PART II. OTHER INFORMATION

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

ITEM 3. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

ITEM 4. CONTROLS AND PROCEDURES

ITEM 1. LEGAL PROCEEDINGS

ITEM 1A. RISK FACTORS

ITEM 2. UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

ITEM 6. EXHIBITS

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

Form 10-Q

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

For the quarterly period ended March 31, 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.

(615) 344-9551

Not Applicable

Securities registered pursuant to Section 12(b) of the Act:

HCA HEALTHCARE, INC.

Form 10-Q

March 31, 2025

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED INCOME STATEMENTS

FOR THE QUARTERS ENDED MARCH 31, 2025 AND 2024

Unaudited

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

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED COMPREHENSIVE INCOME STATEMENTS

FOR THE QUARTERS ENDED MARCH 31, 2025 AND 2024

Unaudited

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

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

Unaudited

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 ENDED MARCH 31, 2025 AND 2024

Unaudited

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

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

FOR THE QUARTERS ENDED MARCH 31, 2025 AND 2024

Unaudited

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 PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (continued)

NOTE 2 — ACQUISITIONS AND DISPOSITIONS

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 2 — ACQUISITIONS AND DISPOSITIONS (continued)

NOTE 3 — INCOME TAXES

NOTE 4 — EARNINGS PER SHARE

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES

4.4

8.1

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 6 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

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

NOTE 7 — LONG-TERM DEBT

NOTE 8 — CONTINGENCIES

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 8 — CONTINGENCIES (continued)

NOTE 9 — SHARE REPURCHASE TRANSACTIONS AND OTHER COMPREHENSIVE LOSS

NOTE 10 — SEGMENT AND GEOGRAPHIC INFORMATION

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 10 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 10 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

FINANCIAL CONDITION AND RESULTS OF OPERATIONS

Forward-Looking Statements

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

First Quarter 2025 Operations Summary

Results of Operations

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Liquidity and Capital Resources

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Liquidity and Capital Resources (continued)

Tax Examinations

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Evaluation of Disclosure Controls and Procedures

Changes in Internal Control Over Financial Reporting

Risks related to our indebtedness:

ITEM 5. OTHER INFORMATION

SIGNATURES

Reporting Entity

Basis of Presentation

Revenues

Revenues (continued)

Reclassifications

Revenue/Volume Trends

Revenue/Volume Trends (continued)

Revenue/Volume Trends (continued)

Key Performance Indicators

Operating Results Summary

Quarters Ended March 31, 2025 and 2024

Market Risk

We have significant indebtedness and may incur further indebtedness in the future. Our indebtedness could adversely affect our ability to raise additional capital to fund our operations, limit our ability to react to changes in the economy or our industry, expose us to interest rate risk to the extent of our variable rate debt and prevent us from meeting our obligations.

We may not be able to generate sufficient cash to service all of our indebtedness and may not be able to refinance our indebtedness on favorable terms. If we are unable to do so, we may be forced to take other actions to satisfy our obligations under our indebtedness, which may not be successful.

Our debt agreements contain restrictions that limit our flexibility in operating our business.

(Mark One)

(Exact name of registrant as specified in its charter)

Delaware	27-3865930
(State or other jurisdiction of<br><br>incorporation or organization)	(I.R.S. Employer<br><br>Identification No.)
One Park Plaza<br><br>Nashville, Tennessee	37203
(Address of principal executive offices)	(Zip Code)

(Registrant’s telephone number, including area code)

(Former name, former address and former fiscal year, if changed since last report)

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 April 28, 2025
Voting common stock, $.01 par value	240,573,900 shares

		Page of<br>Form 10-Q
Part I.	Financial Information
Item 1.	Financial Statements (Unaudited):
	Condensed Consolidated Income Statements — for the quarters ended March 31, 2025 and 2024	3
	Condensed Consolidated Comprehensive Income Statements — for the quarters ended March 31, 2025 and 2024	4
	Condensed Consolidated Balance Sheets — March 31, 2025 and December 31, 2024	5
	Condensed Consolidated Statements of Stockholders’ Equity (Deficit) — for the quarters ended March 31, 2025 and 2024	6
	Condensed Consolidated Statements of Cash Flows — for the quarters ended March 31, 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	27
Item 4.	Controls and Procedures	27
Part II.	Other Information
Item 1.	Legal Proceedings	27
Item 1A.	Risk Factors	28
Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds	29
Item 5.	Other Information	30
Item 6.	Exhibits	31
Signatures		33

(Dollars in millions, except per share amounts)

	2025			2024
Revenues	$	18,321		$	17,339
Salaries and benefits		7,997			7,707
Supplies		2,764			2,671
Other operating expenses		3,845			3,606
Equity in (earnings) losses of affiliates		(18	)		2
Depreciation and amortization		860			795
Interest expense		547			512
Gains on sales of facilities		(1	)		(201	)
		15,994			15,092
Income before income taxes		2,327			2,247
Provision for income taxes		502			445
Net income		1,825			1,802
Net income attributable to noncontrolling interests		215			211
Net income attributable to HCA Healthcare, Inc.	$	1,610		$	1,591
Per share data:
Basic earnings	$	6.52		$	6.01
Diluted earnings	$	6.45		$	5.93
Shares used in earnings per share calculations (in millions):
Basic		246.936			264.435
Diluted		249.440			268.016

(Dollars in millions)

	2025		2024
Net income	$	1,825	$	1,802
Other comprehensive income (loss) before taxes:
Foreign currency translation		30		(8	)
Unrealized gains (losses) on available-for-sale securities		6		(2	)
Other comprehensive income (loss) before taxes		36		(10	)
Income taxes (benefits) related to other comprehensive income items		6		(2	)
Other comprehensive income (loss)		30		(8	)
Comprehensive income		1,855		1,794
Comprehensive income attributable to noncontrolling interests		215		211
Comprehensive income attributable to HCA Healthcare, Inc.	$	1,640	$	1,583

(Dollars in millions)

			December 31,<br>2024
ASSETS
Current assets:
Cash and cash equivalents	1,060		$	1,933
Accounts receivable	11,088			10,751
Inventories	1,794			1,738
Other	2,316			1,992
	16,258			16,414
Property and equipment, at cost	63,680			62,514
Accumulated depreciation	(33,942	)		(33,100	)
	29,738			29,414
Investments of insurance subsidiaries	550			569
Investments in and advances to affiliates	657			662
Goodwill and other intangible assets	10,237			10,093
Right-of-use operating lease assets	2,132			2,131
Other	226			230
	59,798		$	59,513
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY
Current liabilities:
Accounts payable	4,488		$	4,276
Accrued salaries	1,857			2,304
Other accrued expenses	3,767			3,899
Long-term debt due within one year	3,519			4,698
	13,631			15,177
Long-term debt, less debt issuance costs and discounts of 432 and 369	41,057			38,333
Professional liability risks	1,497			1,544
Right-of-use operating lease obligations	1,860			1,863
Income taxes and other liabilities	2,191			2,041
Stockholders’ (deficit) equity:
Common stock 0.01 par; authorized 1,800,000,000 shares; outstanding 242,955,400 shares — 2025 and 249,981,400 shares — 2024	2			3
Accumulated other comprehensive loss	(357	)		(387	)
Retained deficit	(3,164	)		(2,115	)
Stockholders’ deficit attributable to HCA Healthcare, Inc.	(3,519	)		(2,499	)
Noncontrolling interests	3,081			3,054
	(438	)		555
	59,798		$	59,513

All values are in US Dollars.

