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Segment and Geographic Information | 12 Months Ended
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Dec. 31, 2024
Segment Reporting [Abstract] |
Segment and Geographic Information | NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION Effective January 1, 2024, we adopted Accounting Standards Update 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures. We operate in one line of business, which is operating hospitals and related health care entities. We operate in three geographically organized groups: the National, Atlantic and American Groups. At December 31, 2024, the National Group included 55 hospitals located in Alaska, California, Idaho, Indiana, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah and Virginia, the Atlantic Group included 62 hospitals located in Florida, Georgia, Northern Kansas, Missouri and South Carolina, and the American Group included 65 hospitals located in Colorado, Central Kansas, Louisiana and Texas. The eight hospitals we operate in England are included 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, salaries and benefits, supplies, other operating expenses, equity in earnings or losses of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets that are provided to the Chief Operating Decision Maker, which is the Chief Executive Officer, are summarized in the following tables (dollars in millions) and represent the operating segments at December 31, 2024:
|  | For the Year Ended December 31, 2024 |
|  | National Group |  |  | Atlantic Group |  |  | American Group |
Revenues |  | $ | 19,614 |  |  | $ | 23,171 |  |  | $ | 24,601 |
Salaries and benefits |  |  | 7,483 |  |  |  | 8,525 |  |  |  | 8,529 |
Supplies |  |  | 2,812 |  |  |  | 3,553 |  |  |  | 4,035 |
Other operating expenses |  |  | 4,892 |  |  |  | 6,124 |  |  |  | 6,363 |
Equity in (earnings) losses of affiliates |  |  | 2 |  |  |  | (3 | ) |  |  | (62 | )
|  |  | 15,189 |  |  |  | 18,199 |  |  |  | 18,865 |
Adjusted segment EBITDA |  | $ | 4,425 |  |  | $ | 4,972 |  |  | $ | 5,736 |
NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)
|  | For the Year Ended December 31, 2023 |
|  | National Group |  |  | Atlantic Group |  |  | American Group |
Revenues |  | $ | 18,105 |  |  | $ | 21,167 |  |  | $ | 22,318 |
Salaries and benefits |  |  | 7,196 |  |  |  | 8,058 |  |  |  | 8,080 |
Supplies |  |  | 2,658 |  |  |  | 3,331 |  |  |  | 3,616 |
Other operating expenses |  |  | 4,253 |  |  |  | 5,289 |  |  |  | 5,473 |
Equity in (earnings) losses of affiliates |  |  | (2 | ) |  |  | (3 | ) |  |  | (59 | )
|  |  | 14,105 |  |  |  | 16,675 |  |  |  | 17,110 |
Adjusted segment EBITDA |  | $ | 4,000 |  |  | $ | 4,492 |  |  | $ | 5,208 |
|  | For the Year Ended December 31, 2022 |
|  | National Group |  |  | Atlantic Group |  |  | American Group |
Revenues |  | $ | 16,767 |  |  | $ | 19,324 |  |  | $ | 20,858 |
Salaries and benefits |  |  | 6,959 |  |  |  | 7,752 |  |  |  | 7,757 |
Supplies |  |  | 2,569 |  |  |  | 3,088 |  |  |  | 3,331 |
Other operating expenses |  |  | 3,624 |  |  |  | 4,606 |  |  |  | 4,711 |
Equity in (earnings) losses of affiliates |  |  | (1 | ) |  |  | (3 | ) |  |  | (43 | )
|  |  | 13,151 |  |  |  | 15,443 |  |  |  | 15,756 |
