10-Q

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

Form 10-Q

(Mark One)

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

For the quarterly period ended September 30, 2018

Or

☐ 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.

(Exact name of registrant as specified in its charter)

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

(615) 344-9551

(Registrant’s telephone number, including area code)

Not Applicable

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

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 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 October 31, 2018
Voting common stock, $.01 par value	344,160,500 shares

HCA HEALTHCARE, INC.

Form 10-Q

September 30, 2018

		Page of Form 10-Q
Part I.	Financial Information
Item 1.	Financial Statements (Unaudited):
	Condensed Consolidated Income Statements — for the quarters and nine months ended September 30, 2018 and 2017		2
	Condensed Consolidated Comprehensive Income Statements — for the quarters and nine months ended September 30, 2018 and 2017		3
	Condensed Consolidated Balance Sheets — September 30, 2018 and December 31, 2017		4
	Condensed Consolidated Statements of Stockholders’ Deficit — for the quarters and nine months ended September 30, 2018 and 2017		5
	Condensed Consolidated Statements of Cash Flows — for the nine months ended September 30, 2018 and 2017		6
	Notes to Condensed Consolidated Financial Statements		7
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations		29
Item 3.	Quantitative and Qualitative Disclosures About Market Risk		46
Item 4.	Controls and Procedures		46
Part II.	Other Information
Item 1.	Legal Proceedings		46
Item 1A.	Risk Factors		46
Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds		47
Item 6.	Exhibits		48
Signatures			49

1

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED INCOME STATEMENTS

FOR THE QUARTERS AND NINE MONTHS ENDED SEPTEMBER 30, 2018 AND 2017

Unaudited

(Dollars in millions, except per share amounts)

	Quarter						Nine Months
	2018			2017			2018			2017
Revenues	$	11,451		$	10,696		$	34,403		$	32,052
Salaries and benefits		5,377			5,081			15,940			14,878
Supplies		1,890			1,777			5,722			5,369
Other operating expenses		2,097			2,075			6,325			5,970
Equity in earnings of affiliates		(9	)		(13	)		(25	)		(36	)
Depreciation and amortization		582			539			1,697			1,581
Interest expense		442			427			1,309			1,257
Gains on sales of facilities		(6	)		(7	)		(420	)		(10	)
Losses on retirement of debt		9			39			9			39
		10,382			9,918			30,557			29,048
Income before income taxes		1,069			778			3,846			3,004
Provision for income taxes		173			248			702			902
Net income		896			530			3,144			2,102
Net income attributable to noncontrolling interests		137			104			421			360
Net income attributable to HCA Healthcare, Inc.	$	759		$	426		$	2,723		$	1,742
Per share data:
Basic earnings	$	2.20		$	1.18		$	7.82		$	4.77
Diluted earnings	$	2.15		$	1.15		$	7.65		$	4.64
Shares used in earnings per share calculations (in millions):
Basic		345.823			360.170			348.411			365.398
Diluted		353.639			369.834			356.124			375.013

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

2

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED COMPREHENSIVE INCOME STATEMENTS

FOR THE QUARTERS AND NINE MONTHS ENDED SEPTEMBER 30, 2018 AND 2017

Unaudited

(Dollars in millions)

	Quarter						Nine Months
	2018			2017			2018			2017
Net income	$	896		$	530		$	3,144		$	2,102
Other comprehensive income (loss) before taxes:
Foreign currency translation		(13	)		32			(35	)		87
Unrealized (losses) gains on available-for-sale securities		(2	)		—			(8	)		5
Defined benefit plans		—			—			—			—
Pension costs included in salaries and benefits		5			5			15			14
		5			5			15			14
Change in fair value of derivative financial instruments		10			(1	)		60			(9	)
Interest (benefits) costs included in interest expense		(3	)		4			(5	)		17
		7			3			55			8
Other comprehensive (loss) income before taxes		(3	)		40			27			114
Income taxes related to other comprehensive income items		2			15			15			44
Other comprehensive (loss) income		(5	)		25			12			70
Comprehensive income		891			555			3,156			2,172
Comprehensive income attributable to noncontrolling interests		137			104			421			360
Comprehensive income attributable to HCA Healthcare, Inc.	$	754		$	451		$	2,735		$	1,812

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

3

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

Unaudited

(Dollars in millions)

	September 30, 2018			December 31, 2017
ASSETS
Current assets:
Cash and cash equivalents	$	578		$	732
Accounts receivable		6,532			6,501
Inventories		1,634			1,573
Other		1,266			1,171
		10,010			9,977
Property and equipment, at cost		41,978			40,084
Accumulated depreciation		(22,937	)		(22,189	)
		19,041			17,895
Investments of insurance subsidiaries		367			418
Investments in and advances to affiliates		238			199
Goodwill and other intangible assets		7,759			7,394
Other		629			710
	$	38,044		$	36,593
LIABILITIES AND STOCKHOLDERS’ DEFICIT
Current liabilities:
Accounts payable	$	2,414		$	2,606
Accrued salaries		1,456			1,369
Other accrued expenses		2,170			1,983
Long-term debt due within one year		191			200
		6,231			6,158
Long-term debt, less net debt issuance costs of $163 and $164		32,916			32,858
Professional liability risks		1,239			1,198
Income taxes and other liabilities		1,388			1,374
Stockholders’ deficit:
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 345,085,800 shares in 2018 and 350,091,600 shares in 2017		3			4
Accumulated other comprehensive loss		(266	)		(278	)
Retained deficit		(5,342	)		(6,532	)
Stockholders’ deficit attributable to HCA Healthcare, Inc.		(5,605	)		(6,806	)
Noncontrolling interests		1,875			1,811
		(3,730	)		(4,995	)
	$	38,044		$	36,593

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

4

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ DEFICIT

FOR THE QUARTERS AND NINE MONTHS ENDED SEPTEMBER 30, 2018 AND 2017

Unaudited

(Dollars in millions)

	Equity (Deficit) Attributable to HCA Healthcare, Inc.															Equity Attributable to Noncontrolling Interests			Total
	Common Stock						Capital in Excess of Par Value			Accumulated Other Comprehensive Loss			Retained Deficit
	Shares (in millions)			Par Value
Balances, December 31, 2016		370.536		$	4		$	—		$	(338	)	$	(6,968	)	$	1,669		$	(5,633	)
Comprehensive income											18			659			118			795
Repurchase of common stock		(5.121	)					(32	)					(392	)					(424	)
Share-based benefit plans		3.280						35												35
Distributions																	(145	)		(145	)
Other								(3	)								18			15
Balances, March 31, 2017		368.695			4			—			(320	)		(6,701	)		1,660			(5,357	)
Comprehensive income											27			657			138			822
Repurchase of common stock		(6.404	)					(83	)					(459	)					(542	)
Share-based benefit plans		0.604						82												82
Distributions																	(103	)		(103	)
Other								1									18			19
Balances, June 30, 2017		362.895			4			—			(293	)		(6,503	)		1,713			(5,079	)
Comprehensive income											25			426			104			555
Repurchase of common stock		(6.322	)					(70	)					(439	)					(509	)
Share-based benefit plans		0.407						71												71
Distributions																	(115	)		(115	)
Other								(1	)								12			11
Balances, September 30, 2017		356.980			4			—			(268	)		(6,516	)		1,714			(5,066	)
Comprehensive income											(10	)		474			167			631
Repurchase of common stock		(7.245	)					(86	)					(490	)					(576	)
Share-based benefit plans		0.357						93												93
Distributions																	(85	)		(85	)
Other								(7	)								15			8
Balances, December 31, 2017		350.092			4			—			(278	)		(6,532	)		1,811			(4,995	)
Comprehensive income											81			1,144			138			1,363
Repurchase of common stock		(4.370	)											(423	)					(423	)
Share-based benefit plans		5.265												(114	)					(114	)
Cash dividends declared ($0.35 per share)														(126	)					(126	)
Distributions																	(92	)		(92	)
Other																	(47	)		(47	)
Balances, March 31, 2018		350.987			4			—			(197	)		(6,051	)		1,810			(4,434	)
Comprehensive income											(64	)		820			146			902
Repurchase of common stock		(4.670	)		(1	)		(93	)					(376	)					(470	)
Share-based benefit plans		0.443						96												96
Cash dividends declared ($0.35 per share)														(124	)					(124	)
Distributions																	(93	)		(93	)
Other								(3	)								1			(2	)
Balances, June 30, 2018		346.760			3			—			(261	)		(5,731	)		1,864			(4,125	)
Comprehensive income											(5	)		759			137			891
Repurchase of common stock		(2.518	)					(55	)					(247	)					(302	)
Share-based benefit plans		0.844						54												54
Cash dividends declared ($0.35 per share)														(123	)					(123	)
Distributions																	(130	)		(130	)
Other								1									4			5
Balances, September 30, 2018		345.086		$	3		$	—		$	(266	)	$	(5,342	)	$	1,875		$	(3,730	)

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

5

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2018 AND 2017

Unaudited

(Dollars in millions)

	2018			2017
Cash flows from operating activities:
Net income	$	3,144		$	2,102
Adjustments to reconcile net income to net cash provided by operating activities:
Increase (decrease) in cash from operating assets and liabilities:
Accounts receivable		(161	)		(70	)
Inventories and other assets		(136	)		(50	)
Accounts payable and accrued expenses		150			(169	)
Depreciation and amortization		1,697			1,581
Income taxes		—			(9	)
Gains on sales of facilities		(420	)		(10	)
Losses on retirement of debt		9			39
Amortization of debt issuance costs		23			23
Share-based compensation		204			195
Other		76			60
Net cash provided by operating activities		4,586			3,692
Cash flows from investing activities:
Purchase of property and equipment		(2,420	)		(2,033	)
Acquisition of hospitals and health care entities		(1,056	)		(1,142	)
Disposal of hospitals and health care entities		802			24
Change in investments		65			(15	)
Other		(6	)		(6	)
Net cash used in investing activities		(2,615	)		(3,172	)
Cash flows from financing activities:
Issuances of long-term debt		2,000			1,502
Net change in revolving bank credit facilities		(330	)		650
Repayment of long-term debt		(1,652	)		(700	)
Distributions to noncontrolling interests		(315	)		(363	)
Payment of debt issuance costs		(24	)		(25	)
Payment of cash dividends		(366	)		—
Repurchases of common stock		(1,195	)		(1,475	)
Other		(232	)		(37	)
Net cash used in financing activities		(2,114	)		(448	)
Effect of exchange rate changes on cash and cash equivalents		(11	)		—
Change in cash and cash equivalents		(154	)		72
Cash and cash equivalents at beginning of period		732			646
Cash and cash equivalents at end of period	$	578		$	718
Interest payments	$	1,422		$	1,383
Income tax payments, net	$	702		$	911

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

6

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

Reporting Entity

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 September 30, 2018, these affiliates owned and operated 179 hospitals, 122 freestanding surgery 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.

Basis of Presentation

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 $90 million and $83 million for the quarters ended September 30, 2018 and 2017, respectively, and $254 million and $247 million for the nine months ended September 30, 2018 and 2017, respectively. Operating results for the quarter and nine months ended September 30, 2018 are not necessarily indicative of the results that may be expected for the year ending December 31, 2018. 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, 2017.

Revenues

In May 2014, the Financial Accounting Standards Board (“FASB”) issued a new standard related to revenue recognition. We adopted the new standard effective January 1, 2018, using the full retrospective method. The adoption of the new standard did not have an impact on our recognition of net revenues for any periods prior to adoption. The most significant impact of adopting the new standard is to the presentation of our consolidated income statements, where we no longer present the “Provision for doubtful accounts” as a separate line item and our “Revenues” are presented net of estimated implicit price concession revenue deductions. We also have eliminated the related presentation of “allowances for doubtful accounts” on our consolidated balance sheets as a result of the adoption of the new standard.

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

7

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

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

Revenues (continued)

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 allowances 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 discounts and contractual 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. Our revenues from third-party payers and others (including uninsured patients) for the quarters and nine months ended September 30, 2018 and 2017 are summarized in the following table (dollars in millions):

	Quarter
	2018		Ratio			2017		Ratio
Medicare	$	2,404		21.0	%	$	2,298		21.5	%
Managed Medicare		1,344		11.7			1,122		10.5
Medicaid		338		3.0			286		2.7
Managed Medicaid		622		5.4			537		5.0
Managed care and insurers		6,026		52.6			5,605		52.4
International (managed care and insurers)		273		2.4			276		2.6
Other		444		3.9			572		5.3
Revenues	$	11,451		100.0	%	$	10,696		100.0	%

	Nine Months
	2018		Ratio			2017		Ratio
Medicare	$	7,353		21.4	%	$	6,931		21.6	%
Managed Medicare		4,088		11.9			3,463		10.8
Medicaid		976		2.8			956		3.0
Managed Medicaid		1,769		5.1			1,653		5.2
Managed care and insurers		18,081		52.6			16,957		52.9
International (managed care and insurers)		873		2.5			814		2.5
Other		1,263		3.7			1,278		4.0
Revenues	$	34,403		100.0	%	$	32,052		100.0	%

8

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

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

Revenues (continued)

Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. As a result, there is at least a reasonable possibility recorded estimates will change by a material amount. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process).

The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive. Prior to November 2017, patients treated at hospitals for non-elective care, who have income at or below 200% of the federal poverty level, were eligible for charity care. During November 2017, we expanded our charity policy to include patients who have income above 200%, but at or below 400%, of the federal poverty level and we will limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. In implementing the uninsured discount policy, we may first attempt to provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied.

The collection of outstanding receivables for Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the aging of those accounts. Accounts are written off when all reasonable internal and external collection efforts have been performed.

The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period comparisons of our results of operations. At September 30, 2018 and December 31, 2017, estimated implicit price concessions of $5.781 billion and $5.488 billion, respectively, had been recorded as

9

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

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

Revenues (continued)

reductions to our accounts receivable balances to enable us to record our revenues and accounts receivable at the estimated amounts we expect to collect.

To quantify the total impact of the trends related to uninsured 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 and nine months ended September 30, 2018 and 2017 follows (dollars in millions):

	Quarter						Nine Months
	2018			2017			2018			2017
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization)	$	9,946		$	9,472		$	29,684		$	27,798
Cost-to-charges ratio (patient care costs as percentage of gross patient charges)		12.7	%		13.4	%		12.6	%		13.1	%
Total uncompensated care	$	6,786		$	6,089		$	19,524		$	17,137
Multiply by the cost-to-charges ratio		12.7	%		13.4	%		12.6	%		13.1	%
Estimated cost of total uncompensated care	$	862		$	816		$	2,460		$	2,245

Total uncompensated care as a percentage of the sum of revenues and total uncompensated care was 37.2% and 36.3% for the quarters ended September 30, 2018 and 2017, respectively, and 36.2% and 34.8% for the nine months ended September 30, 2018 and 2017, respectively. The total uncompensated care amounts include charity care of $2.314 billion and $1.235 billion, and the related estimated costs of charity care were $295 million and $167 million for the quarters ended September 30, 2018 and 2017, respectively, and charity care of $6.170 billion and $3.494 billion, and the related estimated costs of charity care were $777 million and $458 million for the nine months ended September 30, 2018 and 2017, respectively.

Recent Pronouncements

In February 2016, the FASB issued Accounting Standards Update 2016-02, Leases (“ASU 2016-02”), which requires lessees to recognize assets and liabilities for most leases. ASU 2016-02 is effective for public business entities for annual and interim periods beginning after December 15, 2018. Early adoption is permitted. We are continuing to evaluate the provisions of ASU 2016-02 (and related developments) to determine how our financial statements will be affected, and we believe the primary effect of adopting the new standard will be to record right-of-use assets and obligations for our leases currently classified as operating leases.

During October 2018, the SEC adopted a final rule affecting interim financial statements which requires a reconciliation of changes in stockholders’ equity in the notes to the financial statements or as a separate statement. We have included a single statement presentation of our condensed consolidated statements of stockholders’ deficit for the quarters and nine months ended September 30, 2018 and 2017.

Reclassifications

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

10

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 2 — ACQUISITIONS AND DISPOSITIONS

During the nine months ended September 30, 2018, we paid $788 million to acquire two hospital facilities and $268 million to acquire other nonhospital health care entities. During the nine months ended September 30, 2017, we paid $1.000 billion to acquire seven hospital facilities and $142 million to acquire other nonhospital health care entities. Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values. The purchase price paid in excess of the fair value of identifiable net assets of these acquired entities aggregated $433 million and $655 million for the nine months ended September 30, 2018 and 2017, respectively. The consolidated financial statements include the accounts and operations of the acquired entities subsequent to the respective acquisition dates. The pro forma effects of these acquired entities on our results of operations for periods prior to the respective acquisition dates were not significant.

During the nine months ended September 30, 2018, we received proceeds of $758 million and recognized a net pretax gain of $372 million related to the sale of the two hospital facilities in our Oklahoma market. During the nine months ended September 30, 2018, we also received proceeds of $44 million and recognized a net pretax gain of $48 million related to sales of real estate and other investments. During the nine months ended September 30, 2017, we received proceeds of $24 million and recognized a net pretax gain of $10 million related to sales of real estate and other investments.

NOTE 3 — INCOME TAXES

Our provision for income taxes for the quarters ended September 30, 2018 and 2017, was $173 million and $248 million, respectively, and the effective tax rates were 18.6% and 36.7%, respectively. Our provision for income taxes for the nine months ended September 30, 2018 and 2017, was $702 million and $902 million, respectively, and the effective tax rates were 20.5% and 34.1%, respectively. The reductions in the effective tax rates for 2018 periods were primarily related to the estimated impact of tax rate changes under the 2017 Tax Cuts and Jobs Act (the “Tax Act”). Our provision for income taxes for the quarter and nine months ended September 30, 2018 included tax benefits, of $132 million and $377 million, respectively, related to the reduction in our effective tax rate associated with the impact of the Tax Act. Our provision for income taxes also included tax benefits related to the settlement of employee equity awards of $23 million and $4 million for the quarters ended September 30, 2018 and 2017, respectively, and $119 million and $80 million for the nine months ended September 30, 2018 and 2017, respectively. We also recorded a reduction to the provision for income taxes of $28 million during the quarter ended September 30, 2018 for tax credits related to certain 2017 hurricane-related expenses.

The Tax Act was enacted on December 22, 2017, and it significantly revised U.S. corporate income taxes, including lowering the federal statutory corporate tax rate from 35% to 21% beginning in 2018. Due to the complexity and uncertainty regarding numerous provisions of the Tax Act, we have not completed our accounting for its effects. However, we have made reasonable estimates and recorded provisional amounts in our financial statements as of September 30, 2018. As we complete our analysis of the Tax Act, we may make adjustments to the provisional amounts and record additional amounts for those federal, state, and foreign tax assets and liabilities for which we were unable to make reasonable estimates as of September 30, 2018. Any adjustments or additional amounts recorded may materially impact our provision for income taxes and effective tax rate in the periods in which they are made.

Our liability for unrecognized tax benefits was $440 million, including accrued interest of $45 million, as of September 30, 2018 ($439 million and $44 million, respectively, as of December 31, 2017). Unrecognized tax benefits of $145 million ($145 million as of December 31, 2017) would affect the effective rate, if recognized.

We are subject to examination by federal, 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

11

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 3 — INCOME TAXES (continued)

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.

NOTE 4 — EARNINGS PER SHARE

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 and potential shares, computed using the treasury stock method.

The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2018 and 2017 (dollars and shares in millions, except per share amounts):

	Quarter				Nine Months
	2018		2017		2018		2017
Net income attributable to HCA Healthcare, Inc.	$	759	$	426	$	2,723	$	1,742
Weighted average common shares outstanding		345.823		360.170		348.411		365.398
Effect of dilutive incremental shares		7.816		9.664		7.713		9.615
Shares used for diluted earnings per share		353.639		369.834		356.124		375.013
Earnings per share:
Basic earnings	$	2.20	$	1.18	$	7.82	$	4.77
Diluted earnings	$	2.15	$	1.15	$	7.65	$	4.64

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES

A summary of our insurance subsidiaries’ investments at September 30, 2018 and December 31, 2017 follows (dollars in millions):

	September 30, 2018
	Amortized Cost		Unrealized Amounts					Fair Value
			Gains		Losses
Debt securities	$	343	$	4	$	(2	)	$	345
Money market funds and other		68		—		—			68
	$	411	$	4	$	(2	)		413
Amounts classified as current assets									(46	)
Investment carrying value								$	367

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HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued)

	December 31, 2017
	Amortized Cost		Unrealized Amounts				Fair Value
			Gains		Losses
Debt securities	$	361	$	10	$	—	$	371
Money market funds and other		101		—		—		101
	$	462	$	10	$	—		472
Amounts classified as current assets								(54	)
Investment carrying value							$	418

At September 30, 2018 and December 31, 2017, the investments of our insurance subsidiaries were classified as “available-for-sale.” Changes in temporary unrealized gains and losses are recorded as adjustments to other comprehensive income (loss).

Scheduled maturities of investments in debt securities at September 30, 2018 were as follows (dollars in millions):

	Amortized Cost		Fair Value
Due in one year or less	$	9	$	9
Due after one year through five years		57		58
Due after five years through ten years		210		212
Due after ten years		67		66
	$	343	$	345

The average expected maturity of the investments in debt securities at September 30, 2018 was 5.7 years, compared to the average scheduled maturity of 10.1 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.

NOTE 6 — FINANCIAL INSTRUMENTS

Interest Rate Swap Agreements

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between two parties based on common notional principal amounts and maturity dates. Pay-fixed interest rate swaps effectively convert variable rate obligations to fixed interest rate obligations. The interest payments under these agreements are settled on a net basis. The net interest payments, based on the notional amounts in these agreements, generally match the timing of the related liabilities for the interest rate swap agreements which have been designated as cash flow hedges. The notional amounts of the swap agreements represent amounts used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions.

13

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 6 — FINANCIAL INSTRUMENTS (continued)

Interest Rate Swap Agreements (continued)

The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at September 30, 2018 (dollars in millions):

	Notional Amount		Maturity Date		Fair Value
Pay-fixed interest rate swaps	$	2,000		December 2021	$	88
Pay-fixed interest rate swaps		500		December 2022		17

During the next 12 months, we estimate $26 million will be reclassified from other comprehensive income (“OCI”) and will reduce interest expense.

Derivatives — Results of Operations

The following table presents the effect of our interest rate swaps on our results of operations for the nine months ended September 30, 2018 (dollars in millions):

Derivatives in Cash Flow Hedging Relationships	Amount of Gain Recognized in OCI on Derivatives, Net of Tax		Location of Gain Reclassified from Accumulated OCI into Operations		Amount of Gain Reclassified from Accumulated OCI into Operations
Interest rate swaps	$	46		Interest expense	$	5

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE

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. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment.

Cash Traded Investments

Our cash traded investments 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.

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HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

Derivative Financial Instruments

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments.

Although we determined the majority of the inputs used to value our derivatives fall within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with our derivatives utilize Level 3 inputs, such as estimates of current credit spreads to evaluate the likelihood of default by us and our counterparties. We assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions, and at September 30, 2018 and December 31, 2017, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives.

The following tables summarize our assets measured at fair value on a recurring basis as of September 30, 2018 and December 31, 2017, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

	September 30, 2018
				Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Assets:
Investments of insurance subsidiaries:
Debt securities	$	345		$	—		$	345	$	—
Money market funds and other		68			68			—		—
Investments of insurance subsidiaries		413			68			345		—
Less amounts classified as current assets		(46	)		(46	)		—		—
	$	367			22		$	345	$	—
Interest rate swaps (Other)	$	105		$	—		$	105	$	—

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HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

	December 31, 2017
				Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Assets:
Investments of insurance subsidiaries:
Debt securities	$	371		$	—		$	371	$	—
Money market funds and other		101			101			—		—
Investments of insurance subsidiaries		472			101			371		—
Less amounts classified as current assets		(54	)		(54	)		—		—
	$	418		$	47		$	371	$	—
Interest rate swaps (Other)	$	50		$	—		$	50	$	—

The estimated fair value of our long-term debt was $34.125 billion and $34.689 billion at September 30, 2018 and December 31, 2017, respectively, compared to carrying amounts, excluding net debt issuance costs, aggregating $33.270 billion and $33.222 billion, respectively. The estimates of fair value are generally based upon the quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities.

NOTE 8 — LONG-TERM DEBT

A summary of long-term debt at September 30, 2018 and December 31, 2017, including related interest rates at September 30, 2018, follows (dollars in millions):

	September 30, 2018			December 31, 2017
Senior secured asset-based revolving credit facility (effective interest rate of 3.7%)	$	3,350		$	3,680
Senior secured revolving credit facility		—			—
Senior secured term loan facilities (effective interest rate of 3.6%)		3,825			3,891
Senior secured notes (effective interest rate of 5.6%)		13,800			15,300
Other senior secured debt (effective interest rate of 5.8%)		543			599
Senior secured debt		21,518			23,470
Senior unsecured notes (effective interest rate of 6.3%)		11,752			9,752
Net debt issuance costs		(163	)		(164	)
Total debt (average life of 6.6 years, rates averaging 5.4%)		33,107			33,058
Less amounts due within one year		191			200
	$	32,916		$	32,858

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HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 8 — LONG-TERM DEBT (continued)

During August 2018, we issued $2.000 billion aggregate principal amount of senior notes comprised of $1.000 billion aggregate principal amount of 5.375% notes due 2026 and $1.000 billion aggregate principal amount of 5.625% notes due 2028. We used the net proceeds for general corporate purposes, including funding the purchase of a hospital, and the redemption of all $1.500 billion aggregate principal amount of our existing 3.750% senior secured notes maturing in March 2019. The pretax loss on retirement of debt was $9 million.