(Dollars in millions)


						Capital			Accumulated						Equity
						in Excess			Other						Attributable to
			Par			of Par			Comprehensive			Retained			Noncontrolling
			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	)

All values are in US Dollars.

(Dollars in millions)

	2025			2024
Cash flows from operating activities:
Net income	$	1,825		$	1,802
Adjustments to reconcile net income to net cash provided by <br> operating activities:
Increase (decrease) in cash from operating assets and liabilities:
Accounts receivable		(327	)		(90	)
Inventories and other assets		(360	)		77
Accounts payable and accrued expenses		(1,000	)		(517	)
Depreciation and amortization		860			795
Income taxes		492			444
Gains on sales of facilities		(1	)		(201	)
Amortization of debt issuance costs and discounts		11			9
Share-based compensation		98			87
Other		53			63
Net cash provided by operating activities		1,651			2,469
Cash flows from investing activities:
Purchase of property and equipment		(991	)		(1,118	)
Acquisition of hospitals and health care entities		(227	)		(96	)
Sales of hospitals and health care entities		161			310
Change in investments		28			2
Other		(3	)		(1	)
Net cash used in investing activities		(1,032	)		(903	)
Cash flows from financing activities:
Issuance of long-term debt		5,233			4,483
Net change in revolving credit facilities		220			(1,880	)
Repayment of long-term debt		(3,895	)		(2,066	)
Distributions to noncontrolling interests		(220	)		(152	)
Payment of debt issuance costs		(57	)		(40	)
Payment of dividends		(180	)		(185	)
Repurchase of common stock		(2,506	)		(1,180	)
Other		(90	)		(196	)
Net cash used in financing activities		(1,495	)		(1,216	)
Effect of exchange rate changes on cash and cash equivalents		3			(1	)
Change in cash and cash equivalents		(873	)		349
Cash and cash equivalents at beginning of period		1,933			935
Cash and cash equivalents at end of period	$	1,060		$	1,284
Interest payments	$	539		$	538
Income tax payments, net	$	10		$	1

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 March 31, 2025, these affiliates owned and operated 192 hospitals, 125 freestanding surgery centers and 26 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.

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 $126 million and $90 million for the quarters ended March 31, 2025 and 2024, respectively. Operating results for the quarter 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.

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.

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 ended March 31, 2025 and 2024 are summarized in the following table (dollars in millions):

	2025				2024
Medicare	$	2,895	15.8	%	$	2,838	16.4	%
Managed Medicare		3,299	18.0			3,026	17.4
Medicaid		1,190	6.5			1,000	5.8
Managed Medicaid		879	4.8			978	5.6
Managed care and insurers		9,041	49.4			8,545	49.2
International (managed care and insurers)		445	2.4			412	2.4
Other		572	3.1			540	3.2
Revenues	$	18,321	100.0	%	$	17,339	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 ended March 31, 2025 and 2024 follows (dollars in millions):

	2025			2024
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation<br> and amortization)	$	15,466		$	14,779
Cost-to-charges ratio (patient care costs as a percentage of gross patient charges)		9.6	%		10.1	%
Total uncompensated care	$	10,993		$	10,002
Multiply by the cost-to-charges ratio		9.6	%		10.1	%
Estimated cost of total uncompensated care	$	1,055		$	1,010

The total uncompensated care amounts for the quarters ended March 31, 2025 and 2024 include charity care of $3.644 billion and $3.978 billion, respectively, and the related estimated costs of charity care were $350 million and $402 million, respectively.

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

During the quarter ended March 31, 2025, we paid $190 million to acquire two hospital facilities in New Hampshire and Florida and $37 million to acquire nonhospital health care entities. During the quarter ended March 31, 2024, we paid $50 million to acquire two hospital facilities in Texas and $46 million to acquire nonhospital health care entities. Purchase price amounts are allocated to the related assets acquired and liabilities assumed based upon their respective fair values.

During the quarter ended March 31, 2025, we received proceeds of $157 million related to the sale of a hospital facility in California (effective April 1, 2025). We also received proceeds of $4 million and recognized a pretax gain of $1 million related to sales of real estate and other health care entity investments. During the quarter ended March 31, 2024, we received proceeds of $297 million and recognized a pretax gain of $193 million for the sale of a hospital facility in California. We also received proceeds of $13 million and recognized a pretax gain of $8 million related to sales of real estate and other health care entity investments.

Our provisions for income taxes for the quarters ended March 31, 2025 and 2024 were $502 million and $445 million, respectively, and the effective tax rate was 23.8% and 21.8%, respectively. The increase in the effective tax rate for the quarter ended March 31, 2025 is related primarily to a reduction in the amount of deductible share-based compensation for vested employee equity awards. Our provisions for income taxes included tax benefits related to settlements of employee equity awards of $24 million and $69 million for the quarters ended March 31, 2025 and 2024, respectively.

Our gross unrecognized tax benefits were $512 million, excluding accrued interest of $126 million, as of March 31, 2025 ($504 million and $115 million, respectively, as of December 31, 2024). Unrecognized tax benefits of $308 million ($295 million as of December 31, 2024) would affect the effective rate, if recognized.

At March 31, 2025, the Internal Revenue Service (“IRS”) was examining the Company’s 2022 and 2023 income tax returns and the 2019 income tax returns of certain affiliates. We are subject to examination by the IRS for tax years after 2020, as well as by state and foreign taxing authorities. 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.

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.

The following table sets forth the computation of basic and diluted earnings per share for the quarters ended March 31, 2025 and 2024 (dollars and shares in millions, except per share amounts):

	2025		2024
Net income attributable to HCA Healthcare, Inc.	$	1,610	$	1,591
Weighted average common shares outstanding		246.936		264.435
Effect of dilutive incremental shares		2.504		3.581
Shares used for diluted earnings per share		249.440		268.016
Earnings per share:
Basic earnings	$	6.52	$	6.01
Diluted earnings	$	6.45	$	5.93

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

	March 31, 2025
			Unrealized<br>Amounts
	Amortized<br>Cost		Gains		Losses			Fair<br>Value
Debt securities	$	372	$	1	$	(22	)	$	351
Money market funds and other		306		—		—			306
	$	678	$	1	$	(22	)		657
Amounts classified as current assets									(107	)
Investment carrying value								$	550
	December 31, 2024
---	---	---	---	---	---	---	---	---	---	---
			Unrealized<br>Amounts
	Amortized<br>Cost		Gains		Losses			Fair<br>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 March 31, 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.

Scheduled maturities of investments in debt securities at March 31, 2025 were as follows (dollars in millions):

	Amortized<br>Cost		Fair<br>Value
Due in one year or less	$	24	$	24
Due after one year through five years		146		142
Due after five years through ten years		138		125
Due after ten years		64		60
	$	372	$	351

The average expected maturity of the investments in debt securities at March 31, 2025 was

years, compared to the average scheduled maturity of

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.

