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Published: 2022-10-21 07:02:56 ET
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EX-99.1 2 d311683dex991.htm EX-99.1 EX-99.1

Exhibit 99.1

 

LOGO

 

     

FOR IMMEDIATE RELEASE

 

 

INVESTOR CONTACT:

         MEDIA CONTACT:
Frank Morgan          Harlow Sumerford
615-344-2688          615-344-1851

HCA HEALTHCARE REPORTS THIRD QUARTER 2022 RESULTS

Nashville, Tenn., October 21, 2022 – HCA Healthcare, Inc. (NYSE: HCA) today announced financial and operating results for the third quarter ended September 30, 2022.

Key third quarter metrics (all percentage changes compare 3Q 2022 to 3Q 2021 unless otherwise noted):

 

   

Revenues totaled $14.971 billion

 

   

Net income attributable to HCA Healthcare, Inc. totaled $1.134 billion, or $3.91 per diluted share

 

   

Adjusted EBITDA totaled $2.902 billion

 

   

Cash flows from operating activities totaled $3.020 billion

 

   

Same facility admissions declined 1.5 percent while same facility equivalent admissions increased 2.3 percent

“Despite a difficult comparison to the prior year due to the COVID-19 Delta variant, we are pleased with our results and the execution of our teams in a challenging operating environment, which included tremendous efforts from our courageous frontline caregivers and support teams who worked tirelessly to provide uninterrupted care during Hurricane Ian,” said Sam Hazen, Chief Executive Officer of HCA Healthcare.

Revenues in the third quarter of 2022 totaled $14.971 billion, compared to $15.276 billion in the third quarter of 2021. Net income attributable to HCA Healthcare, Inc. totaled $1.134 billion, or $3.91 per diluted share, compared to $2.269 billion, or $7.00 per diluted share, in the third quarter of 2021. Results for the third quarter of 2022 include losses on sales of facilities of $3 million, or $0.02 per diluted share. Results for the third quarter of 2021 include gains on sales of facilities of $1.047 billion, or $2.43 per diluted share, related to the sale of four hospitals in Georgia and other health care entity investments. In September 2022, the state of Florida received approval from the Centers for Medicare and Medicaid Services for its directed payment program for the program year that began October 1, 2021 and ended September 30, 2022. Revenues for the third quarter of 2022 include approximately $266 million for the full program year. Other operating expenses include approximately $125 million from provider tax assessments related to the same period.

 

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For the third quarter of 2022, Adjusted EBITDA totaled $2.902 billion, compared to $3.224 billion in the third quarter of 2021. Adjusted EBITDA is a non-GAAP financial measure. A table providing supplemental information on Adjusted EBITDA and reconciling net income attributable to HCA Healthcare, Inc. to Adjusted EBITDA is included in this release.

Results for the third quarter 2022 include Hurricane Ian’s impact, primarily on our Florida facilities, causing additional expenses and lost revenues estimated at $35 million. This amount is prior to any potential insurance recoveries.

Same facility admissions declined 1.5 percent while same facility equivalent admissions increased 2.3 percent in the third quarter of 2022, compared to the prior year period. Same facility emergency room visits declined 1.3 percent in the third quarter of 2022, compared to the prior year period. Same facility inpatient surgeries increased 5.6 percent, and same facility outpatient surgeries increased 2.0 percent in the third quarter of 2022, compared to the same period of 2021. Same facility revenue per equivalent admission declined 3.5 percent in the third quarter of 2022, compared to the third quarter of 2021. Year over year comparisons were impacted by significantly higher COVID-19 volumes in the prior year, when COVID-19 represented 12.7 percent of same-facility admissions versus 5.2 percent in the current year quarter.

Nine Months Ended September 30, 2022

Revenues for the nine months ended September 30, 2022 totaled $44.736 billion, compared to $43.688 billion in the same period of 2021. Net income attributable to HCA Healthcare, Inc. was $3.562 billion, or $11.97 per diluted share, for the nine months ended September 30, 2022 compared to $5.142 billion, or $15.43 per diluted share, for the first nine months of 2021. Results for the nine months ended September 30, 2022 include losses on sales of facilities of $25 million, or $0.09 per diluted share, and losses on retirement of debt of $78 million, or $0.20 per diluted share. Results for the nine months ended September 30, 2021 include gains on sales of facilities of $1.057 billion, or $2.39 per diluted share, and losses on retirement of debt of $12 million, or $0.03 per diluted share.

