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HCA Healthcare Reports Third Quarter 2021 Results; Revises 2021 Guidance

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NASHVILLE, Tenn., October 22, 2021--(BUSINESS WIRE)--HCA Healthcare, Inc. (NYSE: HCA) today announced financial and operating results for the third quarter ended September 30, 2021.

Key third quarter metrics (all percentage changes compare 3Q 2021 to 3Q 2020 unless otherwise noted):

  • Revenues totaled $15.276 billion

  • Net income attributable to HCA Healthcare, Inc. totaled $2.269 billion, or $7.00 per diluted share

  • Adjusted EBITDA totaled $3.224 billion

  • Cash flows from operating activities totaled $2.277 billion

  • Same facility admissions and same facility equivalent admissions increased 6.8 percent and 9.3 percent, respectively

"During the third quarter we experienced the most intense surge yet of the pandemic, and our colleagues and physicians delivered record levels of patient care to meet the demand caused by the Delta variant," said Sam Hazen, Chief Executive Officer of HCA Healthcare. "Once again, the disciplined operating culture and strong execution by our teams were on display. I want to thank them for their tremendous work and dedication to serving others."

Revenues in the third quarter of 2021 increased to $15.276 billion, compared to $13.311 billion in the third quarter of 2020. Net income attributable to HCA Healthcare, Inc. totaled $2.269 billion, or $7.00 per diluted share, compared to $668 million, or $1.95 per diluted share, in the third quarter of 2020. 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. Results for the third quarter of 2020 included a reversal of $822 million, or $1.72 per diluted share, in government stimulus income recorded in the second quarter of 2020 related to general distribution funds received from the Provider Relief Fund established by the Coronavirus Aid, Relief, and Economic Security ("CARES") Act and $14 million, or $0.03 per diluted share, of gains on sales of facilities.

For the third quarter of 2021, Adjusted EBITDA totaled $3.224 billion, compared to $2.053 billion in the third quarter of 2020. 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.

Same facility admissions and equivalent admissions increased 6.8 percent and 9.3 percent, respectively, in the third quarter of 2021, compared to the prior year period. Same facility emergency room visits increased 31.2 percent in the third quarter of 2021, compared to the prior year period. Same facility inpatient surgeries declined 4.9 percent, and same facility outpatient surgeries increased 6.4 percent in the third quarter of 2021, compared to the same period of 2020. Same facility revenue per equivalent admission increased 5.2 percent in the third quarter of 2021, compared to the third quarter of 2020, due to increases in acuity of patients treated and favorable payer mix in the quarter.

Because of the pandemic-related impact on volumes in the third quarter of 2020, the Company believes a comparison of volume statistics to the comparable period in 2019 provides additional context to the improvement in operations during 2021. The following table provides a summary of statistical measures for the third quarter of 2021 compared to the same period in 2019 on a same facility basis.

Third Quarter

2021

2019

% Change

Same Facility:

Admissions

531,032

517,151

2.7

%

Equivalent Admissions

892,665

897,774

-0.6

%

Patient Days

2,836,248

2,482,756

14.2

%

Equivalent Patient Days

4,767,733

4,310,064

10.6

%

Inpatient Surgery Cases

125,533

141,313

-11.2

%

Outpatient Surgery Cases

242,450

241,019

0.6

%

Emergency Room Visits

2,301,968

2,198,357

4.7

%

Nine Months Ended September 30, 2021

Revenues for the nine months ended September 30, 2021 totaled $43.688 billion, compared to $37.240 billion in the same period of 2020. Net income attributable to HCA Healthcare, Inc. was $5.142 billion, or $15.43 per diluted share, compared to $2.328 billion, or $6.79 per diluted share, for the first nine months of 2020. Results through September 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. Results for the nine months ended September 30, 2020 included losses on sales of facilities of $6 million, or $0.03 per diluted share, and losses on retirement of debt of $295 million, or $0.66 per diluted share.

Balance Sheet and Cash Flows from Operations

As of September 30, 2021, HCA Healthcare, Inc.’s balance sheet reflected cash and cash equivalents of $1.027 billion, total debt of $32.299 billion, and total assets of $49.562 billion. During the third quarter of 2021, capital expenditures totaled $889 million, excluding acquisitions. Cash flows provided by operating activities in the third quarter totaled $2.277 billion, compared to $2.717 billion in the third quarter of 2020.

