<SEC-DOCUMENT>0001377739-21-000015.txt : 20210407
<SEC-HEADER>0001377739-21-000015.hdr.sgml : 20210407
<ACCEPTANCE-DATETIME>20210407131334
ACCESSION NUMBER:		0001377739-21-000015
CONFORMED SUBMISSION TYPE:	PX14A6G
PUBLIC DOCUMENT COUNT:		3
FILED AS OF DATE:		20210407
DATE AS OF CHANGE:		20210407
EFFECTIVENESS DATE:		20210407

SUBJECT COMPANY:	

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			HCA Healthcare, Inc.
		CENTRAL INDEX KEY:			0000860730
		STANDARD INDUSTRIAL CLASSIFICATION:	SERVICES-GENERAL MEDICAL & SURGICAL HOSPITALS, NEC [8062]
		IRS NUMBER:				273865930
		FISCAL YEAR END:			1231

	FILING VALUES:
		FORM TYPE:		PX14A6G
		SEC ACT:		1934 Act
		SEC FILE NUMBER:	001-11239
		FILM NUMBER:		21811568

	BUSINESS ADDRESS:	
		STREET 1:		ONE PARK PLZ
		CITY:			NASHVILLE
		STATE:			TN
		ZIP:			37203
		BUSINESS PHONE:		6153449551

	MAIL ADDRESS:	
		STREET 1:		ONE PARK PLAZA
		CITY:			NASHVILLE
		STATE:			TN
		ZIP:			37203

	FORMER COMPANY:	
		FORMER CONFORMED NAME:	HCA Holdings, Inc.
		DATE OF NAME CHANGE:	20101126

	FORMER COMPANY:	
		FORMER CONFORMED NAME:	HCA INC/TN
		DATE OF NAME CHANGE:	20010627

	FORMER COMPANY:	
		FORMER CONFORMED NAME:	HCA THE HEALTHCARE CO
		DATE OF NAME CHANGE:	20010419

FILED BY:		

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			INTERNATIONAL BROTHERHOOD OF TEAMSTERS
		CENTRAL INDEX KEY:			0000919788
		STANDARD INDUSTRIAL CLASSIFICATION:	UNKNOWN SIC - 0000 [0000]
		IRS NUMBER:				530215427
		STATE OF INCORPORATION:			DC
		FISCAL YEAR END:			1231

	FILING VALUES:
		FORM TYPE:		PX14A6G

	BUSINESS ADDRESS:	
		STREET 1:		25 LOUISIANA AVENUE, NW
		CITY:			WASHINGTON
		STATE:			DC
		ZIP:			20010
		BUSINESS PHONE:		2026246800
</SEC-HEADER>
<DOCUMENT>
<TYPE>PX14A6G
<SEQUENCE>1
<FILENAME>hca21shletter.htm
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<P>&nbsp;</P>

<P style="TEXT-ALIGN: center">&nbsp; <A name="page_1"></A><B><FONT lang=EN-US style="FONT-SIZE: 12pt" face="times new roman">SECURITIES &amp; EXCHANGE COMMISSION</FONT></B></P>

<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><B><FONT lang=EN-US style="FONT-SIZE: 12pt" face="times new roman">WASHINGTON, D.C.&nbsp;&nbsp; 20549</FONT></B></P>

<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><B><FONT lang=EN-US style="FONT-SIZE: 12pt" face="times new roman"></FONT></B>&nbsp;</P>

<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt; LINE-HEIGHT: 106%" align=center><B><FONT lang=EN-US style="FONT-SIZE: 12pt" face="times new roman">NOTICE OF EXEMPT SOLICITATION (VOLUNTARY SUBMISSION)</FONT></B></P>

<P style="MARGIN: 0in 0in 0pt"><B><FONT lang=EN-US style="FONT-SIZE: 12pt" face="times new roman"></FONT></B>&nbsp;</P>

<P style="MARGIN: 0in 0in 0pt"><B><FONT lang=EN-US style="FONT-SIZE: 12pt" face="times new roman">NAME OF REGISTRANT:</FONT></B><FONT lang=EN-US style="FONT-SIZE: 12pt" face="times new roman"> HCA Healthcare, Inc.</FONT></P>

<P style="MARGIN: 0in 0in 0pt"><B><FONT lang=EN-US style="FONT-SIZE: 12pt" face="times new roman">NAME OF PERSON RELYING ON EXEMPTION:</FONT></B><FONT lang=EN-US style="FONT-SIZE: 12pt" face="times new roman"> International Brotherhood of Teamsters</FONT></P>