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 March 31, 2025 and December 31, 2024, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

	March 31, 2025
				Fair Value Measurements Using
	Fair Value			Quoted Prices in<br>Active Markets for<br>Identical Assets<br>(Level 1)			Significant Other<br>Observable Inputs<br>(Level 2)		Significant<br>Unobservable Inputs<br>(Level 3)
Debt securities	$	351		$	1		$	350	$	—
Money market funds and other		306			306			—		—
Investments of insurance subsidiaries		657			307			350		—
Less amounts classified as current assets		(107	)		(107	)		—		—
	$	550		$	200		$	350	$	—
	December 31, 2024
---	---	---	---	---	---	---	---	---	---	---
				Fair Value Measurements Using
	Fair Value			Quoted Prices in<br>Active Markets for<br>Identical Assets<br>(Level 1)			Significant Other<br>Observable Inputs<br>(Level 2)		Significant<br>Unobservable Inputs<br>(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 long-term debt was $42.876 billion and $40.845 billion at March 31, 2025 and December 31, 2024, respectively, compared to carrying amounts, excluding debt issuance costs and discounts, aggregating $45.008 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.

A summary of long-term debt at March 31, 2025 and December 31, 2024, including related interest rates at March 31, 2025, follows (dollars in millions):

	March 31,<br>2025			December 31,<br>2024
Senior secured term loan facility	$	—			1,238
Other senior secured debt (effective interest rate of 4.6%)		1,022			1,046
Senior secured debt		1,022			2,284
Senior unsecured credit facility (effective interest rate of 5.7%)		220			—
Senior unsecured notes (effective interest rate of 5.2%)		43,766			41,116
Debt issuance costs and discounts		(432	)		(369	)
Total debt (average life of 11.7 years, rates averaging 5.2%)		44,576			43,031
Less amounts due within one year		3,519			4,698
	$	41,057		$	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”). Currently, borrowings under the senior unsecured credit facility bear interest at a rate equal to the Secured Overnight Financing Rate plus 1.250% (plus a 0.10% credit spread adjustment). We concurrently borrowed funds from the senior unsecured credit facility and repaid outstanding borrowings under our $4.5 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 $3.5 billion senior secured revolving cash flow credit facility.

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.

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.

During January 2025 and January 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 quarter ended March 31, 2025, we repurchased 7.762 million shares of our common stock at an average price of $322.84 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 March 31, 2025, we had $8.259 billion of repurchase authorization available under the January 2025 authorization.

The components of accumulated other comprehensive loss are as follows (dollars in millions):

			Foreign<br>Currency<br>Translation<br>Adjustments			Defined<br>Benefit<br>Plans			Total
Balances at December 31, 2024	(21	)	$	(353	)	$	(13	)	$	(387	)
Unrealized gains on available-for-sale securities, net of 2 of income taxes	4									4
Foreign currency translation adjustments, net of 4 of income taxes				26						26
Balances at March 31, 2025	(17	)	$	(327	)	$	(13	)	$	(357	)

All values are in US Dollars.

Effective January 1, 2024, we adopted Accounting Standards Update 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures. 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 March 31, 2025, the National Group included 55 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 ended March 31, 2025 and 2024 and assets at March 31, 2025 and December 31, 2024:

	2025
	National<br>Group		Atlantic<br>Group			American<br>Group
Revenues	$	5,065	$	6,167		$	6,331
Salaries and benefits		1,959		2,216			2,196
Supplies		741		914			1,020
Other operating expenses		1,233		1,576			1,711
Equity in earnings of affiliates		-		(1	)		(14	)
		3,933		4,705			4,913
Adjusted segment EBITDA	$	1,132	$	1,462		$	1,418
	2024
---	---	---	---	---	---	---	---	---	---
	National<br>Group			Atlantic<br>Group			American<br>Group
Revenues	$	4,835		$	5,810		$	5,984
Salaries and benefits		1,890			2,161			2,119
Supplies		705			909			980
Other operating expenses		1,194			1,482			1,580
Equity in earnings of affiliates		(1	)		(1	)		(13	)
		3,788			4,551			4,666
Adjusted segment EBITDA	$	1,047		$	1,259		$	1,318

	2025			2024
Adjusted segment EBITDA:
National Group	$	1,132		$	1,047
Atlantic Group		1,462			1,259
American Group		1,418			1,318
		4,012			3,624
Adjustments to reconcile Total Adjusted segment<br> EBITDA to consolidated Income before income taxes:
Corporate and Other		279			271
Depreciation and amortization		860			795
Interest expense		547			512
Gains on sales of facilities		(1	)		(201	)
Income before income taxes	$	2,327		$	2,247
	2025		2024
---	---	---	---	---
Revenues:
National Group	$	5,065	$	4,835
Atlantic Group		6,167		5,810
American Group		6,331		5,984
Corporate and other		758		710
	$	18,321	$	17,339
Depreciation and amortization:
National Group	$	226	$	212
Atlantic Group		274		258
American Group		279		255
Corporate and other		81		70
	$	860	$	795
	March 31,<br>2025		December 31,<br>2024
---	---	---	---	---
Assets:
National Group	$	13,407	$	12,855
Atlantic Group		17,654		17,168
American Group		20,614		20,714
Corporate and other		8,123		8,776
	$	59,798	$	59,513

This quarterly report on Form 10-Q includes certain disclosures that contain “forward-looking statements” within the meaning of the federal securities laws, which involve risks and uncertainties. Forward-looking statements include statements regarding expected capital expenditures, expected dividends, expected share repurchases, expected net claim payments, expected inflationary pressures, expected labor costs and all other statements that do not relate solely to historical or current facts, and can be identified by the use of words like “may,” “believe,” “will,” “expect,” “project,” “estimate,” “anticipate,” “plan,” “initiative” or “continue.” These forward-looking statements are based on our current plans and expectations and are subject to a number of known and unknown uncertainties and risks, many of which are beyond our control, which could significantly affect current plans and expectations and our future financial position and results of operations. These factors include, but are not limited to, (1) changes in or related to general economic or business conditions nationally and regionally in our markets, including inflation and the impact of trade policies, including changes in, or the imposition of, tariffs and/or trade barriers; changes in revenues resulting from declining patient volumes; changes in payer mix (including increases in uninsured and underinsured patients); potential increased expenses related to labor, pharmaceuticals, supply chain or other expenditures; workforce disruptions; supply and pharmaceutical shortages and disruptions (including as a result of tariffs or geopolitical disruptions); and the impact of potential federal government shutdowns, holds on or cancellations of congressionally authorized spending and interruptions in the distribution of governmental funds, (2) the impact of current and future health care public policy developments and possible changes to other federal, state or local laws and regulations affecting the health care industry, including the expiration of enhanced premium tax credits for individuals eligible to purchase insurance coverage through federal and state-based health insurance marketplaces and changes in the structure and administration of, and funding for, federal and state agencies and programs, (3) the impact of our significant indebtedness and the ability to refinance such indebtedness on acceptable terms, (4) the effects related to the implementation of sequestration spending reductions required under the Budget Control Act of 2011, related legislation extending these reductions, and the potential for future deficit reduction legislation that may alter these spending reductions, which include cuts to Medicare payments, or create additional spending reductions, (5) the ability to achieve operating and financial targets, attain expected levels of patient volumes and revenues, and control the costs of providing services, (6) possible reductions or other changes in Medicare, Medicaid and other state programs, including Medicaid supplemental payment programs, Medicaid waiver programs or state directed payments, that may negatively impact reimbursements to health care providers and insurers and the size of the uninsured or underinsured population, (7) increases in the amount and risk of collectability of uninsured accounts and deductibles and copayment amounts for insured accounts, (8) personnel-related capacity constraints, increases in wages and the ability to attract, utilize and retain qualified management and other personnel, including affiliated physicians, nurses and medical and technical support personnel, (9) the highly competitive nature of the health care business, (10) changes in service mix, revenue mix and surgical volumes, including potential declines in the population covered under third-party payer agreements, the ability to enter into and renew third-party payer provider agreements on acceptable terms and the impact of consumer-driven health plans and physician utilization trends and practices, (11) the efforts of health insurers, health care providers, large employer groups and others to contain health care costs, (12) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (13) the availability and terms of capital to fund the expansion of our business and improvements to our existing facilities, (14) changes in accounting practices, (15) the emergence of and effects related to pandemics, epidemics and outbreaks of infectious diseases or other public health crises, (16) future divestitures which may result in charges and possible impairments of long-lived assets, (17) changes in business strategy or development plans, (18) delays in receiving payments for services provided, (19) the outcome of pending and any future tax audits, disputes and litigation associated with our tax positions, (20) the impact of known and unknown government investigations, litigation and other claims that may be made against us, (21) the impact of actual and potential cybersecurity incidents or security breaches involving us or our vendors and other third parties, (22) our ongoing ability to demonstrate meaningful use of certified electronic health record technology and the impact of interoperability requirements, (23) the impact of natural disasters, such as hurricanes and floods, including Hurricanes Milton and Helene, physical risks from changing global weather patterns or similar events beyond our control on our assets and activities and the communities we serve, (24) changes in U.S. federal, state, or foreign tax laws, interpretations of tax laws by taxing authorities, other standard setting bodies or judicial decisions, (25) the results of our efforts to use technology and resilience initiatives, including artificial intelligence and machine learning, to drive efficiencies, better outcomes and an enhanced patient experience, and (26) other risk factors described in our annual report on Form 10-K for the year ended December 31, 2024 and our other filings with the Securities and Exchange Commission. As a consequence, current plans, anticipated actions and future financial position and results of operations may differ from those expressed in any forward-looking statements made by or on behalf of HCA. You are cautioned not to unduly rely on such forward-looking statements when evaluating the information presented in this report, which forward-looking statements reflect management’s views only as of the date of this report. We undertake no obligation to revise or update any forward-looking statements, whether as a result of new information, future events or otherwise.

