6.8 billion. 3

Shareholders' equity was below zero, so return on equity is not read; the company owed about 105 cents per dollar of assets, and its share count shrank 8.5% over the year. HCA Healthcare's revenue of $76 billion in fiscal 2025 ranks in the top 2% by size among 22 graded names in its industry family; a net margin of 9% ranks in the top 20%; revenue growth of 7.9% a year over the last three filed years ranks in the bottom 43%. The chief executive, Samuel N. Hazen, has been filing under that title since 2019-02-01, 7.7 years; the 18 officers and directors filing in the last fifteen months have been on the record a median of 11.1 years; 9 officer or director changes were reported on Form 8-K since 2023-10-21, against the 18 people in charge now. 1

Future

A quarterly report (Form 10-Q) for the quarter ending 2026-09-30 is due by 2026-11-09. An annual report (Form 10-K) for the fiscal year ending 2026-12-31 is due by 2027-03-01. 4

Cash of $1.0 billion against debt of $44 billion leaves minus 71.2% of its assets as net cash, bottom 12% of its family; cash from operations less capital spending is 10.2% of revenue, top 20%. Revenue grew 7.9% a year over the last three filed years against 6.7% over all 7, speeding up; the newest year grew 7.1%; capital spending grew 4% a year. Revenue of $76 billion in fiscal 2025 came in 1.1% below the $76 billion the prior three years' pace pointed to; net income of $6.8 billion came against a prior three-year average of $5.5 billion; a net margin of 9% came against 8.5% before. 1

How the company operates

HCA Healthcare reported 3 lines of business in fiscal 2025: American Group at $26 billion, Atlantic Group at $25 billion, National Group at $21 billion; 3 of 3 grew in the latest filed year, and the largest line is 37% of revenue. The company is classed under Services-General Medical & Surgical Hospitals. 13

New moves

On 2026-07-29, a Form 8-K reported new debt or an obligation taken on. On 2026-04-30, a Form 8-K reported a major agreement signed and new debt or an obligation taken on. On 2026-04-29, a Form 424B5 reported securities sold off a shelf. On 2025-10-31, a Form 8-K reported a major agreement signed and new debt or an obligation taken on. 4