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Supplemental Condensed Consolidating Financial Information And Other Collateral-related Information | 12 Months Ended
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Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract] |
Supplemental Condensed Consolidating Financial Information And Other Collateral-related Information | NOTE 17 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION AND OTHER COLLATERAL-RELATED INFORMATION HCA Inc. is a 100% owned direct subsidiary of HCA Healthcare, Inc. HCA Healthcare, Inc. has $1.000 billion aggregate principal amount of 6.25% senior unsecured notes due 2021 outstanding. These notes are senior unsecured obligations and are not guaranteed by any of our subsidiaries. The senior secured credit facilities and senior secured notes described in Note 9 are jointly and severally, and 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 ABL credit facility). Our condensed consolidating balance sheets at December 31, 2019 and 2018 and condensed consolidating statements of comprehensive income and cash flows for each of the three years in the period ended December 31, 2019, 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 YEAR ENDED DECEMBER 31, 2019 (Dollars in millions)
|  | HCA Healthcare, Inc. Issuer |  |  | HCA Inc. Issuer |  |  | Subsidiary Guarantors |  |  | Subsidiary Non- Guarantors |  |  | Eliminations |  |  | Condensed Consolidated |
Revenues |  | $ | — |  |  | $ | — |  |  | $ | 29,220 |  |  | $ | 22,116 |  |  | $ | — |  |  | $ | 51,336 |
Salaries and benefits |  |  | — |  |  |  | — |  |  |  | 12,898 |  |  |  | 10,662 |  |  |  | — |  |  |  | 23,560 |
Supplies |  |  | — |  |  |  | — |  |  |  | 4,802 |  |  |  | 3,679 |  |  |  | — |  |  |  | 8,481 |
Other operating expenses |  |  | 7 |  |  |  | — |  |  |  | 4,643 |  |  |  | 4,831 |  |  |  | — |  |  |  | 9,481 |
Equity in earnings of affiliates |  |  | (3,597 | ) |  |  | — |  |  |  | (6 | ) |  |  | (37 | ) |  |  | 3,597 |  |  |  | (43 | )
Depreciation and amortization |  |  | — |  |  |  | — |  |  |  | 1,447 |  |  |  | 1,149 |  |  |  | — |  |  |  | 2,596 |
Interest expense (income) |  |  | 64 |  |  |  | 4,025 |  |  |  | (2,001 | ) |  |  | (264 | ) |  |  | — |  |  |  | 1,824 |
Gains on sales of facilities |  |  | — |  |  |  | — |  |  |  | (14 | ) |  |  | (4 | ) |  |  | — |  |  |  | (18 | )
Losses on retirement of debt |  |  | — |  |  |  | 211 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 211 |
Management fees |  |  | — |  |  |  | — |  |  |  | (768 | ) |  |  | 768 |  |  |  | — |  |  |  | — |
|  |  | (3,526 | ) |  |  | 4,236 |  |  |  | 21,001 |  |  |  | 20,784 |  |  |  | 3,597 |  |  |  | 46,092 |
Income (loss) before income taxes |  |  | 3,526 |  |  |  | (4,236 | ) |  |  | 8,219 |  |  |  | 1,332 |  |  |  | (3,597 | ) |  |  | 5,244 |
Provision (benefit) for income taxes |  |  | 21 |  |  |  | (976 | ) |  |  | 1,874 |  |  |  | 180 |  |  |  | — |  |  |  | 1,099 |
Net income (loss) |  |  | 3,505 |  |  |  | (3,260 | ) |  |  | 6,345 |  |  |  | 1,152 |  |  |  | (3,597 | ) |  |  | 4,145 |
Net income attributable to noncontrolling interests |  |  | — |  |  |  | — |  |  |  | 91 |  |  |  | 549 |  |  |  | — |  |  |  | 640 |
Net income (loss) attributable to HCA Healthcare, Inc. |  | $ | 3,505 |  |  | $ | (3,260 | ) |  | $ | 6,254 |  |  | $ | 603 |  |  | $ | (3,597 | ) |  | $ | 3,505 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. |  | $ | 3,426 |  |  | $ | (3,311 | ) |  | $ | 6,215 |  |  | $ | 614 |  |  | $ | (3,518 | ) |  | $ | 3,426 |
HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE YEAR ENDED DECEMBER 31, 2018 (Dollars in millions)
|  | HCA Healthcare, Inc. Issuer |  |  | HCA Inc. Issuer |  |  | Subsidiary Guarantors |  |  | Subsidiary Non- Guarantors |  |  | Eliminations |  |  | Condensed Consolidated |
Revenues |  | $ | — |  |  | $ | — |  |  | $ | 27,482 |  |  | $ | 19,195 |  |  | $ | — |  |  | $ | 46,677 |
Salaries and benefits |  |  | — |  |  |  | — |  |  |  | 12,287 |  |  |  | 9,138 |  |  |  | — |  |  |  | 21,425 |
Supplies |  |  | — |  |  |  | — |  |  |  | 4,560 |  |  |  | 3,164 |  |  |  | — |  |  |  | 7,724 |