Balance Sheet and Cash Flows from Operations

As of September 30, 2022, HCA Healthcare, Inc.’s balance sheet reflected cash and cash equivalents of $999 million, total debt of $37.710 billion, and total assets of $51.484 billion. During the third quarter of 2022, capital expenditures totaled $1.131 billion, excluding acquisitions. Cash flows provided by operating activities in the third quarter of 2022 totaled $3.020 billion, compared to $2.277 billion in the third quarter of 2021.

During the third quarter of 2022, the Company repurchased 3.361 million shares of its common stock at a cost of $698 million. The Company had $3.106 billion remaining under its repurchase authorization as of September 30, 2022. As of September 30, 2022, the Company had $3.885 billion of availability under its credit facilities.

Dividend

HCA today announced that its Board of Directors declared a quarterly cash dividend of $0.56 per share on the Company’s common stock. The dividend will be paid on December 28, 2022 to stockholders of record at the close of business on December 14, 2022.

 

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The declaration and payment of any future dividend will be subject to the discretion of the Board of Directors and will depend on a variety of factors, including the Company’s financial condition and results of operations and contractual restrictions. Future dividends are expected to be funded by cash balances and future cash flows from operations.

Earnings Conference Call

HCA Healthcare will host a conference call for investors at 8:00 a.m. Central Daylight Time today. All interested investors are invited to access a live audio broadcast of the call via webcast. The broadcast also will be available on a replay basis beginning this afternoon. The webcast can be accessed at: https://investor.hcahealthcare.com/events-and-presentations.

About the Company

As of September 30, 2022, HCA Healthcare operated 182 hospitals and approximately 2,300 ambulatory sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics, in 20 states and the United Kingdom.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the federal securities laws, which involve risks and uncertainties. Forward-looking statements include statements that do not relate solely to historical or current facts. Forward-looking statements 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) developments related to COVID-19, including, without limitation, the length and severity of its impact and the spread of virus strains with new epidemiological characteristics; the volume of canceled or rescheduled procedures and the volume and acuity of COVID-19 patients cared for across our health systems; measures we are taking to respond to COVID-19; the impact and terms (including the termination or expiration) of government and administrative regulation and stimulus and relief measures (including the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act, the Paycheck Protection Program and Health Care Enhancement Act, the Consolidated Appropriations Act, 2021, the American Rescue Plan Act of 2021 (“ARPA”) and other enacted and potential future legislation) and whether various stimulus and relief programs continue or new similar programs are enacted in the future; changes in revenues due to declining patient volumes, changes in payer mix, deteriorating macroeconomic conditions (including increases in uninsured and underinsured patients) and capacity constraints; potential increased expenses related to inflation or labor, supply chain or other expenditures; supply shortages and disruptions; and the timing, availability and adoption of effective medical treatments and vaccines (including boosters), (2) the impact of our substantial indebtedness and the ability to refinance such indebtedness on acceptable terms, (3) the impact of current and future federal and state health reform initiatives and possible changes to other federal, state or local laws and regulations affecting the health care industry, including but not limited to, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the “Affordable Care Act”), and the effects of additional changes to the Affordable Care Act, its implementation, or interpretation (including through executive orders and court challenges), and proposals to expand coverage of federally-funded

 