Revenues increased to $18.321 billion in the first quarter of 2025 from $17.339 billion in the first quarter of 2024. Net income attributable to HCA Healthcare, Inc. totaled $1.610 billion, or $6.45 per diluted share, for the quarter ended March 31, 2025, compared to $1.591 billion, or $5.93 per diluted share, for the quarter ended March 31, 2024. First quarter results for 2024 include gains on sales of facilities of $201 million, or $0.57 per diluted share. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 249.440 million shares for the quarter ended March 31, 2025 and 268.016 million shares for the quarter ended March 31, 2024. During 2024 and the first quarter of 2025, we repurchased 17.798 million shares and 7.762 million shares, respectively, of our common stock.

Revenues increased 5.7% on both a consolidated and same facility basis for the quarter ended March 31, 2025, compared to the quarter ended March 31, 2024. The increase in consolidated revenues can be primarily attributed to the combined impact of a 3.1% increase in equivalent admissions and a 2.5% increase in revenue per equivalent admission. The same facility revenues increase resulted from the combined impact of a 2.8% increase in same facility equivalent admissions and a 2.9% increase in same facility revenue per equivalent admission.

During the quarter ended March 31, 2025, consolidated admissions increased 2.8% and same facility admissions increased 2.6% compared to the quarter ended March 31, 2024. Inpatient surgical volumes increased 0.3% on a consolidated basis and 0.2% on a same facility basis during the quarter ended March 31, 2025, compared to the quarter ended March 31, 2024. Outpatient surgical volumes declined 2.5% on a consolidated basis and 2.1% on a same facility basis during the quarter ended March 31, 2025, compared to the quarter ended March 31, 2024. Emergency department visits increased 3.7% on a consolidated basis and 4.0% on a same facility basis during the quarter ended March 31, 2025, compared to the quarter ended March 31, 2024. Consolidated and same facility uninsured admissions declined 0.2% and 0.7%, respectively, for the quarter ended March 31, 2025, compared to the quarter ended March 31, 2024.

Cash flows from operating activities declined $818 million, from $2.469 billion for the first quarter of 2024 to $1.651 billion for the first quarter of 2025. The decline in cash provided by operating activities was primarily related to the net impact of negative changes in working capital items of $1.157 billion, partially offset by a $176 million increase in net income, excluding gains on sales of facilities.

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.

Revenues increased 5.7% from $17.339 billion in the first quarter of 2024 to $18.321 billion in the first quarter of 2025. 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 self-pay 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 ended March 31, 2025 and 2024 are summarized in the following table (dollars in millions):

	2025				2024
Medicare	$	2,895	15.8	%	$	2,838	16.4	%
Managed Medicare		3,299	18.0			3,026	17.4
Medicaid		1,190	6.5			1,000	5.8
Managed Medicaid		879	4.8			978	5.6
Managed care and insurers		9,041	49.4			8,545	49.2
International (managed care and insurers)		445	2.4			412	2.4
Other		572	3.1			540	3.2
Revenues	$	18,321	100.0	%	$	17,339	100.0	%

Consolidated and same facility revenue per equivalent admission increased 2.5% and 2.9%, respectively, in the first quarter of 2025, compared to the first quarter of 2024. Consolidated and same facility equivalent admissions increased 3.1% and 2.8%, respectively, in the first quarter of 2025, compared to the first quarter of 2024. Consolidated and same facility outpatient surgeries declined 2.5% and 2.1%, respectively, in the first quarter of 2025, compared to the first quarter of 2024. Consolidated and same facility inpatient surgeries increased 0.3% and 0.2%, respectively, in the first quarter of 2025, compared to the first quarter of 2024. Consolidated and same facility emergency department visits increased 3.7% and 4.0%, respectively, in the first quarter of 2025, compared to the first quarter of 2024.

	2025			2024
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation<br> and amortization)	$	15,466		$	14,779
Cost-to-charges ratio (patient care costs as a percentage of gross patient charges)		9.6	%		10.1	%
Total uncompensated care	$	10,993		$	10,002
Multiply by the cost-to-charges ratio		9.6	%		10.1	%
Estimated cost of total uncompensated care	$	1,055		$	1,010

Same facility uninsured admissions declined 0.7%, in the first quarter of 2025 compared to the first quarter of 2024. Same facility uninsured admissions in 2024, compared to 2023, increased 0.1% in the fourth quarter, declined 1.8% in the third quarter, increased 3.5% in the second quarter and increased 2.4% in the first quarter.

The approximate percentages of our admissions related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and insurers and the uninsured for the quarters ended March 31, 2025 and 2024 are set forth in the following table.


Medicare	20	%	20	%
Managed Medicare	27		27
Medicaid	4		4
Managed Medicaid	11		12
Managed care and insurers	32		31
Uninsured	6		6
	100	%	100	%

The approximate percentages of our inpatient revenues related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and insurers for the quarters ended March 31, 2025 and 2024 are set forth in the following table.

At March 31, 2025, we had 102 hospitals in the states of Texas and Florida. During the quarter ended March 31, 2025, 59% of our admissions and 52% of our revenues were generated by these hospitals. Uninsured admissions in Texas and Florida represented 73% of our uninsured admissions during the quarter ended March 31, 2025.