Other operating expenses |  |  | 8 |  |  |  | — |  |  |  | 4,463 |  |  |  | 4,137 |  |  |  | — |  |  |  | 8,608 |
Equity in earnings of affiliates |  |  | (3,688 | ) |  |  | — |  |  |  | (7 | ) |  |  | (22 | ) |  |  | 3,688 |  |  |  | (29 | )
Depreciation and amortization |  |  | — |  |  |  | — |  |  |  | 1,335 |  |  |  | 943 |  |  |  | — |  |  |  | 2,278 |
Interest expense (income) |  |  | 64 |  |  |  | 3,580 |  |  |  | (1,635 | ) |  |  | (254 | ) |  |  | — |  |  |  | 1,755 |
Gains on sales of facilities |  |  | — |  |  |  | — |  |  |  | (357 | ) |  |  | (71 | ) |  |  | — |  |  |  | (428 | )
Losses on retirement of debt |  |  | — |  |  |  | 9 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 9 |
Management fees |  |  | — |  |  |  | — |  |  |  | (639 | ) |  |  | 639 |  |  |  | — |  |  |  | — |
|  |  | (3,616 | ) |  |  | 3,589 |  |  |  | 20,007 |  |  |  | 17,674 |  |  |  | 3,688 |  |  |  | 41,342 |
Income (loss) before income taxes |  |  | 3,616 |  |  |  | (3,589 | ) |  |  | 7,475 |  |  |  | 1,521 |  |  |  | (3,688 | ) |  |  | 5,335 |
Provision (benefit) for income taxes |  |  | (171 | ) |  |  | (834 | ) |  |  | 1,714 |  |  |  | 237 |  |  |  | — |  |  |  | 946 |
Net income (loss) |  |  | 3,787 |  |  |  | (2,755 | ) |  |  | 5,761 |  |  |  | 1,284 |  |  |  | (3,688 | ) |  |  | 4,389 |
Net income attributable to noncontrolling interests |  |  | — |  |  |  | — |  |  |  | 99 |  |  |  | 503 |  |  |  | — |  |  |  | 602 |
Net income (loss) attributable to HCA Healthcare, Inc. |  | $ | 3,787 |  |  | $ | (2,755 | ) |  | $ | 5,662 |  |  | $ | 781 |  |  | $ | (3,688 | ) |  | $ | 3,787 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. |  | $ | 3,779 |  |  | $ | (2,745 | ) |  | $ | 5,712 |  |  | $ | 713 |  |  | $ | (3,680 | ) |  | $ | 3,779 |
HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT FOR THE YEAR ENDED DECEMBER 31, 2017 (Dollars in millions)
|  | HCA Healthcare, Inc. Issuer |  |  | HCA Inc. Issuer |  |  | Subsidiary Guarantors |  |  | Subsidiary Non- Guarantors |  |  | Eliminations |  |  | Condensed Consolidated |
Revenues |  | $ | — |  |  | $ | — |  |  | $ | 25,774 |  |  | $ | 17,840 |  |  | $ | — |  |  | $ | 43,614 |
Salaries and benefits |  |  | — |  |  |  | — |  |  |  | 11,619 |  |  |  | 8,440 |  |  |  | — |  |  |  | 20,059 |
Supplies |  |  | — |  |  |  | — |  |  |  | 4,286 |  |  |  | 3,030 |  |  |  | — |  |  |  | 7,316 |
Other operating expenses |  |  | 6 |  |  |  | — |  |  |  | 4,249 |  |  |  | 3,796 |  |  |  | — |  |  |  | 8,051 |
Equity in earnings of affiliates |  |  | (2,476 | ) |  |  | — |  |  |  | (6 | ) |  |  | (39 | ) |  |  | 2,476 |  |  |  | (45 | )
Depreciation and amortization |  |  | — |  |  |  | — |  |  |  | 1,237 |  |  |  | 894 |  |  |  | — |  |  |  | 2,131 |
Interest expense (income) |  |  | 64 |  |  |  | 3,088 |  |  |  | (1,309 | ) |  |  | (153 | ) |  |  | — |  |  |  | 1,690 |
Gains on sales of facilities |  |  | — |  |  |  | — |  |  |  | (2 | ) |  |  | (6 | ) |  |  | — |  |  |  | (8 | )
Losses on retirement of debt |  |  | — |  |  |  | 39 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 39 |
Management fees |  |  | — |  |  |  | — |  |  |  | (621 | ) |  |  | 621 |  |  |  | — |  |  |  | — |
|  |  | (2,406 | ) |  |  | 3,127 |  |  |  | 19,453 |  |  |  | 16,583 |  |  |  | 2,476 |  |  |  | 39,233 |
Income (loss) before income taxes |  |  | 2,406 |  |  |  | (3,127 | ) |  |  | 6,321 |  |  |  | 1,257 |  |  |  | (2,476 | ) |  |  | 4,381 |
Provision (benefit) for income taxes |  |  | 190 |  |  |  | (1,154 | ) |  |  | 2,293 |  |  |  | 309 |  |  |  | — |  |  |  | 1,638 |
Net income (loss) |  |  | 2,216 |  |  |  | (1,973 | ) |  |  | 4,028 |  |  |  | 948 |  |  |  | (2,476 | ) |  |  | 2,743 |
Net income attributable to noncontrolling interests |  |  | — |  |  |  | — |  |  |  | 108 |  |  |  | 419 |  |  |  | — |  |  |  | 527 |
Net income (loss) attributable to HCA Healthcare, Inc. |  | $ | 2,216 |  |  | $ | (1,973 | ) |  | $ | 3,920 |  |  | $ | 529 |  |  | $ | (2,476 | ) |  | $ | 2,216 |