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insurance programs as an alternative to private insurance or establish a single-payer system (such reforms often referred to as “Medicare for All”), and also including any such laws or governmental regulations which are adopted in response to COVID-19, (4) the effects related to the implementation of sequestration spending reductions required under the Budget Control Act of 2011, related legislation extending these reductions and those required under the Pay-As-You-Go Act of 2010 (“PAYGO Act”) as a result of the federal budget deficit impact of the ARPA, and the potential for future deficit reduction legislation that may alter these spending reductions, which include cuts to Medicare payments, or create additional spending reductions, (5) increases in the amount and risk of collectability of uninsured accounts and deductibles and copayment amounts for insured accounts, (6) the ability to achieve operating and financial targets, and attain expected levels of patient volumes and control the costs of providing services, (7) 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, (8) increases in wages and the ability to attract, utilize and retain qualified management and other personnel, including affiliated physicians, nurses and medical and technical support personnel, and workforce disruptions, (9) the highly competitive nature of the health care business, (10) changes in service mix, revenue mix and surgical volumes, including potential declines in the population covered under third-party payer agreements, the ability to enter into and renew third-party payer provider agreements on acceptable terms and the impact of consumer-driven health plans and physician utilization trends and practices, (11) the efforts of health insurers, health care providers, large employer groups and others to contain health care costs, (12) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (13) the availability and terms of capital to fund the expansion of our business and improvements to our existing facilities, (14) changes in accounting practices, (15) changes in general economic conditions nationally and regionally in our markets, including inflation and economic and business conditions (and the impact thereof on the economy and financial markets) resulting from COVID-19 or other factors, (16) the emergence of and effects related to pandemics, epidemics and infectious diseases, (17) future divestitures which may result in charges and possible impairments of long-lived assets, (18) changes in business strategy or development plans, (19) delays in receiving payments for services provided, (20) the outcome of pending and any future tax audits, disputes and litigation associated with our tax positions, (21) potential adverse impact of known and unknown government investigations, litigation and other claims that may be made against us, (22) the impact of potential cybersecurity incidents or security breaches, (23) our ongoing ability to demonstrate meaningful use of certified electronic health record (“EHR”) technology and the impact of interoperability requirements, (24) the impact of natural disasters, such as hurricanes and floods, physical risks from climate change or similar events beyond our control, (25) changes in U.S. federal, state, or foreign tax laws including interpretive guidance that may be issued by taxing authorities or other standard setting bodies, and (26) other risk factors described in our annual report on Form 10-K for the year ended December 31, 2021 and our other filings with the Securities and Exchange Commission. Many of the factors that will determine our future results are beyond our ability to control or predict. In light of the significant uncertainties inherent in the forward-looking statements contained herein, readers should not place undue reliance on forward-looking statements, which reflect management’s views only as of the date hereof. We undertake no obligation to revise or update any forward-looking statements, or to make any other forward-looking statements, whether as a result of new information, future events or otherwise. All references to “Company” and “HCA Healthcare” as used throughout this release refer to HCA Healthcare, Inc. and its affiliates.

 

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HCA Healthcare, Inc.

Condensed Consolidated Comprehensive Income Statements

Third Quarter

Unaudited

(Dollars in millions, except per share amounts)

 

     2022     2021  
     Amount     Ratio     Amount     Ratio  

Revenues

   $ 14,971       100.0   $ 15,276       100.0

Salaries and benefits

     6,899       46.1       7,094       46.4  

Supplies

     2,320       15.5       2,463       16.1  

Other operating expenses

     2,860       19.1       2,530       16.6  

Equity in earnings of affiliates

     (10     (0.1     (35     (0.2

Depreciation and amortization

     749       5.0       716       4.7  

Interest expense

     446       3.0       398       2.6  

Losses (gains) on sales of facilities

     3             (1,047     (6.9
  

 

 

   

 

 

   

 

 

   

 

 

 
     13,267       88.6       12,119       79.3  
  

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     1,704       11.4       3,157       20.7  

Provision for income taxes

     360       2.4       685       4.5  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income

     1,344       9.0       2,472       16.2  

Net income attributable to noncontrolling interests

     210       1.4       203       1.3  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to HCA Healthcare, Inc.

   $ 1,134       7.6     $ 2,269       14.9  
  

 

 

   

 

 

   

 

 

   

 

 

 

Diluted earnings per share

   $ 3.91       $ 7.00    

Shares used in computing diluted earnings per share (millions)

     289.852         324.029    

Comprehensive income attributable to HCA Healthcare, Inc.

   $ 1,057       $ 2,252    
  

 

 

     

 

 

   

 

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HCA Healthcare, Inc.