We receive a significant portion of our revenues from government health programs, principally Medicare and Medicaid, which are highly regulated and subject to frequent and substantial changes. Some states make additional payments to providers through the Medicaid program that are separate from base payments. These payments may be in the form of payments, such as upper payment limit payments, that are intended to address the difference between Medicaid fee-for-service payments and Medicare reimbursement rates, or payments under other programs that vary by state under Section 1115 waivers. In addition, many states have implemented state directed payment arrangements to direct certain Medicaid managed care plan expenditures. These payments are generally authorized by CMS and subject to periodic extension or reapproval. Most states in which we receive payment have adopted statewide or local provider taxes to fund the non-federal share of Medicaid programs. These additional payments supplement Medicaid base rates that, when taken together, are insufficient to cover the cost of care provided to Medicaid beneficiaries combined with the state or local provider taxes levied.

We are aware these payment programs are currently being reviewed by certain government agencies, and some states requested modifications of their existing supplemental payment programs during the annual renewal process with CMS. It is possible these reviews and requests will result in the restructuring of such supplemental payment programs and could result in the payment programs being reduced or eliminated. Because deliberations about these programs are ongoing, we are unable to estimate the financial impact the program structure modifications, if any, may have on our results of operations.

The health care industry is subject to changing political, regulatory and other influences, including health care reform efforts at the federal and state levels. For example, the enhanced premium tax credits for individuals eligible to purchase insurance coverage through federal and state-based health insurance marketplaces are scheduled to expire at the end of 2025, and further extension is uncertain. We are monitoring and engaged in advocacy efforts around potential health care policy changes and reform. See Item 1A, “Risk Factors” from our Annual Report on Form 10-K for the year ended December 31, 2024 for additional information.

We present certain metrics and statistical information that management uses when assessing our results of operations. We believe this information is useful to investors as it provides insight to how management evaluates operational performance and trends between reporting periods. Information on how these metrics and statistical information are defined is provided in the following tables summarizing operating results and operating data.

The following is a comparative summary of results of operations for the quarters ended March 31, 2025 and 2024 (dollars in millions):

	2025						2024
	Amount			Ratio			Amount			Ratio
Revenues	$	18,321			100.0		$	17,339			100.0
Salaries and benefits		7,997			43.6			7,707			44.4
Supplies		2,764			15.1			2,671			15.4
Other operating expenses		3,845			21.0			3,606			20.9
Equity in (earnings) losses of affiliates		(18	)		(0.1	)		2			—
Depreciation and amortization		860			4.7			795			4.5
Interest expense		547			3.0			512			3.0
Gains on sales of facilities		(1	)		—			(201	)		(1.2	)
		15,994			87.3			15,092			87.0
Income before income taxes		2,327			12.7			2,247			13.0
Provision for income taxes		502			2.7			445			2.6
Net income		1,825			10.0			1,802			10.4
Net income attributable to noncontrolling interests		215			1.2			211			1.2
Net income attributable to HCA Healthcare, Inc.	$	1,610			8.8		$	1,591			9.2
% changes from prior year:
Revenues		5.7	%					11.2	%
Income before income taxes		3.5						16.9
Net income attributable to HCA Healthcare, Inc.		1.2						16.7
Admissions(a)		2.8						6.8
Equivalent admissions(b)		3.1						7.1
Revenue per equivalent admission		2.5						3.9
Same facility % changes from prior year(c):
Revenues		5.7						8.8
Admissions(a)		2.6						6.2
Equivalent admissions(b)		2.8						5.2
Revenue per equivalent admission		2.9						3.5

___________

Represents the total number of patients admitted to our hospitals and is used by management and certain investors as a general measure of inpatient volume.
Equivalent admissions are used by management and certain investors as a general measure of combined inpatient and outpatient volume. Equivalent admissions are computed by multiplying admissions (inpatient volume) by the sum of gross inpatient revenues and gross outpatient revenues and then dividing the resulting amount by gross inpatient revenues. The equivalent admissions computation “equates” outpatient revenues to the volume measure (admissions) used to measure inpatient volume, resulting in a general measure of combined inpatient and outpatient volume.
Same facility information excludes the operations of hospitals and their related facilities which were either acquired or divested during the current and prior period.

Salaries and benefits, as a percentage of revenues, were 43.6% in the first quarter of 2025 and 44.4% in the first quarter of 2024. Salaries and benefits per equivalent admission increased 0.6% in the first quarter of 2025 compared to the first quarter of 2024. Same facility salaries and benefits per full time equivalent increased 2.0% for the first quarter of 2025 compared to the first quarter of 2024.

Supplies, as a percentage of revenues, were 15.1% in the first quarter of 2025 and 15.4% in the first quarter of 2024. Supply costs per equivalent admission increased 0.4% in the first quarter of 2025 compared to the first quarter of 2024. Supply costs per equivalent admission increased 4.6% for medical devices and declined 3.9% for pharmacy supplies and 1.8% for general medical and surgical items in the first quarter of 2025 compared to the first quarter of 2024.

Other operating expenses, as a percentage of revenues, were 21.0% in the first quarter of 2025 and 20.9% in the first quarter of 2024. Other operating expenses is primarily comprised of contract services, professional fees, repairs and maintenance, rents and leases, utilities, insurance (including professional liability insurance) and nonincome taxes. We have seen inflation have a negative impact on certain of these expenses and expect inflationary pressures will continue to impact operating expenses in the future.

Equity in earnings of affiliates was $18 million and equity in losses of affiliates was $2 million in the first quarters of 2025 and 2024, respectively.

Depreciation and amortization increased $65 million, from $795 million in the first quarter of 2024 to $860 million in the first quarter of 2025. The increase in depreciation relates primarily to capital expenditures at our existing facilities.

Interest expense was $547 million in the first quarter of 2025 and $512 million in the first quarter of 2024. Our average debt balance was $43.746 billion for the first quarter of 2025 compared to $40.383 billion for the first quarter of 2024. The average effective interest rate for our long-term debt was 5.1% for each of the quarters ended March 31, 2025 and 2024.

During the first quarters of 2025 and 2024, we recorded gains on sales of facilities of $1 million and $201 million, respectively. The gain for 2024 was primarily related to the sale of a hospital facility in California.

The effective tax rate was 23.8% and 21.8% for the first quarters of 2025 and 2024, respectively. The effective tax rate computations exclude net income attributable to noncontrolling interests as it relates to consolidated partnerships. The increase in the effective tax rate for the quarter ended March 31, 2025 is related primarily to a reduction in the amount of deductible share-based compensation for vested employee equity awards. Our provisions for income taxes for the first quarters of 2025 and 2024 included tax benefits of $24 million and $69 million, respectively, related to employee equity award settlements.

Net income attributable to noncontrolling interests increased from $211 million for the first quarter of 2024 to $215 million for the first quarter of 2025.

Cash provided by operating activities totaled $1.651 billion in the first quarter of 2025 compared to $2.469 billion in the first quarter of 2024. The $818 million decline in cash provided by operating activities, in the first quarter of 2025 compared to the first quarter of 2024, related primarily to the net impact of negative changes in working capital items of $1.157 billion, partially offset by a $176 million increase in net income, excluding gains on sales of facilities. The combination of interest payments and net income tax payments in the first quarters of 2025 and 2024 totaled $549 million and $539 million, respectively. Working capital totaled $2.627 billion at March 31, 2025 and $1.237 billion at December 31, 2024. The increase in working capital is primarily related to the decline in long-term debt due within one year of $1.179 billion.