Adjusted segment EBITDA |  | $ | 3,616 |  |  | $ | 3,881 |  |  | $ | 5,102 |
|  | For the Year Ended December 31, |
|  | 2024 |  |  | 2023 |  |  | 2022 |
Adjusted segment EBITDA: |  |  |  |  |  |  |  |  |
National Group |  | $ | 4,425 |  |  | $ | 4,000 |  |  | $ | 3,616 |
Atlantic Group |  |  | 4,972 |  |  |  | 4,492 |  |  |  | 3,881 |
American Group |  |  | 5,736 |  |  |  | 5,208 |  |  |  | 5,102 |
|  |  | 15,133 |  |  |  | 13,700 |  |  |  | 12,599 |
Adjustments to reconcile Total Adjusted segment EBITDA to consolidated Income before income taxes: |  |  |  |  |  |  |  |  |
Corporate and Other |  |  | 1,251 |  |  |  | 974 |  |  |  | 532 |
Depreciation and amortization |  |  | 3,312 |  |  |  | 3,077 |  |  |  | 2,969 |
Interest expense |  |  | 2,061 |  |  |  | 1,938 |  |  |  | 1,741 |
Losses (gains) on sales of facilities |  |  | (14 | ) |  |  | 5 |  |  |  | (1,301 | )
Losses on retirement of debt |  |  | — |  |  |  | — |  |  |  | 78 |
Income before income taxes |  | $ | 8,523 |  |  | $ | 7,706 |  |  | $ | 8,580 |
NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)
|  | For the Year Ended December 31, |
|  | 2024 |  |  | 2023 |  |  | 2022 |
Revenues: |  |  |  |  |  |  |  |  |
National Group |  | $ | 19,614 |  |  | $ | 18,105 |  |  | $ | 16,767 |
Atlantic Group |  |  | 23,171 |  |  |  | 21,167 |  |  |  | 19,324 |
American Group |  |  | 24,601 |  |  |  | 22,318 |  |  |  | 20,858 |
Corporate and other |  |  | 3,217 |  |  |  | 3,378 |  |  |  | 3,284 |
|  | $ | 70,603 |  |  | $ | 64,968 |  |  | $ | 60,233 |
Depreciation and amortization: |  |  |  |  |  |  |  |  |
National Group |  | $ | 857 |  |  | $ | 834 |  |  | $ | 801 |
Atlantic Group |  |  | 1,061 |  |  |  | 989 |  |  |  | 921 |
American Group |  |  | 1,083 |  |  |  | 971 |  |  |  | 937 |
Corporate and other |  |  | 311 |  |  |  | 283 |  |  |  | 310 |
|  | $ | 3,312 |  |  | $ | 3,077 |  |  | $ | 2,969 |
|  | December 31, |
|  | 2024 |  |  | 2023 |  |  | 2022 |
Assets: |  |  |  |  |  |  |  |  |
National Group |  | $ | 12,855 |  |  | $ | 12,487 |  |  | $ | 11,793 |
Atlantic Group |  |  | 17,168 |  |  |  | 16,098 |  |  |  | 15,092 |
American Group |  |  | 20,714 |  |  |  | 19,786 |  |  |  | 17,934 |
Corporate and other |  |  | 8,776 |  |  |  | 7,840 |  |  |  | 7,619 |
|  | $ | 59,513 |  |  | $ | 56,211 |  |  | $ | 52,438 |
|  | National Group |  |  | Atlantic Group |  |  | American Group |  |  | Corporate and Other |  |  | Total |
Goodwill and other intangible assets: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
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 |
Acquisitions |  |  | — |  |  |  | 8 |  |  |  | 326 |  |  |  | 28 |  |  |  | 362 |
Foreign currency translation, amortization and other |  |  | (3 | ) |  |  | (1 | ) |  |  | — |  |  |  | (66 | ) |  |  | (70 | )
Balance at December 31, 2023 |  |  | 1,241 |  |  |  | 2,064 |  |  |  | 5,478 |  |  |  | 1,162 |  |  |  | 9,945 |
Acquisitions |  |  | — |  |  |  | 61 |  |  |  | 105 |  |  |  | 4 |  |  |  | 170 |
Foreign currency translation, amortization and other |  |  | (4 | ) |  |  | (1 | ) |  |  | 3 |  |  |  | (20 | ) |  |  | (22 | )
Balance at December 31, 2024 |  | $ | 1,237 |  |  | $ | 2,124 |  |  | $ | 5,586 |  |  | $ | 1,146 |  |  | $ | 10,093 |

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