Comprehensive income (loss) attributable to HCA Healthcare, Inc. |  | $ | 2,276 |  |  | $ | (1,953 | ) |  | $ | 3,898 |  |  | $ | 591 |  |  | $ | (2,536 | ) |  | $ | 2,276 |
HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET DECEMBER 31, 2019 (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 |  | $ | — |  |  | $ | — |  |  | $ | 118 |  |  | $ | 503 |  |  | $ | — |  |  | $ | 621 |
Accounts receivable, net |  |  | — |  |  |  | — |  |  |  | 4,037 |  |  |  | 3,343 |  |  |  | — |  |  |  | 7,380 |
Inventories |  |  | — |  |  |  | — |  |  |  | 1,208 |  |  |  | 641 |  |  |  | — |  |  |  | 1,849 |
Other |  |  | — |  |  |  | — |  |  |  | 727 |  |  |  | 619 |  |  |  | — |  |  |  | 1,346 |
|  |  | — |  |  |  | — |  |  |  | 6,090 |  |  |  | 5,106 |  |  |  | — |  |  |  | 11,196 |
Property and equipment, net |  |  | — |  |  |  | — |  |  |  | 13,418 |  |  |  | 9,297 |  |  |  | — |  |  |  | 22,715 |
Investments of insurance subsidiaries |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 315 |  |  |  | — |  |  |  | 315 |
Investments in and advances to affiliates |  |  | 36,684 |  |  |  | — |  |  |  | 29 |  |  |  | 220 |  |  |  | (36,684 | ) |  |  | 249 |
Goodwill and other intangible assets |  |  | — |  |  |  | — |  |  |  | 5,743 |  |  |  | 2,526 |  |  |  | — |  |  |  | 8,269 |
Right-of-use operating lease assets |  |  | — |  |  |  | — |  |  |  | 455 |  |  |  | 1,379 |  |  |  | — |  |  |  | 1,834 |
Other |  |  | 300 |  |  |  | 3 |  |  |  | 29 |  |  |  | 148 |  |  |  | — |  |  |  | 480 |
|  | $ | 36,984 |  |  | $ | 3 |  |  | $ | 25,764 |  |  | $ | 18,991 |  |  | $ | (36,684 | ) |  | $ | 45,058 |
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Current liabilities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Accounts payable |  | $ | — |  |  | $ | — |  |  | $ | 1,903 |  |  | $ | 1,002 |  |  | $ | — |  |  | $ | 2,905 |
Accrued salaries |  |  | — |  |  |  | — |  |  |  | 1,070 |  |  |  | 705 |  |  |  | — |  |  |  | 1,775 |
Other accrued expenses |  |  | 85 |  |  |  | 341 |  |  |  | 1,001 |  |  |  | 1,505 |  |  |  | — |  |  |  | 2,932 |
Long-term debt due within one year |  |  | — |  |  |  | 54 |  |  |  | 50 |  |  |  | 41 |  |  |  | — |  |  |  | 145 |
|  |  | 85 |  |  |  | 395 |  |  |  | 4,024 |  |  |  | 3,253 |  |  |  | — |  |  |  | 7,757 |
Long-term debt, net |  |  | 998 |  |  |  | 32,016 |  |  |  | 213 |  |  |  | 350 |  |  |  | — |  |  |  | 33,577 |
Intercompany balances |  |  | 38,089 |  |  |  | (4,314 | ) |  |  | (33,828 | ) |  |  | 53 |  |  |  | — |  |  |  | — |
Professional liability risks |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 1,370 |  |  |  | — |  |  |  | 1,370 |
Right-of-use operating lease obligations |  |  | — |  |  |  | — |  |  |  | 345 |  |  |  | 1,154 |  |  |  | — |  |  |  | 1,499 |
Income taxes and other liabilities |  |  | 620 |  |  |  | 7 |  |  |  | 252 |  |  |  | 541 |  |  |  | — |  |  |  | 1,420 |
|  |  | 39,792 |  |  |  | 28,104 |  |  |  | (28,994 | ) |  |  | 6,721 |  |  |  | — |  |  |  | 45,623 |
Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. |  |  | (2,808 | ) |  |  | (28,101 | ) |  |  | 54,652 |  |  |  | 10,133 |  |  |  | (36,684 | ) |  |  | (2,808 | )
Noncontrolling interests |  |  | — |  |  |  | — |  |  |  | 106 |  |  |  | 2,137 |  |  |  | — |  |  |  | 2,243 |
|  |  | (2,808 | ) |  |  | (28,101 | ) |  |  | 54,758 |  |  |  | 12,270 |  |  |  | (36,684 | ) |  |  | (565 | )
|  | $ | 36,984 |  |  | $ | 3 |  |  | $ | 25,764 |  |  | $ | 18,991 |  |  | $ | (36,684 | ) |  | $ | 45,058 |
HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING BALANCE SHEET DECEMBER 31, 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 |  | $ | — |  |  | $ | — |  |  | $ | 174 |  |  | $ | 328 |  |  | $ | — |  |  | $ | 502 |
Accounts receivable, net |  |  | — |  |  |  | — |  |  |  | 3,964 |  |  |  | 2,825 |  |  |  | — |  |  |  | 6,789 |
Inventories |  |  | — |  |  |  | — |  |  |  | 1,178 |  |  |  | 554 |  |  |  | — |  |  |  | 1,732 |
Other |  |  | — |  |  |  | — |  |  |  | 669 |  |  |  | 521 |  |  |  | — |  |  |  | 1,190 |
|  |  | — |  |  |  | — |  |  |  | 5,985 |  |  |  | 4,228 |  |  |  | — |  |  |  | 10,213 |
Property and equipment, net |  |  | — |  |  |  | — |  |  |  | 12,450 |  |  |  | 7,307 |  |  |  | — |  |  |  | 19,757 |