NOTE 9 — CONTINGENCIES

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, 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.

NOTE 10 — SHARE REPURCHASES TRANSACTIONS AND OTHER COMPREHENSIVE LOSS

During the nine months ended September 30, 2018, we repurchased 11.558 million shares of our common stock at an average price of $103.42 per share through market purchases pursuant to the $2.0 billion share repurchase program authorized during October 2017. At September 30, 2018, we had $607 million of repurchase authorization available under the October 2017 authorization.

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

	Unrealized Gains on Available- for-Sale Securities			Foreign Currency Translation Adjustments			Defined Benefit Plans			Change in Fair Value of Derivative Instruments			Total
Balances at December 31, 2017	$	7		$	(149	)	$	(168	)	$	32		$	(278	)
Unrealized losses on available-for-sale securities, net of $1 income tax benefit		(7	)		—			—			—			(7	)
Foreign currency translation adjustments		—			(35	)		—			—			(35	)
Change in fair value of derivative instruments, net of $14 of income taxes		—			—			—			46			46
Expense (income) reclassified into operations from other comprehensive income, net of $3 income tax benefit and $1 of income taxes, respectively		—			—			12			(4	)		8
Balances at September 30, 2018	$	—		$	(184	)	$	(156	)	$	74		$	(266	)

17

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 11 — 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. The National Group includes 88 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, South Carolina, Utah and Virginia, and the American Group includes 85 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Mississippi, Missouri, Tennessee and Texas. We also operate six hospitals in England, and these facilities are included in the Corporate and other group.

18

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, 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 and depreciation and amortization for the quarters and nine months ended September 30, 2018 and 2017 are summarized in the following table (dollars in millions):

	Quarter						Nine Months
	2018			2017			2018			2017
Revenues:
National Group	$	5,542		$	5,036		$	16,719		$	15,344
American Group		5,396			5,180			16,113			15,268
Corporate and other		513			480			1,571			1,440
	$	11,451		$	10,696		$	34,403		$	32,052
Equity in earnings of affiliates:
National Group	$	(1	)	$	(8	)	$	(5	)	$	(17	)
American Group		(10	)		(9	)		(29	)		(27	)
Corporate and other		2			4			9			8
	$	(9	)	$	(13	)	$	(25	)	$	(36	)
Adjusted segment EBITDA:
National Group	$	1,127		$	975		$	3,593		$	3,268
American Group		1,072			930			3,250			2,977
Corporate and other		(103	)		(129	)		(402	)		(374	)
	$	2,096		$	1,776		$	6,441		$	5,871
Depreciation and amortization:
National Group	$	245		$	219		$	702		$	650
American Group		258			251			765			727
Corporate and other		79			69			230			204
	$	582		$	539		$	1,697		$	1,581
Adjusted segment EBITDA	$	2,096		$	1,776		$	6,441		$	5,871
Depreciation and amortization		582			539			1,697			1,581
Interest expense		442			427			1,309			1,257
Gains on sales of facilities		(6	)		(7	)		(420	)		(10	)
Losses on retirement of debt		9			39			9			39
Income before income taxes	$	1,069		$	778		$	3,846		$	3,004

19

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION

During December 2012, HCA Healthcare, Inc. issued $1.000 billion aggregate principal amount of 6.250% senior unsecured notes due 2021. These notes are senior unsecured obligations and are not guaranteed by any of our subsidiaries.

HCA Inc., a direct wholly-owned subsidiary of HCA Healthcare, Inc., is the obligor under a significant portion of our other indebtedness, including our senior secured credit facilities, senior secured notes and senior unsecured notes (other than the senior unsecured notes issued by HCA Healthcare, Inc.). The senior secured notes and senior unsecured notes issued by HCA Inc. are fully and unconditionally guaranteed by HCA Healthcare, Inc. The senior secured credit facilities and senior secured notes are fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, 100% owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our senior secured asset-based revolving credit facility).

Our summarized condensed consolidating comprehensive income statements for the quarters and nine months ended September 30, 2018 and 2017, condensed consolidating balance sheets at September 30, 2018 and December 31, 2017 and condensed consolidating statements of cash flows for the nine months ended September 30, 2018 and 2017, segregating HCA Healthcare, Inc. issuer, HCA Inc. issuer, the subsidiary guarantors, the subsidiary non-guarantors and eliminations, follow:

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE QUARTER ENDED SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	6,747		$	4,704		$	—		$	11,451
Salaries and benefits		—			—			3,090			2,287			—			5,377
Supplies		—			—			1,115			775			—			1,890
Other operating expenses		2			—			1,137			958			—			2,097
Equity in earnings of affiliates		(728	)		—			(2	)		(7	)		728			(9	)
Depreciation and amortization		—			—			340			242			—			582
Interest expense (income)		16			913			(423	)		(64	)		—			442
Losses (gains) on sales of facilities		—			—			(6	)		—			—			(6	)
Losses on retirement of debt		—			9			—			—			—			9
Management fees		—			—			(158	)		158			—			—
		(710	)		922			5,093			4,349			728			10,382
Income (loss) before income taxes		710			(922	)		1,654			355			(728	)		1,069
Provision (benefit) for income taxes		(49	)		(214	)		379			57			—			173
Net income (loss)		759			(708	)		1,275			298			(728	)		896
Net income attributable to noncontrolling interests		—			—			22			115			—			137
Net income (loss) attributable to HCA Healthcare, Inc.	$	759		$	(708	)	$	1,253		$	183		$	(728	)	$	759
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	754		$	(703	)	$	1,258		$	168		$	(723	)	$	754

20

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE QUARTER ENDED SEPTEMBER 30, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors (as adjusted)			Subsidiary Non- Guarantors (as adjusted)			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	6,303		$	4,393		$	—		$	10,696
Salaries and benefits		—			—			2,915			2,166			—			5,081
Supplies		—			—			1,033			744			—			1,777
Other operating expenses		—			—			1,093			982			—			2,075
Equity in earnings of affiliates		(436	)		—			(1	)		(12	)		436			(13	)
Depreciation and amortization		—			—			311			228			—			539
Interest expense (income)		16			792			(342	)		(39	)		—			427
Gains on sales of facilities		—			—			(3	)		(4	)		—			(7	)
Losses on retirement of debt		—			39			—			—			—			39
Management fees		—			—			(159	)		159			—			—
		(420	)		831			4,847			4,224			436			9,918
Income (loss) before income taxes		420			(831	)		1,456			169			(436	)		778
Provision (benefit) for income taxes		(6	)		(307	)		528			33			—			248
Net income (loss)		426			(524	)		928			136			(436	)		530
Net income attributable to noncontrolling interests		—			—			24			80			—			104
Net income (loss) attributable to HCA Healthcare, Inc.	$	426		$	(524	)	$	904		$	56		$	(436	)	$	426
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	451		$	(522	)	$	907		$	76		$	(461	)	$	451

21

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	20,297		$	14,106		$	—		$	34,403
Salaries and benefits		—			—			9,184			6,756			—			15,940
Supplies		—			—			3,383			2,339			—			5,722
Other operating expenses		7			—			3,387			2,931			—			6,325
Equity in earnings of affiliates		(2,670	)		—			(5	)		(20	)		2,670			(25	)
Depreciation and amortization		—			—			992			705			—			1,697
Interest expense (income)		48			2,617			(1,179	)		(177	)		—			1,309
Gains on sales of facilities		—			—			(378	)		(42	)		—			(420	)
Losses on retirement of debt		—			9			—			—			—			9
Management fees		—			—			(473	)		473			—			—
		(2,615	)		2,626			14,911			12,965			2,670			30,557
Income (loss) before income taxes		2,615			(2,626	)		5,386			1,141			(2,670	)		3,846
Provision (benefit) for income taxes		(108	)		(610	)		1,235			185			—			702
Net income (loss)		2,723			(2,016	)		4,151			956			(2,670	)		3,144
Net income attributable to noncontrolling interests		—			—			72			349			—			421
Net income (loss) attributable to HCA Healthcare, Inc.	$	2,723		$	(2,016	)	$	4,079		$	607		$	(2,670	)	$	2,723
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	2,735		$	(1,974	)	$	4,091		$	565		$	(2,682	)	$	2,735

22

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors (as adjusted)			Subsidiary Non- Guarantors (as adjusted)			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	19,008		$	13,044		$	—		$	32,052
Salaries and benefits		—			—			8,689			6,189			—			14,878
Supplies		—			—			3,163			2,206			—			5,369
Other operating expenses		5			—			3,207			2,758			—			5,970
Equity in earnings of affiliates		(1,702	)		—			(4	)		(32	)		1,702			(36	)
Depreciation and amortization		—			—			923			658			—			1,581
Interest expense (income)		48			2,280			(947	)		(124	)		—			1,257
Gains on sales of facilities		—			—			(6	)		(4	)		—			(10	)
Losses on retirement of debt		—			39			—			—			—			39
Management fees		—			—			(479	)		479			—			—
		(1,649	)		2,319			14,546			12,130			1,702			29,048
Income (loss) before income taxes		1,649			(2,319	)		4,462			914			(1,702	)		3,004
Provision (benefit) for income taxes		(93	)		(856	)		1,619			232			—			902
Net income (loss)		1,742			(1,463	)		2,843			682			(1,702	)		2,102
Net income attributable to noncontrolling interests		—			—			74			286			—			360
Net income (loss) attributable to HCA Healthcare, Inc.	$	1,742		$	(1,463	)	$	2,769		$	396		$	(1,702	)	$	1,742
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	1,812		$	(1,458	)	$	2,778		$	452		$	(1,772	)	$	1,812

23

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
ASSETS
Current assets:
Cash and cash equivalents	$	—		$	—		$	105		$	473		$	—		$	578
Accounts receivable		—			—			3,854			2,678			—			6,532
Inventories		—			—			1,088			546			—			1,634
Other		47			—			667			552			—			1,266
		47			—			5,714			4,249			—			10,010
Property and equipment, net		—			—			12,192			6,849			—			19,041
Investments of insurance subsidiaries		—			—			—			367			—			367
Investments in and advances to affiliates		32,263			—			29			209			(32,263	)		238
Goodwill and other intangible assets		—			—			5,736			2,023			—			7,759
Other		389			106			29			105			—			629
	$	32,699		$	106		$	23,700		$	13,802		$	(32,263	)	$	38,044
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY
Current liabilities:
Accounts payable	$	—		$	—		$	1,627		$	787		$	—		$	2,414
Accrued salaries		—			—			914			542			—			1,456
Other accrued expenses		10			296			790			1,074			—			2,170
Long-term debt due within one year		—			97			61			33			—			191
		10			393			3,392			2,436			—			6,231
Long-term debt, net		996			31,471			281			168			—			32,916
Intercompany balances		36,790			(7,734	)		(27,263	)		(1,793	)		—			—
Professional liability risks		—			—			—			1,239			—			1,239
Income taxes and other liabilities		508			—			364			516			—			1,388
		38,304			24,130			(23,226	)		2,566			—			41,774
Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc.		(5,605	)		(24,024	)		46,846			9,441			(32,263	)		(5,605	)
Noncontrolling interests		—			—			80			1,795			—			1,875
		(5,605	)		(24,024	)		46,926			11,236			(32,263	)		(3,730	)
	$	32,699		$	106		$	23,700		$	13,802		$	(32,263	)	$	38,044

24

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

DECEMBER 31, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
ASSETS
Current assets:
Cash and cash equivalents	$	1		$	—		$	112		$	619		$	—		$	732
Accounts receivable		—			—			3,693			2,808			—			6,501
Inventories		—			—			1,030			543			—			1,573
Other		—			—			663			508			—			1,171
		1			—			5,498			4,478			—			9,977
Property and equipment, net		—			—			11,110			6,785			—			17,895
Investments of insurance subsidiaries		—			—			—			418			—			418
Investments in and advances to affiliates		29,581			—			22			177			(29,581	)		199
Goodwill and other intangible assets		—			—			4,893			2,501			—			7,394
Other		510			50			47			103			—			710
	$	30,092		$	50		$	21,570		$	14,462		$	(29,581	)	$	36,593
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY
Current liabilities:
Accounts payable	$	—		$	—		$	1,793		$	813		$	—		$	2,606
Accrued salaries		—			—			862			507			—			1,369
Other accrued expenses		29			378			536			1,040			—			1,983
Long-term debt due within one year		—			97			64			39			—			200
		29			475			3,255			2,399			—			6,158
Long-term debt, net		995			31,367			307			189			—			32,858
Intercompany balances		35,322			(9,742	)		(25,228	)		(352	)		—			—
Professional liability risks		—			—			—			1,198			—			1,198
Income taxes and other liabilities		552			—			357			465			—			1,374
		36,898			22,100			(21,309)			3,899			—			41,588
Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc.		(6,806	)		(22,050	)		42,755			8,876			(29,581	)		(6,806	)
Noncontrolling interests		—			—			124			1,687			—			1,811
		(6,806	)		(22,050	)		42,879			10,563			(29,581	)		(4,995	)
	$	30,092		$	50		$	21,570		$	14,462		$	(29,581	)	$	36,593

25

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
Cash flows from operating activities:
Net income (loss)	$	2,723		$	(2,016	)	$	4,151		$	956		$	(2,670	)	$	3,144
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Changes in operating assets and liabilities		(15	)		(83	)		(154	)		105			—			(147	)
Depreciation and amortization		—			—			992			705			—			1,697
Gains on sales of facilities		—			—			(378	)		(42	)		—			(420	)
Losses on retirement of debt		—			9			—			—			—			9
Amortization of debt issuance costs		—			23			—			—			—			23
Share-based compensation		—			—			204			—			—			204
Equity in earnings of affiliates		(2,670	)		—			—			—			2,670			—
Other		67			—			—			9			—			76
Net cash provided by (used in) operating activities		105			(2,067	)		4,815			1,733			—			4,586
Cash flows from investing activities:
Purchase of property and equipment		—			—			(1,425	)		(995	)		—			(2,420	)
Acquisition of hospitals and health care entities		—			—			(894	)		(162	)		—			(1,056	)
Disposition of hospitals and health care entities		—			—			770			32			—			802
Change in investments		—			—			19			46			—			65
Other		—			—			(18	)		12			—			(6	)
Net cash used in investing activities		—			—			(1,548	)		(1,067	)		—			(2,615	)
Cash flows from financing activities:
Issuance of long-term debt		—			2,000			—			—			—			2,000
Net change in revolving credit facilities		—			(330	)		—			—			—			(330	)
Repayment of long-term debt		—			(1,566	)		(44	)		(42	)		—			(1,652	)
Distributions to noncontrolling interests		—			—			(63	)		(252	)		—			(315	)
Payment of debt issuance costs		—			(24	)		—			—			—			(24	)
Payment of cash dividends		(366	)		—			—			—			—			(366	)
Repurchases of common stock		(1,195	)		—			—			—			—			(1,195	)
Changes in intercompany balances with affiliates, net		1,697			1,987			(3,167	)		(517	)		—			—
Other		(242	)		—			—			10			—			(232	)
Net cash (used in) provided by financing activities		(106	)		2,067			(3,274	)		(801	)		—			(2,114	)
Effect on exchange rate changes on cash and cash equivalents		—			—			—			(11	)		—			(11	)
Change in cash and cash equivalents		(1	)		—			(7	)		(146	)		—			(154	)
Cash and cash equivalents at beginning of period		1			—			112			619			—			732
Cash and cash equivalents at end of period	$	—		$	—		$	105		$	473		$	—		$	578

26

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors (as adjusted)			Subsidiary Non- Guarantors (as adjusted)			Eliminations			Condensed Consolidated
Cash flows from operating activities:
Net income (loss)	$	1,742		$	(1,463	)	$	2,843		$	682		$	(1,702	)	$	2,102
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Changes in operating assets and liabilities		(15	)		(293	)		(191	)		210			—			(289	)
Depreciation and amortization		—			—			923			658			—			1,581
Income taxes		(9	)		—			—			—			—			(9	)
Gains on sales of facilities		—			—			(6	)		(4	)		—			(10	)
Losses on retirement of debt		—			39			—			—			—			39
Amortization of debt issuance costs		—			23			—			—			—			23
Share-based compensation		—			—			195			—			—			195
Equity in earnings of affiliates		(1,702	)		—			—			—			1,702			—
Other		58			—			2			—			—			60
Net cash provided by (used in) operating activities		74			(1,694	)		3,766			1,546			—			3,692
Cash flows from investing activities:
Purchase of property and equipment		—			—			(1,161	)		(872	)		—			(2,033	)
Acquisition of hospitals and health care entities		—			—			(9	)		(1,133	)		—			(1,142	)
Disposition of hospitals and health care entities		—			—			12			12			—			24
Change in investments		—			—			1			(16	)		—			(15	)
Other		—			—			(7	)		1			—			(6	)
Net cash used in investing activities		—			—			(1,164	)		(2,008	)		—			(3,172	)
Cash flows from financing activities:
Issuance of long-term debt		—			1,500			—			2			—			1,502
Net change in revolving credit facilities		—			650			—			—			—			650
Repayment of long-term debt		—			(604	)		(54	)		(42	)		—			(700	)
Distributions to noncontrolling interests		—			—			(105	)		(258	)		—			(363	)
Payment of debt issuance costs		—			(25	)		—			—			—			(25	)
Repurchases of common stock		(1,475	)		—			—			—			—			(1,475	)
Changes in intercompany balances with affiliates, net		1,468			173			(2,439	)		798			—			—
Other		(66	)		—			1			28			—			(37	)
Net cash (used in) provided by financing activities		(73	)		1,694			(2,597	)		528			—			(448	)
Change in cash and cash equivalents		1			—			5			66			—			72
Cash and cash equivalents at beginning of period		—			—			114			532			—			646
Cash and cash equivalents at end of period	$	1		$	—		$	119		$	598		$	—		$	718

27

HCA HEALTHCARE, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

The above supplemental condensed consolidating financial information for the quarter and nine months ended September 30, 2017 has been adjusted to properly record the impact of certain subsidiaries that were non-guarantors becoming guarantors, primarily related to the Company acquiring previous noncontrolling interests of non-guarantor subsidiaries that then became guarantor subsidiaries. The impact of these adjustments was immaterial as they had no impact to our consolidated income statements, balance sheets or statements of cash flows, had no impact on any liquidity measures of the Company, nor did they impact any financial ratios based on our consolidated balance sheets or income statements. There was also no impact to our loan covenant reporting or compliance. The impact of the adjustments was limited to reclassifications between the Subsidiary Guarantors and Subsidiary Non-Guarantors columns of the condensed consolidating financial statements. The application of these adjustments to the consolidating information for the quarter and nine months ended September 30, 2017 is summarized as follows (dollars in millions):

	As Previously Reported			Adjustment			As Adjusted
Quarter ended September 30, 2017
Net income (loss) attributable to HCA Healthcare, Inc.:
HCA Healthcare, Inc. Issuer	$	426		$	—		$	426
HCA Inc. Issuer		(524	)		—			(524	)
Subsidiary Guarantors		787			117			904
Subsidiary Non-Guarantors		173			(117	)		56
Eliminations		(436	)		—			(436	)
Condensed Consolidated	$	426		$	—		$	426

	As Previously Reported			Adjustment			As Adjusted
Nine months ended September 30, 2017
Net income (loss) attributable to HCA Healthcare, Inc.:
HCA Healthcare, Inc. Issuer	$	1,742		$	—		$	1,742
HCA Inc. Issuer		(1,463	)		—			(1,463	)
Subsidiary Guarantors		2,467			302			2,769
Subsidiary Non-Guarantors		698			(302	)		396
Eliminations		(1,702	)		—			(1,702	)
Condensed Consolidated	$	1,742		$	—		$	1,742

	As Previously Reported			Adjustment			As Adjusted
Nine months ended September 30, 2017
Net cash provided (used in) operating activities:
HCA Healthcare, Inc. Issuer	$	74		$	—		$	74
HCA Inc. Issuer		(1,694	)		—			(1,694	)
Subsidiary Guarantors		3,342			424			3,766
Subsidiary Non-Guarantors		1,970			(424	)		1,546
Eliminations		—			—			—
Condensed Consolidated	$	3,692		$	—		$	3,692

28

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS

Forward-Looking Statements

This quarterly report on Form 10-Q includes certain disclosures which contain “forward-looking statements.” Forward-looking statements include statements regarding expected share-based compensation expense, expected capital expenditures and expected net claim payments 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) the impact of our substantial indebtedness and the ability to refinance such indebtedness on acceptable terms, (2) the impact of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the “Health Reform Law”), including the effects of any repeal of, or changes to, the Health Reform Law or changes to its implementation, the possible enactment of additional federal or state health care reforms and possible changes to other federal, state or local laws or regulations affecting the health care industry, (3) the effects related to the continued implementation of the sequestration spending reductions required under the Budget Control Act of 2011, and 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, (4) increases in the amount and risk of collectability of uninsured accounts and deductibles and copayment amounts for insured accounts, (5) the ability to achieve operating and financial targets, and attain expected levels of patient volumes and control the costs of providing services, (6) possible changes in Medicare, Medicaid and other state programs, including Medicaid supplemental payment programs or Medicaid waiver programs, that may impact reimbursements to health care providers and insurers and the size of the uninsured or underinsured population, (7) the highly competitive nature of the health care business, (8) 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, (9) the efforts of health insurers, health care providers, large employer groups and others to contain health care costs, (10) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (11) increases in wages and the ability to attract and retain qualified management and personnel, including affiliated physicians, nurses and medical and technical support personnel, (12) the availability and terms of capital to fund the expansion of our business and improvements to our existing facilities, (13) changes in accounting practices, (14) changes in general economic conditions nationally and regionally in our markets, (15) the emergence and effects related to infectious diseases, (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) potential adverse impact of known and unknown government investigations, litigation and other claims that may be made against us, (21) the impact of potential cybersecurity incidents or security breaches, (22) our ongoing ability to demonstrate meaningful use of certified electronic health record (“EHR”) technology, (23) the impact of natural disasters, such as hurricanes and floods, or similar events beyond our control, (24) changes in interpretations, assumptions and expectations regarding the 2017 Tax Cuts and Jobs Act, including additional guidance that may be issued by federal and state taxing authorities or other standard-setting bodies, and (25) other risk factors described in our annual report on Form 10-K for the year ended December 31, 2017 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.

29

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Third Quarter 2018 Operations Summary

Revenues increased to $11.451 billion in the third quarter of 2018 from $10.696 billion in the third quarter of 2017. Net income attributable to HCA Healthcare, Inc. totaled $759 million, or $2.15 per diluted share, for the quarter ended September 30, 2018, compared to $426 million, or $1.15 per diluted share, for the quarter ended September 30, 2017. Third quarter 2018 results included net gains on sales of facilities of $6 million, or $0.01 per diluted share, and losses on retirement of debt of $9 million, or $0.02 per diluted share. Third quarter 2017 results included net gains on sales of facilities of $7 million, or $0.01 per diluted share, and losses on retirement of debt of $39 million, or $0.07 per diluted share. Third quarter 2018 results also included a reduction to the provision for income taxes of $132 million, or $0.37 per diluted share, related to the estimated impact of tax rate changes under the 2017 Tax Cuts and Jobs Act which, along with other revisions, lowered the federal statutory corporate tax rate from 35% to 21% beginning in 2018. Third quarter 2017 results include additional expenses and losses of revenues of approximately $140 million, or $0.24 per diluted share, associated with the impact of hurricanes Harvey and Irma, and a negative impact to operating results related to the Texas Medicaid Waiver program of $50 million, or $0.08 per diluted share, related to final settlement amounts for the program year ended September 30, 2017. The amount associated with the hurricanes is prior to any insurance recoveries. During the third quarter of 2018, we recorded a reduction to the provision for income taxes of $28 million, or $0.08 per diluted share, for tax credits related to certain 2017 hurricane-related expenses. Our provisions for income taxes for the third quarters of 2018 and 2017 also included tax benefits of $23 million, or $0.07 per diluted share, and $4 million, or $0.01 per diluted share, respectively, related to employee equity award settlements. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 353.639 million shares for the quarter ended September 30, 2018 and 369.834 million shares for the quarter ended September 30, 2017. During 2017 and the first nine months of 2018, we repurchased 25.092 million shares and 11.558 million shares of our common stock, respectively.

Revenues increased 7.1% on a consolidated basis and increased 7.4% on a same facility basis for the quarter ended September 30, 2018, compared to the quarter ended September 30, 2017. The increase in consolidated revenues can be primarily attributed to the combined impact of a 2.5% increase in revenue per equivalent admission and a 4.4% increase in equivalent admissions. The same facility revenues increase primarily resulted from the combined impact of a 3.9% increase in same facility revenue per equivalent admission and a 3.4% increase in same facility equivalent admissions.