<P style="MARGIN: 0in 0in 0pt"><B><FONT lang=EN-US style="FONT-SIZE: 12pt" face="times new roman">ADDRESS OF PERSON RELYING ON EXEMPTION:</FONT></B><FONT lang=EN-US style="FONT-SIZE: 12pt" face="times new roman"> 25 Louisiana Avenue, NW, Washington, DC 20001</FONT></P>

<P style="MARGIN: 0in 0in 0pt"><B><FONT lang=EN-US style="FONT-SIZE: 12pt" color=#1a1a1a face="times new roman">Written materials are submitted pursuant to Rule 14a-6(g)(1) promulgated under the Securities Exchange Act of 1934:</FONT></B></P>

<P style="MARGIN: 0in 0in 0pt"><B><FONT lang=EN-US style="FONT-SIZE: 12pt" color=#1a1a1a face="times new roman">__________________________________________________________________________________________________________________________________________________________________</FONT></B></P>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="Times New Roman">April 2021</FONT></P>

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<P style="MARGIN: 0in 0in 0pt"><B><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman">Re: &nbsp;&nbsp;Please Support Shareholder Proposal on&nbsp;</FONT></B><B><FONT lang=EN-US style="FONT-SIZE: 12.5pt; TEXT-DECORATION: none; BACKGROUND: white" color=#0563c1 face="Times New Roman">Impact of Quality Metrics on Executive Compensation</FONT></B><B><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman">&nbsp;at HCA Healthcare, Inc.</FONT></B></P>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="Times New Roman">Dear HCA Shareholders:</FONT></P>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="Times New Roman">The COVID-19 pandemic underscores the centrality of care, quality and human capital management to the operation of private hospitals.&nbsp; It is more important than ever, therefore, that executives are both incentivized and held accountable for performance in these areas. &nbsp;However, at present quality care metrics make up just 20% of HCA&#8217;s annual incentive award, with the remaining 80% tied to EBITDA.</FONT><SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="times new roman">1</FONT></SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="Times New Roman">&nbsp; We believe now is the appropriate time for HCA, building on the experiences of the past year, to more meaningfully embed its pledge that &#8220;quality care is at the core of everything we do.&#8221;&nbsp; Accordingly, we urge your support for Item 5, which calls for a report on the feasibility of increasing the impact of quality metrics on executive pay. </FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="Times New Roman"></FONT>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="Times New Roman">As you review this proposal, we would highlight the following:</FONT></P>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0in 0.5in; TEXT-INDENT: -0.25in"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face=symbol>&#183;</FONT><FONT lang=EN-US style="FONT-SIZE: 7pt" face="times new roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </FONT><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="times new roman">HCA&#8217;s &#8220;Patient Experience,&#8221; arguably the most important metric for a hospital chain, came in well below target in 2020 and far below 2019 levels; nevertheless, the annual incentive award paid out at 142%.</FONT><SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="times new roman">2</FONT></SUP></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0in 0.5in; TEXT-INDENT: -0.25in"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face=symbol>&#183;</FONT><FONT lang=EN-US style="FONT-SIZE: 7pt" face="times new roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </FONT><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="times new roman">The already-limited role of quality metrics is weakened further by the use of an EBITDA multiplier, which can amplify or negate quality care payouts.</FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0in 0.5in; TEXT-INDENT: -0.25in"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face=symbol>&#183;</FONT><FONT lang=EN-US style="FONT-SIZE: 7pt" face="times new roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </FONT><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="times new roman">While HCA hit near-record earnings in 2020, and management enjoyed above target payouts in the short- (142%) and long-term incentive plans (163%), the company </FONT>


<FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="times new roman">continues to face extensive criticism over its human capital management practices and provision of personal protective equipment (PPE) amid the pandemic. </FONT></P>

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<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman"></FONT>&nbsp;</P>

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<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman">This is not a solicitation to vote your proxy. Please DO NOT send us your proxy as it would not be voted.</FONT></P>

<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><FONT style="DISPLAY: none"><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman"></FONT></FONT><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman">1</FONT><FONT style="DISPLAY: none"><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman"></FONT></FONT></P></DIV>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 10pt; VERTICAL-ALIGN: super" face="times new roman">1</FONT><FONT lang=EN-US style="FONT-SIZE: 10pt" face="Times New Roman"> EBITDA is a non-GAAP measure that calculates earnings before interest, taxes, depreciation and amortization.</FONT></P><FONT lang=EN-US></FONT></DIV>