Investments of insurance subsidiaries |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 362 |  |  |  | — |  |  |  | 362 |
Investments in and advances to affiliates |  |  | 33,166 |  |  |  | — |  |  |  | 29 |  |  |  | 203 |  |  |  | (33,166 | ) |  |  | 232 |
Goodwill and other intangible assets |  |  | — |  |  |  | — |  |  |  | 5,724 |  |  |  | 2,229 |  |  |  | — |  |  |  | 7,953 |
Other |  |  | 478 |  |  |  | 64 |  |  |  | 35 |  |  |  | 113 |  |  |  | — |  |  |  | 690 |
|  | $ | 33,644 |  |  | $ | 64 |  |  | $ | 24,223 |  |  | $ | 14,442 |  |  | $ | (33,166 | ) |  | $ | 39,207 |
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Current liabilities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Accounts payable |  | $ | — |  |  | $ | — |  |  | $ | 1,721 |  |  | $ | 856 |  |  | $ | — |  |  | $ | 2,577 |
Accrued salaries |  |  | — |  |  |  | — |  |  |  | 998 |  |  |  | 582 |  |  |  | — |  |  |  | 1,580 |
Other accrued expenses |  |  | 142 |  |  |  | 403 |  |  |  | 905 |  |  |  | 1,174 |  |  |  | — |  |  |  | 2,624 |
Long-term debt due within one year |  |  | — |  |  |  | 696 |  |  |  | 55 |  |  |  | 37 |  |  |  | — |  |  |  | 788 |
|  |  | 142 |  |  |  | 1,099 |  |  |  | 3,679 |  |  |  | 2,649 |  |  |  | — |  |  |  | 7,569 |
Long-term debt, net |  |  | 996 |  |  |  | 30,544 |  |  |  | 212 |  |  |  | 281 |  |  |  | — |  |  |  | 32,033 |
Intercompany balances |  |  | 36,951 |  |  |  | (6,789 | ) |  |  | (28,415 | ) |  |  | (1,747 | ) |  |  | — |  |  |  | — |
Professional liability risks |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 1,275 |  |  |  | — |  |  |  | 1,275 |
Income taxes and other liabilities |  |  | 505 |  |  |  | — |  |  |  | 223 |  |  |  | 520 |  |  |  | — |  |  |  | 1,248 |
|  |  | 38,594 |  |  |  | 24,854 |  |  |  | (24,301 | ) |  |  | 2,978 |  |  |  | — |  |  |  | 42,125 |
Stockholders’ (deficit) equity attributable to HCA Healthcare, Inc. |  |  | (4,950 | ) |  |  | (24,790 | ) |  |  | 48,437 |  |  |  | 9,519 |  |  |  | (33,166 | ) |  |  | (4,950 | )
Noncontrolling interests |  |  | — |  |  |  | — |  |  |  | 87 |  |  |  | 1,945 |  |  |  | — |  |  |  | 2,032 |
|  |  | (4,950 | ) |  |  | (24,790 | ) |  |  | 48,524 |  |  |  | 11,464 |  |  |  | (33,166 | ) |  |  | (2,918 | )
|  | $ | 33,644 |  |  | $ | 64 |  |  | $ | 24,223 |  |  | $ | 14,442 |  |  | $ | (33,166 | ) |  | $ | 39,207 |
HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE YEAR ENDED DECEMBER 31, 2019 (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) |  | $ | 3,505 |  |  | $ | (3,260 | ) |  | $ | 6,345 |  |  | $ | 1,152 |  |  | $ | (3,597 | ) |  | $ | 4,145 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Change in operating assets and liabilities |  |  | — |  |  |  | (62 | ) |  |  | 17 |  |  |  | (43 | ) |  |  | — |  |  |  | (88 | )
Depreciation and amortization |  |  | — |  |  |  | — |  |  |  | 1,447 |  |  |  | 1,149 |  |  |  | — |  |  |  | 2,596 |
Income taxes |  |  | 250 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 250 |
Gains on sales of facilities |  |  | — |  |  |  | — |  |  |  | (14 | ) |  |  | (4 | ) |  |  | — |  |  |  | (18 | )
Losses on retirement of debt |  |  | — |  |  |  | 211 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 211 |
Amortization of debt issuance costs |  |  | — |  |  |  | 30 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 30 |
Share-based compensation |  |  | — |  |  |  | — |  |  |  | 347 |  |  |  | — |  |  |  | — |  |  |  | 347 |
Equity in earnings of affiliates |  |  | (3,597 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 3,597 |  |  |  | — |
Other |  |  | 109 |  |  |  | — |  |  |  | 23 |  |  |  | (3 | ) |  |  | — |  |  |  | 129 |
Net cash provided by (used in) operating activities |  |  | 267 |  |  |  | (3,081 | ) |  |  | 8,165 |  |  |  | 2,251 |  |  |  | — |  |  |  | 7,602 |
Cash flows from investing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Purchase of property and equipment |  |  | — |  |  |  | — |  |  |  | (2,342 | ) |  |  | (1,816 | ) |  |  | — |  |  |  | (4,158 | )