Condensed Consolidated Comprehensive Income Statements

For the Nine Months Ended September 30, 2022 and 2021

Unaudited

(Dollars in millions, except per share amounts)

 

     2022     2021  
     Amount     Ratio     Amount     Ratio  

Revenues

   $ 44,736       100.0   $ 43,688       100.0

Salaries and benefits

     20,630       46.1       19,780       45.3  

Supplies

     6,942       15.5       7,067       16.2  

Other operating expenses

     8,305       18.6       7,424       17.0  

Equity in earnings of affiliates

     (29     (0.1     (78     (0.2

Depreciation and amortization

     2,219       4.9       2,125       4.8  

Interest expense

     1,288       2.9       1,168       2.7  

Losses (gains) on sales of facilities

     25       0.1       (1,057     (2.4

Losses on retirement of debt

     78       0.2       12        
  

 

 

   

 

 

   

 

 

   

 

 

 
     39,458       88.2       36,441       83.4  
  

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     5,278       11.8       7,247       16.6  

Provision for income taxes

     1,090       2.4       1,531       3.5  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income

     4,188       9.4       5,716       13.1  

Net income attributable to noncontrolling interests

     626       1.4       574       1.3  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to HCA Healthcare, Inc.

   $ 3,562       8.0     $ 5,142       11.8  
  

 

 

   

 

 

   

 

 

   

 

 

 

Diluted earnings per share

   $ 11.97       $ 15.43    

Shares used in computing diluted earnings per share (millions)

     297.702         333.248    

Comprehensive income attributable to HCA Healthcare, Inc.

   $ 3,374       $ 5,152    
  

 

 

     

 

 

   

 

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HCA Healthcare, Inc.

Condensed Consolidated Balance Sheets

Unaudited

(Dollars in millions)

 

     September 30,
2022
    June 30,
2022
    December 31,
2021
 

ASSETS

      

Current assets:

      

Cash and cash equivalents

   $ 999     $ 858     $ 1,451  

Accounts receivable

     8,552       8,628       8,095  

Inventories

     2,009       2,043       1,986  

Other

     1,921       2,408       2,010  
  

 

 

   

 

 

   

 

 

 
     13,481       13,937       13,542  

Property and equipment, at cost

     53,730       52,816       51,350  

Accumulated depreciation

     (28,752     (28,229     (27,287
  

 

 

   

 

 

   

 

 

 
     24,978       24,587       24,063  

Investments of insurance subsidiaries

     372       379       438  

Investments in and advances to affiliates

     444       435       448  

Goodwill and other intangible assets

     9,651       9,593       9,540  

Right-of-use operating lease assets

     2,097       2,139       2,113  

Other

     461       514       598  
  

 

 

   

 

 

   

 

 

 
   $ 51,484     $ 51,584     $ 50,742  
  

 

 

   

 

 

   

 

 

 

LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY

      

Current liabilities:

      

Accounts payable

   $ 4,161     $ 3,742     $ 4,111  

Accrued salaries

     1,625       1,895       1,912  

Other accrued expenses

     3,780       3,116       3,322  

Long-term debt due within one year

     218       246       237  
  

 

 

   

 

 

   

 

 

 
     9,784       8,999       9,582  

Long-term debt, less debt issuance costs and discounts of $309, $316 and $248

     37,492       38,657       34,342  

Professional liability risks

     1,510       1,533       1,514  

Right-of-use operating lease obligations

     1,762       1,796       1,755  

Income taxes and other liabilities

     1,714       1,741       2,060  

Stockholders’ (deficit) equity:

      

Stockholders’ deficit attributable to HCA Healthcare, Inc.

     (3,370     (3,680     (933

Noncontrolling interests

     2,592       2,538       2,422  
  

 

 

   

 

 

   

 

 

 
     (778     (1,142     1,489  
  

 

 

   

 

 

   

 

 

 
   $ 51,484     $ 51,584     $ 50,742  
  

 

 

   

 

 

   

 

 

 

 

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HCA Healthcare, Inc.