During the third quarter of 2021, the Company repurchased 9.605 million shares of its common stock at a cost of $2.329 billion. The Company had $2.658 billion remaining under its repurchase authorization as of September 30, 2021. As of September 30, 2021, the Company had $5.920 billion of availability under its credit facilities.

Dividend

HCA today announced that its Board of Directors declared a quarterly cash dividend of $0.48 per share on the Company’s common stock. The dividend will be paid on December 29, 2021 to stockholders of record at the close of business on December 14, 2021.

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.

2021 Revised Guidance

The 2021 guidance ranges for the year have been revised from our second quarter release and are as follows:

2021 Guidance Range

Revenues

$58.7 to $59.3 billion

Adjusted EBITDA

$12.50 to $12.80 billion

EPS (diluted)

$17.20 to $17.80 per diluted share

Capital Expenditures

Approximately $3.7 billion

The Company’s 2021 guidance contains a number of assumptions, including, among others, the Company’s current expectations regarding the impact of the COVID-19 pandemic and related government legislation, and excludes the impact of items such as, but not limited to, gains or losses on sales of facilities, losses on retirement of debt, legal claims costs and impairment of long-lived assets.

Adjusted EBITDA is a non-GAAP financial measure. A table reconciling forecasted net income attributable to HCA Healthcare, Inc. to forecasted Adjusted EBITDA is included in this release.

The Company’s guidance is based on current plans and expectations and is subject to a number of known and unknown uncertainties and risks, including those set forth below in the Company’s "Forward-Looking Statements."

Earnings Conference Call

HCA Healthcare will host a conference call for investors at 9:00 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, 2021, HCA Healthcare operated 183 hospitals and approximately 2,000 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 the Company’s financial guidance for the year ending December 31, 2021, as well as other 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 the pandemic and the spread of virus strains with new epidemiological characteristics; the volume of canceled or rescheduled procedures and the volume of COVID-19 patients cared for across our health systems; measures we are taking to respond to the COVID-19 pandemic; the impact and terms of government and administrative regulation and stimulus (including the Families First Coronavirus Response Act, the CARES Act, the Paycheck Protection Program and Health Care Enhancement Act, the Consolidated Appropriations Act, 2021, the American Rescue Plan Act of 2021 and other enacted and potential future legislation); changes in revenues due to declining patient volumes, changes in payer mix and deteriorating macroeconomic conditions (including increases in uninsured and underinsured patients); potential increased expenses related to labor, supply chain or other expenditures; workforce disruptions; supply shortages and disruptions; and the timing, availability and adoption of effective medical treatments and vaccines, (2) the impact of our substantial indebtedness and the ability to refinance such indebtedness on acceptable terms, as well as risks associated with disruptions in the financial markets and the business of financial institutions as the result of the COVID-19 pandemic which could impact us from a financial perspective, (3) the impact of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the "Affordable Care Act"), including the effects of changes or court challenges to the Affordable Care Act or additional 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, including proposals to expand coverage of federally-funded 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 the COVID-19 pandemic, (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 American Rescue Plan Act of 2021, 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) the highly competitive nature of the health care business, (9) 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, (10) the efforts of health insurers, health care providers, large employer groups and others to contain health care costs, (11) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (12) increases in wages and the ability to attract and retain qualified management and personnel, including affiliated physicians, nurses and medical and technical support personnel, (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 economic and business conditions (and the impact thereof on the economy, financial markets and banking industry) resulting from the COVID-19 pandemic, (16) the emergence of and effects related to other 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, or similar events beyond our control, (25) changes in the 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, 2020 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.

HCA Healthcare, Inc.

Condensed Consolidated Comprehensive Income Statements

Third Quarter

(Dollars in millions, except per share amounts)

2021

2020

Amount

Ratio

Amount

Ratio

Revenues

$

15,276

100.0

%

$

13,311

100.0

%

Salaries and benefits

7,094

46.4

6,097

45.8

Supplies

2,463

16.1

2,128

16.0

Other operating expenses

2,530

16.6

2,251

16.9

Government stimulus income reversal

-

-

822

6.2

Equity in earnings of affiliates

(35

)

(0.2

)

(40

)

(0.3

)

Depreciation and amortization

716

4.7

694

5.2

Interest expense

398

2.6

385

2.9

Gains on sales of facilities

(1,047

)

(6.9

)

(14

)

(0.1

)

12,119

79.3

12,323

92.6

Income before income taxes

3,157

20.7

988

7.4

Provision for income taxes

685

4.5

209

1.5

Net income

2,472

16.2

779

5.9

Net income attributable to noncontrolling interests

203

1.3

111

0.9

Net income attributable to HCA Healthcare, Inc.

