Segment and Geographic Information

12 Months Ended

Dec. 31, 2022

Segment Reporting [Abstract]

Segment and Geographic Information

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION

We operate in one line of business, which is operating hospitals and related health care entities. We operate in two geographically organized groups: the National and American Groups. At December 31, 2022, the National Group included 96 hospitals located in Alaska, California, Florida, Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, North Carolina, South Carolina, Utah and Virginia, and the American Group included 79 hospitals located in Colorado, Kansas, southern Kentucky, Louisiana, Missouri, Tennessee and Texas. We also operate seven hospitals in England, and these facilities 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, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions) and represent the operating segments at December 31, 2022:

	For the Year Ended December 31,
	2022			2021			2020
Revenues:
National Group	$	30,350		$	29,826		$	25,694
American Group		26,865			26,152			23,593
Corporate and other		3,018			2,774			2,246
	$	60,233		$	58,752		$	51,533
Equity in earnings of affiliates:
National Group	$	(4	)	$	(33	)	$	(28	)
American Group		(43	)		(53	)		(42	)
Corporate and other		2			(27	)		16
	$	(45	)	$	(113	)	$	(54	)
Adjusted segment EBITDA:
National Group	$	6,379		$	7,200		$	5,532
American Group		6,055			6,156			5,333
Corporate and other		(367	)		(712	)		(828	)
	$	12,067		$	12,644		$	10,037
Depreciation and amortization:
National Group	$	1,464		$	1,359		$	1,216
American Group		1,219			1,183			1,164
Corporate and other		286			311			341
	$	2,969		$	2,853		$	2,721

	For the Year Ended December 31,
	2022			2021			2020
Adjusted segment EBITDA	$	12,067		$	12,644		$	10,037
Depreciation and amortization		2,969			2,853			2,721
Interest expense		1,741			1,566			1,584
Losses (gains) on sales of facilities		(1,301	)		(1,620	)		7
Losses on retirement of debt		78			12			295
Income before income taxes	$	8,580		$	9,833		$	5,430

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

	December 31,
	2022		2021		2020
Assets:
National Group	$	22,863	$	21,205	$	18,913
American Group		22,216		21,428		20,760
Corporate and other		7,359		8,109		7,817
	$	52,438	$	50,742	$	47,490

	National Group			American Group			Corporate and Other			Total
Goodwill and other intangible assets:
Balance at December 31, 2019	$	1,739		$	5,765		$	765		$	8,269
Acquisitions		38			27			279			344
Foreign currency translation, amortization and other		(2	)		(17	)		(16	)		(35	)
Balance at December 31, 2020		1,775			5,775			1,028			8,578
Acquisitions		735			67			260			1,062
Foreign currency translation, amortization and other		(18	)		(10	)		(72	)		(100	)
Balance at December 31, 2021		2,492			5,832			1,216			9,540
Acquisitions		165			91			6			262
Foreign currency translation, amortization and other		(5	)		(62	)		(82	)		(149	)
Balance at December 31, 2022	$	2,652		$	5,861		$	1,140		$	9,653

Effective January 1, 2023, we reorganized our operations into three geographically organized groups: the National, American and Atlantic Groups. The National Group includes 57 hospitals located in Alaska, California, Idaho, Indiana, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah and Virginia, the American Group includes 57 hospitals located in Colorado, Central Kansas, Louisiana and Texas, and the Atlantic Group includes 61 hospitals located in Florida, Georgia, Northern Kansas, Missouri and South Carolina. The seven hospitals we operate in England will remain in the Corporate and other group. Operating segment reporting with this reorganized group structure will be provided in periodic filings starting with the first quarter of 2023, with retrospective presentation of all periods presented.