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Income Taxes | 12 Months Ended
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Dec. 31, 2024
Income Tax Disclosure [Abstract] |
Income Taxes | NOTE 4 — INCOME TAXES The provision for income taxes consists of the following (dollars in millions):
|  | 2024 |  |  | 2023 |  |  | 2022 |
Current: |  |  |  |  |  |  |  |  |
Federal |  | $ | 1,202 |  |  | $ | 1,118 |  |  | $ | 1,222 |
State |  |  | 212 |  |  |  | 213 |  |  |  | 206 |
Foreign |  |  | 20 |  |  |  | 3 |  |  |  | 18 |
Deferred: |  |  |  |  |  |  |  |  |
Federal |  |  | 394 |  |  |  | 241 |  |  |  | 261 |
State |  |  | 31 |  |  |  | 21 |  |  |  | 27 |
Foreign |  |  | 7 |  |  |  | 19 |  |  |  | 12 |
|  | $ | 1,866 |  |  | $ | 1,615 |  |  | $ | 1,746 |
Our provision for income taxes for the years ended December 31, 2024, 2023 and 2022 included tax benefits of $102 million, $93 million and $77 million, respectively, related to the settlement of employee equity awards. The provision for income taxes reflects a $61 million reduction in interest (net of tax) and penalty expense and $36 million and $23 million of interest expense (net of tax) for the years ended December 31, 2024, 2023 and 2022, respectively. During 2024, we derecognized deferred tax assets and increased our tax provision by $276 million due to an internal restructuring of certain affiliates. Our foreign pretax income was $79 million, $85 million and $66 million for the years ended December 31, 2024, 2023 and 2022, respectively. NOTE 4 — INCOME TAXES (continued) A reconciliation of the federal statutory rate to the effective income tax rate follows:
|  | 2024 |  |  | 2023 |  |  | 2022 |
Federal statutory rate |  |  | 21.0 | % |  |  | 21.0 | % |  |  | 21.0 | %
State income taxes, net of federal tax benefit |  |  | 2.7 |  |  |  | 2.6 |  |  |  | 2.3 |
Change in liability for uncertain tax positions |  |  | (2.3 | ) |  |  | 0.4 |  |  |  | 0.7 |
Tax benefit from settlements of employee equity awards |  |  | (1.2 | ) |  |  | (1.2 | ) |  |  | (0.9 | )
Internal restructuring of affiliates |  |  | 3.5 |  |  |  | — |  |  |  | — |
Other items, net |  |  | 0.8 |  |  |  | 0.8 |  |  |  | 0.5 |
Effective income tax rate on income attributable to HCA Healthcare, Inc. |  |  | 24.5 |  |  |  | 23.6 |  |  |  | 23.6 |
Income attributable to noncontrolling interests from consolidated partnerships |  |  | (2.6 | ) |  |  | (2.6 | ) |  |  | (3.3 | )
Effective income tax rate on income before income taxes |  |  | 21.9 | % |  |  | 21.0 | % |  |  | 20.3 | %
A summary of the items comprising our deferred tax assets and liabilities at December 31 follows (dollars in millions):
|  | 2024 |  |  | 2023 |
|  | Assets |  |  | Liabilities |  |  | Assets |  |  | Liabilities |
Depreciation and fixed asset basis differences |  | $ | — |  |  | $ | 1,139 |  |  | $ | — |  |  | $ | 1,048 |
Allowances for professional liability and other risks |  |  | 395 |  |  |  | — |  |  |  | 452 |  |  |  | — |
Accounts receivable |  |  | 418 |  |  |  | — |  |  |  | 363 |  |  |  | — |
Compensation |  |  | 285 |  |  |  | — |  |  |  | 308 |  |  |  | — |
Right-of-use lease assets and obligations |  |  | 478 |  |  |  | 462 |  |  |  | 506 |  |  |  | 492 |
Other |  |  | 297 |  |  |  | 932 |  |  |  | 592 |  |  |  | 860 |
|  | $ | 1,873 |  |  | $ | 2,533 |  |  | $ | 2,221 |  |  | $ | 2,400 |
At December 31, 2024, state net operating loss carryforwards (expiring in years 2025 through 2042) available to offset future taxable income approximated $167 million. Utilization of net operating loss carryforwards in any one year may be limited. The following table summarizes the activity related to our gross unrecognized tax benefits, excluding accrued interest and penalties of $115 million and $177 million as of December 31, 2024 and 2023, respectively (dollars in millions):
|  | 2024 |  |  | 2023 |
Balance at January 1 |  | $ | 639 |  |  | $ | 639 |
Additions based on tax positions related to the current year |  |  | 40 |  |  |  | 30 |
Additions for tax positions of prior years |  |  | 63 |  |  |  | 4 |
Reductions for tax positions of prior years |  |  | (206 | ) |  |  | (10 | )
Settlements |  |  | (17 | ) |  |  | — |
Lapse of applicable statutes of limitations |  |  | (15 | ) |  |  | (24 | )
Balance at December 31 |  | $ | 504 |  |  | $ | 639 |
Unrecognized tax benefits of $295 million as of December 31, 2024 ($320 million as of December 31, 2023) would affect the effective rate, if recognized. During 2024, the Internal Revenue Service (“IRS”) completed its examination of our 2016, 2017 and 2018 income tax returns, resolving all federal income tax matters for those years, and the 2020 federal statute of limitations expired. We reduced our tax provision by $254 million, including interest of $118 million (net of tax). Of this amount, $181 million, including $47 million of interest (net of tax) related to the tax rate changes under the 2017 Tax Cuts and Jobs Act. NOTE 4 — INCOME TAXES (continued) At December 31, 2024, the IRS was examining the Company's 2022 and 2023 income tax returns and the 2019 income tax returns of certain affiliates. We are subject to examination by the IRS for tax years after 2020, as well as by state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change.

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