Acquisition of hospitals and health care entities |  |  | — |  |  |  | — |  |  |  | (43 | ) |  |  | (1,639 | ) |  |  | — |  |  |  | (1,682 | )
Sales of hospitals and health care entities |  |  | — |  |  |  | — |  |  |  | 42 |  |  |  | 19 |  |  |  | — |  |  |  | 61 |
Change in investments |  |  | — |  |  |  | — |  |  |  | 6 |  |  |  | 19 |  |  |  | — |  |  |  | 25 |
Other |  |  | — |  |  |  | — |  |  |  | (7 | ) |  |  | 41 |  |  |  | — |  |  |  | 34 |
Net cash used in investing activities |  |  | — |  |  |  | — |  |  |  | (2,344 | ) |  |  | (3,376 | ) |  |  | — |  |  |  | (5,720 | )
Cash flows from financing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Issuance of long-term debt |  |  | — |  |  |  | 6,451 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 6,451 |
Net change in revolving bank credit facilities |  |  | — |  |  |  | (560 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (560 | )
Repayment of long-term debt |  |  | — |  |  |  | (5,227 | ) |  |  | (59 | ) |  |  | (38 | ) |  |  | — |  |  |  | (5,324 | )
Distributions to noncontrolling interests |  |  | — |  |  |  | — |  |  |  | (104 | ) |  |  | (438 | ) |  |  | — |  |  |  | (542 | )
Payment of debt issuance costs |  |  | — |  |  |  | (73 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (73 | )
Payment of dividends |  |  | (550 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (550 | )
Repurchases of common stock |  |  | (1,031 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (1,031 | )
Changes in intercompany balances with affiliates, net |  |  | 1,457 |  |  |  | 2,490 |  |  |  | (5,714 | ) |  |  | 1,767 |  |  |  | — |  |  |  | — |
Other |  |  | (143 | ) |  |  | — |  |  |  | — |  |  |  | 1 |  |  |  | — |  |  |  | (142 | )
Net cash (used in) provided by financing activities |  |  | (267 | ) |  |  | 3,081 |  |  |  | (5,877 | ) |  |  | 1,292 |  |  |  | — |  |  |  | (1,771 | )
Effect of exchange rate changes on cash and cash equivalents |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 8 |  |  |  | — |  |  |  | 8 |
Change in cash and cash equivalents |  |  | — |  |  |  | — |  |  |  | (56 | ) |  |  | 175 |  |  |  | — |  |  |  | 119 |
Cash and cash equivalents at beginning of period |  |  | — |  |  |  | — |  |  |  | 174 |  |  |  | 328 |  |  |  | — |  |  |  | 502 |
Cash and cash equivalents at end of period |  | $ | — |  |  | $ | — |  |  | $ | 118 |  |  | $ | 503 |  |  | $ | — |  |  | $ | 621 |
HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE YEAR ENDED DECEMBER 31, 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) |  | $ | 3,787 |  |  | $ | (2,755 | ) |  | $ | 5,761 |  |  | $ | 1,284 |  |  | $ | (3,688 | ) |  | $ | 4,389 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Change in operating assets and liabilities |  |  | — |  |  |  | 23 |  |  |  | (178 | ) |  |  | 188 |  |  |  | — |  |  |  | 33 |
Depreciation and amortization |  |  | — |  |  |  | — |  |  |  | 1,335 |  |  |  | 943 |  |  |  | — |  |  |  | 2,278 |
Income taxes |  |  | 74 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 74 |
Gains on sales of facilities |  |  | — |  |  |  | — |  |  |  | (357 | ) |  |  | (71 | ) |  |  | — |  |  |  | (428 | )
Losses on retirement of debt |  |  | — |  |  |  | 9 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 9 |
Amortization of debt issuance costs |  |  | — |  |  |  | 31 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 31 |
Share-based compensation |  |  | — |  |  |  | — |  |  |  | 268 |  |  |  | — |  |  |  | — |  |  |  | 268 |
Equity in earnings of affiliates |  |  | (3,688 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 3,688 |  |  |  | — |
Other |  |  | 91 |  |  |  | — |  |  |  | 25 |  |  |  | (9 | ) |  |  | — |  |  |  | 107 |
Net cash provided by (used in) operating activities |  |  | 264 |  |  |  | (2,692 | ) |  |  | 6,854 |  |  |  | 2,335 |  |  |  | — |  |  |  | 6,761 |
Cash flows from investing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Purchase of property and equipment |  |  | — |  |  |  | — |  |  |  | (2,008 | ) |  |  | (1,565 | ) |  |  | — |  |  |  | (3,573 | )
Acquisition of hospitals and health care entities |  |  | — |  |  |  | — |  |  |  | (897 | ) |  |  | (356 | ) |  |  | — |  |  |  | (1,253 | )