During the quarter ended September 30, 2018, consolidated admissions and same facility admissions increased 3.2% and 3.1%, respectively, compared to the quarter ended September 30, 2017. Surgeries increased 3.5% on a consolidated basis and 3.2% on a same facility basis during the quarter ended September 30, 2018, compared to the quarter ended September 30, 2017. Emergency department visits increased 0.4% on a consolidated basis and declined 0.4% on a same facility basis during the quarter ended September 30, 2018, compared to the quarter ended September 30, 2017. Same facility uninsured admissions increased 8.8% for the quarter ended September 30, 2018, compared to the quarter ended September 30, 2017.

Cash flows from operating activities increased $713 million from $1.008 billion for the third quarter of 2017 to $1.721 billion for the third quarter of 2018. The increase in cash provided by operating activities was primarily related to the combined impact of an increase in net income of $366 million, positive changes of $149 million related to working capital items and a benefit from income tax payments of $158 million.

Results of Operations

Revenue/Volume Trends

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

30

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Revenue/Volume Trends (continued)

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 7.1% from $10.696 billion in the third quarter of 2017 to $11.451 billion in the third quarter of 2018. Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual allowances 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 discounts and contractual 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. Our revenues from third-party payers and others (including uninsured patients) for the quarters and nine months ended September 30, 2018 and 2017 are summarized in the following table (dollars in millions):

	Quarter
	2018		Ratio			2017		Ratio
Medicare	$	2,404		21.0	%	$	2,298		21.5	%
Managed Medicare		1,344		11.7			1,122		10.5
Medicaid		338		3.0			286		2.7
Managed Medicaid		622		5.4			537		5.0
Managed care and insurers		6,026		52.6			5,605		52.4
International (managed care and insurers)		273		2.4			276		2.6
Other		444		3.9			572		5.3
Revenues	$	11,451		100.0	%	$	10,696		100.0	%

31

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Revenue/Volume Trends (continued)

	Nine Months
	2018		Ratio			2017		Ratio
Medicare	$	7,353		21.4	%	$	6,931		21.6	%
Managed Medicare		4,088		11.9			3,463		10.8
Medicaid		976		2.8			956		3.0
Managed Medicaid		1,769		5.1			1,653		5.2
Managed care and insurers		18,081		52.6			16,957		52.9
International (managed care and insurers)		873		2.5			814		2.5
Other		1,263		3.7			1,278		4.0
Revenues	$	34,403		100.0	%	$	32,052		100.0	%

Consolidated and same facility revenue per equivalent admission increased 2.5% and 3.9%, respectively, in the third quarter of 2018, compared to the third quarter of 2017. Consolidated and same facility equivalent admissions increased 4.4% and 3.4%, respectively, in the third quarter of 2018, compared to the third quarter of 2017. Consolidated and same facility outpatient surgeries increased 4.9% and 4.2%, respectively, in the third quarter of 2018, compared to the third quarter of 2017. Consolidated and same facility inpatient surgeries increased 1.1% and 1.6%, respectively, in the third quarter of 2018, compared to the third quarter of 2017. Consolidated and same facility emergency department visits increased 0.4% and declined 0.4%, respectively, in the third quarter of 2018, compared to the third quarter of 2017.

To quantify the total impact of the trends related to uninsured 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 and nine months ended September 30, 2018 and 2017 follows (dollars in millions):

	Quarter						Nine Months
	2018			2017			2018			2017
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization)	$	9,946		$	9,472		$	29,684		$	27,798
Cost-to-charges ratio (patient care costs as percentage of gross patient charges)		12.7	%		13.4	%		12.6	%		13.1	%
Total uncompensated care	$	6,786		$	6,089		$	19,524		$	17,137
Multiply by the cost-to-charges ratio		12.7	%		13.4	%		12.6	%		13.1	%
Estimated cost of total uncompensated care	$	862		$	816		$	2,460		$	2,245

Total uncompensated care as a percentage of the sum of revenues and total uncompensated care was 37.2% and 36.3% for the quarters ended September 30, 2018 and 2017, respectively, and 36.2% and 34.8% for the nine months ended September 30, 2018 and 2017, respectively.

Same facility uninsured admissions increased by 3,383 admissions, or 8.8%, in the third quarter of 2018, compared to the third quarter of 2017. Same facility uninsured admissions increased 7.8%, in the second quarter of 2018, compared to the second quarter of 2017. Same facility uninsured admissions increased 10.1%, in the first quarter of 2018, compared to the first quarter of 2017. Same facility uninsured admissions in 2017, compared to 2016, increased 6.4% in the fourth quarter of 2017, increased 6.4% in the third quarter of 2017, increased 4.9% in the second quarter of 2017 and increased 3.2% in the first quarter of 2017.

32

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Revenue/Volume Trends (continued)

The approximate percentages of our admissions related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and insurers and the uninsured for the quarters and nine months ended September 30, 2018 and 2017 are set forth in the following table.

	Quarter						Nine Months
	2018			2017			2018			2017
Medicare		29	%		30	%		30	%		31	%
Managed Medicare		17			15			17			16
Medicaid		5			5			5			5
Managed Medicaid		12			13			12			12
Managed care and insurers		28			28			28			28
Uninsured		9			9			8			8
		100	%		100	%		100	%		100	%

The approximate percentages of our inpatient revenues related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and insurers and other for the quarters and nine months ended September 30, 2018 and 2017 are set forth in the following table.

	Quarter						Nine Months
	2018			2017			2018			2017
Medicare		28	%		29	%		28	%		29	%
Managed Medicare		13			12			14			13
Medicaid		4			4			4			5
Managed Medicaid		6			5			6			5
Managed care and insurers		49			48			48			48
Other		—			2			—			—
		100	%		100	%		100	%		100	%

At September 30, 2018, we had 92 hospitals in the states of Texas and Florida. During the third quarter of 2018, 57% of our admissions and 49% of our revenues were generated by these hospitals. Uninsured admissions in Texas and Florida represented 70% of our uninsured admissions during the third quarter of 2018.

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. In December 2017, the Centers for Medicare & Medicaid Services (“CMS”) announced that it will phase out federal matching funds for Designated State Health Programs under waivers granted under section 1115 of the Social Security Act. Texas currently operates its Healthcare Transformation and Quality Improvement Program pursuant to a Medicaid waiver. In December 2017, CMS approved an extension of this waiver through September 30, 2022, but indicated that it will phase out some of the federal funding. Our Texas Medicaid revenues included Medicaid supplemental payments of $101 million and $60 million during the third quarters of 2018 and 2017, respectively, and $296 million and $261 million during the first nine months of 2018 and 2017, respectively.

In addition, we receive supplemental payments in several other states. We are aware these supplemental payment programs are currently being reviewed by certain state agencies and some states have made waiver requests to CMS to replace their existing supplemental payment programs. It is possible these reviews and

33

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Revenue/Volume Trends (continued)

waiver 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.

Operating Results Summary

The following is a comparative summary of results of operations for the quarters and nine months ended September 30, 2018 and 2017 (dollars in millions):

	Quarter
	2018						2017
	Amount			Ratio			Amount			Ratio
Revenues	$	11,451			100.0		$	10,696			100.0
Salaries and benefits		5,377			46.9			5,081			47.5
Supplies		1,890			16.5			1,777			16.6
Other operating expenses		2,097			18.4			2,075			19.4
Equity in earnings of affiliates		(9	)		(0.1	)		(13	)		(0.1	)
Depreciation and amortization		582			5.1			539			5.0
Interest expense		442			3.9			427			4.0
Gains on sales of facilities		(6	)		(0.1	)		(7	)		(0.1	)
Losses on retirement of debt		9			0.1			39			0.4
		10,382			90.7			9,918			92.7
Income before income taxes		1,069			9.3			778			7.3
Provision for income taxes		173			1.5			248			2.3
Net income		896			7.8			530			5.0
Net income attributable to noncontrolling interests		137			1.2			104			1.0
Net income attributable to HCA Healthcare, Inc.	$	759			6.6		$	426			4.0
% changes from prior year:
Revenues		7.1	%					4.2	%
Income before income taxes		37.5						(23.6	)
Net income attributable to HCA Healthcare, Inc.		78.3						(31.1	)
Admissions(a)		3.2						2.7
Equivalent admissions(b)		4.4						2.5
Revenue per equivalent admission		2.5						1.6
Same facility % changes from prior year(c):
Revenues		7.4						2.3
Admissions(a)		3.1						0.6
Equivalent admissions(b)		3.4						0.3
Revenue per equivalent admission		3.9						2.0

34

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Operating Results Summary (continued)

	Nine Months
	2018						2017
	Amount			Ratio			Amount			Ratio
Revenues	$	34,403			100.0		$	32,052			100.0
Salaries and benefits		15,940			46.3			14,878			46.4
Supplies		5,722			16.6			5,369			16.8
Other operating expenses		6,325			18.5			5,970			18.6
Equity in earnings of affiliates		(25	)		(0.1	)		(36	)		(0.1	)
Depreciation and amortization		1,697			4.9			1,581			4.9
Interest expense		1,309			3.8			1,257			3.9
Gains on sales of facilities		(420	)		(1.2	)		(10	)		—
Losses on retirement of debt		9			—			39			0.1
		30,557			88.8			29,048			90.6
Income before income taxes		3,846			11.2			3,004			9.4
Provision for income taxes		702			2.1			902			2.8
Net income		3,144			9.1			2,102			6.6
Net income attributable to noncontrolling interests		421			1.2			360			1.2
Net income attributable to HCA Healthcare, Inc.	$	2,723			7.9		$	1,742			5.4
% changes from prior year:
Revenues		7.3	%					3.9	%
Income before income taxes		28.0						(7.4	)
Net income attributable to HCA Healthcare, Inc.		56.4						(11.6	)
Admissions(a)		4.1						1.8
Equivalent admissions(b)		4.7						2.1
Revenue per equivalent admission		2.5						1.7
Same facility % changes from prior year(c):
Revenues		6.6						3.0
Admissions(a)		2.7						1.0
Equivalent admissions(b)		2.7						1.2
Revenue per equivalent admission		3.8						1.8

(a) 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.

(b) 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.

(c) Same facility information excludes the operations of hospitals and their related facilities which were either acquired or divested during the current and prior period.

35

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Quarters Ended September 30, 2018 and 2017

Net income attributable to HCA Healthcare, Inc. totaled $759 million, or $2.15 per diluted share, for the third quarter of 2018, compared to $426 million, or $1.15 per diluted share, for the third quarter of 2017. Third quarter 2018 results included net gains on sales of facilities of $6 million, or $0.01 per diluted share, and losses on retirement of debt of $9 million, or $0.02 per diluted share. Third quarter 2017 results include net gains on sales of facilities of $7 million, or $0.01 per diluted share, and losses on retirement of debt of $39 million, or $0.07 per diluted share. Third quarter 2018 results also included a reduction to the provision for income taxes of $132 million, or $0.37 per diluted share, related to the impact of tax rate changes under the 2017 Tax Cuts and Jobs Act. Third quarter 2017 results also include additional expenses and losses of revenues of approximately $140 million, or $0.24 per diluted share, associated with the impact of hurricanes Harvey and Irma, and a negative impact to operating results related to the Texas Medicaid waiver program of $50 million, or $0.08 per diluted share, related to final settlement amounts for the program year ended September 30, 2017. The amount associated with the hurricanes is prior to any insurance recoveries. During the third quarter of 2018, we recorded a reduction to the provision for income taxes of $28 million, or $0.08 per diluted share, for tax credits related to certain 2017 hurricane-related expenses. Our provisions for income taxes for the third quarters of 2018 and 2017 also included tax benefits of $23 million, or $0.07 per diluted share, and $4 million, or $0.01 per diluted share, respectively, related to employee equity award settlements. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 353.639 million shares for the quarter ended September 30, 2018 and 369.834 million shares for the quarter ended September 30, 2017. During 2017 and the first nine months of 2018, we repurchased 25.092 million shares and 11.558 million shares of our common stock, respectively.

Revenues increased 7.1% primarily due to the combined impact of revenue per equivalent admission growth of 2.5% and a 4.4% increase in equivalent admissions for the third quarter of 2018 compared to the third quarter of 2017. Same facility revenues increased 7.4% due to the combined impact of a 3.9% increase in same facility revenue per equivalent admission and a 3.4% increase in same facility equivalent admissions for the third quarter of 2018 compared to the third quarter of 2017.

Salaries and benefits, as a percentage of revenues, were 46.9% in the third quarter of 2018 and 47.5% in the third quarter of 2017. Salaries and benefits per equivalent admission increased 1.3% in the third quarter of 2018 compared to the third quarter of 2017. Same facility labor rate increases averaged 3.1% for the third quarter of 2018 compared to the third quarter of 2017.

Supplies, as a percentage of revenues, were 16.5% in the third quarter of 2018 and 16.6% in the third quarter of 2017. Supply costs per equivalent admission increased 1.9% in the third quarter of 2018 compared to the third quarter of 2017. Supply costs per equivalent admission increased 5.0% for medical devices and 1.8% for general medical and surgical items, and declined 2.5% for pharmacy supplies in the third quarter of 2018 compared to the third quarter of 2017.

Other operating expenses, as a percentage of revenues, were 18.4% in the third quarter of 2018 and 19.4% in the third quarter of 2017. 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. Provisions for losses related to professional liability risks were $60 million and $116 million for the third quarters of 2018 and 2017, respectively. During the third quarter of 2018, we recorded a reduction of $70 million, or $0.15 per diluted share, to our provision for professional liability risks related to the receipt of updated actuarial information.

36

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Quarters Ended September 30, 2018 and 2017 (continued)

Equity in earnings of affiliates was $9 million and $13 million in the third quarters of 2018 and 2017, respectively.

Depreciation and amortization increased $43 million, from $539 million in the third quarter of 2017 to $582 million in the third quarter of 2018. The increase in depreciation relates to both acquired facilities and increased capital expenditures at our existing facilities.

Interest expense was $442 million in the third quarter of 2018 and $427 million in the third quarter of 2017. Our average debt balance was $33.091 billion for the third quarter of 2018 compared to $32.337 billion for the third quarter of 2017. The average effective interest rate for our long-term debt increased to 5.3% from 5.2% for the quarters ended September 30, 2018 and 2017, respectively.

During the third quarters of 2018 and 2017, we recorded net gains on sales of facilities of $6 million and $7 million, respectively.

During August 2018, we issued $2.000 billion aggregate principal amount of senior notes comprised of $1.000 billion aggregate principal amount of 5.375% notes due 2026 and $1.000 billion aggregate principal amount of 5.625% notes due 2028. We used the net proceeds for general corporate purposes, including funding the purchase of a hospital, and the redemption of all $1.500 billion aggregate principal amount of our existing 3.750% senior secured notes maturing in March 2019. The pretax loss on retirement of debt was $9 million. During June 2017, we issued $1.500 billion aggregate principal amount of 5.500% senior secured notes due 2047. We used the net proceeds for general corporate purposes, including funding the purchase of certain hospital acquisitions, and the redemption of all $500 million aggregate principal amount of our existing 8.000% senior notes maturing in October 2018. The pretax loss on retirement of debt was $39 million.

The effective tax rates were 18.6% and 36.7% for the third quarters of 2018 and 2017, respectively. The effective tax rate computations exclude net income attributable to noncontrolling interests as it relates to consolidated partnerships. Our provisions for income taxes for the third quarters of 2018 and 2017 included tax benefits of $23 million and $4 million, respectively, related to employee equity award settlements. Our provision for income taxes for the third quarter of 2018 also included $28 million of reductions for tax credits related to certain 2017 hurricane-related expenses. Excluding the effect of these adjustments, the effective tax rate for the third quarters of 2018 and 2017 would have been 24.1% and 37.2%, respectively. The reduction in the effective tax rate was primarily related to the estimated impact of tax rate changes under the 2017 Tax Cuts and Jobs Act which, along with other revisions, lowered the federal statutory corporate tax rate from 35% to 21% beginning in 2018.

Net income attributable to noncontrolling interests increased from $104 million for the third quarter of 2017 to $137 million for the third quarter of 2018. The increase in net income attributable to noncontrolling interests related primarily to one of our Texas markets.

37

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Nine Months Ended September 30, 2018 and 2017

Net income attributable to HCA Healthcare, Inc. totaled $2.723 billion, or $7.65 per diluted share, in the nine months ended September 30, 2018, compared to $1.742 billion, or $4.64 per diluted share, in the nine months ended September 30, 2017. The first nine months of 2018 results included net gains on sales of facilities of $420 million, or $0.89 per diluted share, and losses on retirement of debt of $9 million, or $0.02 per diluted share. The first nine months of 2017 results include net gains on sales of facilities of $10 million, or $0.02 per diluted share, and losses on retirement of debt of $39 million, or $0.07 per diluted share. The first nine months of 2018 results also included a reduction to the provision for income taxes of $316 million, or $0.89 per diluted share, on net income attributable to HCA Healthcare, Inc., excluding gains on sales of facilities and losses on retirement of debt, related to the estimated impact of tax rate changes under the 2017 Tax Cuts and Jobs Act. The first nine months of 2017 results also include additional expenses and losses of revenues of approximately $140 million, or $0.24 per diluted share, associated with the impact of hurricanes Harvey and Irma, and a negative impact to operating results related to the Texas Medicaid waiver program of $50 million, or $0.08 per diluted share, related to final settlement amounts for the program year ended September 30, 2017. The amount associated with the hurricanes is prior to any insurance recoveries. During the nine months ended September 30, 2018, we recorded a reduction to the provision for income taxes of $28 million, or $0.08 per diluted share, for tax credits related to certain 2017 hurricane-related expenses. Our provisions for income taxes for the first nine months of 2018 and 2017 also included tax benefits of $119 million, or $0.33 per diluted share, and $80 million, or $0.21 per diluted share, respectively, related to employee equity award settlements. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 356.124 million shares for the nine months ended September 30, 2018 and 375.013 million shares for the nine months ended September 30, 2017. During 2017 and the first nine months of 2018, we repurchased 25.092 million shares and 11.558 million shares of our common stock, respectively.

Revenues increased 7.3% due to the combined impact of revenue per equivalent admission growth of 2.5% and a 4.7% increase in equivalent admissions for the first nine months of 2018 compared to the first nine months of 2017. Same facility revenues increased 6.6% due to the combined impact of a 3.8% increase in same facility revenue per equivalent admission and a 2.7% increase in same facility equivalent admissions for the first nine months of 2018 compared to the first nine months of 2017.

Salaries and benefits, as a percentage of revenues, were 46.3% in the first nine months of 2018 and 46.4% in the first nine months of 2017. Salaries and benefits per equivalent admission increased 2.3% in the first nine months of 2018 compared to the first nine months of 2017. Same facility labor rate increases averaged 3.3% for the first nine months of 2018 compared to the first nine months of 2017.

Supplies, as a percentage of revenues, were 16.6% in the first nine months of 2018 and 16.8% in the first nine months of 2017. Supply costs per equivalent admission increased 1.8% in the first nine months of 2018 compared to the first nine months of 2017. Supply costs per equivalent admission increased 4.0% for medical devices and 1.6% for general medical and surgical items, and declined 0.8% for pharmacy supplies in the first nine months of 2018 compared to the first nine months of 2017.

Other operating expenses, as a percentage of revenues, were 18.5% in the first nine months of 2018 and 18.6% in the first nine months of 2017. 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. Provisions for losses related to professional liability risks were $312 million and $353 million for the first nine months of 2018 and 2017, respectively. During the first nine months of 2018, we recorded a reduction of $70 million, or $0.15 per diluted share, to our provision for professional liability risks related to the receipt of updated actuarial information.

38

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Results of Operations (continued)

Nine Months Ended September 30, 2018 and 2017 (continued)

Equity in earnings of affiliates was $25 million and $36 million in the first nine months of 2018 and 2017, respectively.

Depreciation and amortization increased $116 million, from $1.581 billion in the first nine months of 2017 to $1.697 billion in the first nine months of 2018. The increase in depreciation relates to both acquired facilities and increased capital expenditures at our existing facilities.

Interest expense was $1.309 billion in the first nine months of 2018 and $1.257 billion in the first nine months of 2017. Our average debt balance was $33.129 billion for the first nine months of 2018 compared to $31.846 billion for the first nine months of 2017. The average effective interest rate for our long-term debt was 5.3% for each of the nine months ended September 30, 2018 and 2017.

During the first nine months of 2018 and 2017, we recorded net gains on sales of facilities of $420 million and $10 million, respectively. The net gains on sales of facilities for 2018 related primarily to the sale of the two hospital facilities in our Oklahoma market.

During August 2018, we issued $2.000 billion aggregate principal amount of senior notes comprised of $1.000 billion aggregate principal amount of 5.375% notes due 2026 and $1.000 billion aggregate principal amount of 5.625% notes due 2028. We used the net proceeds for general corporate purposes, including funding the purchase of a hospital, and the redemption of all $1.500 billion aggregate principal amount of our existing 3.750% senior secured notes maturing in March 2019. The pretax loss on retirement of debt was $9 million. During June 2017, we issued $1.500 billion aggregate principal amount of 5.500% senior secured notes due 2047. We used the net proceeds for general corporate purposes, including funding the purchase of certain hospital acquisitions, and the redemption of all $500 million aggregate principal amount of our existing 8.000% senior notes maturing in October 2018. The pretax loss on retirement of debt was $39 million.

The effective tax rates were 20.5% and 34.1% for the first nine months of 2018 and 2017, respectively. The effective tax rate computations exclude net income attributable to noncontrolling interests as it relates to consolidated partnerships. Our provisions for income taxes for the first nine months of 2018 and 2017 included tax benefits of $119 million and $80 million, respectively, related to employee equity award settlements. Our provision for income taxes for the first nine months of 2018 also included $28 million of reductions for tax credits related to certain 2017 hurricane-related expenses. Excluding the effect of these adjustments, the effective tax rate for the first nine months of 2018 and 2017 would have been 24.8% and 37.1%, respectively. The reduction in the effective tax rate was primarily related to the estimated impact of tax rate changes under the 2017 Tax Cuts and Jobs Act which, along with other revisions, lowered the federal statutory corporate tax rate from 35% to 21% beginning in 2018.

Net income attributable to noncontrolling interests increased from $360 million for the first nine months of 2017 to $421 million for the first nine months of 2018. The increase in net income attributable to noncontrolling interests related primarily to two of our Texas markets.

39

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Liquidity and Capital Resources

Cash provided by operating activities totaled $4.586 billion in the first nine months of 2018 compared to $3.692 billion in the first nine months of 2017. The $894 million increase in cash provided by operating activities in the first nine months of 2018 compared to the first nine months of 2017 related primarily to the combined impact of the increase in net income, excluding gains on sales of facilities, of $632 million, depreciation and amortization of $116 million and positive changes of $142 million related to working capital items. The combined interest payments and net tax payments in the first nine months of 2018 and 2017 were $2.124 billion and $2.294 billion, respectively. Working capital totaled $3.779 billion at September 30, 2018 and $3.819 billion at December 31, 2017.

Cash used in investing activities was $2.615 billion in the first nine months of 2018 compared to $3.172 billion in the first nine months of 2017. Acquisitions of hospitals and health care entities declined from $1.142 billion in the first nine months of 2017 to $1.056 billion in the first nine months of 2018. Excluding acquisitions, capital expenditures were $2.420 billion in the first nine months of 2018 and $2.033 billion in the first nine months of 2017. Capital expenditures, excluding acquisitions, are expected to approximate $3.5 billion in 2018. At September 30, 2018, there were projects under construction which had estimated additional costs to complete and equip over the next five years of approximately $3.9 billion. We expect to finance capital expenditures with internally generated and borrowed funds. Cash received from disposals of hospitals and health care entities increased $778 million for the first nine months of 2018 compared to the first nine months of 2017 primarily related to the receipt of $758 million from the sale of the two hospital facilities in our Oklahoma market.

Cash used in financing activities totaled $2.114 billion in the first nine months of 2018 compared to $448 million in the first nine months of 2017. During the first nine months of 2018, net cash flows used in financing activities included a net increase of $18 million in our indebtedness, payments of cash dividends of $366 million, repurchases of common stock of $1.195 billion and distributions to noncontrolling interests of $315 million. During the first nine months of 2017, net cash flows used in financing activities included a net increase of $1.452 billion in our indebtedness, repurchases of common stock of $1.475 billion and distributions to noncontrolling interests of $363 million.

We are a highly leveraged company with significant debt service requirements. Our debt totaled $33.107 billion at September 30, 2018. Our interest expense was $1.309 billion for the first nine months of 2018 and $1.257 billion for the first nine months of 2017.

In addition to cash flows from operations, available sources of capital include amounts available under our senior secured credit facilities ($2.382 billion and $2.562 billion available as of September 30, 2018 and October 31, 2018, respectively) and anticipated access to public and private debt markets.

During August 2018, we issued $2.000 billion aggregate principal amount of senior notes comprised of $1.000 billion aggregate principal amount of 5.375% notes due 2026 and $1.000 billion aggregate principal amount of 5.625% notes due 2028. We used the net proceeds for general corporate purposes, including funding the purchase of a hospital, and the redemption of all $1.500 billion aggregate principal amount of our existing 3.750% senior secured notes maturing in March 2019.