$

2,269

14.9

$

668

5.0

Diluted earnings per share

$

7.00

$

1.95

Shares used in computing diluted earnings per share (millions)

324.029

343.346

Comprehensive income attributable to HCA Healthcare, Inc.

$

2,252

$

715

HCA Healthcare, Inc.

Condensed Consolidated Comprehensive Income Statements

For the Nine Months Ended September 30, 2021 and 2020

(Dollars in millions, except per share amounts)

2021

2020

Amount

Ratio

Amount

Ratio

Revenues

$

43,688

100.0

%

$

37,240

100.0

%

Salaries and benefits

19,780

45.3

17,545

47.1

Supplies

7,067

16.2

5,999

16.1

Other operating expenses

7,424

17.0

6,825

18.3

Equity in earnings of affiliates

(78

)

(0.2

)

(48

)

(0.1

)

Depreciation and amortization

2,125

4.8

2,059

5.6

Interest expense

1,168

2.7

1,201

3.2

Losses (gains) on sales of facilities

(1,057

)

(2.4

)

6

-

Losses on retirement of debt

12

-

295

0.8

36,441

83.4

33,882

91.0

Income before income taxes

7,247

16.6

3,358

9.0

Provision for income taxes

1,531

3.5

665

1.8

Net income

5,716

13.1

2,693

7.2

Net income attributable to noncontrolling interests

574

1.3

365

0.9

Net income attributable to HCA Healthcare, Inc

$

5,142

11.8

$

2,328

6.3

Diluted earnings per share

$

15.43

$

6.79

Shares used in computing diluted earnings per share (millions)

333.248

343.014

Comprehensive income attributable to HCA Healthcare, Inc.

$

5,152

$

2,273

HCA Healthcare, Inc.

Condensed Consolidated Balance Sheets

(Dollars in millions)

September 30,

June 30,

December 31,

2021

2021

2020

ASSETS

Current assets:

Cash and cash equivalents

$

1,027

$

1,120

$

1,793

Accounts receivable

8,433

7,636

7,051

Inventories

2,019

2,027

2,025

Other

1,769

1,692

1,464

13,248

12,475

12,333

Property and equipment, at cost

50,695

50,698

49,317

Accumulated depreciation

(27,148

)

(27,227

)

(26,118

)

23,547

23,471

23,199

Investments of insurance subsidiaries

418

410

388

Investments in and advances to affiliates

412

382

422

Goodwill and other intangible assets

9,153

8,680

8,578

Right-of-use operating lease assets

2,099

2,118

2,024

Other

685

628

546

$

49,562

$

48,164

$

47,490

LIABILITIES AND STOCKHOLDERS' EQUITY

Current liabilities:

Accounts payable

$

3,759

$

3,531

$

3,535

Accrued salaries

2,134

1,896

1,720

Other accrued expenses

3,481

2,935

3,240

Long-term debt due within one year

250

253

209

9,624

8,615

8,704

Long-term debt, less debt issuance costs and discounts of $253, $255 and $236

32,049

32,319

30,795

Professional liability risks

1,522

1,585

1,486

Right-of-use operating lease obligations

1,742

1,767

1,673

Income taxes and other liabilities

2,800

2,088

1,940

Stockholders' equity:

Stockholders' (deficit) equity attributable to HCA Healthcare, Inc.

(695

)

(593

)

572

Noncontrolling interests

2,520

2,383

2,320

1,825

1,790

2,892

$

49,562

$

48,164

$

47,490

HCA Healthcare, Inc.

Condensed Consolidated Statements of Cash Flows

For the Nine Months Ended September 30, 2021 and 2020

(Dollars in millions)

2021

2020

Cash flows from operating activities:

Net income

$

5,716

$

2,693

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

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

Accounts receivable

(1,312

)

930

Inventories and other assets

(333

)

(36

)

Accounts payable and accrued expenses

731

542

Government stimulus refund liability

-

6,123

Depreciation and amortization

2,125

2,059

Income taxes

185

(114

)

Losses (gains) on sales of facilities .

(1,057

)

6

Losses on retirement of debt

12

295

Amortization of debt issuance costs and discounts

21

22

Share-based compensation

...

341

229

Other

87

66

Net cash provided by operating activities

6,516

12,815

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