Sales of hospitals and health care entities |  |  | — |  |  |  | — |  |  |  | 770 |  |  |  | 38 |  |  |  | — |  |  |  | 808 |
Change in investments |  |  | — |  |  |  | — |  |  |  | 12 |  |  |  | 45 |  |  |  | — |  |  |  | 57 |
Other |  |  | — |  |  |  | — |  |  |  | (9 | ) |  |  | 69 |  |  |  | — |  |  |  | 60 |
Net cash used in investing activities |  |  | — |  |  |  | — |  |  |  | (2,132 | ) |  |  | (1,769 | ) |  |  | — |  |  |  | (3,901 | )
Cash flows from financing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Issuance of long-term debt |  |  | — |  |  |  | 2,000 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 2,000 |
Net change in revolving bank credit facilities |  |  | — |  |  |  | (640 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (640 | )
Repayment of long-term debt |  |  | — |  |  |  | (1,590 | ) |  |  | (72 | ) |  |  | (42 | ) |  |  | — |  |  |  | (1,704 | )
Distributions to noncontrolling interests |  |  | — |  |  |  | — |  |  |  | (83 | ) |  |  | (358 | ) |  |  | — |  |  |  | (441 | )
Payment of debt issuance costs |  |  | — |  |  |  | (25 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (25 | )
Payment of dividends |  |  | (487 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (487 | )
Repurchases of common stock |  |  | (1,530 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (1,530 | )
Changes in intercompany balances with affiliates, net |  |  | 2,004 |  |  |  | 2,947 |  |  |  | (4,505 | ) |  |  | (446 | ) |  |  | — |  |  |  | — |
Other |  |  | (252 | ) |  |  | — |  |  |  | — |  |  |  | 4 |  |  |  | — |  |  |  | (248 | )
Net cash (used in) provided by financing activities |  |  | (265 | ) |  |  | 2,692 |  |  |  | (4,660 | ) |  |  | (842 | ) |  |  | — |  |  |  | (3,075 | )
Effect of exchange rate changes on cash and cash equivalents |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (15 | ) |  |  | — |  |  |  | (15 | )
Change in cash and cash equivalents |  |  | (1 | ) |  |  | — |  |  |  | 62 |  |  |  | (291 | ) |  |  | — |  |  |  | (230 | )
Cash and cash equivalents at beginning of period |  |  | 1 |  |  |  | — |  |  |  | 112 |  |  |  | 619 |  |  |  | — |  |  |  | 732 |
Cash and cash equivalents at end of period |  | $ | — |  |  | $ | — |  |  | $ | 174 |  |  | $ | 328 |  |  | $ | — |  |  | $ | 502 |
HCA HEALTHCARE, INC. CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS FOR THE YEAR ENDED DECEMBER 31, 2017 (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) |  | $ | 2,216 |  |  | $ | (1,973 | ) |  | $ | 4,028 |  |  | $ | 948 |  |  | $ | (2,476 | ) |  | $ | 2,743 |
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Change in operating assets and liabilities |  |  | — |  |  |  | (193 | ) |  |  | (219 | ) |  |  | 116 |  |  |  | — |  |  |  | (296 | )
Depreciation and amortization |  |  | — |  |  |  | — |  |  |  | 1,237 |  |  |  | 894 |  |  |  | — |  |  |  | 2,131 |
Income taxes |  |  | 433 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 433 |
Gains on sales of facilities |  |  | — |  |  |  | — |  |  |  | (2 | ) |  |  | (6 | ) |  |  | — |  |  |  | (8 | )
Losses on retirement of debt |  |  | — |  |  |  | 39 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 39 |
Amortization of debt issuance costs |  |  | — |  |  |  | 31 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 31 |
Share-based compensation |  |  | — |  |  |  | — |  |  |  | 270 |  |  |  | — |  |  |  | — |  |  |  | 270 |
Equity in earnings of affiliates |  |  | (2,476 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 2,476 |  |  |  | — |
Other |  |  | 78 |  |  |  | — |  |  |  | — |  |  |  | 5 |  |  |  | — |  |  |  | 83 |
Net cash provided by (used in) operating activities |  |  | 251 |  |  |  | (2,096 | ) |  |  | 5,314 |  |  |  | 1,957 |  |  |  | — |  |  |  | 5,426 |
Cash flows from investing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Purchase of property and equipment |  |  | — |  |  |  | — |  |  |  | (1,681 | ) |  |  | (1,334 | ) |  |  | — |  |  |  | (3,015 | )
Acquisition of hospitals and health care entities |  |  | — |  |  |  | — |  |  |  | (26 | ) |  |  | (1,186 | ) |  |  | — |  |  |  | (1,212 | )