Cash used in investing activities was $1.032 billion in the first quarter of 2025 compared to $903 million in the first quarter of 2024. Excluding acquisitions, capital expenditures were $991 million in the first quarter of 2025 and $1.118 billion in the first quarter of 2024. Planned capital expenditures are expected to approximate between $5.0 billion and $5.2 billion in 2025. At March 31, 2025, there were projects under construction that had estimated additional costs to complete and equip over the next five years of approximately $5.6 billion. We expect to finance capital expenditures with internally generated and borrowed funds. We expended $227 million and $96 million for acquisitions of hospitals and health care entities during the first quarters of 2025 and 2024, respectively. Cash flows from sales of hospitals and health care entities were $161 million and $310 million for the first quarter of 2025 and 2024, respectively.

Cash used in financing activities totaled $1.495 billion in the first quarter of 2025, compared to $1.216 billion in the first quarter of 2024. During the first quarter of 2025, net cash flows used in financing activities included a net increase of $1.558 billion in our indebtedness, payment of dividends of $180 million, repurchase of common stock of $2.506 billion and distributions to noncontrolling interests of $220 million. During the first quarter of 2024, net cash flows used in financing activities included a net increase of $537 million in our indebtedness, payment of dividends of $185 million, repurchase of common stock of $1.180 billion and distributions to noncontrolling interests of $152 million.

We have significant debt service requirements. Our debt totaled $44.576 billion at March 31, 2025. Our interest expense was $547 million for the first quarter of 2025 and $512 million for the first quarter of 2024.

In addition to cash flows from operations, available sources of capital include amounts available under our senior unsecured credit facility ($7.766 billion and $6.366 billion available as of March 31, 2025 and April 28, 2025, respectively) and anticipated access to public and private debt markets.

Investments of our insurance subsidiaries, held to maintain statutory equity levels and to provide liquidity to pay claims, totaled $657 million at both March 31, 2025 and December 31, 2024. An insurance subsidiary maintained net reserves for professional liability risks of $70 million and $127 million at March 31, 2025 and December 31, 2024, respectively. Our facilities are insured by our insurance subsidiary for losses up to $110 million per occurrence; however, this coverage is subject, in most cases, to a $15 million per occurrence self-insured retention. Additionally, an insurance subsidiary has entered into reinsurance contracts providing reimbursement for a certain portion of losses in excess of self-insured retentions. Net reserves for the self-insured professional liability risks retained were $1.944 billion and $1.924 billion at March 31, 2025 and December 31, 2024, respectively. Claims payments, net of reinsurance recoveries, during the next 12 months are expected to approximate $554 million. We estimate that approximately $520 million of the expected net claim payments during the next 12 months will relate to claims subject to the self-insured retention.

Management believes that cash flows from operations, amounts available under our senior secured credit facilities and our anticipated access to public and private debt markets will be sufficient to meet expected liquidity needs for the foreseeable future.

We are exposed to market risk related to changes in market values of securities. The investment securities held by our insurance subsidiaries were recorded at $657 million at March 31, 2025. These investments are carried at fair value, with changes in unrealized gains and losses that are not credit-related being recorded as adjustments to other comprehensive income. At March 31, 2025, we had net unrealized losses of $21 million on the insurance subsidiaries’ investments.

We are exposed to market risk related to market illiquidity. Investments in debt and equity securities held by our insurance subsidiaries could be impaired by the inability to access the capital markets. Should the insurance subsidiaries require significant amounts of cash in excess of normal cash requirements to pay claims and other expenses on short notice, we may have difficulty selling these investments in a timely manner or be forced to sell them at a price less than what we might otherwise have been able to in a normal market environment. We may be required to recognize credit-related impairments on our investment securities in future periods should issuers default on interest payments or should the fair market valuations of the securities deteriorate due to ratings downgrades or other issue-specific factors.

We are also exposed to market risk related to changes in interest rates. With respect to our interest-bearing liabilities, approximately $520 million of long-term debt at March 31, 2025 was subject to variable rates of interest, while the remaining balance of long-term debt of $44.056 billion at March 31, 2025 was subject to fixed rates of interest. Both the general level of interest rates and, for the senior unsecured credit facility, our leverage affect our variable interest rates. Our variable debt is comprised primarily of amounts outstanding under the senior unsecured credit facility and the floating rate senior notes due 2028. The average effective interest rate for our long-term debt was 5.1% for each of the quarters ended March 31, 2025 and 2024, respectively.

The estimated fair value of our total long-term debt was $42.876 billion at March 31, 2025. The estimates of fair value are based upon the quoted market prices for the same or similar issues of long-term debt with the same maturities. Based on a hypothetical 1% increase in interest rates, the potential annualized reduction to future pretax earnings would be approximately $5 million. To mitigate the impact of fluctuations in interest rates, we generally target a majority of our debt portfolio to be maintained at fixed rates.

We are exposed to currency translation risk related to our foreign operations. We currently do not consider the market risk related to foreign currency translation to be material to our consolidated financial statements or our liquidity.

At March 31, 2025, the Internal Revenue Service (“IRS”) was examining the Company’s 2022 and 2023 income tax returns and the 2019 income tax returns of certain affiliates. We are subject to examination by the IRS for tax years after 2020, as well as by state and foreign taxing authorities. Management believes HCA Healthcare, Inc. and its subsidiaries and affiliates properly reported taxable income and paid taxes in accordance with applicable laws and agreements established with IRS, state and foreign taxing authorities and final resolution of any disputes will not have a material, adverse effect on our results of operations or financial position. However, if payments due upon final resolution of any issues exceed our recorded estimates, such resolutions could have a material, adverse effect on our results of operations or financial position.

Operating Data
	2025		2024
Number of hospitals in operation at:
March 31		192		188
June 30				188
September 30				187
December 31				190
Number of freestanding outpatient surgical centers in operation at:
March 31		125		121
June 30				123
September 30				125
December 31				124
Licensed hospital beds at(a):
March 31		50,571		49,724
June 30				49,844
September 30				49,890
December 31				49,985
Weighted average beds in service(b):
Quarter:
First		42,862		42,564
Second				42,624
Third				42,640
Fourth				42,705
Year				42,633
Average daily census(c):
Quarter:
First		31,518		30,567
Second				29,259
Third				29,247
Fourth				29,258
Year				29,581
Admissions(d):
Quarter:
First		576,361		560,869
Second				554,456
Third				562,100
Fourth				559,170
Year				2,236,595
Equivalent admissions(e):
Quarter:
First		1,012,090		981,521
Second				994,835
Third				1,006,106
Fourth				1,007,623
Year				3,990,085
Average length of stay (days)(f):
Quarter:
First		4.9		5.0
Second				4.8
Third				4.8
Fourth				4.8
Year				4.8


Emergency room visits(g):
Quarter:
First	2,518,716		2,428,914
Second			2,414,960
Third			2,446,962
Fourth			2,498,429
Year			9,789,265
Outpatient surgeries(h):
Quarter:
First	246,620		252,835
Second			258,967
Third			249,364
Fourth			263,832
Year			1,024,998
Inpatient surgeries(i):
Quarter:
First	133,759		133,398
Second			135,860
Third			135,803
Fourth			135,643
Year			540,704
Days revenues in accounts receivable(j):
Quarter:
First	54		53
Second			53
Third			52
Fourth			54
Outpatient revenues as a % of patient revenues(k):
Quarter:
First	37	%	37	%
Second			38	%
Third			38	%
Fourth			38	%
Year			38	%