During March 2018, we entered into a joinder agreement to refinance our existing senior secured term B-8 loan credit facility maturing on February 15, 2024, repay a portion of our existing senior secured term B-9 loan credit facility maturing on March 18, 2023 and pay related fees and expenses with a new $1.500 billion senior secured term B-10 loan credit facility maturing on March 13, 2025. The senior secured term

40

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Liquidity and Capital Resources (continued)

B-10 loan credit facility will bear interest at LIBOR plus an applicable margin of 2.00% or a base rate plus an applicable margin of 1.00%, compared to applicable margins of 2.25% and 1.25%, respectively, under the senior secured term B-8 loan credit facility.

During March 2018, we also entered into an additional joinder agreement to refinance a portion of our existing senior secured term B-9 loan credit facility maturing on March 18, 2023 and pay related fees and expenses with a new approximately $1.166 billion senior secured term B-11 loan credit facility maturing on March 18, 2023. The senior secured term B-11 loan credit facility will bear interest at LIBOR plus an applicable margin of 1.75% or a base rate plus an applicable margin of 0.75%, compared to applicable margins of 2.00% and 1.00%, respectively, under the senior secured term B-9 loan credit facility.

Investments of our professional liability insurance subsidiaries, to maintain statutory equity and pay claims, totaled $413 million and $472 million at September 30, 2018 and December 31, 2017, respectively. An insurance subsidiary maintained net reserves for professional liability risks of $186 million and $194 million at September 30, 2018 and December 31, 2017, respectively. Our facilities are insured by a 100% owned insurance subsidiary for losses up to $50 million per occurrence; however, this coverage is generally subject to a $15 million per occurrence self-insured retention. Net reserves for the self-insured professional liability risks retained were $1.459 billion and $1.409 billion at September 30, 2018 and December 31, 2017, respectively. Claims payments, net of reinsurance recoveries, during the next 12 months are expected to approximate $449 million. We estimate that approximately $413 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 during the next 12 months.

Market Risk

We are exposed to market risk related to changes in market values of securities. The investments in our 100% owned insurance subsidiaries were $413 million at September 30, 2018. These investments are carried at fair value, with changes in unrealized gains and losses being recorded as adjustments to other comprehensive income. At September 30, 2018, we had a net unrealized gain of $2 million on the insurance subsidiaries’ investments.

We are exposed to market risk related to market illiquidity. Investments in debt and equity securities of our 100% owned insurance subsidiaries could be impaired by the inability to access the capital markets. Should the 100% owned 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 other-than-temporary 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, and we periodically enter into interest rate swap agreements to manage our exposure to these fluctuations. Our interest rate swap agreements involve the exchange of fixed and variable rate interest payments between two parties, based on common notional principal amounts and maturity dates. The notional amounts of the swap agreements represent balances

41

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Liquidity and Capital Resources (continued)

Market Risk (continued)

used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions. The interest payments under these agreements are settled on a net basis. These derivatives have been recognized in the financial statements at their respective fair values. Changes in the fair value of these derivatives, which are designated as cash flow hedges, are included in other comprehensive income, and changes in the fair value of derivatives which have not been designated as hedges are recorded in operations.

With respect to our interest-bearing liabilities, approximately $4.676 billion of long-term debt at September 30, 2018 was subject to variable rates of interest, while the remaining balance in long-term debt of $28.431 billion at September 30, 2018 was subject to fixed rates of interest. Both the general level of interest rates and, for the senior secured credit facilities, our leverage affect our variable interest rates. Our variable debt is comprised primarily of amounts outstanding under the senior secured credit facilities. Borrowings under the senior secured credit facilities bear interest at a rate equal to an applicable margin plus, at our option, either (a) a base rate determined by reference to the higher of (1) the federal funds rate plus 0.50% and (2) the prime rate of Bank of America or (b) a LIBOR rate for the currency of such borrowing for the relevant interest period. The applicable margin for borrowings under the senior secured credit facilities may fluctuate according to a leverage ratio. The average effective interest rate for our long-term debt was 5.3% for each of the nine months ended September 30, 2018 and 2017.

The estimated fair value of our total long-term debt was $34.125 billion at September 30, 2018. 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 $47 million. To mitigate the impact of fluctuations in interest rates, we generally target a portion 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.

Tax Examinations

We are subject to examination by federal, state and foreign taxing authorities. Management believes HCA Healthcare, Inc. and its predecessors, 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.

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Operating Data

	2018		2017
Number of hospitals in operation at:
March 31		178		171
June 30		178		172
September 30		179		177
December 31				179
Number of freestanding outpatient surgical centers in operation at:
March 31		120		118
June 30		122		119
September 30		122		119
December 31				120
Licensed hospital beds at(a):
March 31		46,745		44,374
June 30		46,723		44,727
September 30		47,060		46,250
December 31				46,738
Weighted average licensed beds(b):
Quarter:
First		46,686		44,362
Second		46,667		44,605
Third		46,909		45,887
Fourth				46,636
Year				45,380
Average daily census(c):
Quarter:
First		28,130		26,699
Second		26,047		25,353
Third		25,991		25,653
Fourth				26,304
Year				26,000
Admissions(d):
Quarter:
First		507,873		485,761
Second		494,610		473,174
Third		497,899		482,557
Fourth				495,121
Year				1,936,613
Equivalent admissions(e):
Quarter:
First		849,164		812,192
Second		851,047		809,367
Third		854,940		818,887
Fourth				845,986
Year				3,286,432

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Operating Data (continued)

	2018			2017
Average length of stay (days)(f):
Quarter:
First		5.0			4.9
Second		4.8			4.9
Third		4.8			4.9
Fourth					4.9
Emergency room visits(g):
Quarter:
First		2,302,112			2,163,138
Second		2,148,338			2,116,123
Third		2,139,375			2,130,460
Fourth					2,214,416
Year					8,624,137
Outpatient surgeries(h):
Quarter:
First		230,869			225,915
Second		244,367			234,215
Third		235,258			224,252
Fourth					250,925
Year					935,307
Inpatient surgeries(i):
Quarter:
First		136,650			133,341
Second		139,049			134,553
Third		138,699			137,187
Fourth					141,147
Year					546,228
Days revenues in accounts receivable(j):
Quarter:
First		50			48
Second		52			49
Third		52			51
Fourth					52
Outpatient revenues as a % of patient revenues(k):
Quarter:
First		37	%		38	%
Second		39	%		37	%
Third		39	%		38	%
Fourth					39	%
Year					38	%

(a) Licensed beds are those beds for which a facility has been granted approval to operate from the applicable state licensing agency.

(b) Represents the average number of licensed beds, weighted based on periods owned.

(c) Represents the average number of patients in our hospital beds each day.

(d) 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.

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (Continued)

Operating Data (continued)

(e) 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.

(f) Represents the average number of days admitted patients stay in our hospitals.

(g) Represents the number of patients treated in our emergency rooms.

(h) 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.

(i) 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.

(j) 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.

(k) Represents the percentage of patient revenues related to patients who are not admitted to our hospitals.

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ITEM 3.    QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

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.”

ITEM 4.    CONTROLS AND PROCEDURES

Evaluation of Disclosure Controls and Procedures

HCA’s management, with participation of HCA’s chief executive officer and chief financial officer, has evaluated the effectiveness of HCA’s disclosure controls and procedures as of September 30, 2018. 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 September 30, 2018. There were no material changes in HCA’s internal control over financial reporting during the third quarter of 2018.

Changes in Internal Control Over Financial Reporting

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.

PART II. OTHER INFORMATION

ITEM 1.    LEGAL PROCEEDINGS

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. Further, under the federal False Claims Act, 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.

ITEM 1A.    RISK FACTORS

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, 2017, 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, 2017.

46

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

During the quarter ended September 30, 2018, we repurchased 2,517,742 shares of our common stock at an average price of $120.26 per share through market purchases pursuant to the $2 billion share repurchase program authorized during October 2017. At September 30, 2018, we had $607 million of repurchase authorization available under the October 2017 authorization.

The following table provides certain information with respect to our repurchases of common stock from July 1, 2018 through September 30, 2018 (dollars in millions, except per share amounts).

Period	Total Number of Shares Purchased		Average Price Paid per Share		Total Number of Shares Purchased as Part of Publicly Announced Plans or Programs		Approximate Dollar Value of Shares That May Yet Be Purchased Under Publicly Announced Plans  or Programs
July 1, 2018 through July 31, 2018		1,095,236	$	106.68		1,095,236	$	793
August 1, 2018 through August 31, 2018		709,923	$	128.18		709,923	$	702
September 1, 2018 through September 30, 2018		712,583	$	133.25		712,583	$	607
Total for third quarter 2018		2,517,742	$	120.26		2,517,742	$	607

On October 29, 2018, our Board of Directors declared a quarterly dividend of $0.35 per share on our common stock payable on December 28, 2018 to stockholders of record on December 3, 2018. 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. Our ability to declare future dividends may also from time to time be limited by the terms of our debt agreements.

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ITEM 6.    EXHIBITS

(a) List of Exhibits:

4.1	—	Supplemental Indenture No. 19, dated as of August 23, 2018, among HCA Inc., HCA Healthcare, Inc., 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 August 23, 2018 and incorporated herein by reference).
4.2	—	Supplemental Indenture No. 20, dated as of August 23, 2018, among HCA Inc., HCA Healthcare, Inc., 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 August 23, 2018 and incorporated herein by reference).
4.3	—	Form of Global Note representing the 2026 Notes (included in Exhibit 4.1).
4.4	—	Form of Global Note representing the 2028 Notes (included in Exhibit 4.2).
10.1	—	Amended and Restated Employment Agreement dated September 10, 2018 (R. Milton Johnson) (filed as Exhibit 10.1 to the Company’s Current Report on Form 8-K filed September 12, 2018 and incorporated herein by reference).*
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 quarters and nine months ended September 30, 2018 and 2017, filed with the SEC on November 6, 2018, formatted in Extensible Business Reporting Language: (i) the condensed consolidated balance sheets at September 30, 2018 and December 31, 2017, (ii) the condensed consolidated income statements for the quarters and nine months ended September 30, 2018 and 2017, (iii) the condensed consolidated comprehensive income statements for the quarters and nine months ended September 30, 2018 and 2017, (iv) the condensed consolidated statements of stockholders’ deficit for the quarters and nine months ended September 30, 2018 and 2017, (v) the condensed consolidated statements of cash flows for the nine months ended September 30, 2018 and 2017 and (vi) the notes to condensed consolidated financial statements.

* Management compensatory plan or arrangement.

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SIGNATURES

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/ WILLIAM B. RUTHERFORD
	William B. Rutherford
	Executive Vice President and Chief Financial Officer

Date: November 6, 2018

49

EX-31.1

EXHIBIT 31.1

CERTIFICATION

I, R. Milton Johnson, certify that:

1. I have reviewed this quarterly report on Form 10-Q of HCA Healthcare, Inc.;

2. 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;

3. 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;

4. 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

5. 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/ R. MILTON JOHNSON
	R. Milton Johnson
	Chairman and Chief Executive Officer

Date: November 6, 2018

EX-31.2

EXHIBIT 31.2

CERTIFICATION

I, William B. Rutherford, certify that:

1. I have reviewed this quarterly report on Form 10-Q of HCA Healthcare, Inc.;

2. 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;

3. 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;

4. 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

5. 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/ WILLIAM B. RUTHERFORD
	William B. Rutherford
	Executive Vice President and Chief Financial Officer

Date: November 6, 2018

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 September 30, 2018, 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/ R. MILTON JOHNSON
	R. Milton Johnson
	Chairman and Chief Executive Officer

November 6, 2018

By:	/S/ WILLIAM B. RUTHERFORD
	William B. Rutherford
	Executive Vice President and Chief Financial Officer

November 6, 2018

XML

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2018	Oct. 31, 2018
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2018
Document Fiscal Year Focus	2018
Document Fiscal Period Focus	Q3
Trading Symbol	HCA
Entity Registrant Name	HCA Healthcare, Inc.
Entity Central Index Key	0000860730
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		344,160,500

XML

Condensed Consolidated Income Statements - USD ($) shares in Thousands, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Income Statement [Abstract]
Revenues	$ 11,451	$ 10,696	$ 34,403	$ 32,052
Salaries and benefits	5,377	5,081	15,940	14,878
Supplies	1,890	1,777	5,722	5,369
Other operating expenses	2,097	2,075	6,325	5,970
Equity in earnings of affiliates	(9)	(13)	(25)	(36)
Depreciation and amortization	582	539	1,697	1,581
Interest expense	442	427	1,309	1,257
Gain on sales of facilities	(6)	(7)	(420)	(10)
Losses on retirement of debt	9	39	9	39
Total expenses including equity in earnings of affiliates	10,382	9,918	30,557	29,048
Income before income taxes	1,069	778	3,846	3,004
Provision for income taxes	173	248	702	902
Net income	896	530	3,144	2,102
Net income attributable to noncontrolling interests	137	104	421	360
Net income attributable to HCA Healthcare, Inc.	$ 759	$ 426	$ 2,723	$ 1,742
Per share data:
Basic earnings	$ 2.20	$ 1.18	$ 7.82	$ 4.77
Diluted earnings	$ 2.15	$ 1.15	$ 7.65	$ 4.64
Shares used in earnings per share calculations (in millions):
Basic	345,823	360,170	348,411	365,398
Diluted	353,639	369,834	356,124	375,013

XML

Condensed Consolidated Comprehensive Income Statements - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Statement of Comprehensive Income [Abstract]
Net income	$ 896	$ 530	$ 3,144	$ 2,102
Other comprehensive income (loss) before taxes:
Foreign currency translation	(13)	32	(35)	87
Unrealized (losses) gains on available-for-sale securities	(2)		(8)	5
Defined benefit plans	0	0	0	0
Pension costs included in salaries and benefits	5	5	15	14
Total defined benefit plans	5	5	15	14
Change in fair value of derivative financial instruments	10	(1)	60	(9)
Interest (benefits) costs included in interest expense	(3)	4	(5)	17
Total change in fair value of derivative financial instruments	7	3	55	8
Other comprehensive (loss) income before taxes	(3)	40	27	114
Income taxes related to other comprehensive income items	2	15	15	44
Other comprehensive (loss) income	(5)	25	12	70
Comprehensive income	891	555	3,156	2,172
Comprehensive income attributable to noncontrolling interests	137	104	421	360
Comprehensive income attributable to HCA Healthcare, Inc.	$ 754	$ 451	$ 2,735	$ 1,812

XML

Condensed Consolidated Balance Sheets - USD ($) $ in Millions	Sep. 30, 2018	Dec. 31, 2017
Current assets:
Cash and cash equivalents	$ 578	$ 732
Accounts receivable	6,532	6,501
Inventories	1,634	1,573
Other	1,266	1,171
Total current assets	10,010	9,977
Property and equipment, at cost	41,978	40,084
Accumulated depreciation	(22,937)	(22,189)
Property and equipment, net	19,041	17,895
Investments of insurance subsidiaries	367	418
Investments in and advances to affiliates	238	199
Goodwill and other intangible assets	7,759	7,394
Other	629	710
Total assets	38,044	36,593
Current liabilities:
Accounts payable	2,414	2,606
Accrued salaries	1,456	1,369
Other accrued expenses	2,170	1,983
Long-term debt due within one year	191	200
Total current liabilities	6,231	6,158
Long-term debt, less net debt issuance costs of $163 and $164	32,916	32,858
Professional liability risks	1,239	1,198
Income taxes and other liabilities	1,388	1,374
Stockholders' deficit:
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 345,085,800 shares in 2018 and 350,091,600 shares in 2017	3	4
Accumulated other comprehensive loss	(266)	(278)
Retained deficit	(5,342)	(6,532)
Stockholders' deficit attributable to HCA Healthcare, Inc.	(5,605)	(6,806)
Noncontrolling interests	1,875	1,811
Total stockholders' deficit	(3,730)	(4,995)
Total liabilities and stockholders' deficit	$ 38,044	$ 36,593

XML

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions	Sep. 30, 2018	Dec. 31, 2017
Statement of Financial Position [Abstract]
Debt issuance cost	$ 163	$ 164
Common stock, par value	$ 0.01	$ 0.01
Common stock, shares authorized	1,800,000,000	1,800,000,000
Common stock, shares outstanding	345,085,800	350,091,600

XML

Condensed Consolidated Statements of Stockholders' Deficit - USD ($) $ in Millions	Total	Common Stock [Member]	Capital in Excess of Par Value [Member]	Accumulated Other Comprehensive Loss [Member]	Retained Deficit [Member]	Equity Attributable to Noncontrolling Interests [Member]
Balances at Dec. 31, 2016	$ (5,633)	$ 4		$ (338)	$ (6,968)	$ 1,669
Balance, shares at Dec. 31, 2016		370,536,000
Comprehensive income	795			18	659	118
Repurchase of common stock	(424)		$ (32)		(392)
Repurchase of common stock, shares		(5,121,000)
Share-based benefit plans	35		35
Share-based benefit plans, shares		3,280,000
Distributions	(145)					(145)
Other	15		(3)			18
Balance at Mar. 31, 2017	(5,357)	$ 4		(320)	(6,701)	1,660
Balance, shares at Mar. 31, 2017		368,695,000
Balances at Dec. 31, 2016	(5,633)	$ 4		(338)	(6,968)	1,669
Balance, shares at Dec. 31, 2016		370,536,000
Comprehensive income	2,172
Balance at Sep. 30, 2017	(5,066)	$ 4		(268)	(6,516)	1,714
Balance, shares at Sep. 30, 2017		356,980,000
Balances at Mar. 31, 2017	(5,357)	$ 4		(320)	(6,701)	1,660
Balance, shares at Mar. 31, 2017		368,695,000
Comprehensive income	822			27	657	138
Repurchase of common stock	(542)		(83)		(459)
Repurchase of common stock, shares		(6,404,000)
Share-based benefit plans	82		82
Share-based benefit plans, shares		604,000
Distributions	(103)					(103)
Other	(19)		(1)			(18)
Balance at Jun. 30, 2017	(5,079)	$ 4		(293)	(6,503)	1,713
Balance, shares at Jun. 30, 2017		362,895,000
Comprehensive income	555			25	426	104
Repurchase of common stock	(509)		(70)		(439)
Repurchase of common stock, shares		(6,322,000)
Share-based benefit plans	71		71
Share-based benefit plans, shares		407,000
Distributions	(115)					(115)
Other	(11)		1			(12)
Balance at Sep. 30, 2017	(5,066)	$ 4		(268)	(6,516)	1,714
Balance, shares at Sep. 30, 2017		356,980,000
Comprehensive income	631			(10)	474	167
Repurchase of common stock	(576)		(86)		(490)
Repurchase of common stock, shares		(7,245,000)
Share-based benefit plans	93		93
Share-based benefit plans, shares		357,000
Distributions	(85)					(85)
Other	(8)		7			(15)
Balance at Dec. 31, 2017	(4,995)	$ 4		(278)	(6,532)	1,811
Balance, shares at Dec. 31, 2017		350,092,000
Comprehensive income	1,363			81	1,144	138
Repurchase of common stock	(423)				(423)
Repurchase of common stock, shares		(4,370,000)
Share-based benefit plans	(114)				(114)
Share-based benefit plans, shares		5,265,000
Cash dividends declared ($0.35 per share)	(126)				(126)
Distributions	(92)					(92)
Other	47					47
Balance at Mar. 31, 2018	(4,434)	$ 4		(197)	(6,051)	1,810
Balance, shares at Mar. 31, 2018		350,987,000
Balances at Dec. 31, 2017	(4,995)	$ 4		(278)	(6,532)	1,811
Balance, shares at Dec. 31, 2017		350,092,000
Comprehensive income	$ 3,156
Repurchase of common stock, shares	(11,558,000)
Balance at Sep. 30, 2018	$ (3,730)	$ 3		(266)	(5,342)	1,875
Balance, shares at Sep. 30, 2018		345,086,000
Balances at Mar. 31, 2018	(4,434)	$ 4		(197)	(6,051)	1,810
Balance, shares at Mar. 31, 2018		350,987,000
Comprehensive income	902			(64)	820	146
Repurchase of common stock	(470)	$ (1)	(93)		(376)
Repurchase of common stock, shares		(4,670,000)
Share-based benefit plans	96		96
Share-based benefit plans, shares		443,000
Cash dividends declared ($0.35 per share)	(124)				(124)
Distributions	(93)					(93)
Other	2		3			(1)
Balance at Jun. 30, 2018	(4,125)	$ 3		(261)	(5,731)	1,864
Balance, shares at Jun. 30, 2018		346,760,000
Comprehensive income	891			(5)	759	137
Repurchase of common stock	(302)		(55)		(247)
Repurchase of common stock, shares		(2,518,000)
Share-based benefit plans	54		54
Share-based benefit plans, shares		844,000
Cash dividends declared ($0.35 per share)	(123)				(123)
Distributions	(130)					(130)
Other	(5)		$ (1)			(4)
Balance at Sep. 30, 2018	$ (3,730)	$ 3		$ (266)	$ (5,342)	$ 1,875
Balance, shares at Sep. 30, 2018		345,086,000

XML

Condensed Consolidated Statements of Stockholders' Deficit (Parenthetical) - $ / shares	3 Months Ended
	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018
Statement of Stockholders' Equity [Abstract]
Cash dividends declared, per share	$ 0.35	$ 0.35	$ 0.35

XML

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Cash flows from operating activities:
Net income	$ 3,144	$ 2,102
Increase (decrease) in cash from operating assets and liabilities:
Accounts receivable	(161)	(70)
Inventories and other assets	(136)	(50)
Accounts payable and accrued expenses	150	(169)
Depreciation and amortization	1,697	1,581
Income taxes		(9)
Gain on sales of facilities	(420)	(10)
Losses on retirement of debt	9	39
Amortization of debt issuance costs	23	23
Share-based compensation	204	195
Other	76	60
Net cash provided by (used in) operating activities	4,586	3,692
Cash flows from investing activities:
Purchase of property and equipment	(2,420)	(2,033)
Acquisition of hospitals and health care entities	(1,056)	(1,142)
Disposal of hospitals and health care entities	802	24
Change in investments	65	(15)
Other	(6)	(6)
Net cash used in investing activities	(2,615)	(3,172)
Cash flows from financing activities:
Issuances of long-term debt	2,000	1,502
Net change in revolving bank credit facilities	(330)	650
Repayment of long-term debt	(1,652)	(700)
Distributions to noncontrolling interests	(315)	(363)
Payment of debt issuance costs	(24)	(25)
Payment of cash dividends	(366)
Repurchases of common stock	(1,195)	(1,475)
Other	(232)	(37)
Net cash (used in) provided by financing activities	(2,114)	(448)
Effect of exchange rate changes on cash and cash equivalents	(11)
Change in cash and cash equivalents	(154)	72
Cash and cash equivalents at beginning of period	732	646
Cash and cash equivalents at end of period	578	718
Interest payments	1,422	1,383
Income tax payments, net	$ 702	$ 911

XML

Basis of Presentation and Significant Accounting Policies

9 Months Ended

Sep. 30, 2018

Accounting Policies [Abstract]

Basis of Presentation and Significant Accounting Policies

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

Reporting Entity

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 September 30, 2018, these affiliates owned and operated 179 hospitals, 122 freestanding surgery 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.

Basis of Presentation

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 $90 million and $83 million for the quarters ended September 30, 2018 and 2017, respectively, and $254 million and $247 million for the nine months ended September 30, 2018 and 2017, respectively. Operating results for the quarter and nine months ended September 30, 2018 are not necessarily indicative of the results that may be expected for the year ending December 31, 2018. 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, 2017.

Revenues

In May 2014, the Financial Accounting Standards Board (“FASB”) issued a new standard related to revenue recognition. We adopted the new standard effective January 1, 2018, using the full retrospective method. The adoption of the new standard did not have an impact on our recognition of net revenues for any periods prior to adoption. The most significant impact of adopting the new standard is to the presentation of our consolidated income statements, where we no longer present the “Provision for doubtful accounts” as a separate line item and our “Revenues” are presented net of estimated implicit price concession revenue deductions. We also have eliminated the related presentation of “allowances for doubtful accounts” on our consolidated balance sheets as a result of the adoption of the new standard.

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 allowances 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 discounts and contractual 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. Our revenues from third-party payers and others (including uninsured patients) for the quarters and nine months ended September 30, 2018 and 2017 are summarized in the following table (dollars in millions):

	Quarter
	2018		Ratio			2017		Ratio
Medicare	$	2,404		21.0	%	$	2,298		21.5	%
Managed Medicare		1,344		11.7			1,122		10.5
Medicaid		338		3.0			286		2.7
Managed Medicaid		622		5.4			537		5.0
Managed care and insurers		6,026		52.6			5,605		52.4
International (managed care and insurers)		273		2.4			276		2.6
Other		444		3.9			572		5.3
Revenues	$	11,451		100.0	%	$	10,696		100.0	%

	Nine Months
	2018		Ratio			2017		Ratio
Medicare	$	7,353		21.4	%	$	6,931		21.6	%
Managed Medicare		4,088		11.9			3,463		10.8
Medicaid		976		2.8			956		3.0
Managed Medicaid		1,769		5.1			1,653		5.2
Managed care and insurers		18,081		52.6			16,957		52.9
International (managed care and insurers)		873		2.5			814		2.5
Other		1,263		3.7			1,278		4.0
Revenues	$	34,403		100.0	%	$	32,052		100.0	%

Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. As a result, there is at least a reasonable possibility recorded estimates will change by a material amount. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process).