Sales of hospitals and health care entities |  |  | — |  |  |  | — |  |  |  | 14 |  |  |  | 11 |  |  |  | — |  |  |  | 25 |
Change in investments |  |  | — |  |  |  | — |  |  |  | (1 | ) |  |  | (72 | ) |  |  | — |  |  |  | (73 | )
Other |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (4 | ) |  |  | — |  |  |  | (4 | )
Net cash used in investing activities |  |  | — |  |  |  | — |  |  |  | (1,694 | ) |  |  | (2,585 | ) |  |  | — |  |  |  | (4,279 | )
Cash flows from financing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Issuance of long-term debt |  |  | — |  |  |  | 1,500 |  |  |  | — |  |  |  | 2 |  |  |  | — |  |  |  | 1,502 |
Net change in revolving bank credit facilities |  |  | — |  |  |  | 760 |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | 760 |
Repayment of long-term debt |  |  | — |  |  |  | (628 | ) |  |  | (77 | ) |  |  | (48 | ) |  |  | — |  |  |  | (753 | )
Distributions to noncontrolling interests |  |  | — |  |  |  | — |  |  |  | (140 | ) |  |  | (308 | ) |  |  | — |  |  |  | (448 | )
Payment of debt issuance costs |  |  | — |  |  |  | (26 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (26 | )
Repurchases of common stock |  |  | (2,051 | ) |  |  | — |  |  |  | — |  |  |  | — |  |  |  | — |  |  |  | (2,051 | )
Changes in intercompany balances with affiliates, net |  |  | 1,867 |  |  |  | 490 |  |  |  | (3,404 | ) |  |  | 1,047 |  |  |  | — |  |  |  | — |
Other |  |  | (66 | ) |  |  | — |  |  |  | — |  |  |  | 21 |  |  |  | — |  |  |  | (45 | )
Net cash (used in) provided by financing activities |  |  | (250 | ) |  |  | 2,096 |  |  |  | (3,621 | ) |  |  | 714 |  |  |  | — |  |  |  | (1,061 | )
Change in cash and cash equivalents |  |  | 1 |  |  |  | — |  |  |  | (1 | ) |  |  | 86 |  |  |  | — |  |  |  | 86 |
Cash and cash equivalents at beginning of period |  |  | — |  |  |  | — |  |  |  | 113 |  |  |  | 533 |  |  |  | — |  |  |  | 646 |
Cash and cash equivalents at end of period |  | $ | 1 |  |  | $ | — |  |  | $ | 112 |  |  | $ | 619 |  |  | $ | — |  |  | $ | 732 |
Healthtrust, Inc. — The Hospital Company (“Healthtrust”) is the first-tier subsidiary of HCA Inc. The common stock of Healthtrust has been pledged as collateral for the senior secured credit facilities and senior secured notes described in Note 9. Rule 3-16 of Regulation S-X under the Securities Act requires the filing of separate financial statements for any affiliate of the registrant whose securities constitute a substantial portion of the collateral for any class of securities registered or being registered. We believe the separate financial statements requirement applies to Healthtrust due to the pledge of its common stock as collateral for the senior secured notes. Due to the corporate structure relationship of HCA and Healthtrust, HCA’s operating subsidiaries are also the operating subsidiaries of Healthtrust. The corporate structure relationship, combined with the application of push-down accounting in Healthtrust’s consolidated financial statements related to HCA’s debt and financial instruments, results in the consolidated financial statements of Healthtrust being substantially identical to the consolidated financial statements of HCA. The consolidated financial statements of HCA and Healthtrust present the identical amounts for revenues, expenses, net income, assets, liabilities, total stockholders’ deficit, net cash provided by operating activities, net cash used in investing activities and net cash used in financing activities. Certain individual line items in the HCA consolidated statements of stockholders’ deficit and cash flows are combined into one line item in the Healthtrust consolidated statements of stockholder’s deficit and cash flows. Reconciliations of the HCA Healthcare, Inc. Consolidated Statements of Stockholders’ Deficit and Consolidated Statements of Cash Flows presentations to the Healthtrust, Inc. — The Hospital Company Consolidated Statements of Stockholder’s Deficit and Consolidated Statements of Cash Flows presentations for the years ended December 31, are as follows (dollars in millions):