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<P style="MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 10pt; VERTICAL-ALIGN: super" face="times new roman">2</FONT><FONT lang=EN-US style="FONT-SIZE: 10pt" face="Times New Roman"> Patient Experience is measured by two patient surveys, one for inpatient and the other for ER. Questions encompass critical aspects of the hospital experience, such as communication with health professionals, cleanliness, pain management, and the overall rating of the hospital and would you recommend this hospital to friends and family. </FONT></P><FONT lang=EN-US></FONT></DIV></DIV>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="Times New Roman">Overall, for a company that claims, &#8220;quality and patient care&#8230;is an integral part of our compensation programs&#8221; and &#8220;at the core of everything we do,&#8221; it is astonishing to find that of the more than $30 million in compensation paid to CEO Hazen in 2020, just $226,000 was directly tied to incentives to improve quality and patient care performance.</FONT><SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="times new roman">3</FONT></SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="Times New Roman">&nbsp; The company insists that quality of care is embedded within </FONT><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">the EBITDA weighted portion of the annual incentive award, noting that there are &#8220;numerous hospital-based quality arrangements that align quality care and our financial performance.&#8221;&nbsp; However, with </FONT><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="Times New Roman">record EBITDA coupled with below target quality metric results, it is far from clear that EBITDA is effective at capturing quality care performance</FONT><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">. Accordingly, we urge investors to vote in favor of Item 5. </FONT></P>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><B><I><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Sub-Par Quality Care Performance; Above Target Bonus Payouts</FONT></I></B></P>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Given HCA&#8217;s insistence that &#8220;quality and patient care&#8221; is &#8220;at the core of everything we do,&#8221; it is confounding that quality metric scores fell precipitously in 2020, and yet the annual bonus payout vested at 142% of target. </FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Overall, the 20% of the annual bonus weighted to quality metrics paid out at less than 50% in 2020, down from more than 100% last year.&nbsp; Particularly troubling is that the Patient Experience category, arguably the most important measures for a health care company, paid out at just 8% of the target award opportunity, reflecting among other things a near-halving of the company&#8217;s inpatient satisfaction performance.</FONT><SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="times new roman">4</FONT></SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman"> </FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">There is no question that achieving above-target EBITDA ought to be rewarded;</FONT><SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="times new roman">5</FONT></SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman"> however, creating long-term value demands hospitals also deliver on patient outcomes. Given the discrepancy between earnings and care quality in 2020, on the one hand, and the overall 142% payout level for the bonus on the other, it is not clear that the current 80-20 split in the bonus structure appropriately balances these two equally crucial measures of success. &nbsp;</FONT><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="Times New Roman">On the contrary, the current structure appears to woefully underweight the importance of quality of care.</FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><B><I><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT></I></B>&nbsp;</P>

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<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman"></FONT>&nbsp;</P>

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<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman">This is not a solicitation to vote your proxy. Please DO NOT send us your proxy as it would not be voted.</FONT></P>

<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><FONT style="DISPLAY: none"><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman"></FONT></FONT><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman">2</FONT><FONT style="DISPLAY: none"><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman"></FONT></FONT></P></DIV>

