During the first quarter of 2026, the Company did not experience a typical seasonal volume increase, primarily due to respiratory activity. Respiratory-related admissions were down 42 percent, and respiratory-related emergency room visits were down 32 percent, compared to the first quarter of 2025. In addition, a winter storm in January negatively impacted first quarter volumes in certain of our markets.
These unfavorable volume impacts were mostly offset by the recognition of certain Medicaid supplemental programs that were not included in the Company's initial 2026 guidance.
Balance Sheet and Cash Flows from Operations
As of March 31, 2026, HCA Healthcare, Inc.’s balance sheet reflected cash and cash equivalents of $940 million, total debt of $48.023 billion, and total assets of $61.450 billion. During the first quarter of 2026, capital expenditures totaled $1.119 billion, excluding acquisitions. Cash flows provided by operating activities in the first quarter of 2026 totaled $2.014 billion, compared to $1.651 billion in the first quarter of 2025.
During the first quarter of 2026, the Company repurchased 3.157 million shares of its common stock at a cost of $1.571 billion. The Company had $9.179 billion remaining under its repurchase authorization as of March 31, 2026. As of March 31, 2026, the Company had $4.336 billion of availability under its credit facility (after giving effect to letters of credit and amounts reserved to backstop its commercial paper program).
Dividend
HCA today announced that its Board of Directors declared a quarterly cash dividend of $0.78 per share on the Company’s common stock. The dividend will be paid on June 30, 2026 to stockholders of record at the close of business on June 16, 2026.
The declaration and payment of any future dividend will be subject to the discretion of the Board of Directors and will depend on a variety of factors, including the Company’s financial condition and results of operations. Future dividends are expected to be funded by cash balances and future cash flows from operations.
2026 Guidance
Today, the Company is reaffirming its 2026 estimated guidance ranges previously issued on January 27, 2026.
The Company’s guidance contains a number of assumptions, including, among others, the
Company’s current expectations regarding volume growth coupled with an anticipated mostly
stable operating environment, payer mix, the impact of current and future health care public
policy developments, including the estimated impact on health insurance exchanges from
administrative reforms and the expiration of the enhanced premium tax credits, anticipated
results from resiliency initiatives, as well as general business or economic conditions, including
inflation and the impact of trade policies, including tariffs, and excludes the impact of items such
as, but not limited to, gains or losses on sales of facilities, losses on retirement of debt, legal
claims costs and impairment of long-lived assets. In addition, the Company’s guidance excludes
the impact of future approvals that could impact reimbursement under certain state Medicaid
directed and supplemental payments.
Adjusted EBITDA is a non-GAAP financial measure. A table reconciling forecasted net income
attributable to HCA Healthcare, Inc. to forecasted Adjusted EBITDA is included in this release.