The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive. Prior to November 2017, patients treated at hospitals for non-elective care, who have income at or below 200% of the federal poverty level, were eligible for charity care. During November 2017, we expanded our charity policy to include patients who have income above 200%, but at or below 400%, of the federal poverty level and we will limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. In implementing the uninsured discount policy, we may first attempt to provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied.

The collection of outstanding receivables for Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the aging of those accounts. Accounts are written off when all reasonable internal and external collection efforts have been performed.

The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period comparisons of our results of operations. At September 30, 2018 and December 31, 2017, estimated implicit price concessions of $5.781 billion and $5.488 billion, respectively, had been recorded as reductions to our accounts receivable balances to enable us to record our revenues and accounts receivable at the estimated amounts we expect to collect.

To quantify the total impact of the trends related to uninsured 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 and nine months ended September 30, 2018 and 2017 follows (dollars in millions):

	Quarter						Nine Months
	2018			2017			2018			2017
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization)	$	9,946		$	9,472		$	29,684		$	27,798
Cost-to-charges ratio (patient care costs as percentage of gross patient charges)		12.7	%		13.4	%		12.6	%		13.1	%
Total uncompensated care	$	6,786		$	6,089		$	19,524		$	17,137
Multiply by the cost-to-charges ratio		12.7	%		13.4	%		12.6	%		13.1	%
Estimated cost of total uncompensated care	$	862		$	816		$	2,460		$	2,245

Total uncompensated care as a percentage of the sum of revenues and total uncompensated care was 37.2% and 36.3% for the quarters ended September 30, 2018 and 2017, respectively, and 36.2% and 34.8% for the nine months ended September 30, 2018 and 2017, respectively. The total uncompensated care amounts include charity care of $2.314 billion and $1.235 billion, and the related estimated costs of charity care were $295 million and $167 million for the quarters ended September 30, 2018 and 2017, respectively, and charity care of $6.170 billion and $3.494 billion, and the related estimated costs of charity care were $777 million and $458 million for the nine months ended September 30, 2018 and 2017, respectively.

Recent Pronouncements

In February 2016, the FASB issued Accounting Standards Update 2016-02, Leases (“ASU 2016-02”), which requires lessees to recognize assets and liabilities for most leases. ASU 2016-02 is effective for public business entities for annual and interim periods beginning after December 15, 2018. Early adoption is permitted. We are continuing to evaluate the provisions of ASU 2016-02 (and related developments) to determine how our financial statements will be affected, and we believe the primary effect of adopting the new standard will be to record right-of-useassets and obligations for our leases currently classified as operating leases.

During October 2018, the SEC adopted a final rule affecting interim financial statements which requires a reconciliation of changes in stockholders’ equity in the notes to the financial statements or as a separate statement. We have included a single statement presentation of our condensed consolidated statements of stockholders’ deficit for the quarters and nine months ended September 30, 2018 and 2017.

Reclassifications

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

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Acquisitions and Dispositions

9 Months Ended

Sep. 30, 2018

Business Combinations [Abstract]

Acquisitions and Dispositions

NOTE 2 — ACQUISITIONS AND DISPOSITIONS

During the nine months ended September 30, 2018, we paid $788 million to acquire two hospital facilities and $268 million to acquire other nonhospital health care entities. During the nine months ended September 30, 2017, we paid $1.000 billion to acquire seven hospital facilities and $142 million to acquire other nonhospital health care entities. Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values. The purchase price paid in excess of the fair value of identifiable net assets of these acquired entities aggregated $433 million and $655 million for the nine months ended September 30, 2018 and 2017, respectively. The consolidated financial statements include the accounts and operations of the acquired entities subsequent to the respective acquisition dates. The pro forma effects of these acquired entities on our results of operations for periods prior to the respective acquisition dates were not significant.

During the nine months ended September 30, 2018, we received proceeds of $758 million and recognized a net pretax gain of $372 million related to the sale of the two hospital facilities in our Oklahoma market. During the nine months ended September 30, 2018, we also received proceeds of $44 million and recognized a net pretax gain of $48 million related to sales of real estate and other investments. During the nine months ended September 30, 2017, we received proceeds of $24 million and recognized a net pretax gain of $10 million related to sales of real estate and other investments.

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Income Taxes

9 Months Ended

Sep. 30, 2018

Income Tax Disclosure [Abstract]

Income Taxes

NOTE 3 — INCOME TAXES

Our provision for income taxes for the quarters ended September 30, 2018 and 2017, was $173 million and $248 million, respectively, and the effective tax rates were 18.6% and 36.7%, respectively. Our provision for income taxes for the nine months ended September 30, 2018 and 2017, was $702 million and $902 million, respectively, and the effective tax rates were 20.5% and 34.1%, respectively. The reductions in the effective tax rates for 2018 periods were primarily related to the estimated impact of tax rate changes under the 2017 Tax Cuts and Jobs Act (the “Tax Act”). Our provision for income taxes for the quarter and nine months ended September 30, 2018 included tax benefits, of $132 million and $377 million, respectively, related to the reduction in our effective tax rate associated with the impact of the Tax Act. Our provision for income taxes also included tax benefits related to the settlement of employee equity awards of $23 million and $4 million for the quarters ended September 30, 2018 and 2017, respectively, and $119 million and $80 million for the nine months ended September 30, 2018 and 2017, respectively. We also recorded a reduction to the provision for income taxes of $28 million during the quarter ended September 30, 2018 for tax credits related to certain 2017 hurricane-related expenses.

The Tax Act was enacted on December 22, 2017, and it significantly revised U.S. corporate income taxes, including lowering the federal statutory corporate tax rate from 35% to 21% beginning in 2018. Due to the complexity and uncertainty regarding numerous provisions of the Tax Act, we have not completed our accounting for its effects. However, we have made reasonable estimates and recorded provisional amounts in our financial statements as of September 30, 2018. As we complete our analysis of the Tax Act, we may make adjustments to the provisional amounts and record additional amounts for those federal, state, and foreign tax assets and liabilities for which we were unable to make reasonable estimates as of September 30, 2018. Any adjustments or additional amounts recorded may materially impact our provision for income taxes and effective tax rate in the periods in which they are made.

Our liability for unrecognized tax benefits was $440 million, including accrued interest of $45 million, as of September 30, 2018 ($439 million and $44 million, respectively, as of December 31, 2017). Unrecognized tax benefits of $145 million ($145 million as of December 31, 2017) would affect the effective rate, if recognized.

We are subject to examination by federal, 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.

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Earnings Per Share

9 Months Ended

Sep. 30, 2018

Earnings Per Share [Abstract]

Earnings Per Share

NOTE 4 — EARNINGS PER SHARE

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 and potential shares, computed using the treasury stock method.

The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2018 and 2017 (dollars and shares in millions, except per share amounts):

	Quarter				Nine Months
	2018		2017		2018		2017
Net income attributable to HCA Healthcare, Inc.	$	759	$	426	$	2,723	$	1,742
Weighted average common shares outstanding		345.823		360.170		348.411		365.398
Effect of dilutive incremental shares		7.816		9.664		7.713		9.615
Shares used for diluted earnings per share		353.639		369.834		356.124		375.013
Earnings per share:
Basic earnings	$	2.20	$	1.18	$	7.82	$	4.77
Diluted earnings	$	2.15	$	1.15	$	7.65	$	4.64

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Investments of Insurance Subsidiaries

9 Months Ended

Sep. 30, 2018

Investments, Debt and Equity Securities [Abstract]

Investments of Insurance Subsidiaries

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES

A summary of our insurance subsidiaries’ investments at September 30, 2018 and December 31, 2017 follows (dollars in millions):

	September 30, 2018
	Amortized Cost		Unrealized Amounts					Fair Value
			Gains		Losses
Debt securities	$	343	$	4	$	(2	)	$	345
Money market funds and other		68		—		—			68
	$	411	$	4	$	(2	)		413
Amounts classified as current assets									(46	)
Investment carrying value								$	367

	December 31, 2017
	Amortized Cost		Unrealized Amounts				Fair Value
			Gains		Losses
Debt securities	$	361	$	10	$	—	$	371
Money market funds and other		101		—		—		101
	$	462	$	10	$	—		472
Amounts classified as current assets								(54	)
Investment carrying value							$	418

At September 30, 2018 and December 31, 2017, the investments of our insurance subsidiaries were classified as “available-for-sale.” Changes in temporary unrealized gains and losses are recorded as adjustments to other comprehensive income (loss).

Scheduled maturities of investments in debt securities at September 30, 2018 were as follows (dollars in millions):

	Amortized Cost		Fair Value
Due in one year or less	$	9	$	9
Due after one year through five years		57		58
Due after five years through ten years		210		212
Due after ten years		67		66
	$	343	$	345

The average expected maturity of the investments in debt securities at September 30, 2018 was 5.7 years, compared to the average scheduled maturity of 10.1 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.

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Financial Instruments

9 Months Ended

Sep. 30, 2018

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Financial Instruments

NOTE 6 — FINANCIAL INSTRUMENTS

Interest Rate Swap Agreements

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between two parties based on common notional principal amounts and maturity dates. Pay-fixed interest rate swaps effectively convert variable rate obligations to fixed interest rate obligations. The interest payments under these agreements are settled on a net basis. The net interest payments, based on the notional amounts in these agreements, generally match the timing of the related liabilities for the interest rate swap agreements which have been designated as cash flow hedges. The notional amounts of the swap agreements represent amounts used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions.

The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at September 30, 2018 (dollars in millions):

	Notional Amount		Maturity Date		Fair Value
Pay-fixed interest rate swaps	$	2,000		December 2021	$	88
Pay-fixed interest rate swaps		500		December 2022		17

During the next 12 months, we estimate $26 million will be reclassified from other comprehensive income (“OCI”) and will reduce interest expense.

Derivatives — Results of Operations

The following table presents the effect of our interest rate swaps on our results of operations for the nine months ended September 30, 2018 (dollars in millions):

Derivatives in Cash Flow Hedging Relationships	Amount of Gain Recognized in OCI on Derivatives, Net of Tax		Location of Gain Reclassified from Accumulated OCI into Operations		Amount of Gain Reclassified from Accumulated OCI into Operations
Interest rate swaps	$	46		Interest expense	$	5

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Assets and Liabilities Measured at Fair Value

9 Months Ended

Sep. 30, 2018

Fair Value Disclosures [Abstract]

Assets and Liabilities Measured at Fair Value

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE

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. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment.

Cash Traded Investments

Our cash traded investments 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.

Derivative Financial Instruments

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments.

Although we determined the majority of the inputs used to value our derivatives fall within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with our derivatives utilize Level 3 inputs, such as estimates of current credit spreads to evaluate the likelihood of default by us and our counterparties. We assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions, and at September 30, 2018 and December 31, 2017, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives.

The following tables summarize our assets measured at fair value on a recurring basis as of September 30, 2018 and December 31, 2017, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

	September 30, 2018
				Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Assets:
Investments of insurance subsidiaries:
Debt securities	$	345		$	—		$	345	$	—
Money market funds and other		68			68			—		—
Investments of insurance subsidiaries		413			68			345		—
Less amounts classified as current assets		(46	)		(46	)		—		—
	$	367			22		$	345	$	—
Interest rate swaps (Other)	$	105		$	—		$	105	$	—

	December 31, 2017
				Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Assets:
Investments of insurance subsidiaries:
Debt securities	$	371		$	—		$	371	$	—
Money market funds and other		101			101			—		—
Investments of insurance subsidiaries		472			101			371		—
Less amounts classified as current assets		(54	)		(54	)		—		—
	$	418		$	47		$	371	$	—
Interest rate swaps (Other)	$	50		$	—		$	50	$	—

The estimated fair value of our long-term debt was $34.125 billion and $34.689 billion at September 30, 2018 and December 31, 2017, respectively, compared to carrying amounts, excluding net debt issuance costs, aggregating $33.270 billion and $33.222 billion, respectively. The estimates of fair value are generally based upon the quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities.

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Long-Term Debt

9 Months Ended

Sep. 30, 2018

Debt Disclosure [Abstract]

Long-Term Debt

NOTE 8 — LONG-TERM DEBT

A summary of long-term debt at September 30, 2018 and December 31, 2017, including related interest rates at September 30, 2018, follows (dollars in millions):

	September 30, 2018			December 31, 2017
Senior secured asset-based revolving credit facility (effective interest rate of 3.7%)	$	3,350		$	3,680
Senior secured revolving credit facility		—			—
Senior secured term loan facilities (effective interest rate of 3.6%)		3,825			3,891
Senior secured notes (effective interest rate of 5.6%)		13,800			15,300
Other senior secured debt (effective interest rate of 5.8%)		543			599
Senior secured debt		21,518			23,470
Senior unsecured notes (effective interest rate of 6.3%)		11,752			9,752
Net debt issuance costs		(163	)		(164	)
Total debt (average life of 6.6 years, rates averaging 5.4%)		33,107			33,058
Less amounts due within one year		191			200
	$	32,916		$	32,858

During August 2018, we issued $2.000 billion aggregate principal amount of senior notes comprised of $1.000 billion aggregate principal amount of 5.375% notes due 2026 and $1.000 billion aggregate principal amount of 5.625% notes due 2028. We used the net proceeds for general corporate purposes, including funding the purchase of a hospital, and the redemption of all $1.500 billion aggregate principal amount of our existing 3.750% senior secured notes maturing in March 2019. The pretax loss on retirement of debt was $9 million.

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Contingencies

9 Months Ended

Sep. 30, 2018

Commitments and Contingencies Disclosure [Abstract]

Contingencies

NOTE 9 — CONTINGENCIES

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, 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.

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Share Repurchases Transactions and Other Comprehensive Loss

9 Months Ended

Sep. 30, 2018

Federal Home Loan Banks [Abstract]

Share Repurchases Transactions and Other Comprehensive Loss

NOTE 10 — SHARE REPURCHASES TRANSACTIONS AND OTHER COMPREHENSIVE LOSS

During the nine months ended September 30, 2018, we repurchased 11.558 million shares of our common stock at an average price of $103.42 per share through market purchases pursuant to the $2.0 billion share repurchase program authorized during October 2017. At September 30, 2018, we had $607 million of repurchase authorization available under the October 2017 authorization.

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

	Unrealized Gains on Available- for-Sale Securities			Foreign Currency Translation Adjustments			Defined Benefit Plans			Change in Fair Value of Derivative Instruments			Total
Balances at December 31, 2017	$	7		$	(149	)	$	(168	)	$	32		$	(278	)
Unrealized losses on available-for-sale securities, net of $1 income tax benefit		(7	)		—			—			—			(7	)
Foreign currency translation adjustments		—			(35	)		—			—			(35	)
Change in fair value of derivative instruments, net of $14 of income taxes		—			—			—			46			46
Expense (income) reclassified into operations from other comprehensive income, net of $3 income tax benefit and $1 of income taxes, respectively		—			—			12			(4	)		8
Balances at September 30, 2018	$	—		$	(184	)	$	(156	)	$	74		$	(266	)

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Segment and Geographic Information

9 Months Ended

Sep. 30, 2018

Segment Reporting [Abstract]

Segment and Geographic Information

NOTE 11 — 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. The National Group includes 88 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, South Carolina, Utah and Virginia, and the American Group includes 85 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Mississippi, Missouri, Tennessee and Texas. We also operate six 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, 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 and depreciation and amortization for the quarters and nine months ended September 30, 2018 and 2017 are summarized in the following table (dollars in millions):

	Quarter						Nine Months
	2018			2017			2018			2017
Revenues:
National Group	$	5,542		$	5,036		$	16,719		$	15,344
American Group		5,396			5,180			16,113			15,268
Corporate and other		513			480			1,571			1,440
	$	11,451		$	10,696		$	34,403		$	32,052
Equity in earnings of affiliates:
National Group	$	(1	)	$	(8	)	$	(5	)	$	(17	)
American Group		(10	)		(9	)		(29	)		(27	)
Corporate and other		2			4			9			8
	$	(9	)	$	(13	)	$	(25	)	$	(36	)
Adjusted segment EBITDA:
National Group	$	1,127		$	975		$	3,593		$	3,268
American Group		1,072			930			3,250			2,977
Corporate and other		(103	)		(129	)		(402	)		(374	)
	$	2,096		$	1,776		$	6,441		$	5,871
Depreciation and amortization:
National Group	$	245		$	219		$	702		$	650
American Group		258			251			765			727
Corporate and other		79			69			230			204
	$	582		$	539		$	1,697		$	1,581
Adjusted segment EBITDA	$	2,096		$	1,776		$	6,441		$	5,871
Depreciation and amortization		582			539			1,697			1,581
Interest expense		442			427			1,309			1,257
Gains on sales of facilities		(6	)		(7	)		(420	)		(10	)
Losses on retirement of debt		9			39			9			39
Income before income taxes	$	1,069		$	778		$	3,846		$	3,004

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Supplemental Condensed Consolidating Financial Information

9 Months Ended

Sep. 30, 2018

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Supplemental Condensed Consolidating Financial Information

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION

During December 2012, HCA Healthcare, Inc. issued $1.000 billion aggregate principal amount of 6.250% senior unsecured notes due 2021. These notes are senior unsecured obligations and are not guaranteed by any of our subsidiaries.

HCA Inc., a direct wholly-owned subsidiary of HCA Healthcare, Inc., is the obligor under a significant portion of our other indebtedness, including our senior secured credit facilities, senior secured notes and senior unsecured notes (other than the senior unsecured notes issued by HCA Healthcare, Inc.). The senior secured notes and senior unsecured notes issued by HCA Inc. are fully and unconditionally guaranteed by HCA Healthcare, Inc. The senior secured credit facilities and senior secured notes are fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, 100% owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our senior secured asset-based revolving credit facility).

Our summarized condensed consolidating comprehensive income statements for the quarters and nine months ended September 30, 2018 and 2017, condensed consolidating balance sheets at September 30, 2018 and December 31, 2017 and condensed consolidating statements of cash flows for the nine months ended September 30, 2018 and 2017, segregating HCA Healthcare, Inc. issuer, HCA Inc. issuer, the subsidiary guarantors, the subsidiary non-guarantors and eliminations, follow:

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE QUARTER ENDED SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	6,747		$	4,704		$	—		$	11,451
Salaries and benefits		—			—			3,090			2,287			—			5,377
Supplies		—			—			1,115			775			—			1,890
Other operating expenses		2			—			1,137			958			—			2,097
Equity in earnings of affiliates		(728	)		—			(2	)		(7	)		728			(9	)
Depreciation and amortization		—			—			340			242			—			582
Interest expense (income)		16			913			(423	)		(64	)		—			442
Losses (gains) on sales of facilities		—			—			(6	)		—			—			(6	)
Losses on retirement of debt		—			9			—			—			—			9
Management fees		—			—			(158	)		158			—			—
		(710	)		922			5,093			4,349			728			10,382
Income (loss) before income taxes		710			(922	)		1,654			355			(728	)		1,069
Provision (benefit) for income taxes		(49	)		(214	)		379			57			—			173
Net income (loss)		759			(708	)		1,275			298			(728	)		896
Net income attributable to noncontrolling interests		—			—			22			115			—			137
Net income (loss) attributable to HCA Healthcare, Inc.	$	759		$	(708	)	$	1,253		$	183		$	(728	)	$	759
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	754		$	(703	)	$	1,258		$	168		$	(723	)	$	754

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE QUARTER ENDED SEPTEMBER 30, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors (as adjusted)			Subsidiary Non- Guarantors (as adjusted)			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	6,303		$	4,393		$	—		$	10,696
Salaries and benefits		—			—			2,915			2,166			—			5,081
Supplies		—			—			1,033			744			—			1,777
Other operating expenses		—			—			1,093			982			—			2,075
Equity in earnings of affiliates		(436	)		—			(1	)		(12	)		436			(13	)
Depreciation and amortization		—			—			311			228			—			539
Interest expense (income)		16			792			(342	)		(39	)		—			427
Gains on sales of facilities		—			—			(3	)		(4	)		—			(7	)
Losses on retirement of debt		—			39			—			—			—			39
Management fees		—			—			(159	)		159			—			—
		(420	)		831			4,847			4,224			436			9,918
Income (loss) before income taxes		420			(831	)		1,456			169			(436	)		778
Provision (benefit) for income taxes		(6	)		(307	)		528			33			—			248
Net income (loss)		426			(524	)		928			136			(436	)		530
Net income attributable to noncontrolling interests		—			—			24			80			—			104
Net income (loss) attributable to HCA Healthcare, Inc.	$	426		$	(524	)	$	904		$	56		$	(436	)	$	426
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	451		$	(522	)	$	907		$	76		$	(461	)	$	451

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	20,297		$	14,106		$	—		$	34,403
Salaries and benefits		—			—			9,184			6,756			—			15,940
Supplies		—			—			3,383			2,339			—			5,722
Other operating expenses		7			—			3,387			2,931			—			6,325
Equity in earnings of affiliates		(2,670	)		—			(5	)		(20	)		2,670			(25	)
Depreciation and amortization		—			—			992			705			—			1,697
Interest expense (income)		48			2,617			(1,179	)		(177	)		—			1,309
Gains on sales of facilities		—			—			(378	)		(42	)		—			(420	)
Losses on retirement of debt		—			9			—			—			—			9
Management fees		—			—			(473	)		473			—			—
		(2,615	)		2,626			14,911			12,965			2,670			30,557
Income (loss) before income taxes		2,615			(2,626	)		5,386			1,141			(2,670	)		3,846
Provision (benefit) for income taxes		(108	)		(610	)		1,235			185			—			702
Net income (loss)		2,723			(2,016	)		4,151			956			(2,670	)		3,144
Net income attributable to noncontrolling interests		—			—			72			349			—			421
Net income (loss) attributable to HCA Healthcare, Inc.	$	2,723		$	(2,016	)	$	4,079		$	607		$	(2,670	)	$	2,723
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	2,735		$	(1,974	)	$	4,091		$	565		$	(2,682	)	$	2,735

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors (as adjusted)			Subsidiary Non- Guarantors (as adjusted)			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	19,008		$	13,044		$	—		$	32,052
Salaries and benefits		—			—			8,689			6,189			—			14,878
Supplies		—			—			3,163			2,206			—			5,369
Other operating expenses		5			—			3,207			2,758			—			5,970
Equity in earnings of affiliates		(1,702	)		—			(4	)		(32	)		1,702			(36	)
Depreciation and amortization		—			—			923			658			—			1,581
Interest expense (income)		48			2,280			(947	)		(124	)		—			1,257
Gains on sales of facilities		—			—			(6	)		(4	)		—			(10	)
Losses on retirement of debt		—			39			—			—			—			39
Management fees		—			—			(479	)		479			—			—
		(1,649	)		2,319			14,546			12,130			1,702			29,048
Income (loss) before income taxes		1,649			(2,319	)		4,462			914			(1,702	)		3,004
Provision (benefit) for income taxes		(93	)		(856	)		1,619			232			—			902
Net income (loss)		1,742			(1,463	)		2,843			682			(1,702	)		2,102
Net income attributable to noncontrolling interests		—			—			74			286			—			360
Net income (loss) attributable to HCA Healthcare, Inc.	$	1,742		$	(1,463	)	$	2,769		$	396		$	(1,702	)	$	1,742
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	1,812		$	(1,458	)	$	2,778		$	452		$	(1,772	)	$	1,812

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
ASSETS
Current assets:
Cash and cash equivalents	$	—		$	—		$	105		$	473		$	—		$	578
Accounts receivable		—			—			3,854			2,678			—			6,532
Inventories		—			—			1,088			546			—			1,634
Other		47			—			667			552			—			1,266
		47			—			5,714			4,249			—			10,010
Property and equipment, net		—			—			12,192			6,849			—			19,041
Investments of insurance subsidiaries		—			—			—			367			—			367
Investments in and advances to affiliates		32,263			—			29			209			(32,263	)		238
Goodwill and other intangible assets		—			—			5,736			2,023			—			7,759
Other		389			106			29			105			—			629
	$	32,699		$	106		$	23,700		$	13,802		$	(32,263	)	$	38,044
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY
Current liabilities:
Accounts payable	$	—		$	—		$	1,627		$	787		$	—		$	2,414
Accrued salaries		—			—			914			542			—			1,456
Other accrued expenses		10			296			790			1,074			—			2,170
Long-term debt due within one year		—			97			61			33			—			191
		10			393			3,392			2,436			—			6,231
Long-term debt, net		996			31,471			281			168			—			32,916
Intercompany balances		36,790			(7,734	)		(27,263	)		(1,793	)		—			—
Professional liability risks		—			—			—			1,239			—			1,239
Income taxes and other liabilities		508			—			364			516			—			1,388
		38,304			24,130			(23,226	)		2,566			—			41,774
Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc.		(5,605	)		(24,024	)		46,846			9,441			(32,263	)		(5,605	)
Noncontrolling interests		—			—			80			1,795			—			1,875
		(5,605	)		(24,024	)		46,926			11,236			(32,263	)		(3,730	)
	$	32,699		$	106		$	23,700		$	13,802		$	(32,263	)	$	38,044