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<P style="MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 10pt; VERTICAL-ALIGN: super" color=black face="times new roman">3</FONT><FONT lang=EN-US style="FONT-SIZE: 10pt" color=black face="Times New Roman"> If the quality metric portion of the annual incentive had paid out at target, it would still have only represented $500,000, or less than 2% of his total reported compensation for fiscal 2020.<B> </B></FONT></P><FONT lang=EN-US></FONT></DIV>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 10pt; VERTICAL-ALIGN: super" face="times new roman">4</FONT><FONT lang=EN-US style="FONT-SIZE: 10pt" face="Times New Roman"> </FONT><FONT lang=EN-US style="FONT-SIZE: 10pt; BACKGROUND: white" color=black face="Times New Roman">On &#8220;Inpatient (HCAHPS),&#8221; a leading patient satisfaction survey, only 37% of HCA&#8217;s hospitals achieved a year-over-year improvement or exceeded 75<SUP>th</SUP> percentile performance; the company had been targeting 65%, and recorded a 63% performance in 2019. In terms of hospital-associated infections, the company scored effectively zero payouts on three of the six core infection types &#8211; again down significantly from 2019.</FONT></P><FONT lang=EN-US></FONT></DIV>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 10pt; VERTICAL-ALIGN: super" face="times new roman">5</FONT><FONT lang=EN-US style="FONT-SIZE: 10pt" face="Times New Roman"> Although this was only after eliminating March and April from the EBITDA results in light of the pandemic, and making adjustment accordingly. Without the adjustment, the payout to CEO Hazen would have been 44% of target.&nbsp; </FONT></P><FONT lang=EN-US></FONT></DIV></DIV>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><B><I><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT></I></B>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><B><I><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">EBITDA Multiplier Undermines Integrity of Quality Care Metrics</FONT></I></B></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><B><I><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT></I></B>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Further confusing HCA&#8217;s approach to incentivizing quality care is the role of an EBITDA multiplier.</FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Under the plan, we note that if EBITDA performance exceeds the target level, each individual quality of care metric which qualifies for 100% payout is multiplied by the EBITDA payout percentage. &nbsp;Conversely, if EBITDA is less than 90% of target, no payment is made on the quality portion of the annual incentive. &nbsp;In short, EBITDA can provide a secondary boost to quality care payouts under the first scenario, while in the second -- in the case of below target EBITDA &#8211; EBITDA plays a determining role in eliminating any payout.</FONT></P>

<P style="BACKGROUND: white; TEXT-ALIGN: justify; MARGIN: 12pt 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">What are the consequences of this? On the one hand, u</FONT><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman">sing financial results to amplify performance on certain quality metrics has the effect of reducing the monetary impact to executives of subpar performance on other quality metrics. &nbsp;On the other, </FONT><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">nullifying any payout on quality metrics in the event of a shortfall in EBITDA, renders quality care incentives entirely contingent on profitability. &nbsp;Either way, the integrity of the quality metrics is undermined.</FONT><SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="times new roman">6</FONT></SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman"> </FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><B><I><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Staffing Levels, PPE Provision Concerns </FONT></I></B></P>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Finally, we would emphasize that the quality of HCA&#8217;s health care is, above all else, a function of the company&#8217;s human capital management practices -- and here we see worrying trends.</FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Since the pandemic began, HCA employees have filed over 100 complaints with the Occupational Health and Safety Administration over the lack of PPE, the failure to adequately ensure Covid-19 safety protocols are followed, or the general risks run by staff shortages amid overwhelming demand.</FONT><SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="times new roman">7</FONT></SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">&nbsp; In one tragic case, a Covid-19 patient died at a Denver-area hospital run by HCA, after staff shortages led to the battery in a machine measuring blood oxygen levels to run down.</FONT><SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="times new roman">8</FONT></SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">&nbsp; A </FONT><I><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Denver Post</FONT></I><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman"> investigation into the incident found that the hospital has a record of understaffing. Unfortunately, understaffing at this facility does not appear an isolated issue. &nbsp;According to the Institute for Policy Studies, HCA&#8217;s 2019 staffing levels were 29% below the national average. &nbsp;</FONT></P>

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<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman">This is not a solicitation to vote your proxy. Please DO NOT send us your proxy as it would not be voted.</FONT></P>

<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><FONT style="DISPLAY: none"><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman"></FONT></FONT><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman">3</FONT><FONT style="DISPLAY: none"><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman"></FONT></FONT></P></DIV>

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<DIV id=ftn6><FONT lang=EN-US></FONT>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 10pt; VERTICAL-ALIGN: super" face="times new roman">6</FONT><FONT lang=EN-US style="FONT-SIZE: 10pt" face="Times New Roman"> </FONT><FONT lang=EN-US style="FONT-SIZE: 10pt; BACKGROUND: white" color=black face="Times New Roman">By way of illustration, this year&#8217;s annual incentive payout for the quality care portion was just 45.7% - reflecting the company&#8217;s overall poor performance on quality care. However, even this low payout level is 55% higher than what it would have been without the EBITDA multiplier. In so doing, the company seems to be saying (to shareholders and executives) that strong EBITDA performance makes up for some of the shortfall in quality care performance. </FONT></P><FONT lang=EN-US></FONT></DIV>

