Segment and Geographic Information (Tables)

12 Months Ended

Dec. 31, 2024

Segment Reporting [Abstract]

Schedule Of Geographic Distributions Of Revenues, Salaries And Benefits, Supplies, Other Operating Expenses, Equity In Earnings Of Affiliates, Adjusted Segment EBITDA, Depreciation And Amortization, Assets And Goodwill And Other Intangible Assets

The geographic distributions of our revenues, salaries and benefits, supplies, other operating expenses, equity in earnings or losses of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible 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 at December 31, 2024:

	For the Year Ended December 31, 2024
	National Group		Atlantic Group			American Group
Revenues	$	19,614	$	23,171		$	24,601
Salaries and benefits		7,483		8,525			8,529
Supplies		2,812		3,553			4,035
Other operating expenses		4,892		6,124			6,363
Equity in (earnings) losses of affiliates		2		(3	)		(62	)
		15,189		18,199			18,865
Adjusted segment EBITDA	$	4,425	$	4,972		$	5,736

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

	For the Year Ended December 31, 2023
	National Group			Atlantic Group			American Group
Revenues	$	18,105		$	21,167		$	22,318
Salaries and benefits		7,196			8,058			8,080
Supplies		2,658			3,331			3,616
Other operating expenses		4,253			5,289			5,473
Equity in (earnings) losses of affiliates		(2	)		(3	)		(59	)
		14,105			16,675			17,110
Adjusted segment EBITDA	$	4,000		$	4,492		$	5,208

	For the Year Ended December 31, 2022
	National Group			Atlantic Group			American Group
Revenues	$	16,767		$	19,324		$	20,858
Salaries and benefits		6,959			7,752			7,757
Supplies		2,569			3,088			3,331
Other operating expenses		3,624			4,606			4,711
Equity in (earnings) losses of affiliates		(1	)		(3	)		(43	)
		13,151			15,443			15,756
Adjusted segment EBITDA	$	3,616		$	3,881		$	5,102

	For the Year Ended December 31,
	2024			2023		2022
Adjusted segment EBITDA:
National Group	$	4,425		$	4,000	$	3,616
Atlantic Group		4,972			4,492		3,881
American Group		5,736			5,208		5,102
		15,133			13,700		12,599
Adjustments to reconcile Total Adjusted segment   EBITDA to consolidated Income before income taxes:
Corporate and Other		1,251			974		532
Depreciation and amortization		3,312			3,077		2,969
Interest expense		2,061			1,938		1,741
Losses (gains) on sales of facilities		(14	)		5		(1,301	)
Losses on retirement of debt		—			—		78
Income before income taxes	$	8,523		$	7,706	$	8,580

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

	For the Year Ended December 31,
	2024		2023		2022
Revenues:
National Group	$	19,614	$	18,105	$	16,767
Atlantic Group		23,171		21,167		19,324
American Group		24,601		22,318		20,858
Corporate and other		3,217		3,378		3,284
	$	70,603	$	64,968	$	60,233
Depreciation and amortization:
National Group	$	857	$	834	$	801
Atlantic Group		1,061		989		921
American Group		1,083		971		937
Corporate and other		311		283		310
	$	3,312	$	3,077	$	2,969

	December 31,
	2024		2023		2022
Assets:
National Group	$	12,855	$	12,487	$	11,793
Atlantic Group		17,168		16,098		15,092
American Group		20,714		19,786		17,934
Corporate and other		8,776		7,840		7,619
	$	59,513	$	56,211	$	52,438

	National Group			Atlantic Group			American Group		Corporate and Other			Total
Goodwill and other intangible assets:
Balance at December 31, 2021	$	1,212		$	1,970		$	5,062	$	1,296		$	9,540
Acquisitions		75			90			90		7			262
Foreign currency translation, amortization and other		(43	)		(3	)		—		(103	)		(149	)
Balance at December 31, 2022		1,244			2,057			5,152		1,200			9,653
Acquisitions		—			8			326		28			362
Foreign currency translation, amortization and other		(3	)		(1	)		—		(66	)		(70	)
Balance at December 31, 2023		1,241			2,064			5,478		1,162			9,945
Acquisitions		—			61			105		4			170
Foreign currency translation, amortization and other		(4	)		(1	)		3		(20	)		(22	)
Balance at December 31, 2024	$	1,237		$	2,124		$	5,586	$	1,146		$	10,093