__________

Licensed beds are those beds for which a facility has been granted approval to operate from the applicable state licensing agency.
Represents the average number of beds in service, weighted based on periods owned.
Represents the average number of patients in our hospital beds each day.
Represents the total number of patients admitted to our hospitals and is used by management and certain investors as a general measure of inpatient volume.
Equivalent admissions are used by management and certain investors as a general measure of combined inpatient and outpatient volume. Equivalent admissions are computed by multiplying admissions (inpatient volume) by the sum of gross inpatient revenues and gross outpatient revenues and then dividing the resulting amount by gross inpatient revenues. The equivalent admissions computation “equates” outpatient revenues to the volume measure (admissions) used to measure inpatient volume resulting in a general measure of combined inpatient and outpatient volume.
Represents the average number of days admitted patients stay in our hospitals.
Represents the number of patients treated in our emergency rooms.
Represents the number of surgeries performed on patients who were not admitted to our hospitals. Pain management and endoscopy procedures are not included in outpatient surgeries.
Represents the number of surgeries performed on patients who have been admitted to our hospitals. Pain management and endoscopy procedures are not included in inpatient surgeries.
Revenues per day is calculated by dividing revenues for the quarter by the days in the quarter. Days revenues in accounts receivable is then calculated as accounts receivable at the end of the quarter divided by revenues per day.
Represents the percentage of patient revenues related to patients who are not admitted to our hospitals.

The information called for by this item is provided under the caption “Market Risk” under Item 2, “Management’s Discussion and Analysis of Financial Condition and Results of Operations.”

HCA’s management, with the participation of HCA’s chief executive officer and chief financial officer, has evaluated the effectiveness of HCA’s disclosure controls and procedures as of March 31, 2025. Based on that evaluation, HCA’s chief executive officer and chief financial officer concluded that HCA’s disclosure controls and procedures were effective as of March 31, 2025.

During the period covered by this report, there have been no changes in our internal control over financial reporting that have materially affected or are reasonably likely to materially affect our internal control over financial reporting.

The information set forth in “Note 8 – Contingencies” in the notes to the condensed consolidated financial statements is incorporated herein by reference.

Reference is made to the factors set forth under the caption “Forward-Looking Statements” in Part I, Item 2 of this quarterly report on Form 10-Q and other risk factors described in our annual report on Form 10-K for the year ended December 31, 2024, which are incorporated herein by reference. There have not been any material changes to the risk factors previously disclosed in our annual report on Form 10-K for the year ended December 31, 2024, except as set forth below.

As of March 31, 2025, our total indebtedness was $44.576 billion. As of March 31, 2025, we had availability of $7.766 billion under our senior unsecured credit facility (after giving effect to all issued and outstanding letters of credit). Our indebtedness could have important consequences, including:

increasing our vulnerability to downturns or adverse changes in general economic, industry or competitive conditions and adverse changes in government regulations;
requiring a portion of cash flows from operations to be dedicated to the payment of principal and interest on our indebtedness, therefore reducing our ability to use our cash flows to fund our operations, capital expenditures and future business opportunities;
exposing us to the risk of increased interest rates on our existing borrowings that are at variable rates of interest or refinancing our debt in a rising or high rate environment;
limiting our ability to make strategic acquisitions or causing us to make nonstrategic divestitures;
limiting our ability to obtain additional financing for working capital, capital expenditures, share repurchases, dividends, product or service line development, debt service requirements, acquisitions and general corporate or other purposes; and
limiting our ability to adjust to changing market conditions and placing us at a competitive disadvantage compared to our competitors who have less debt.

We and our subsidiaries have the ability to incur additional indebtedness in the future, subject to the restrictions contained in our senior unsecured credit facility and the indentures governing our outstanding notes. If new indebtedness is added to our current debt levels, interest rates and the related risks that we now face could intensify.

Our ability to make scheduled payments on or to refinance our debt obligations depends on our financial condition and operating performance, which are subject to prevailing economic and competitive conditions and to certain financial, business and other factors beyond our control. We cannot guarantee we will maintain a level of cash flows from operating activities sufficient to permit us to pay the principal, premium, if any, and interest on our indebtedness.

In addition, we conduct our operations through our subsidiaries. Accordingly, repayment of our indebtedness is dependent on the generation of cash flows by our subsidiaries and their ability to make such cash available to us by dividend, debt repayment or otherwise. Our subsidiaries may not be able to, or may not be permitted to, make distributions to enable us to make payments in respect of our indebtedness. Each subsidiary is a distinct legal entity, and, under certain circumstances, legal and contractual restrictions may limit our ability to obtain cash from our subsidiaries.

We may find it necessary or prudent to refinance our outstanding indebtedness, the terms of which refinancing may not be favorable to us. Our ability to refinance our indebtedness on favorable terms, or at all, is directly affected by the then current global economic and financial conditions which affect the availability of debt financing and the rates at which such financing is available. In addition, our ability to incur secured indebtedness depends in part on the value of our assets, which depends, in turn, on the strength of our cash flows and results of operations, and on economic and market conditions and other factors.

If our cash flows and capital resources are insufficient to fund our debt service obligations or we are unable to refinance our indebtedness, we may be forced to reduce or delay investments and capital expenditures, or to sell assets, seek additional capital or restructure our indebtedness. These alternative measures may not be successful and may not permit us to meet our scheduled debt service obligations. If our operating results and available cash are insufficient to meet our debt service obligations, we could face substantial liquidity problems and might be required to dispose of material assets or operations to meet our debt service and other obligations. We may not be able to consummate those dispositions, or the proceeds from the dispositions may not be adequate to meet any debt service obligations then due.

Our senior unsecured credit facility and the indentures governing our outstanding notes contain various covenants that limit our ability to engage in specified types of transactions. These covenants limit our and/or certain of our subsidiaries’ ability to, among other things:

incur additional indebtedness or issue certain preferred shares;
create liens;
engage in certain sale and lease-back transactions; and
consolidate, merge, sell or otherwise dispose of all or substantially all of our assets.

Under our senior unsecured credit facility, we are required to satisfy and maintain a specified financial ratio. Our ability to maintain this financial ratio may be affected by global economic and financial conditions or other events beyond our control, and there can be no assurance we will continue to maintain this ratio. A breach of this or any other covenant could result in a default under our senior unsecured credit facility. Upon the occurrence of an event of default under our senior unsecured credit facility, the lenders thereunder could elect to declare all amounts outstanding under our senior unsecured credit facility to be immediately due and payable and terminate all commitments to extend further credit, which would also result in an event of default under a significant portion of our other outstanding indebtedness. If any of the lenders under our senior unsecured credit facility accelerate the repayment of borrowings, there can be no assurance there will be sufficient assets to repay our senior unsecured credit facility and our other indebtedness.

During January 2025 and January 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 quarter ended March 31, 2025, we repurchased 7,761,597 shares of our common stock at an average price of $322.84 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 March 31, 2025, we had $8.259 billion of repurchase authorization available under the January 2025 authorization.

The following table provides certain information with respect to our repurchases of common stock from January 1, 2025 through March 31, 2025 (dollars in billions, except per share amounts).