Condensed Consolidated Statements of Cash Flows

For the Nine Months Ended September 30, 2022 and 2021

Unaudited

(Dollars in millions)

 

     2022     2021  

Cash flows from operating activities:

    

Net income

   $ 4,188     $ 5,716  

Adjustments to reconcile net income to net cash provided by operating activities:

    

Increase (decrease) in cash from operating assets and liabilities:

    

Accounts receivable

     (487     (1,312

Inventories and other assets

     53       (333

Accounts payable and accrued expenses

     (644     731  

Depreciation and amortization

     2,219       2,125  

Income taxes

     159       185  

Losses (gains) on sales of facilities

     25       (1,057

Losses on retirement of debt

     78       12  

Amortization of debt issuance costs and discounts

     22       21  

Share-based compensation

     258       341  

Other

     124       87  
  

 

 

   

 

 

 

Net cash provided by operating activities

     5,995       6,516  
  

 

 

   

 

 

 

Cash flows from investing activities:

    

Purchase of property and equipment

     (3,072     (2,385

Acquisition of hospitals and health care entities

     (176     (488

Sales of hospitals and health care entities

     652       1,980  

Change in investments

     10       (38

Other

     (10     2  
  

 

 

   

 

 

 

Net cash used in investing activities

     (2,596     (929
  

 

 

   

 

 

 

Cash flows from financing activities:

    

Issuances of long-term debt

     5,976       4,337  

Net change in revolving credit facilities

     (230     500  

Repayment of long-term debt

     (2,774     (3,787

Distributions to noncontrolling interests

     (550     (501

Payment of debt issuance costs

     (53     (38

Payment of dividends

     (497     (476

Repurchase of common stock

     (5,481     (6,143

Other

     (209     (241
  

 

 

   

 

 

 

Net cash used in financing activities

     (3,818     (6,349
  

 

 

   

 

 

 

Effect of exchange rate changes on cash and cash equivalents

     (33     (4
  

 

 

   

 

 

 

Change in cash and cash equivalents

     (452     (766

Cash and cash equivalents at beginning of period

     1,451       1,793  
  

 

 

   

 

 

 

Cash and cash equivalents at end of period

   $ 999     $ 1,027  
  

 

 

   

 

 

 

Interest payments

   $ 1,329     $ 1,127  

Income tax payments, net

   $ 931     $ 1,346  

 

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HCA Healthcare, Inc.

Operating Statistics

 

     Third Quarter     For the Nine Months
Ended September 30,
 
     2022     2021     2022     2021  

Operations:

        

Number of Hospitals

     182       183       182       183  

Number of Freestanding Outpatient Surgery Centers*

     125       123       125       123  

Licensed Beds at End of Period

     49,179       48,950       49,179       48,950  

Weighted Average Beds in Service

     42,056       42,088       41,936       42,304  

Reported:

        

Admissions

     523,092       536,848       1,545,161       1,575,269  

% Change

     -2.6       -1.9  

Equivalent Admissions

     917,262       905,627       2,679,309       2,654,328  

% Change

     1.3       0.9  

Revenue per Equivalent Admission

   $ 16,322     $ 16,868     $ 16,697     $ 16,459  

% Change

     -3.2       1.4  

Inpatient Revenue per Admission

   $ 17,387     $ 18,102     $ 17,268     $ 17,115  

% Change

     -3.9       0.9  

Patient Days

     2,602,416       2,865,220       7,855,462       8,166,211  

% Change

     -9.2       -3.8  

Equivalent Patient Days

     4,565,120       4,833,197       13,621,371       13,760,066  

% Change

     -5.5       -1.0  

Inpatient Surgery Cases

     132,470       126,436       390,311       390,486  

% Change

     4.8       0.0  

Outpatient Surgery Cases

     252,026       249,192       757,629       742,527  

% Change

     1.1       2.0  

Emergency Room Visits

     2,278,782       2,338,180       6,559,170       6,308,386  

% Change

     -2.5       4.0  

Outpatient Revenues as a

        

Percentage of Patient Revenues

     36.6     34.1     37.6     36.0

Average Length of Stay (days)

     4.975       5.337       5.084       5.184  

Occupancy**

     70.8     77.6     72.1     74.5

Same Facility:

        