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

DECEMBER 31, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
ASSETS
Current assets:
Cash and cash equivalents	$	1		$	—		$	112		$	619		$	—		$	732
Accounts receivable		—			—			3,693			2,808			—			6,501
Inventories		—			—			1,030			543			—			1,573
Other		—			—			663			508			—			1,171
		1			—			5,498			4,478			—			9,977
Property and equipment, net		—			—			11,110			6,785			—			17,895
Investments of insurance subsidiaries		—			—			—			418			—			418
Investments in and advances to affiliates		29,581			—			22			177			(29,581	)		199
Goodwill and other intangible assets		—			—			4,893			2,501			—			7,394
Other		510			50			47			103			—			710
	$	30,092		$	50		$	21,570		$	14,462		$	(29,581	)	$	36,593
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY
Current liabilities:
Accounts payable	$	—		$	—		$	1,793		$	813		$	—		$	2,606
Accrued salaries		—			—			862			507			—			1,369
Other accrued expenses		29			378			536			1,040			—			1,983
Long-term debt due within one year		—			97			64			39			—			200
		29			475			3,255			2,399			—			6,158
Long-term debt, net		995			31,367			307			189			—			32,858
Intercompany balances		35,322			(9,742	)		(25,228	)		(352	)		—			—
Professional liability risks		—			—			—			1,198			—			1,198
Income taxes and other liabilities		552			—			357			465			—			1,374
		36,898			22,100			(21,309)			3,899			—			41,588
Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc.		(6,806	)		(22,050	)		42,755			8,876			(29,581	)		(6,806	)
Noncontrolling interests		—			—			124			1,687			—			1,811
		(6,806	)		(22,050	)		42,879			10,563			(29,581	)		(4,995	)
	$	30,092		$	50		$	21,570		$	14,462		$	(29,581	)	$	36,593

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
Cash flows from operating activities:
Net income (loss)	$	2,723		$	(2,016	)	$	4,151		$	956		$	(2,670	)	$	3,144
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Changes in operating assets and liabilities		(15	)		(83	)		(154	)		105			—			(147	)
Depreciation and amortization		—			—			992			705			—			1,697
Gains on sales of facilities		—			—			(378	)		(42	)		—			(420	)
Losses on retirement of debt		—			9			—			—			—			9
Amortization of debt issuance costs		—			23			—			—			—			23
Share-based compensation		—			—			204			—			—			204
Equity in earnings of affiliates		(2,670	)		—			—			—			2,670			—
Other		67			—			—			9			—			76
Net cash provided by (used in) operating activities		105			(2,067	)		4,815			1,733			—			4,586
Cash flows from investing activities:
Purchase of property and equipment		—			—			(1,425	)		(995	)		—			(2,420	)
Acquisition of hospitals and health care entities		—			—			(894	)		(162	)		—			(1,056	)
Disposition of hospitals and health care entities		—			—			770			32			—			802
Change in investments		—			—			19			46			—			65
Other		—			—			(18	)		12			—			(6	)
Net cash used in investing activities		—			—			(1,548	)		(1,067	)		—			(2,615	)
Cash flows from financing activities:
Issuance of long-term debt		—			2,000			—			—			—			2,000
Net change in revolving credit facilities		—			(330	)		—			—			—			(330	)
Repayment of long-term debt		—			(1,566	)		(44	)		(42	)		—			(1,652	)
Distributions to noncontrolling interests		—			—			(63	)		(252	)		—			(315	)
Payment of debt issuance costs		—			(24	)		—			—			—			(24	)
Payment of cash dividends		(366	)		—			—			—			—			(366	)
Repurchases of common stock		(1,195	)		—			—			—			—			(1,195	)
Changes in intercompany balances with affiliates, net		1,697			1,987			(3,167	)		(517	)		—			—
Other		(242	)		—			—			10			—			(232	)
Net cash (used in) provided by financing activities		(106	)		2,067			(3,274	)		(801	)		—			(2,114	)
Effect on exchange rate changes on cash and cash equivalents		—			—			—			(11	)		—			(11	)
Change in cash and cash equivalents		(1	)		—			(7	)		(146	)		—			(154	)
Cash and cash equivalents at beginning of period		1			—			112			619			—			732
Cash and cash equivalents at end of period	$	—		$	—		$	105		$	473		$	—		$	578

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors (as adjusted)			Subsidiary Non- Guarantors (as adjusted)			Eliminations			Condensed Consolidated
Cash flows from operating activities:
Net income (loss)	$	1,742		$	(1,463	)	$	2,843		$	682		$	(1,702	)	$	2,102
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Changes in operating assets and liabilities		(15	)		(293	)		(191	)		210			—			(289	)
Depreciation and amortization		—			—			923			658			—			1,581
Income taxes		(9	)		—			—			—			—			(9	)
Gains on sales of facilities		—			—			(6	)		(4	)		—			(10	)
Losses on retirement of debt		—			39			—			—			—			39
Amortization of debt issuance costs		—			23			—			—			—			23
Share-based compensation		—			—			195			—			—			195
Equity in earnings of affiliates		(1,702	)		—			—			—			1,702			—
Other		58			—			2			—			—			60
Net cash provided by (used in) operating activities		74			(1,694	)		3,766			1,546			—			3,692
Cash flows from investing activities:
Purchase of property and equipment		—			—			(1,161	)		(872	)		—			(2,033	)
Acquisition of hospitals and health care entities		—			—			(9	)		(1,133	)		—			(1,142	)
Disposition of hospitals and health care entities		—			—			12			12			—			24
Change in investments		—			—			1			(16	)		—			(15	)
Other		—			—			(7	)		1			—			(6	)
Net cash used in investing activities		—			—			(1,164	)		(2,008	)		—			(3,172	)
Cash flows from financing activities:
Issuance of long-term debt		—			1,500			—			2			—			1,502
Net change in revolving credit facilities		—			650			—			—			—			650
Repayment of long-term debt		—			(604	)		(54	)		(42	)		—			(700	)
Distributions to noncontrolling interests		—			—			(105	)		(258	)		—			(363	)
Payment of debt issuance costs		—			(25	)		—			—			—			(25	)
Repurchases of common stock		(1,475	)		—			—			—			—			(1,475	)
Changes in intercompany balances with affiliates, net		1,468			173			(2,439	)		798			—			—
Other		(66	)		—			1			28			—			(37	)
Net cash (used in) provided by financing activities		(73	)		1,694			(2,597	)		528			—			(448	)
Change in cash and cash equivalents		1			—			5			66			—			72
Cash and cash equivalents at beginning of period		—			—			114			532			—			646
Cash and cash equivalents at end of period	$	1		$	—		$	119		$	598		$	—		$	718

The above supplemental condensed consolidating financial information for the quarter and nine months ended September 30, 2017 has been adjusted to properly record the impact of certain subsidiaries that were non-guarantors becoming guarantors, primarily related to the Company acquiring previous noncontrolling interests of non-guarantor subsidiaries that then became guarantor subsidiaries. The impact of these adjustments was immaterial as they had no impact to our consolidated income statements, balance sheets or statements of cash flows, had no impact on any liquidity measures of the Company, nor did they impact any financial ratios based on our consolidated balance sheets or income statements. There was also no impact to our loan covenant reporting or compliance. The impact of the adjustments was limited to reclassifications between the Subsidiary Guarantors and Subsidiary Non-Guarantors columns of the condensed consolidating financial statements. The application of these adjustments to the consolidating information for the quarter and nine months ended September 30, 2017 is summarized as follows (dollars in millions):

	As Previously Reported			Adjustment			As Adjusted
Quarter ended September 30, 2017
Net income (loss) attributable to HCA Healthcare, Inc.:
HCA Healthcare, Inc. Issuer	$	426		$	—		$	426
HCA Inc. Issuer		(524	)		—			(524	)
Subsidiary Guarantors		787			117			904
Subsidiary Non-Guarantors		173			(117	)		56
Eliminations		(436	)		—			(436	)
Condensed Consolidated	$	426		$	—		$	426

	As Previously Reported			Adjustment			As Adjusted
Nine months ended September 30, 2017
Net income (loss) attributable to HCA Healthcare, Inc.:
HCA Healthcare, Inc. Issuer	$	1,742		$	—		$	1,742
HCA Inc. Issuer		(1,463	)		—			(1,463	)
Subsidiary Guarantors		2,467			302			2,769
Subsidiary Non-Guarantors		698			(302	)		396
Eliminations		(1,702	)		—			(1,702	)
Condensed Consolidated	$	1,742		$	—		$	1,742

	As Previously Reported			Adjustment			As Adjusted
Nine months ended September 30, 2017
Net cash provided (used in) operating activities:
HCA Healthcare, Inc. Issuer	$	74		$	—		$	74
HCA Inc. Issuer		(1,694	)		—			(1,694	)
Subsidiary Guarantors		3,342			424			3,766
Subsidiary Non-Guarantors		1,970			(424	)		1,546
Eliminations		—			—			—
Condensed Consolidated	$	3,692		$	—		$	3,692

XML

Basis of Presentation and Significant Accounting Policies (Policies)

9 Months Ended

Sep. 30, 2018

Basis of Presentation

Basis of Presentation

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 $90 million and $83 million for the quarters ended September 30, 2018 and 2017, respectively, and $254 million and $247 million for the nine months ended September 30, 2018 and 2017, respectively. Operating results for the quarter and nine months ended September 30, 2018 are not necessarily indicative of the results that may be expected for the year ending December 31, 2018. 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, 2017.

Revenues

Revenues

In May 2014, the Financial Accounting Standards Board (“FASB”) issued a new standard related to revenue recognition. We adopted the new standard effective January 1, 2018, using the full retrospective method. The adoption of the new standard did not have an impact on our recognition of net revenues for any periods prior to adoption. The most significant impact of adopting the new standard is to the presentation of our consolidated income statements, where we no longer present the “Provision for doubtful accounts” as a separate line item and our “Revenues” are presented net of estimated implicit price concession revenue deductions. We also have eliminated the related presentation of “allowances for doubtful accounts” on our consolidated balance sheets as a result of the adoption of the new standard.

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 allowances 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 discounts and contractual 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. Our revenues from third-party payers and others (including uninsured patients) for the quarters and nine months ended September 30, 2018 and 2017 are summarized in the following table (dollars in millions):

	Quarter
	2018		Ratio			2017		Ratio
Medicare	$	2,404		21.0	%	$	2,298		21.5	%
Managed Medicare		1,344		11.7			1,122		10.5
Medicaid		338		3.0			286		2.7
Managed Medicaid		622		5.4			537		5.0
Managed care and insurers		6,026		52.6			5,605		52.4
International (managed care and insurers)		273		2.4			276		2.6
Other		444		3.9			572		5.3
Revenues	$	11,451		100.0	%	$	10,696		100.0	%

	Nine Months
	2018		Ratio			2017		Ratio
Medicare	$	7,353		21.4	%	$	6,931		21.6	%
Managed Medicare		4,088		11.9			3,463		10.8
Medicaid		976		2.8			956		3.0
Managed Medicaid		1,769		5.1			1,653		5.2
Managed care and insurers		18,081		52.6			16,957		52.9
International (managed care and insurers)		873		2.5			814		2.5
Other		1,263		3.7			1,278		4.0
Revenues	$	34,403		100.0	%	$	32,052		100.0	%

Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. As a result, there is at least a reasonable possibility recorded estimates will change by a material amount. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process).

The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive. Prior to November 2017, patients treated at hospitals for non-elective care, who have income at or below 200% of the federal poverty level, were eligible for charity care. During November 2017, we expanded our charity policy to include patients who have income above 200%, but at or below 400%, of the federal poverty level and we will limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. In implementing the uninsured discount policy, we may first attempt to provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied.

The collection of outstanding receivables for Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the aging of those accounts. Accounts are written off when all reasonable internal and external collection efforts have been performed.

The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period comparisons of our results of operations. At September 30, 2018 and December 31, 2017, estimated implicit price concessions of $5.781 billion and $5.488 billion, respectively, had been recorded as reductions to our accounts receivable balances to enable us to record our revenues and accounts receivable at the estimated amounts we expect to collect.

To quantify the total impact of the trends related to uninsured 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 and nine months ended September 30, 2018 and 2017 follows (dollars in millions):

	Quarter						Nine Months
	2018			2017			2018			2017
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization)	$	9,946		$	9,472		$	29,684		$	27,798
Cost-to-charges ratio (patient care costs as percentage of gross patient charges)		12.7	%		13.4	%		12.6	%		13.1	%
Total uncompensated care	$	6,786		$	6,089		$	19,524		$	17,137
Multiply by the cost-to-charges ratio		12.7	%		13.4	%		12.6	%		13.1	%
Estimated cost of total uncompensated care	$	862		$	816		$	2,460		$	2,245

Total uncompensated care as a percentage of the sum of revenues and total uncompensated care was 37.2% and 36.3% for the quarters ended September 30, 2018 and 2017, respectively, and 36.2% and 34.8% for the nine months ended September 30, 2018 and 2017, respectively. The total uncompensated care amounts include charity care of $2.314 billion and $1.235 billion, and the related estimated costs of charity care were $295 million and $167 million for the quarters ended September 30, 2018 and 2017, respectively, and charity care of $6.170 billion and $3.494 billion, and the related estimated costs of charity care were $777 million and $458 million for the nine months ended September 30, 2018 and 2017, respectively.

Recent Pronouncements

Recent Pronouncements

In February 2016, the FASB issued Accounting Standards Update 2016-02, Leases (“ASU 2016-02”), which requires lessees to recognize assets and liabilities for most leases. ASU 2016-02 is effective for public business entities for annual and interim periods beginning after December 15, 2018. Early adoption is permitted. We are continuing to evaluate the provisions of ASU 2016-02 (and related developments) to determine how our financial statements will be affected, and we believe the primary effect of adopting the new standard will be to record right-of-useassets and obligations for our leases currently classified as operating leases.

During October 2018, the SEC adopted a final rule affecting interim financial statements which requires a reconciliation of changes in stockholders’ equity in the notes to the financial statements or as a separate statement. We have included a single statement presentation of our condensed consolidated statements of stockholders’ deficit for the quarters and nine months ended September 30, 2018 and 2017.

Reclassifications

Reclassifications

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

Earning Per Share

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 and potential shares, computed using the treasury stock method.

Fair Value Measurements and Disclosures

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. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment.

Cash Traded Investments

Cash Traded Investments

Our cash traded investments 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.

Derivative Financial Instruments

Derivative Financial Instruments

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments.

Although we determined the majority of the inputs used to value our derivatives fall within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with our derivatives utilize Level 3 inputs, such as estimates of current credit spreads to evaluate the likelihood of default by us and our counterparties. We assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions, and at September 30, 2018 and December 31, 2017, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives.

Interest Rate Swaps [Member]

Interest Rate Swap Agreements

Interest Rate Swap Agreements

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between two parties based on common notional principal amounts and maturity dates. Pay-fixed interest rate swaps effectively convert variable rate obligations to fixed interest rate obligations. The interest payments under these agreements are settled on a net basis. The net interest payments, based on the notional amounts in these agreements, generally match the timing of the related liabilities for the interest rate swap agreements which have been designated as cash flow hedges. The notional amounts of the swap agreements represent amounts used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions.

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Basis of Presentation and Significant Accounting Policies (Tables)

9 Months Ended

Sep. 30, 2018

Accounting Policies [Abstract]

Schedule of Revenues from Third Party Payers, Uninsured and Other Payers

Our revenues from third-party payers and others (including uninsured patients) for the quarters and nine months ended September 30, 2018 and 2017 are summarized in the following table (dollars in millions):

	Quarter
	2018		Ratio			2017		Ratio
Medicare	$	2,404		21.0	%	$	2,298		21.5	%
Managed Medicare		1,344		11.7			1,122		10.5
Medicaid		338		3.0			286		2.7
Managed Medicaid		622		5.4			537		5.0
Managed care and insurers		6,026		52.6			5,605		52.4
International (managed care and insurers)		273		2.4			276		2.6
Other		444		3.9			572		5.3
Revenues	$	11,451		100.0	%	$	10,696		100.0	%

	Nine Months
	2018		Ratio			2017		Ratio
Medicare	$	7,353		21.4	%	$	6,931		21.6	%
Managed Medicare		4,088		11.9			3,463		10.8
Medicaid		976		2.8			956		3.0
Managed Medicaid		1,769		5.1			1,653		5.2
Managed care and insurers		18,081		52.6			16,957		52.9
International (managed care and insurers)		873		2.5			814		2.5
Other		1,263		3.7			1,278		4.0
Revenues	$	34,403		100.0	%	$	32,052		100.0	%

Schedule of Estimated Cost of Uncompensated Care

A summary of the estimated cost of total uncompensated care for the quarters and nine months ended September 30, 2018 and 2017 follows (dollars in millions):

	Quarter						Nine Months
	2018			2017			2018			2017
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization)	$	9,946		$	9,472		$	29,684		$	27,798
Cost-to-charges ratio (patient care costs as percentage of gross patient charges)		12.7	%		13.4	%		12.6	%		13.1	%
Total uncompensated care	$	6,786		$	6,089		$	19,524		$	17,137
Multiply by the cost-to-charges ratio		12.7	%		13.4	%		12.6	%		13.1	%
Estimated cost of total uncompensated care	$	862		$	816		$	2,460		$	2,245

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Earnings Per Share (Tables)

9 Months Ended

Sep. 30, 2018

Earnings Per Share [Abstract]

Schedule of Computations of Basic and Diluted Earnings Per Share

The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2018 and 2017 (dollars and shares in millions, except per share amounts):

	Quarter				Nine Months
	2018		2017		2018		2017
Net income attributable to HCA Healthcare, Inc.	$	759	$	426	$	2,723	$	1,742
Weighted average common shares outstanding		345.823		360.170		348.411		365.398
Effect of dilutive incremental shares		7.816		9.664		7.713		9.615
Shares used for diluted earnings per share		353.639		369.834		356.124		375.013
Earnings per share:
Basic earnings	$	2.20	$	1.18	$	7.82	$	4.77
Diluted earnings	$	2.15	$	1.15	$	7.65	$	4.64

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Investments of Insurance Subsidiaries (Tables)

9 Months Ended

Sep. 30, 2018

Investments, Debt and Equity Securities [Abstract]

Schedule of Investments

A summary of our insurance subsidiaries’ investments at September 30, 2018 and December 31, 2017 follows (dollars in millions):

	September 30, 2018
	Amortized Cost		Unrealized Amounts					Fair Value
			Gains		Losses
Debt securities	$	343	$	4	$	(2	)	$	345
Money market funds and other		68		—		—			68
	$	411	$	4	$	(2	)		413
Amounts classified as current assets									(46	)
Investment carrying value								$	367

	December 31, 2017
	Amortized Cost		Unrealized Amounts				Fair Value
			Gains		Losses
Debt securities	$	361	$	10	$	—	$	371
Money market funds and other		101		—		—		101
	$	462	$	10	$	—		472
Amounts classified as current assets								(54	)
Investment carrying value							$	418

Schedule of Maturities of Investments

Scheduled maturities of investments in debt securities at September 30, 2018 were as follows (dollars in millions):

	Amortized Cost		Fair Value
Due in one year or less	$	9	$	9
Due after one year through five years		57		58
Due after five years through ten years		210		212
Due after ten years		67		66
	$	343	$	345

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Financial Instruments (Tables)

9 Months Ended

Sep. 30, 2018

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges

The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at September 30, 2018 (dollars in millions):

	Notional Amount		Maturity Date		Fair Value
Pay-fixed interest rate swaps	$	2,000		December 2021	$	88
Pay-fixed interest rate swaps		500		December 2022		17

Effect of Interest Rate on Results of Operations

The following table presents the effect of our interest rate swaps on our results of operations for the nine months ended September 30, 2018 (dollars in millions):

Derivatives in Cash Flow Hedging Relationships	Amount of Gain Recognized in OCI on Derivatives, Net of Tax		Location of Gain Reclassified from Accumulated OCI into Operations		Amount of Gain Reclassified from Accumulated OCI into Operations
Interest rate swaps	$	46		Interest expense	$	5

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Assets and Liabilities Measured at Fair Value (Tables)

9 Months Ended

Sep. 30, 2018

Fair Value Disclosures [Abstract]

Schedule of Assets Measured at Fair Value on Recurring Basis

The following tables summarize our assets measured at fair value on a recurring basis as of September 30, 2018 and December 31, 2017, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

	September 30, 2018
				Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Assets:
Investments of insurance subsidiaries:
Debt securities	$	345		$	—		$	345	$	—
Money market funds and other		68			68			—		—
Investments of insurance subsidiaries		413			68			345		—
Less amounts classified as current assets		(46	)		(46	)		—		—
	$	367			22		$	345	$	—
Interest rate swaps (Other)	$	105		$	—		$	105	$	—

	December 31, 2017
				Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets (Level 1)			Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Assets:
Investments of insurance subsidiaries:
Debt securities	$	371		$	—		$	371	$	—
Money market funds and other		101			101			—		—
Investments of insurance subsidiaries		472			101			371		—
Less amounts classified as current assets		(54	)		(54	)		—		—
	$	418		$	47		$	371	$	—
Interest rate swaps (Other)	$	50		$	—		$	50	$	—

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Long-Term Debt (Tables)

9 Months Ended

Sep. 30, 2018

Debt Disclosure [Abstract]

Schedule of Long-Term Debt

A summary of long-term debt at September 30, 2018 and December 31, 2017, including related interest rates at September 30, 2018, follows (dollars in millions):

	September 30, 2018			December 31, 2017
Senior secured asset-based revolving credit facility (effective interest rate of 3.7%)	$	3,350		$	3,680
Senior secured revolving credit facility		—			—
Senior secured term loan facilities (effective interest rate of 3.6%)		3,825			3,891
Senior secured notes (effective interest rate of 5.6%)		13,800			15,300
Other senior secured debt (effective interest rate of 5.8%)		543			599
Senior secured debt		21,518			23,470
Senior unsecured notes (effective interest rate of 6.3%)		11,752			9,752
Net debt issuance costs		(163	)		(164	)
Total debt (average life of 6.6 years, rates averaging 5.4%)		33,107			33,058
Less amounts due within one year		191			200
	$	32,916		$	32,858

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Share Repurchases Transactions and Other Comprehensive Loss (Tables)

9 Months Ended

Sep. 30, 2018

Federal Home Loan Banks [Abstract]

Components of Accumulated Other Comprehensive Loss

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

	Unrealized Gains on Available- for-Sale Securities			Foreign Currency Translation Adjustments			Defined Benefit Plans			Change in Fair Value of Derivative Instruments			Total
Balances at December 31, 2017	$	7		$	(149	)	$	(168	)	$	32		$	(278	)
Unrealized losses on available-for-sale securities, net of $1 income tax benefit		(7	)		—			—			—			(7	)
Foreign currency translation adjustments		—			(35	)		—			—			(35	)
Change in fair value of derivative instruments, net of $14 of income taxes		—			—			—			46			46
Expense (income) reclassified into operations from other comprehensive income, net of $3 income tax benefit and $1 of income taxes, respectively		—			—			12			(4	)		8
Balances at September 30, 2018	$	—		$	(184	)	$	(156	)	$	74		$	(266	)

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Segment and Geographic Information (Tables)

9 Months Ended

Sep. 30, 2018

Segment Reporting [Abstract]

Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA and Depreciation and Amortization

The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2018 and 2017 are summarized in the following table (dollars in millions):

	Quarter						Nine Months
	2018			2017			2018			2017
Revenues:
National Group	$	5,542		$	5,036		$	16,719		$	15,344
American Group		5,396			5,180			16,113			15,268
Corporate and other		513			480			1,571			1,440
	$	11,451		$	10,696		$	34,403		$	32,052
Equity in earnings of affiliates:
National Group	$	(1	)	$	(8	)	$	(5	)	$	(17	)
American Group		(10	)		(9	)		(29	)		(27	)
Corporate and other		2			4			9			8
	$	(9	)	$	(13	)	$	(25	)	$	(36	)
Adjusted segment EBITDA:
National Group	$	1,127		$	975		$	3,593		$	3,268
American Group		1,072			930			3,250			2,977
Corporate and other		(103	)		(129	)		(402	)		(374	)
	$	2,096		$	1,776		$	6,441		$	5,871
Depreciation and amortization:
National Group	$	245		$	219		$	702		$	650
American Group		258			251			765			727
Corporate and other		79			69			230			204
	$	582		$	539		$	1,697		$	1,581
Adjusted segment EBITDA	$	2,096		$	1,776		$	6,441		$	5,871
Depreciation and amortization		582			539			1,697			1,581
Interest expense		442			427			1,309			1,257
Gains on sales of facilities		(6	)		(7	)		(420	)		(10	)
Losses on retirement of debt		9			39			9			39
Income before income taxes	$	1,069		$	778		$	3,846		$	3,004