Period		Average Price<br>Paid per Share			Approximate<br>Dollar Value of<br>Shares That<br>May Yet Be<br>Purchased<br>Under Publicly<br>Announced Plans<br>or Programs
January 1, 2025 - January 31, 2025	1,901,781	$	316.08	1,901,781	$	10.163
February 1, 2025 - February 28, 2025	2,992,516	$	323.80	2,992,516	$	9.914
March 1, 2025 - March 31, 2025	2,867,300	$	326.32	2,867,300	$	8.259
Total for first quarter 2025	7,761,597	$	322.84	7,761,597

On April 24, 2025, our Board of Directors declared a quarterly dividend of $0.72 per share on our common stock payable on June 30, 2025 to stockholders of record at the close of business on June 16, 2025. Future declarations of quarterly dividends and the establishment of future record and payment dates are subject to the final determination of our Board of Directors.

(c) During the three months ended March 31, 2025, no director or officer (as defined in Rule 16a-1(f) of the Securities Exchange Act of 1934) of the Company adopted or terminated a “Rule 10b5-1 trading arrangement” or “non-Rule 10b5-1 trading arrangement,” as each term is defined in Item 408(a) of Regulation S-K.

(a) List of Exhibits:

4.1	—	Supplemental Indenture No. 44, dated as of February 21, 2025, among HCA Inc., HCA Healthcare, Inc., CSC Delaware Trust Company, as trustee, and Deutsche Bank Trust Company Americas, as paying agent, registrar and transfer agent (filed as Exhibit 4.2 to the Company’s Current Report on Form 8-K filed on February 21, 2025, and incorporated herein by reference).
4.2	—	Supplemental Indenture No. 45, dated as of February 21, 2025, among HCA Inc., HCA Healthcare, Inc., CSC Delaware Trust Company, as trustee, and Deutsche Bank Trust Company Americas, as paying agent, registrar and transfer agent (filed as Exhibit 4.3 to the Company’s Current Report on Form 8-K filed on February 21, 2025, and incorporated herein by reference).
4.3	—	Supplemental Indenture No. 46, dated as of February 21, 2025, among HCA Inc., HCA Healthcare, Inc., CSC Delaware Trust Company, as trustee, and Deutsche Bank Trust Company Americas, as paying agent, registrar and transfer agent (filed as Exhibit 4.4 to the Company’s Current Report on Form 8-K filed on February 21, 2025, and incorporated herein by reference).
4.4	—	Supplemental Indenture No. 47, dated as of February 21, 2025, among HCA Inc., HCA Healthcare, Inc., CSC Delaware Trust Company, as trustee, and Deutsche Bank Trust Company Americas, as paying agent, registrar and transfer agent (filed as Exhibit 4.5 to the Company’s Current Report on Form 8-K filed on February 21, 2025, and incorporated herein by reference).
4.5	—	Supplemental Indenture No. 48, dated as of February 21, 2025, among HCA Inc., HCA Healthcare, Inc., CSC Delaware Trust Company, as trustee, and Deutsche Bank Trust Company Americas, as paying agent, registrar and transfer agent (filed as Exhibit 4.6 to the Company’s Current Report on Form 8-K filed on February 21, 2025, and incorporated herein by reference).
4.6	—	Supplemental Indenture No. 49, dated as of February 21, 2025, among HCA Inc., HCA Healthcare, Inc., CSC Delaware Trust Company, as trustee, and Deutsche Bank Trust Company Americas, as paying agent, registrar and transfer agent (filed as Exhibit 4.7 to the Company’s Current Report on Form 8-K filed on February 21, 2025, and incorporated herein by reference).
4.7	—	Form of 5.000% Senior Notes due 2028 (included in Exhibit 4.1)
4.8	—	Form of Floating Rate Senior Notes due 2028 (included in Exhibit 4.2)
4.9	—	Form of 5.250% Senior Notes due 2030 (included in Exhibit 4.3)
4.10	—	Form of 5.500% Senior Notes due 2032 (included in Exhibit 4.4)
4.11	—	Form of 5.750% Senior Notes due 2035 (included in Exhibit 4.5)
4.12	—	Form of 6.200% Senior Notes due 2055 (included in Exhibit 4.6)
10.1	—	Credit Agreement dated as of February 20, 2025, by and among HCA Inc., as borrower, Bank of America, N.A., as administrative agent, and the lenders party thereto (filed as Exhibit 10.1 to the Company’s Current Report on Form 8-K filed on February 20, 2025, and incorporated herein by reference).
10.2	—	HCA Healthcare, Inc. 2025 Executive Officer Performance Excellence Program (filed as Exhibit 10.1 to the Company’s Current Report on Form 8-K filed on February 24, 2025, and incorporated herein by reference).*
22	—	List of Subsidiary Guarantors and Pledged Securities.
31.1	—	Certification of Chief Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
31.2	—	Certification of Chief Financial Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
32	—	Certification Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101	—	The following financial information from our quarterly report on Form 10-Q for the quarter ended March 31, 2025 filed with the SEC on May 1, 2025, formatted in Inline Extensible Business Reporting
		Language: (i) the condensed consolidated balance sheets at March 31, 2025 and December 31, 2024, (ii) the condensed consolidated income statements for the quarters ended March 31, 2025 and 2024, (iii) the condensed consolidated comprehensive income statements for the quarters ended March 31, 2025 and 2024, (iv) the condensed consolidated statements of stockholders’ equity (deficit) for the quarters ended March 31, 2025 and 2024, (v) the condensed consolidated statements of cash flows for the quarters ended March 31, 2025 and 2024 and (vi) the notes to condensed consolidated financial statements. The instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
---	---	---
104	—	The cover page from the Company’s Quarterly Report on Form 10-Q for the quarter ended March 31, 2025, formatted in Inline XBRL (included in Exhibit 101).

__________

*Management compensatory plan or arrangement.

Managed Medicare

Managed Medicaid

Managed care and insurers

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

HCA Healthcare, Inc.
By:	/S/ Michael A. Marks
	Michael A. Marks
	Executive Vice President and Chief Financial Officer

Date: May 1, 2025

EX-22

EXHIBIT 22

List of Subsidiary Guarantors

All of the senior notes issued by HCA Inc. in 2014 or later are fully and unconditionally guaranteed on an unsecured basis by HCA Healthcare, Inc.

EX-31.1

EXHIBIT 31.1

CERTIFICATION

I, Samuel N. Hazen, certify that:

I have reviewed this quarterly report on Form 10-Q of HCA Healthcare, Inc.;
Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;
Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;
The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

(a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

(c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

By:	/S/ SAMUEL N. HAZEN
	Samuel N. Hazen
	Chief Executive Officer

Date: May 1, 2025

EX-31.2

EXHIBIT 31.2

CERTIFICATION

I, Michael A. Marks, certify that:

I have reviewed this quarterly report on Form 10-Q of HCA Healthcare, Inc.;
Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;
Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;
The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

By:	/S/ Michael A. Marks
	Michael A. Marks
	Executive Vice President and Chief Financial Officer

Date: May 1, 2025

EX-32

EXHIBIT 32

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of HCA Healthcare, Inc. (the “Company”) on Form 10-Q for the quarter ended March 31, 2025, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), each of the undersigned certifies, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that:

(1) The Report fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

By:	/S/ SAMUEL N. HAZEN
	Samuel N. Hazen
	Chief Executive Officer

May 1, 2025

By:	/S/ Michael A. Marks
	Michael A. Marks
	Executive Vice President and Chief Financial Officer

May 1, 2025