<DIV id=ftn7><FONT lang=EN-US></FONT>

<P style="MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 10pt; VERTICAL-ALIGN: super" face="times new roman">7</FONT><FONT lang=EN-US style="FONT-SIZE: 10pt" face="Times New Roman"> </FONT><FONT lang=EN-US style="FONT-SIZE: 10pt; BACKGROUND: white" color=black face="Times New Roman">Critically, complaints continued to be filed in 2021.</FONT></P><FONT lang=EN-US></FONT></DIV>

<DIV id=ftn8><FONT lang=EN-US></FONT>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 10pt; VERTICAL-ALIGN: super" face="times new roman">8</FONT><FONT lang=EN-US style="FONT-SIZE: 10pt" face="Times New Roman"> https://www.denverpost.com/2020/08/31/healthone-hca-hospitals-low-staffing-levels/.</FONT></P><FONT lang=EN-US></FONT></DIV></DIV>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"><BR><BR><BR></FONT><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">At the same time, and perhaps unsurprisingly, HCA employees are increasingly vocal about the health and safety risks they face and the sense that their sacrifices are not being valued.</FONT><SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="times new roman">9</FONT></SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">&nbsp; In fact, last June, the New York Times reported that &#8220;HCA executives warned that they would lay off thousands of nurses if they didn&#8217;t agree to wage freezes and other concessions.&#8221;</FONT><SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="times new roman">10</FONT></SUP><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">&nbsp; While neither ultimately transpired, even a cursory web search reveals a high level of controversy over HCA&#8217;s workplace practices.&nbsp; </FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><B><I><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Summary: Long-term Value Creation Demands More Balanced Pay Incentives</FONT></I></B></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><B><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT></B>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">HCA may insist that it</FONT><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"> &#8220;has a long history of considering annually the appropriate use of performance on quality metrics in its executive compensation programs,&#8221; but the failure to reexamine the annual incentive structure given the challenges of the past year is worrying. &nbsp;The overall bonus payouts are not only starkly at odds with HCA&#8217;s own quality scores, but appear to ignore the challenges HCA nurses and doctors confront on the frontlines. &nbsp;For these reasons, we believe long-term value is well-served by passing Item 5. </FONT></P>

<P style="MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" face="Times New Roman"></FONT>&nbsp;</P>

<P style="MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman">For more information, please contact Michael Pryce-Jones at: </FONT><U><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=#0563c1 face="Times New Roman">mpryce-jones@teamster.org</FONT></U><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"> or by telephone at: 202.769 8842.</FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Sincerely,</FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt">
<IMG id=Picture2 border=0 src="x21040710022900.gif" width=162 height=65></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">Ken Hall</FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">General Secretary-Treasurer</FONT></P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt; BACKGROUND: white" color=black face="Times New Roman">KH/cz</FONT></P>

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<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT>&nbsp;</P>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><B><I><FONT lang=EN-US style="FONT-SIZE: 12.5pt" color=black face="Times New Roman"></FONT></I></B>&nbsp;</P>

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<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman">This is not a solicitation to vote your proxy. Please DO NOT send us your proxy as it would not be voted.</FONT></P>

<P style="TEXT-ALIGN: center; MARGIN: 0in 0in 0pt" align=center><FONT style="DISPLAY: none"><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman"></FONT></FONT><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman">4</FONT><FONT style="DISPLAY: none"><FONT lang=EN-US style="FONT-SIZE: 12pt" face="Times New Roman"></FONT></FONT></P></DIV>

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<DIV id=ftn9><FONT lang=EN-US></FONT>

<P style="TEXT-ALIGN: justify; MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 10pt; VERTICAL-ALIGN: super" face="times new roman">9</FONT><FONT lang=EN-US style="FONT-SIZE: 10pt" face="Times New Roman"> https://www.nytimes.com/2021/01/28/health/covid-health-workers-unions.html.</FONT></P><FONT lang=EN-US></FONT></DIV>

<DIV id=ftn10><FONT lang=EN-US></FONT>

<P style="MARGIN: 0in 0in 0pt"><FONT lang=EN-US style="FONT-SIZE: 10pt; VERTICAL-ALIGN: super" face="times new roman">10</FONT><FONT lang=EN-US style="FONT-SIZE: 10pt" face="Times New Roman"> https://www.nytimes.com/2020/06/08/business/hospitals-bailouts-ceo-pay.html.</FONT></P><FONT lang=EN-US></FONT></DIV></DIV>

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end
</TEXT>
</DOCUMENT>
</SEC-DOCUMENT>
