XML 29 R21.htm IDEA: XBRL DOCUMENT
v3.23.1

Segment and Geographic Information | 12 Months Ended
--- | ---
Dec. 31, 2022
Segment Reporting [Abstract] |
Segment and Geographic Information | NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION We operate in one line of business, which is operating hospitals and related health care entities. At December 31, 2022, we operated in two geographically organized groups: the National and American Groups. Effective January 1, 2023, we reorganized our operations into three geographically organized groups: the National, American and Atlantic Groups. The National Group includes our hospitals located in Alaska, California, Idaho, Indiana, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah and Virginia, the American Group includes our hospitals located in Colorado, Central Kansas, Louisiana and Texas, and the Atlantic Group includes our hospitals located in Florida, Georgia, Northern Kansas, Missouri and South Carolina. The hospitals we operate in England remain in the Corporate and other group. Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses and gains on sales of facilities, losses on retirement of debt, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions) and represent the operating segments under the January 1, 2023 reorganized segment structure:
|  | For the Year Ended December 31, |
|  | 2022 |  |  | 2021 |  |  | 2020 |
Revenues: |  |  |  |  |  |  |  |  |  |  |  |
National Group |  | $ | 16,767 |  |  | $ | 16,329 |  |  | $ | 14,428 |
Atlantic Group |  |  | 19,324 |  |  |  | 19,098 |  |  |  | 16,199 |
American Group |  |  | 20,858 |  |  |  | 19,636 |  |  |  | 17,479 |
Corporate and other |  |  | 3,284 |  |  |  | 3,689 |  |  |  | 3,427 |
|  | $ | 60,233 |  |  | $ | 58,752 |  |  | $ | 51,533 |
Equity in earnings of affiliates: |  |  |  |  |  |  |  |  |  |  |  |
National Group |  | $ | (1 | ) |  | $ | (33 | ) |  | $ | (28 | )
Atlantic Group |  |  | (3 | ) |  |  | (2 | ) |  |  | (2 | )
American Group |  |  | (43 | ) |  |  | (50 | ) |  |  | (40 | )
Corporate and other |  |  | 2 |  |  |  | (28 | ) |  |  | 16 |
|  | $ | (45 | ) |  | $ | (113 | ) |  | $ | (54 | )
Adjusted segment EBITDA: |  |  |  |  |  |  |  |  |  |  |  |
National Group |  | $ | 3,616 |  |  | $ | 4,202 |  |  | $ | 3,243 |
Atlantic Group |  |  | 3,881 |  |  |  | 4,218 |  |  |  | 3,405 |
American Group |  |  | 5,102 |  |  |  | 4,836 |  |  |  | 4,061 |
Corporate and other |  |  | (532 | ) |  |  | (612 | ) |  |  | (672 | )
|  | $ | 12,067 |  |  | $ | 12,644 |  |  | $ | 10,037 |
Depreciation and amortization: |  |  |  |  |  |  |  |  |  |  |  |
National Group |  | $ | 801 |  |  | $ | 754 |  |  | $ | 686 |
Atlantic Group |  |  | 921 |  |  |  | 848 |  |  |  | 764 |
American Group |  |  | 937 |  |  |  | 897 |  |  |  | 873 |
Corporate and other |  |  | 310 |  |  |  | 354 |  |  |  | 398 |
|  | $ | 2,969 |  |  | $ | 2,853 |  |  | $ | 2,721 |
|  | For the Year Ended December 31, |
|  | 2022 |  |  | 2021 |  |  | 2020 |
Adjusted segment EBITDA |  | $ | 12,067 |  |  | $ | 12,644 |  |  | $ | 10,037 |
Depreciation and amortization |  |  | 2,969 |  |  |  | 2,853 |  |  |  | 2,721 |
Interest expense |  |  | 1,741 |  |  |  | 1,566 |  |  |  | 1,584 |
Losses (gains) on sales of facilities |  |  | (1,301 | ) |  |  | (1,620 | ) |  |  | 7 |
Losses on retirement of debt |  |  | 78 |  |  |  | 12 |  |  |  | 295 |
Income before income taxes |  | $ | 8,580 |  |  | $ | 9,833 |  |  | $ | 5,430 |
|  | December 31, |
|  | 2022 |  |  | 2021 |  |  | 2020 |
Assets: |  |  |  |  |  |  |  |  |  |  |  |
National Group |  | $ | 11,793 |  |  | $ | 11,236 |  |  | $ | 10,605 |
Atlantic Group |  |  | 15,092 |  |  |  | 13,944 |  |  |  | 11,909 |
American Group |  |  | 17,934 |  |  |  | 17,224 |  |  |  | 16,082 |
Corporate and other |  |  | 7,619 |  |  |  | 8,338 |  |  |  | 8,894 |
|  | $ | 52,438 |  |  | $ | 50,742 |  |  | $ | 47,490 |
|  | National Group |  |  | Atlantic Group |  |  | American Group |  |  | Corporate and Other |  |  | Total |
Goodwill and other intangible assets: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Balance at December 31, 2019 |  | $ | 1,062 |  |  | $ | 1,366 |  |  | $ | 4,970 |  |  | $ | 871 |  |  | $ | 8,269 |
Acquisitions |  |  | 29 |  |  |  | 9 |  |  |  | 27 |  |  |  | 279 |  |  |  | 344 |
Foreign currency translation, amortization and other |  |  | (2 | ) |  |  | — |  |  |  | (1 | ) |  |  | (32 | ) |  |  | (35 | )
Balance at December 31, 2020 |  |  | 1,089 |  |  |  | 1,375 |  |  |  | 4,996 |  |  |  | 1,118 |  |  |  | 8,578 |
Acquisitions |  |  | 126 |  |  |  | 610 |  |  |  | 66 |  |  |  | 260 |  |  |  | 1,062 |
Foreign currency translation, amortization and other |  |  | (3 | ) |  |  | (15 | ) |  |  | — |  |  |  | (82 | ) |  |  | (100 | )
Balance at December 31, 2021 |  |  | 1,212 |  |  |  | 1,970 |  |  |  | 5,062 |  |  |  | 1,296 |  |  |  | 9,540 |
Acquisitions |  |  | 75 |  |  |  | 90 |  |  |  | 90 |  |  |  | 7 |  |  |  | 262 |
Foreign currency translation, amortization and other |  |  | (43 | ) |  |  | (3 | ) |  |  | — |  |  |  | (103 | ) |  |  | (149 | )
Balance at December 31, 2022 |  | $ | 1,244 |  |  | $ | 2,057 |  |  | $ | 5,152 |  |  | $ | 1,200 |  |  | $ | 9,653 |

X
- References No definition available. + Details
Name: | us-gaap_SegmentReportingAbstract
Namespace Prefix: | us-gaap_
Data Type: | xbrli:stringItemType
Balance Type: | na
Period Type: | duration

X
- Definition The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 31 -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8924-108599 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 34 -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8981-108599 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 21 -Subparagraph (a) -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8721-108599 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 40 -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9031-108599 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (f) -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599 Reference 6: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (e) -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 26 -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8844-108599 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 41 -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9038-108599 Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (d) -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599 Reference 10: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 22 -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8736-108599 Reference 11: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 42 -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9054-108599 Reference 12: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 15 -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8657-108599 Reference 13: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 21 -Subparagraph (b) -URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8721-108599 Reference 14: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -URI https://asc.fasb.org/topic&trid=2134510 + Details
Name: | us-gaap_SegmentReportingDisclosureTextBlock
Namespace Prefix: | us-gaap_
Data Type: | dtr-types:textBlockItemType
Balance Type: | na
Period Type: | duration