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Supplemental Condensed Consolidating Financial Information (Tables)

9 Months Ended

Sep. 30, 2018

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Condensed Consolidating Comprehensive Income Statement

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE QUARTER ENDED SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	6,747		$	4,704		$	—		$	11,451
Salaries and benefits		—			—			3,090			2,287			—			5,377
Supplies		—			—			1,115			775			—			1,890
Other operating expenses		2			—			1,137			958			—			2,097
Equity in earnings of affiliates		(728	)		—			(2	)		(7	)		728			(9	)
Depreciation and amortization		—			—			340			242			—			582
Interest expense (income)		16			913			(423	)		(64	)		—			442
Losses (gains) on sales of facilities		—			—			(6	)		—			—			(6	)
Losses on retirement of debt		—			9			—			—			—			9
Management fees		—			—			(158	)		158			—			—
		(710	)		922			5,093			4,349			728			10,382
Income (loss) before income taxes		710			(922	)		1,654			355			(728	)		1,069
Provision (benefit) for income taxes		(49	)		(214	)		379			57			—			173
Net income (loss)		759			(708	)		1,275			298			(728	)		896
Net income attributable to noncontrolling interests		—			—			22			115			—			137
Net income (loss) attributable to HCA Healthcare, Inc.	$	759		$	(708	)	$	1,253		$	183		$	(728	)	$	759
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	754		$	(703	)	$	1,258		$	168		$	(723	)	$	754

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE QUARTER ENDED SEPTEMBER 30, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors (as adjusted)			Subsidiary Non- Guarantors (as adjusted)			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	6,303		$	4,393		$	—		$	10,696
Salaries and benefits		—			—			2,915			2,166			—			5,081
Supplies		—			—			1,033			744			—			1,777
Other operating expenses		—			—			1,093			982			—			2,075
Equity in earnings of affiliates		(436	)		—			(1	)		(12	)		436			(13	)
Depreciation and amortization		—			—			311			228			—			539
Interest expense (income)		16			792			(342	)		(39	)		—			427
Gains on sales of facilities		—			—			(3	)		(4	)		—			(7	)
Losses on retirement of debt		—			39			—			—			—			39
Management fees		—			—			(159	)		159			—			—
		(420	)		831			4,847			4,224			436			9,918
Income (loss) before income taxes		420			(831	)		1,456			169			(436	)		778
Provision (benefit) for income taxes		(6	)		(307	)		528			33			—			248
Net income (loss)		426			(524	)		928			136			(436	)		530
Net income attributable to noncontrolling interests		—			—			24			80			—			104
Net income (loss) attributable to HCA Healthcare, Inc.	$	426		$	(524	)	$	904		$	56		$	(436	)	$	426
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	451		$	(522	)	$	907		$	76		$	(461	)	$	451

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	20,297		$	14,106		$	—		$	34,403
Salaries and benefits		—			—			9,184			6,756			—			15,940
Supplies		—			—			3,383			2,339			—			5,722
Other operating expenses		7			—			3,387			2,931			—			6,325
Equity in earnings of affiliates		(2,670	)		—			(5	)		(20	)		2,670			(25	)
Depreciation and amortization		—			—			992			705			—			1,697
Interest expense (income)		48			2,617			(1,179	)		(177	)		—			1,309
Gains on sales of facilities		—			—			(378	)		(42	)		—			(420	)
Losses on retirement of debt		—			9			—			—			—			9
Management fees		—			—			(473	)		473			—			—
		(2,615	)		2,626			14,911			12,965			2,670			30,557
Income (loss) before income taxes		2,615			(2,626	)		5,386			1,141			(2,670	)		3,846
Provision (benefit) for income taxes		(108	)		(610	)		1,235			185			—			702
Net income (loss)		2,723			(2,016	)		4,151			956			(2,670	)		3,144
Net income attributable to noncontrolling interests		—			—			72			349			—			421
Net income (loss) attributable to HCA Healthcare, Inc.	$	2,723		$	(2,016	)	$	4,079		$	607		$	(2,670	)	$	2,723
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	2,735		$	(1,974	)	$	4,091		$	565		$	(2,682	)	$	2,735

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors (as adjusted)			Subsidiary Non- Guarantors (as adjusted)			Eliminations			Condensed Consolidated
Revenues	$	—		$	—		$	19,008		$	13,044		$	—		$	32,052
Salaries and benefits		—			—			8,689			6,189			—			14,878
Supplies		—			—			3,163			2,206			—			5,369
Other operating expenses		5			—			3,207			2,758			—			5,970
Equity in earnings of affiliates		(1,702	)		—			(4	)		(32	)		1,702			(36	)
Depreciation and amortization		—			—			923			658			—			1,581
Interest expense (income)		48			2,280			(947	)		(124	)		—			1,257
Gains on sales of facilities		—			—			(6	)		(4	)		—			(10	)
Losses on retirement of debt		—			39			—			—			—			39
Management fees		—			—			(479	)		479			—			—
		(1,649	)		2,319			14,546			12,130			1,702			29,048
Income (loss) before income taxes		1,649			(2,319	)		4,462			914			(1,702	)		3,004
Provision (benefit) for income taxes		(93	)		(856	)		1,619			232			—			902
Net income (loss)		1,742			(1,463	)		2,843			682			(1,702	)		2,102
Net income attributable to noncontrolling interests		—			—			74			286			—			360
Net income (loss) attributable to HCA Healthcare, Inc.	$	1,742		$	(1,463	)	$	2,769		$	396		$	(1,702	)	$	1,742
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$	1,812		$	(1,458	)	$	2,778		$	452		$	(1,772	)	$	1,812

Schedule of Condensed Consolidating Balance Sheet

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
ASSETS
Current assets:
Cash and cash equivalents	$	—		$	—		$	105		$	473		$	—		$	578
Accounts receivable		—			—			3,854			2,678			—			6,532
Inventories		—			—			1,088			546			—			1,634
Other		47			—			667			552			—			1,266
		47			—			5,714			4,249			—			10,010
Property and equipment, net		—			—			12,192			6,849			—			19,041
Investments of insurance subsidiaries		—			—			—			367			—			367
Investments in and advances to affiliates		32,263			—			29			209			(32,263	)		238
Goodwill and other intangible assets		—			—			5,736			2,023			—			7,759
Other		389			106			29			105			—			629
	$	32,699		$	106		$	23,700		$	13,802		$	(32,263	)	$	38,044
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY
Current liabilities:
Accounts payable	$	—		$	—		$	1,627		$	787		$	—		$	2,414
Accrued salaries		—			—			914			542			—			1,456
Other accrued expenses		10			296			790			1,074			—			2,170
Long-term debt due within one year		—			97			61			33			—			191
		10			393			3,392			2,436			—			6,231
Long-term debt, net		996			31,471			281			168			—			32,916
Intercompany balances		36,790			(7,734	)		(27,263	)		(1,793	)		—			—
Professional liability risks		—			—			—			1,239			—			1,239
Income taxes and other liabilities		508			—			364			516			—			1,388
		38,304			24,130			(23,226	)		2,566			—			41,774
Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc.		(5,605	)		(24,024	)		46,846			9,441			(32,263	)		(5,605	)
Noncontrolling interests		—			—			80			1,795			—			1,875
		(5,605	)		(24,024	)		46,926			11,236			(32,263	)		(3,730	)
	$	32,699		$	106		$	23,700		$	13,802		$	(32,263	)	$	38,044

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

DECEMBER 31, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
ASSETS
Current assets:
Cash and cash equivalents	$	1		$	—		$	112		$	619		$	—		$	732
Accounts receivable		—			—			3,693			2,808			—			6,501
Inventories		—			—			1,030			543			—			1,573
Other		—			—			663			508			—			1,171
		1			—			5,498			4,478			—			9,977
Property and equipment, net		—			—			11,110			6,785			—			17,895
Investments of insurance subsidiaries		—			—			—			418			—			418
Investments in and advances to affiliates		29,581			—			22			177			(29,581	)		199
Goodwill and other intangible assets		—			—			4,893			2,501			—			7,394
Other		510			50			47			103			—			710
	$	30,092		$	50		$	21,570		$	14,462		$	(29,581	)	$	36,593
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY
Current liabilities:
Accounts payable	$	—		$	—		$	1,793		$	813		$	—		$	2,606
Accrued salaries		—			—			862			507			—			1,369
Other accrued expenses		29			378			536			1,040			—			1,983
Long-term debt due within one year		—			97			64			39			—			200
		29			475			3,255			2,399			—			6,158
Long-term debt, net		995			31,367			307			189			—			32,858
Intercompany balances		35,322			(9,742	)		(25,228	)		(352	)		—			—
Professional liability risks		—			—			—			1,198			—			1,198
Income taxes and other liabilities		552			—			357			465			—			1,374
		36,898			22,100			(21,309)			3,899			—			41,588
Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc.		(6,806	)		(22,050	)		42,755			8,876			(29,581	)		(6,806	)
Noncontrolling interests		—			—			124			1,687			—			1,811
		(6,806	)		(22,050	)		42,879			10,563			(29,581	)		(4,995	)
	$	30,092		$	50		$	21,570		$	14,462		$	(29,581	)	$	36,593

Schedule of Condensed Consolidating Statement of Cash Flows

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2018

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors			Subsidiary Non- Guarantors			Eliminations			Condensed Consolidated
Cash flows from operating activities:
Net income (loss)	$	2,723		$	(2,016	)	$	4,151		$	956		$	(2,670	)	$	3,144
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Changes in operating assets and liabilities		(15	)		(83	)		(154	)		105			—			(147	)
Depreciation and amortization		—			—			992			705			—			1,697
Gains on sales of facilities		—			—			(378	)		(42	)		—			(420	)
Losses on retirement of debt		—			9			—			—			—			9
Amortization of debt issuance costs		—			23			—			—			—			23
Share-based compensation		—			—			204			—			—			204
Equity in earnings of affiliates		(2,670	)		—			—			—			2,670			—
Other		67			—			—			9			—			76
Net cash provided by (used in) operating activities		105			(2,067	)		4,815			1,733			—			4,586
Cash flows from investing activities:
Purchase of property and equipment		—			—			(1,425	)		(995	)		—			(2,420	)
Acquisition of hospitals and health care entities		—			—			(894	)		(162	)		—			(1,056	)
Disposition of hospitals and health care entities		—			—			770			32			—			802
Change in investments		—			—			19			46			—			65
Other		—			—			(18	)		12			—			(6	)
Net cash used in investing activities		—			—			(1,548	)		(1,067	)		—			(2,615	)
Cash flows from financing activities:
Issuance of long-term debt		—			2,000			—			—			—			2,000
Net change in revolving credit facilities		—			(330	)		—			—			—			(330	)
Repayment of long-term debt		—			(1,566	)		(44	)		(42	)		—			(1,652	)
Distributions to noncontrolling interests		—			—			(63	)		(252	)		—			(315	)
Payment of debt issuance costs		—			(24	)		—			—			—			(24	)
Payment of cash dividends		(366	)		—			—			—			—			(366	)
Repurchases of common stock		(1,195	)		—			—			—			—			(1,195	)
Changes in intercompany balances with affiliates, net		1,697			1,987			(3,167	)		(517	)		—			—
Other		(242	)		—			—			10			—			(232	)
Net cash (used in) provided by financing activities		(106	)		2,067			(3,274	)		(801	)		—			(2,114	)
Effect on exchange rate changes on cash and cash equivalents		—			—			—			(11	)		—			(11	)
Change in cash and cash equivalents		(1	)		—			(7	)		(146	)		—			(154	)
Cash and cash equivalents at beginning of period		1			—			112			619			—			732
Cash and cash equivalents at end of period	$	—		$	—		$	105		$	473		$	—		$	578

HCA HEALTHCARE, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2017

(Dollars in millions)

	HCA Healthcare, Inc. Issuer			HCA Inc. Issuer			Subsidiary Guarantors (as adjusted)			Subsidiary Non- Guarantors (as adjusted)			Eliminations			Condensed Consolidated
Cash flows from operating activities:
Net income (loss)	$	1,742		$	(1,463	)	$	2,843		$	682		$	(1,702	)	$	2,102
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Changes in operating assets and liabilities		(15	)		(293	)		(191	)		210			—			(289	)
Depreciation and amortization		—			—			923			658			—			1,581
Income taxes		(9	)		—			—			—			—			(9	)
Gains on sales of facilities		—			—			(6	)		(4	)		—			(10	)
Losses on retirement of debt		—			39			—			—			—			39
Amortization of debt issuance costs		—			23			—			—			—			23
Share-based compensation		—			—			195			—			—			195
Equity in earnings of affiliates		(1,702	)		—			—			—			1,702			—
Other		58			—			2			—			—			60
Net cash provided by (used in) operating activities		74			(1,694	)		3,766			1,546			—			3,692
Cash flows from investing activities:
Purchase of property and equipment		—			—			(1,161	)		(872	)		—			(2,033	)
Acquisition of hospitals and health care entities		—			—			(9	)		(1,133	)		—			(1,142	)
Disposition of hospitals and health care entities		—			—			12			12			—			24
Change in investments		—			—			1			(16	)		—			(15	)
Other		—			—			(7	)		1			—			(6	)
Net cash used in investing activities		—			—			(1,164	)		(2,008	)		—			(3,172	)
Cash flows from financing activities:
Issuance of long-term debt		—			1,500			—			2			—			1,502
Net change in revolving credit facilities		—			650			—			—			—			650
Repayment of long-term debt		—			(604	)		(54	)		(42	)		—			(700	)
Distributions to noncontrolling interests		—			—			(105	)		(258	)		—			(363	)
Payment of debt issuance costs		—			(25	)		—			—			—			(25	)
Repurchases of common stock		(1,475	)		—			—			—			—			(1,475	)
Changes in intercompany balances with affiliates, net		1,468			173			(2,439	)		798			—			—
Other		(66	)		—			1			28			—			(37	)
Net cash (used in) provided by financing activities		(73	)		1,694			(2,597	)		528			—			(448	)
Change in cash and cash equivalents		1			—			5			66			—			72
Cash and cash equivalents at beginning of period		—			—			114			532			—			646
Cash and cash equivalents at end of period	$	1		$	—		$	119		$	598		$	—		$	718

Summary of Restatement Adjustments to Financial Statements

The application of these adjustments to the consolidating information for the quarter and nine months ended September 30, 2017 is summarized as follows (dollars in millions):

	As Previously Reported			Adjustment			As Adjusted
Quarter ended September 30, 2017
Net income (loss) attributable to HCA Healthcare, Inc.:
HCA Healthcare, Inc. Issuer	$	426		$	—		$	426
HCA Inc. Issuer		(524	)		—			(524	)
Subsidiary Guarantors		787			117			904
Subsidiary Non-Guarantors		173			(117	)		56
Eliminations		(436	)		—			(436	)
Condensed Consolidated	$	426		$	—		$	426

	As Previously Reported			Adjustment			As Adjusted
Nine months ended September 30, 2017
Net income (loss) attributable to HCA Healthcare, Inc.:
HCA Healthcare, Inc. Issuer	$	1,742		$	—		$	1,742
HCA Inc. Issuer		(1,463	)		—			(1,463	)
Subsidiary Guarantors		2,467			302			2,769
Subsidiary Non-Guarantors		698			(302	)		396
Eliminations		(1,702	)		—			(1,702	)
Condensed Consolidated	$	1,742		$	—		$	1,742

	As Previously Reported			Adjustment			As Adjusted
Nine months ended September 30, 2017
Net cash provided (used in) operating activities:
HCA Healthcare, Inc. Issuer	$	74		$	—		$	74
HCA Inc. Issuer		(1,694	)		—			(1,694	)
Subsidiary Guarantors		3,342			424			3,766
Subsidiary Non-Guarantors		1,970			(424	)		1,546
Eliminations		—			—			—
Condensed Consolidated	$	3,692		$	—		$	3,692

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Basis of Presentation and Significant Accounting Policies - Additional Information (Detail) $ in Millions		1 Months Ended	3 Months Ended		9 Months Ended		12 Months Ended
	Oct. 31, 2017	Nov. 30, 2017	Sep. 30, 2018 USD ($) State Hospital Surgery_Center	Sep. 30, 2017 USD ($)	Sep. 30, 2018 USD ($) State Hospital Surgery_Center	Sep. 30, 2017 USD ($)	Dec. 31, 2017 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Number of owned and operated hospitals | Hospital			179		179
Number of freestanding surgery centers | Surgery_Center			122		122
Number of facilities locations | State			20		20
General and administrative expense			$ 90	$ 83	$ 254	$ 247
Estimated implicit price concessions recorded as reductions to revenues and accounts receivable					$ 5,781		$ 5,488
Percentage of sum of revenues and uncompensated care			37.20%	36.30%	36.20%	34.80%
Charity care amount			$ 2,314	$ 1,235	$ 6,170	$ 3,494
Estimated costs of charity care			$ 295	$ 167	$ 777	$ 458
Inpatient Services [Member]
Summary Of Significant Accounting Policies [Line Items]
Performance obligations for inpatient/ outpatient services satisfied period			5 days		5 days
Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Percentage of income of federal poverty level eligible for charity care	200.00%	400.00%
Maximum [Member] | Outpatient Services [Member]
Summary Of Significant Accounting Policies [Line Items]
Performance obligations for inpatient/ outpatient services satisfied period			1 day		1 day
Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Percentage of income of federal poverty level eligible for charity care		200.00%

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Basis of Presentation and Significant Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 11,451	$ 10,696	$ 34,403	$ 32,052
Revenues ratio from third party payers	100.00%	100.00%	100.00%	100.00%
Medicare [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 2,404	$ 2,298	$ 7,353	$ 6,931
Revenues from third party payers, Ratio	21.00%	21.50%	21.40%	21.60%
Managed Medicare [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 1,344	$ 1,122	$ 4,088	$ 3,463
Revenues from third party payers, Ratio	11.70%	10.50%	11.90%	10.80%
Medicaid [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 338	$ 286	$ 976	$ 956
Revenues from third party payers, Ratio	3.00%	2.70%	2.80%	3.00%
Managed Medicaid [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 622	$ 537	$ 1,769	$ 1,653
Revenues from third party payers, Ratio	5.40%	5.00%	5.10%	5.20%
Managed Care and Insurers [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 6,026	$ 5,605	$ 18,081	$ 16,957
Revenues from third party payers, Ratio	52.60%	52.40%	52.60%	52.90%
International (Managed Care and Other Insurers) [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 273	$ 276	$ 873	$ 814
Revenues from third party payers, Ratio	2.40%	2.60%	2.50%	2.50%
Product and Service, Other [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 444	$ 572	$ 1,263	$ 1,278
Other, Ratio	3.90%	5.30%	3.70%	4.00%
Health Care, Patient Service [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 11,451	$ 10,696	$ 34,403	$ 32,052

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Basis of Presentation and Significant Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Accounting Policies [Abstract]
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization)	$ 9,946	$ 9,472	$ 29,684	$ 27,798
Cost-to-charges ratio (patient care costs as percentage of gross patient charges)	12.70%	13.40%	12.60%	13.10%
Total uncompensated care	$ 6,786	$ 6,089	$ 19,524	$ 17,137
Multiply by the cost-to-charges ratio	12.70%	13.40%	12.60%	13.10%
Estimated cost of total uncompensated care	$ 862	$ 816	$ 2,460	$ 2,245

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Acquisitions and Dispositions - Additional Information (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2018 USD ($) Hospital	Sep. 30, 2017 USD ($) Hospital
Business Acquisition [Line Items]
Number of hospitals purchased | Hospital	2	7
Proceeds from sale of business	$ 802,000	$ 24,000
Real Estate and Other Investments [Member]
Business Acquisition [Line Items]
Pretax gain (loss) on sales of business	48,000	10,000
Proceeds from sale of business	44,000	24,000
Discontinued Operations, Disposed of by Sale [Member] | Oklahoma [Member]
Business Acquisition [Line Items]
Pretax gain (loss) on sales of business	372,000
Proceeds from sale of business	$ 758,000
Number of hospitals sold | Hospital	2
Hospitals [Member]
Business Acquisition [Line Items]
Aggregate purchase price	$ 788,000	1,000,000
Nonhospital Health Care [Member]
Business Acquisition [Line Items]
Aggregate purchase price	268,000	142,000
Other [Member]
Business Acquisition [Line Items]
Fair value of identifiable net assets of acquired entities	$ 433,000	$ 655,000

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Income Taxes - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Provision for income taxes	$ 173	$ 248	$ 702	$ 902
Effective tax rates	18.60%	36.70%	20.50%	34.10%
Provision for income tax benefit excluding gains on sale	$ 132		$ 377
Provision for tax benefits related to settlement of employee awards	23	$ 4	$ 119	$ 80
Reduction to provision for income taxes for tax credits	28
Effective tax rate			21.00%		35.00%
Liability for unrecognized tax benefits	440		$ 440		$ 439
Unrecognized tax benefits, accrued interest	45		45		44
Unrecognized tax benefits that would impact effective tax rate	$ 145		$ 145		$ 145

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Earnings Per Share - Schedule of Computations of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Earnings Per Share [Abstract]
Net income attributable to HCA Healthcare, Inc.	$ 759	$ 426	$ 2,723	$ 1,742
Weighted average common shares outstanding	345,823	360,170	348,411	365,398
Effect of dilutive incremental shares	7,816	9,664	7,713	9,615
Shares used for diluted earnings per share	353,639	369,834	356,124	375,013
Basic earnings	$ 2.20	$ 1.18	$ 7.82	$ 4.77
Diluted earnings	$ 2.15	$ 1.15	$ 7.65	$ 4.64

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Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions	Sep. 30, 2018	Dec. 31, 2017
Debt Securities, Available-for-sale [Line Items]
Amounts classified as current assets	$ (46)	$ (54)
Investment carrying value	367	418
Amortized Cost	411	462
Unrealized Amounts, Gains	4	10
Unrealized Amounts, Losses	(2)
Fair Value	413	472
Money Market Funds and Other [Member]
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	68	101
Fair Value	68	101
Debt Securities [Member] | States and Municipalities [Member]
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	343	361
Unrealized Amounts, Gains	4	10
Unrealized Amounts, Losses	(2)
Fair Value	$ 345	$ 371

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Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions	Sep. 30, 2018 USD ($)
Investments, Debt and Equity Securities [Abstract]
Due in one year or less, Amortized Cost	$ 9
Due after one year through five years, Amortized Cost	57
Due after five years through ten years, Amortized Cost	210
Due after ten years, Amortized Cost	67
Amortized Cost, Total	343
Due in one year or less, Fair Value	9
Due after one year through five years, Fair Value	58
Due after five years through ten years, Fair Value	212
Due after ten years, Fair Value	66
Fair Value, Total	$ 345

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Investments of Insurance Subsidiaries - Additional Information (Detail)	9 Months Ended
	Sep. 30, 2018
Investments, Debt and Equity Securities [Abstract]
Available for sale securities expected maturity of debt securities	5 years 8 months 12 days
Available for sale securities average scheduled maturity	10 years 1 month 6 days

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Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) - Pay-Fixed Interest Rate Swaps [Member]	9 Months Ended
	Sep. 30, 2018 USD ($)
Maturity Date, 2021 [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Notional Amount	$ 2,000,000,000
Fair Value	$ 88,000,000
Maturity Date	Dec. 31, 2021
Maturity Date, 2022 [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Notional Amount	$ 500,000,000
Fair Value	$ 17,000,000
Maturity Date	Dec. 31, 2022

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Financial Instruments - Additional Information (Detail) $ in Millions	9 Months Ended
	Sep. 30, 2018 USD ($)
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Estimated amount reclassified from other comprehensive income and reduce interest expense	$ 26

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Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain Recognized in OCI on Derivatives, Net of Tax	$ 10	$ (1)	$ 60	$ (9)
Interest Rate Swaps [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain Recognized in OCI on Derivatives, Net of Tax			46
Interest Rate Swaps [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Interest rate swaps			$ 5

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Assets and Liabilities Measured at Fair Value - Schedule of Assets Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Millions	Sep. 30, 2018	Dec. 31, 2017
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Assets, Fair Value Disclosure	$ 413	$ 472
Less amounts classified as current assets	(46)	(54)
Investments of insurance subsidiaries, noncurrent	367	418
Interest Rate Swaps [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Derivative Asset	105	50
States and Municipalities [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt Securities, Available-for-sale Securities	345	371
Money Market Funds and Other [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Assets, Fair Value Disclosure	68	101
Quoted Prices in Active Markets for Identical Assets (Level 1) [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Assets, Fair Value Disclosure	68	101
Less amounts classified as current assets	(46)	(54)
Investments of insurance subsidiaries, noncurrent	22	47
Quoted Prices in Active Markets for Identical Assets (Level 1) [Member] | Money Market Funds and Other [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Assets, Fair Value Disclosure	68	101
Significant Other Observable Inputs (Level 2) [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Assets, Fair Value Disclosure	345	371
Investments of insurance subsidiaries, noncurrent	345	371
Significant Other Observable Inputs (Level 2) [Member] | Interest Rate Swaps [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Derivative Asset	105	50
Significant Other Observable Inputs (Level 2) [Member] | States and Municipalities [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt Securities, Available-for-sale Securities	$ 345	$ 371