Admissions

     518,597       526,573       1,532,798       1,536,627  

% Change

     -1.5       -0.2  

Equivalent Admissions

     905,470       885,169       2,645,609       2,579,997  

% Change

     2.3       2.5  

Revenue per Equivalent Admission

   $ 16,283     $ 16,874     $ 16,674     $ 16,539  

% Change

     -3.5       0.8  

Inpatient Revenue per Admission

   $ 17,428     $ 18,081     $ 17,306     $ 17,168  

% Change

     -3.6       0.8  

Inpatient Surgery Cases

     131,289       124,381       387,339       382,570  

% Change

     5.6       1.2  

Outpatient Surgery Cases

     242,276       237,607       726,278       709,535  

% Change

     2.0       2.4  

Emergency Room Visits

     2,252,569       2,281,501       6,486,667       6,106,868  

% Change

     -1.3       6.2  

 

*

Excludes freestanding endoscopy centers (21 centers at both September 30, 2022 and September 30, 2021).

**

Reflects the rate of occupancy (patient days and observations) based on weighted average beds in service.

 

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HCA Healthcare, Inc.

Supplemental Non-GAAP Disclosures

Operating Results Summary

(Dollars in millions, except per share amounts)

 

     Third Quarter     For the Nine Months
Ended September 30,
 
     2022     2021     2022     2021  

Revenues

   $ 14,971     $ 15,276     $ 44,736     $ 43,688  

Net income attributable to HCA Healthcare, Inc.

   $ 1,134     $ 2,269     $ 3,562     $ 5,142  

Losses (gains) on sales of facilities (net of tax)

     4       (788     28       (795

Losses on retirement of debt (net of tax)

                 60       9  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt (a)

     1,138       1,481       3,650       4,356  

Depreciation and amortization

     749       716       2,219       2,125  

Interest expense

     446       398       1,288       1,168  

Provision for income taxes

     359       426       1,105       1,272  

Net income attributable to noncontrolling interests

     210       203       626       574  
  

 

 

   

 

 

   

 

 

   

 

 

 

Adjusted EBITDA (a)

   $ 2,902     $ 3,224     $ 8,888     $ 9,495  
  

 

 

   

 

 

   

 

 

   

 

 

 

Adjusted EBITDA margin (a)

     19.4     21.1     19.9     21.7

Diluted earnings per share:

        

Net income attributable to HCA Healthcare, Inc.

   $ 3.91     $ 7.00     $ 11.97     $ 15.43  

Losses (gains) on sales of facilities

     0.02       (2.43     0.09       (2.39

Losses on retirement of debt

                 0.20       0.03  
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt (a)

   $ 3.93     $ 4.57     $ 12.26     $ 13.07  
  

 

 

   

 

 

   

 

 

   

 

 

 

Shares used in computing diluted earnings per share (millions)

     289.852       324.029       297.702       333.248  

 

(a)

Net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt, and Adjusted EBITDA should not be considered as measures of financial performance under generally accepted accounting principles (“GAAP”). We believe net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt, and Adjusted EBITDA are important measures that supplement discussions and analysis of our results of operations. We believe it is useful to investors to provide disclosures of our results of operations on the same basis used by management. Management relies upon net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt, and Adjusted EBITDA as the primary measures to review and assess operating performance of its health care facilities and their management teams.

Management and investors review both the overall performance (including net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt, and GAAP net income attributable to HCA Healthcare, Inc.) and operating performance (Adjusted EBITDA) of our health care facilities. Adjusted EBITDA and the Adjusted EBITDA margin (Adjusted EBITDA divided by revenues) are utilized by management and investors to compare our current operating results with the corresponding periods during the previous year and to compare our operating results with other companies in the health care industry. It is reasonable to expect that losses (gains) on sales of facilities and losses on retirement of debt will occur in future periods, but the amounts recognized can vary significantly from period to period, do not directly relate to the ongoing operations of our health care facilities and complicate period comparisons of our results of operations and operations comparisons with other health care companies.

Net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt, and Adjusted EBITDA are not measures of financial performance under GAAP, and should not be considered as alternatives to net income attributable to HCA Healthcare, Inc. as a measure of operating performance or cash flows from operating, investing and financing activities as a measure of liquidity. Because net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt, and Adjusted EBITDA are not measurements determined in accordance with GAAP and are susceptible to varying calculations, net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt, and Adjusted EBITDA, as presented, may not be comparable to other similarly titled measures presented by other companies.

 

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