|  | 2019 |  |  | 2018 |  |  | 2017 |
Presentation in HCA Healthcare, Inc. Consolidated Statements of Stockholders’ Deficit: |  |  |  |  |  |  |  |  |  |  |  |
Repurchases of common stock |  | $ | (1,031 | ) |  | $ | (1,530 | ) |  | $ | (2,051 | )
Share-based benefit plans |  |  | 313 |  |  |  | 115 |  |  |  | 281 |
Cash dividends declared ($1.60 per share — 2019 and $1.40 per share — 2018) |  |  | (555 | ) |  |  | (496 | ) |  |  | — |
Other |  |  | (11 | ) |  |  | (12 | ) |  |  | (10 | )
Presentation in Healthtrust, Inc. — The Hospital Company Consolidated Statements of Stockholder’s Deficit: |  |  |  |  |  |  |  |  |  |  |  |
Distributions to HCA Healthcare, Inc., net of contributions from HCA Healthcare, Inc. |  | $ | (1,284 | ) |  | $ | (1,923 | ) |  | $ | (1,780 | )
Presentation in HCA Healthcare, Inc. Consolidated Statements of Cash Flows (cash flows from financing activities): |  |  |  |  |  |  |  |  |  |  |  |
Repurchases of common stock |  | $ | (1,031 | ) |  | $ | (1,530 | ) |  | $ | (2,051 | )
Payment of dividends |  |  | (550 | ) |  |  | (487 | ) |  |  | — |
Presentation in Healthtrust, Inc. — The Hospital Company Consolidated Statements of Cash Flows (cash flows from financing activities): |  |  |  |  |  |  |  |  |  |  |  |
Cash distributions to HCA Healthcare, Inc. |  | $ | (1,581 | ) |  | $ | (2,017 | ) |  | $ | (2,051 | )
Due to the consolidated financial statements of Healthtrust being substantially identical to the consolidated financial statements of HCA, except for the items presented in the table above, the separate consolidated financial statements of Healthtrust are not presented. HCA HEALTHCARE, INC. QUARTERLY CONSOLIDATED FINANCIAL INFORMATION (UNAUDITED) (Dollars in millions, except per share amounts)
|  | 2019 |
|  | First |  |  | Second |  |  | Third |  |  | Fourth |
Revenues |  | $ | 12,517 |  |  | $ | 12,602 |  |  | $ | 12,694 |  |  | $ | 13,523 |
Net income |  | $ | 1,181 | (a) |  | $ | 927 | (b) |  | $ | 764 | (c) |  | $ | 1,273 |
Net income attributable to HCA Healthcare, Inc. |  | $ | 1,039 | (a) |  | $ | 783 | (b) |  | $ | 612 | (c) |  | $ | 1,071 |
Basic earnings per share |  | $ | 3.03 |  |  | $ | 2.29 |  |  | $ | 1.80 |  |  | $ | 3.16 |
Diluted earnings per share |  | $ | 2.97 |  |  | $ | 2.25 |  |  | $ | 1.76 |  |  | $ | 3.09 |
|  | 2018 |
|  | First |  |  | Second |  |  | Third |  |  | Fourth |
Revenues |  | $ | 11,423 |  |  | $ | 11,529 |  |  | $ | 11,451 |  |  | $ | 12,274 |
Net income |  | $ | 1,282 | ( d ) |  | $ | 966 | ( e ) |  | $ | 896 | ( f ) |  | $ | 1,245 | ( g )
Net income attributable to HCA Healthcare, Inc. |  | $ | 1,144 | ( d ) |  | $ | 820 | ( e ) |  | $ | 759 | ( f ) |  | $ | 1,064 | ( g )
Basic earnings per share |  | $ | 3.26 |  |  | $ | 2.35 |  |  | $ | 2.20 |  |  | $ | 3.09 |
Diluted earnings per share |  | $ | 3.18 |  |  | $ | 2.31 |  |  | $ | 2.15 |  |  | $ | 3.01 |
(a) | First quarter results include $1 million of losses on sales of facilities (See Note 3 of the notes to consolidated financial statements).
(b) | Second quarter results include $14 million of gains on sales of facilities (See Note 3 of the notes to consolidated financial statements).
(c) | Third quarter results include $ 162 million of losses on retirement of debt (See Note 9 of the notes to consolidated financial statements).
(d) | F irst quarter results include $305 million of gains on sales of facilities (See Note 3 of the notes to consolidated financial statements).
( e ) | Second quarter results include $8 million of gains on sales of facilities (See Note 3 of the notes to consolidated financial statements).
( f ) | Third quarter results include $ 5 million of gains on sales of facilities (See Note 3 of the notes to consolidated financial statements) and $7 million of losses on retirement of debt (See Note 9 of the notes to consolidated financial statements).
( g ) | Fourth quarter results include $6 million of gains on sales of facilities (See Note 3 of the notes to consolidated financial statements).

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