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Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions	Sep. 30, 2018	Dec. 31, 2017
Fair Value Disclosures [Abstract]
Estimated fair value of long-term debt	$ 34,125	$ 34,689
Carrying amounts of long-term debt	$ 33,270	$ 33,222

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Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions	Sep. 30, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Senior secured debt	$ 21,518	$ 23,470
Net debt issuance costs	(163)	(164)
Total debt (average life of 6.6 years, rates averaging 5.4%)	33,107	33,058
Less amounts due within one year	191	200
Long-term debt	32,916	32,858
Senior Secured Asset-Based Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Long-term line of credit	3,350	3,680
Senior Secured Term Loan Facilities [Member]
Debt Instrument [Line Items]
Senior secured debt	3,825	3,891
Senior Secured Notes [Member]
Debt Instrument [Line Items]
Senior secured debt	13,800	15,300
Other Senior Secured Debt [Member]
Debt Instrument [Line Items]
Other senior secured debt	543	599
Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Senior unsecured notes	$ 11,752	$ 9,752

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Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail)	9 Months Ended
	Sep. 30, 2018
Debt Instrument [Line Items]
Total debt average term	6 years 7 months 6 days
Total debt average rate	5.40%
Senior Secured Asset-Based Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Effective interest rate	3.70%
Senior Secured Term Loan Facilities [Member]
Debt Instrument [Line Items]
Effective interest rate	3.60%
Senior Secured Notes [Member]
Debt Instrument [Line Items]
Effective interest rate	5.60%
Other Senior Secured Debt [Member]
Debt Instrument [Line Items]
Effective interest rate	5.80%
Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Effective interest rate	6.30%

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Long-Term Debt - Additional Information (Detail) - USD ($)	1 Months Ended	3 Months Ended		9 Months Ended
	Aug. 31, 2018	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Debt Instrument [Line Items]
Pretax loss on retirement of debt		$ (9,000,000)	$ (39,000,000)	$ (9,000,000)	$ (39,000,000)
Senior Notes [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount	$ 2,000,000,000
Senior Notes [Member] | 5.375% Senior Notes Due 2026 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount	$ 1,000,000,000
Debt instrument, stated interest	5.375%
Senior Notes [Member] | 5.625% Senior Notes Due 2028 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount	$ 1,000,000,000
Debt instrument, stated interest	5.625%
Senior Notes [Member] | Senior Notes Due2019 [Member]
Debt Instrument [Line Items]
Debt instrument, stated interest	3.75%
Proceeds from new term loan	$ 1,500,000,000
Pretax loss on retirement of debt	$ 9,000,000

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Share Repurchases Transactions and Other Comprehensive Loss - Additional Information (Detail) - USD ($)	9 Months Ended
	Sep. 30, 2018	Oct. 31, 2017
Equity [Abstract]
Repurchase of common stock, shares	11,558,000
Repurchase price of common stock, per share	$ 103.42
Share repurchase program, remaining authorized repurchase amount	$ 607,000,000
Share repurchase program authorized amount		$ 2,000,000,000

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Share Repurchases Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) $ in Millions	9 Months Ended
	Sep. 30, 2018 USD ($)
Equity [Abstract]
Unrealized gains on available-for-sale securities, beginning balances	$ 7
Unrealized losses on available-for-sale securities, net of income tax benefit	(7)
Foreign currency translation adjustments, beginning balances	(149)
Foreign currency translation adjustments	(35)
Foreign currency translation adjustments, ending balances	(184)
Defined benefit plans, beginning balances	(168)
Defined benefit plans, (income) expense reclassified into operations from other comprehensive income	12
Defined benefit plans, ending balances	(156)
Change in fair value of derivative instruments, beginning balances	32
Change in fair value of derivative instruments net of income taxes	46
Change in fair value of derivative instruments, ending balances	74
Accumulated other comprehensive income, net of tax, beginning balances	(278)
Unrealized losses on available-for-sale securities, net of income tax benefit	(7)
Foreign currency translation adjustments	(35)
Change in fair value of derivative instruments	46
Expense (income) reclassified into operations from other comprehensive income, Total	8
Accumulated other comprehensive income (loss), net of tax, ending balances	$ (266)

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Share Repurchases Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) $ in Millions	9 Months Ended
	Sep. 30, 2018 USD ($)
Equity [Abstract]
Unrealized losses on available-for-sale securities, tax benefit portion	$ 1
Defined benefit plans, Expense (income) reclassified into operations from other comprehensive income, Income tax benefit	3
Defined benefit plans, Expense (income) reclassified into operations from other comprehensive income, net of Income taxes	1
Change in fair value of derivative instruments, change in fair value of derivative instruments, income taxes	$ 4

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Segment and Geographic Information - Additional Information (Detail)	9 Months Ended
	Sep. 30, 2018 Hospital
Segment Reporting Information [Line Items]
Number of geographically organized groups	2
Number of owned and operated hospitals	179
Reorganization Group [Member] | National Group [Member]
Segment Reporting Information [Line Items]
Number of owned and operated hospitals	88
Reorganization Group [Member] | American Group [Member]
Segment Reporting Information [Line Items]
Number of owned and operated hospitals	85
Reorganization Group [Member] | Corporate and Other [Member]
Segment Reporting Information [Line Items]
Number of owned and operated hospitals	6

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Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization and Assets (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Segment Reporting Information [Line Items]
Revenues	$ 11,451	$ 10,696	$ 34,403	$ 32,052
Equity in earnings of affiliates	9	13	25	36
Adjusted segment EBITDA	2,096	1,776	6,441	5,871
Depreciation and amortization	582	539	1,697	1,581
Interest expense	442	427	1,309	1,257
Gain on sales of facilities	(6)	(7)	(420)	(10)
Losses on retirement of debt	9	39	9	39
Income before income taxes	1,069	778	3,846	3,004
National Group [Member]
Segment Reporting Information [Line Items]
Revenues	5,542	5,036	16,719	15,344
Equity in earnings of affiliates	(1)	(8)	(5)	(17)
Adjusted segment EBITDA	1,127	975	3,593	3,268
Depreciation and amortization	245	219	702	650
American Group [Member]
Segment Reporting Information [Line Items]
Revenues	5,396	5,180	16,113	15,268
Equity in earnings of affiliates	(10)	(9)	(29)	(27)
Adjusted segment EBITDA	1,072	930	3,250	2,977
Depreciation and amortization	258	251	765	727
Corporate and Other [Member]
Segment Reporting Information [Line Items]
Revenues	513	480	1,571	1,440
Equity in earnings of affiliates	2	4	9	8
Adjusted segment EBITDA	(103)	(129)	(402)	(374)
Depreciation and amortization	$ 79	$ 69	$ 230	$ 204

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Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Additional Information (Detail) - USD ($)	Sep. 30, 2018	Dec. 31, 2012
Supplemental Condensed Consolidating Financial Information [Line Items]
Ownership percentage held by parent	100.00%
Senior Unsecured Notes Due 2021 [Member]
Supplemental Condensed Consolidating Financial Information [Line Items]
Debt instrument, principal amount		$ 1,000,000,000
Debt instrument, stated interest		6.25%

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Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Comprehensive Income Statement (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Condensed Statement of Income Captions [Line Items]
Revenues	$ 11,451	$ 10,696	$ 34,403	$ 32,052
Salaries and benefits	5,377	5,081	15,940	14,878
Supplies	1,890	1,777	5,722	5,369
Other operating expenses	2,097	2,075	6,325	5,970
Equity in earnings of affiliates	(9)	(13)	(25)	(36)
Depreciation and amortization	582	539	1,697	1,581
Interest expense (income)	442	427	1,309	1,257
Losses (gains) on sales of facilities	(6)	(7)	(420)	(10)
Losses on retirement of debt	9	39	9	39
Total expenses including equity in earnings of affiliates	10,382	9,918	30,557	29,048
Income (loss) before income taxes	1,069	778	3,846	3,004
Provision (benefit) for income taxes	173	248	702	902
Net income (loss)	896	530	3,144	2,102
Net income attributable to noncontrolling interests	137	104	421	360
Net income (loss) attributable to HCA Healthcare, Inc.	759	426	2,723	1,742
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	754	451	2,735	1,812
Health Care, Patient Service [Member]
Condensed Statement of Income Captions [Line Items]
Revenues	11,451	10,696	34,403	32,052
HCA Healthcare, Inc. Issuer [Member]
Condensed Statement of Income Captions [Line Items]
Other operating expenses	2		7	5
Equity in earnings of affiliates	(728)	(436)	(2,670)	(1,702)
Interest expense (income)	16	16	48	48
Total expenses including equity in earnings of affiliates	(710)	(420)	(2,615)	(1,649)
Income (loss) before income taxes	710	420	2,615	1,649
Provision (benefit) for income taxes	(49)	(6)	(108)	(93)
Net income (loss)	759	426	2,723	1,742
Net income (loss) attributable to HCA Healthcare, Inc.	759	426	2,723	1,742
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	754	451	2,735	1,812
HCA Inc. Issuer [Member]
Condensed Statement of Income Captions [Line Items]
Interest expense (income)	913	792	2,617	2,280
Losses on retirement of debt	9	39	9	39
Total expenses including equity in earnings of affiliates	922	831	2,626	2,319
Income (loss) before income taxes	(922)	(831)	(2,626)	(2,319)
Provision (benefit) for income taxes	(214)	(307)	(610)	(856)
Net income (loss)	(708)	(524)	(2,016)	(1,463)
Net income (loss) attributable to HCA Healthcare, Inc.	(708)	(524)	(2,016)	(1,463)
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	(703)	(522)	(1,974)	(1,458)
Subsidiary Guarantors [Member]
Condensed Statement of Income Captions [Line Items]
Salaries and benefits	3,090	2,915	9,184	8,689
Supplies	1,115	1,033	3,383	3,163
Other operating expenses	1,137	1,093	3,387	3,207
Equity in earnings of affiliates	(2)	(1)	(5)	(4)
Depreciation and amortization	340	311	992	923
Interest expense (income)	(423)	(342)	(1,179)	(947)
Losses (gains) on sales of facilities	(6)	(3)	(378)	(6)
Management fees	(158)	(159)	(473)	(479)
Total expenses including equity in earnings of affiliates	5,093	4,847	14,911	14,546
Income (loss) before income taxes	1,654	1,456	5,386	4,462
Provision (benefit) for income taxes	379	528	1,235	1,619
Net income (loss)	1,275	928	4,151	2,843
Net income attributable to noncontrolling interests	22	24	72	74
Net income (loss) attributable to HCA Healthcare, Inc.	1,253	904	4,079	2,769
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	1,258	907	4,091	2,778
Subsidiary Guarantors [Member] | Health Care, Patient Service [Member]
Condensed Statement of Income Captions [Line Items]
Revenues	6,747	6,303	20,297	19,008
Subsidiary Non-Guarantors [Member]
Condensed Statement of Income Captions [Line Items]
Salaries and benefits	2,287	2,166	6,756	6,189
Supplies	775	744	2,339	2,206
Other operating expenses	958	982	2,931	2,758
Equity in earnings of affiliates	(7)	(12)	(20)	(32)
Depreciation and amortization	242	228	705	658
Interest expense (income)	(64)	(39)	(177)	(124)
Losses (gains) on sales of facilities		(4)	(42)	(4)
Management fees	158	159	473	479
Total expenses including equity in earnings of affiliates	4,349	4,224	12,965	12,130
Income (loss) before income taxes	355	169	1,141	914
Provision (benefit) for income taxes	57	33	185	232
Net income (loss)	298	136	956	682
Net income attributable to noncontrolling interests	115	80	349	286
Net income (loss) attributable to HCA Healthcare, Inc.	183	56	607	396
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	168	76	565	452
Subsidiary Non-Guarantors [Member] | Health Care, Patient Service [Member]
Condensed Statement of Income Captions [Line Items]
Revenues	4,704	4,393	14,106	13,044
Eliminations [Member]
Condensed Statement of Income Captions [Line Items]
Equity in earnings of affiliates	728	436	2,670	1,702
Total expenses including equity in earnings of affiliates	728	436	2,670	1,702
Income (loss) before income taxes	(728)	(436)	(2,670)	(1,702)
Net income (loss)	(728)	(436)	(2,670)	(1,702)
Net income (loss) attributable to HCA Healthcare, Inc.	(728)	(436)	(2,670)	(1,702)
Comprehensive income (loss) attributable to HCA Healthcare, Inc.	$ (723)	$ (461)	$ (2,682)	$ (1,772)

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Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Balance Sheet (Detail) - USD ($) $ in Millions	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2016
Current assets:
Cash and cash equivalents	$ 578			$ 732
Accounts receivable	6,532			6,501
Inventories	1,634			1,573
Other	1,266			1,171
Total current assets	10,010			9,977
Property and equipment, net	19,041			17,895
Investments of insurance subsidiaries	367			418
Investments in and advances to affiliates	238			199
Goodwill and other intangible assets	7,759			7,394
Other	629			710
Total assets	38,044			36,593
Current liabilities:
Accounts payable	2,414			2,606
Accrued salaries	1,456			1,369
Other accrued expenses	2,170			1,983
Long-term debt due within one year	191			200
Total current liabilities	6,231			6,158
Long-term debt, net	32,916			32,858
Professional liability risks	1,239			1,198
Income taxes and other liabilities	1,388			1,374
Total liabilities	41,774			41,588
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	(5,605)			(6,806)
Noncontrolling interests	1,875			1,811
Total stockholders' deficit	(3,730)	$ (4,125)	$ (4,434)	(4,995)	$ (5,066)	$ (5,079)	$ (5,357)	$ (5,633)
Total liabilities and stockholders' deficit	38,044			36,593
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	(5,605)			(6,806)
Noncontrolling interests	1,875			1,811
Total stockholders' deficit	(3,730)	$ (4,125)	$ (4,434)	(4,995)	$ (5,066)	$ (5,079)	$ (5,357)	$ (5,633)
Total liabilities and stockholders' deficit	38,044			36,593
HCA Healthcare, Inc. Issuer [Member]
Current assets:
Cash and cash equivalents				1
Other	47
Total current assets	47			1
Investments in and advances to affiliates	32,263			29,581
Other	389			510
Total assets	32,699			30,092
Current liabilities:
Other accrued expenses	10			29
Total current liabilities	10			29
Long-term debt, net	996			995
Intercompany balances	36,790			35,322
Income taxes and other liabilities	508			552
Total liabilities	38,304			36,898
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	(5,605)			(6,806)
Total stockholders' deficit	(5,605)			(6,806)
Total liabilities and stockholders' deficit	32,699			30,092
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	(5,605)			(6,806)
Total stockholders' deficit	(5,605)			(6,806)
Total liabilities and stockholders' deficit	32,699			30,092
HCA Inc. Issuer [Member]
Current assets:
Other	106			50
Total assets	106			50
Current liabilities:
Other accrued expenses	296			378
Long-term debt due within one year	97			97
Total current liabilities	393			475
Long-term debt, net	31,471			31,367
Intercompany balances	(7,734)			(9,742)
Total liabilities	24,130			22,100
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	(24,024)			(22,050)
Total stockholders' deficit	(24,024)			(22,050)
Total liabilities and stockholders' deficit	106			50
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	(24,024)			(22,050)
Total stockholders' deficit	(24,024)			(22,050)
Total liabilities and stockholders' deficit	106			50
Subsidiary Guarantors [Member]
Current assets:
Cash and cash equivalents	105			112
Accounts receivable	3,854			3,693
Inventories	1,088			1,030
Other	667			663
Total current assets	5,714			5,498
Property and equipment, net	12,192			11,110
Investments in and advances to affiliates	29			22
Goodwill and other intangible assets	5,736			4,893
Other	29			47
Total assets	23,700			21,570
Current liabilities:
Accounts payable	1,627			1,793
Accrued salaries	914			862
Other accrued expenses	790			536
Long-term debt due within one year	61			64
Total current liabilities	3,392			3,255
Long-term debt, net	281			307
Intercompany balances	(27,263)			(25,228)
Income taxes and other liabilities	364			357
Total liabilities	(23,226)			(21,309)
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	46,846			42,755
Noncontrolling interests	80			124
Total stockholders' deficit	46,926			42,879
Total liabilities and stockholders' deficit	23,700			21,570
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	46,846			42,755
Noncontrolling interests	80			124
Total stockholders' deficit	46,926			42,879
Total liabilities and stockholders' deficit	23,700			21,570
Subsidiary Non-Guarantors [Member]
Current assets:
Cash and cash equivalents	473			619
Accounts receivable	2,678			2,808
Inventories	546			543
Other	552			508
Total current assets	4,249			4,478
Property and equipment, net	6,849			6,785
Investments of insurance subsidiaries	367			418
Investments in and advances to affiliates	209			177
Goodwill and other intangible assets	2,023			2,501
Other	105			103
Total assets	13,802			14,462
Current liabilities:
Accounts payable	787			813
Accrued salaries	542			507
Other accrued expenses	1,074			1,040
Long-term debt due within one year	33			39
Total current liabilities	2,436			2,399
Long-term debt, net	168			189
Intercompany balances	(1,793)			(352)
Professional liability risks	1,239			1,198
Income taxes and other liabilities	516			465
Total liabilities	2,566			3,899
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	9,441			8,876
Noncontrolling interests	1,795			1,687
Total stockholders' deficit	11,236			10,563
Total liabilities and stockholders' deficit	13,802			14,462
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	9,441			8,876
Noncontrolling interests	1,795			1,687
Total stockholders' deficit	11,236			10,563
Total liabilities and stockholders' deficit	13,802			14,462
Eliminations [Member]
Current assets:
Investments in and advances to affiliates	(32,263)			(29,581)
Total assets	(32,263)			(29,581)
Current liabilities:
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	(32,263)			(29,581)
Total stockholders' deficit	(32,263)			(29,581)
Total liabilities and stockholders' deficit	(32,263)			(29,581)
Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.	(32,263)			(29,581)
Total stockholders' deficit	(32,263)			(29,581)
Total liabilities and stockholders' deficit	$ (32,263)			$ (29,581)

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Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Schedule of Condensed Consolidating Statement of Cash Flows (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Cash flows from operating activities:
Net income (loss)	$ 896	$ 530	$ 3,144	$ 2,102
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Changes in operating assets and liabilities			(147)	(289)
Depreciation and amortization	582	539	1,697	1,581
Income taxes				(9)
Gain on sales of facilities	(6)	(7)	(420)	(10)
Losses on retirement of debt	9	39	9	39
Amortization of debt issuance costs			23	23
Share-based compensation			204	195
Other			76	60
Net cash provided by (used in) operating activities			4,586	3,692
Cash flows from investing activities:
Purchase of property and equipment			(2,420)	(2,033)
Acquisition of hospitals and health care entities			(1,056)	(1,142)
Disposition of hospitals and health care entities			802	24
Change in investments			65	(15)
Other			(6)	(6)
Net cash used in investing activities			(2,615)	(3,172)
Cash flows from financing activities:
Issuance of long-term debt			2,000	1,502
Net change in revolving credit facilities			(330)	650
Repayment of long-term debt			(1,652)	(700)
Distributions to noncontrolling interests			(315)	(363)
Payment of debt issuance costs			(24)	(25)
Payment of cash dividends			(366)
Repurchases of common stock			(1,195)	(1,475)
Other			(232)	(37)
Net cash (used in) provided by financing activities			(2,114)	(448)
Effect on exchange rate changes on cash and cash equivalents			(11)
Change in cash and cash equivalents			(154)	72
Cash and cash equivalents at beginning of period			732	646
Cash and cash equivalents at end of period	578	718	578	718
Eliminations [Member]
Cash flows from operating activities:
Net income (loss)	(728)	(436)	(2,670)	(1,702)
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Equity in earnings of affiliates			2,670	1,702
HCA Healthcare, Inc. Issuer [Member]
Cash flows from operating activities:
Net income (loss)	759	426	2,723	1,742
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Changes in operating assets and liabilities			(15)	(15)
Income taxes				(9)
Equity in earnings of affiliates			(2,670)	(1,702)
Other			67	58
Net cash provided by (used in) operating activities			105	74
Cash flows from financing activities:
Payment of cash dividends			(366)
Repurchases of common stock			(1,195)	(1,475)
Changes in intercompany balances with affiliates, net			1,697	1,468
Other			(242)	(66)
Net cash (used in) provided by financing activities			(106)	(73)
Change in cash and cash equivalents			(1)	1
Cash and cash equivalents at beginning of period			1
Cash and cash equivalents at end of period		1		1
HCA Inc. Issuer [Member]
Cash flows from operating activities:
Net income (loss)	(708)	(524)	(2,016)	(1,463)
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Changes in operating assets and liabilities			(83)	(293)
Losses on retirement of debt	9	39	9	39
Amortization of debt issuance costs			23	23
Net cash provided by (used in) operating activities			(2,067)	(1,694)
Cash flows from financing activities:
Issuance of long-term debt			2,000	1,500
Net change in revolving credit facilities			(330)	650
Repayment of long-term debt			(1,566)	(604)
Payment of debt issuance costs			(24)	(25)
Changes in intercompany balances with affiliates, net			1,987	173
Net cash (used in) provided by financing activities			2,067	1,694
Subsidiary Guarantors [Member]
Cash flows from operating activities:
Net income (loss)	1,275	928	4,151	2,843
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Changes in operating assets and liabilities			(154)	(191)
Depreciation and amortization	340	311	992	923
Gain on sales of facilities	(6)	(3)	(378)	(6)
Share-based compensation			204	195
Other				2
Net cash provided by (used in) operating activities			4,815	3,766
Cash flows from investing activities:
Purchase of property and equipment			(1,425)	(1,161)
Acquisition of hospitals and health care entities			(894)	(9)
Disposition of hospitals and health care entities			770	12
Change in investments			19	1
Other			(18)	(7)
Net cash used in investing activities			(1,548)	(1,164)
Cash flows from financing activities:
Repayment of long-term debt			(44)	(54)
Distributions to noncontrolling interests			(63)	(105)
Changes in intercompany balances with affiliates, net			(3,167)	(2,439)
Other				1
Net cash (used in) provided by financing activities			(3,274)	(2,597)
Change in cash and cash equivalents			(7)	5
Cash and cash equivalents at beginning of period			112	114
Cash and cash equivalents at end of period	105	119	105	119
Subsidiary Non-Guarantors [Member]
Cash flows from operating activities:
Net income (loss)	298	136	956	682
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Changes in operating assets and liabilities			105	210
Depreciation and amortization	242	228	705	658
Gain on sales of facilities		(4)	(42)	(4)
Other			9
Net cash provided by (used in) operating activities			1,733	1,546
Cash flows from investing activities:
Purchase of property and equipment			(995)	(872)
Acquisition of hospitals and health care entities			(162)	(1,133)
Disposition of hospitals and health care entities			32	12
Change in investments			46	(16)
Other			12	1
Net cash used in investing activities			(1,067)	(2,008)
Cash flows from financing activities:
Issuance of long-term debt				2
Repayment of long-term debt			(42)	(42)
Distributions to noncontrolling interests			(252)	(258)
Changes in intercompany balances with affiliates, net			(517)	798
Other			10	28
Net cash (used in) provided by financing activities			(801)	528
Effect on exchange rate changes on cash and cash equivalents			(11)
Change in cash and cash equivalents			(146)	66
Cash and cash equivalents at beginning of period			619	532
Cash and cash equivalents at end of period	$ 473	$ 598	$ 473	$ 598

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Supplemental Condensed Consolidating Financial Information and Other Collateral-Related Information - Summary of Restatement Adjustments to Financial Statements (Detail) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.	$ 759	$ 426	$ 2,723	$ 1,742
Net cash provided by operating activities				3,692
HCA Healthcare, Inc. Issuer [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.	759	426	2,723	1,742
Net cash provided by operating activities				74
HCA Inc. Issuer [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.	(708)	(524)	(2,016)	(1,463)
Net cash provided by operating activities				(1,694)
Subsidiary Guarantors [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.	1,253	904	4,079	2,769
Net cash provided by operating activities				3,766
Subsidiary Non-Guarantors [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.	183	56	607	396
Net cash provided by operating activities				1,546
Eliminations [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.	$ (728)	(436)	$ (2,670)	(1,702)
As Previously Reported [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.		426		1,742
Net cash provided by operating activities				3,692
As Previously Reported [Member] | HCA Healthcare, Inc. Issuer [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.		426		1,742
Net cash provided by operating activities				74
As Previously Reported [Member] | HCA Inc. Issuer [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.		(524)		(1,463)
Net cash provided by operating activities				(1,694)
As Previously Reported [Member] | Subsidiary Guarantors [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.		787		2,467
Net cash provided by operating activities				3,342
As Previously Reported [Member] | Subsidiary Non-Guarantors [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.		173		698
Net cash provided by operating activities				1,970
As Previously Reported [Member] | Eliminations [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.		(436)		(1,702)
Adjustment [Member] | Subsidiary Guarantors [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.		117		302
Net cash provided by operating activities				424
Adjustment [Member] | Subsidiary Non-Guarantors [Member]
Adjustments or Reclassifications [Line Items]
Net income attributable to HCA Healthcare, Inc.		$ (117)		(302)
Net cash provided by operating activities				$ (424)