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Segment and Geographic Information (Tables) | 9 Months Ended
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Sep. 30, 2025
Segment Reporting [Abstract] |
Schedule of Geographic Distributions of Revenues, Equity in Earnings or Losses of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization | The geographic distributions of our revenues, salaries and benefits, supplies, other operating expenses, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization and 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 for the quarters and nine months ended September 30, 2025 and 2024 and assets at September 30, 2025 and December 31, 2024:
| Quarter |  |  | Nine Months |
| 2025 |
| National Group |  | Atlantic Group |  | American Group |  |  | National Group |  | Atlantic Group |  | American Group |
Revenues | $ | 5,525 |  | $ | 6,142 |  | $ | 6,688 |  |  | $ | 15,790 |  | $ | 18,431 |  | $ | 19,512 |
Salaries and benefits |  | 1,970 |  |  | 2,288 |  |  | 2,275 |  |  |  | 5,848 |  |  | 6,750 |  |  | 6,687 |
Supplies |  | 742 |  |  | 889 |  |  | 1,053 |  |  |  | 2,238 |  |  | 2,738 |  |  | 3,140 |
Other operating expenses |  | 1,466 |  |  | 1,627 |  |  | 1,796 |  |  |  | 3,954 |  |  | 4,793 |  |  | 5,156 |
Equity in earnings of affiliates |  | (1 | ) |  | (1 | ) |  | (16 | ) |  |  | (1 | ) |  | (3 | ) |  | (47 | )
|  | 4,177 |  |  | 4,803 |  |  | 5,108 |  |  |  | 12,039 |  |  | 14,278 |  |  | 14,936 |
Adjusted segment EBITDA | $ | 1,348 |  | $ | 1,339 |  | $ | 1,580 |  |  | $ | 3,751 |  | $ | 4,153 |  | $ | 4,576 |
NOTE 10 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)
| Quarter |  |  | Nine Months |
| 2024 |
| National Group |  | Atlantic Group |  | American Group |  |  | National Group |  | Atlantic Group |  | American Group |
Revenues | $ | 4,931 |  | $ | 5,738 |  | $ | 6,078 |  |  | $ | 14,622 |  | $ | 17,429 |  | $ | 18,105 |
Salaries and benefits |  | 1,897 |  |  | 2,190 |  |  | 2,176 |  |  |  | 5,656 |  |  | 6,500 |  |  | 6,405 |
Supplies |  | 696 |  |  | 858 |  |  | 1,007 |  |  |  | 2,094 |  |  | 2,651 |  |  | 2,965 |
Other operating expenses |  | 1,270 |  |  | 1,555 |  |  | 1,549 |  |  |  | 3,668 |  |  | 4,581 |  |  | 4,689 |
Equity in (earnings) losses of affiliates |  | — |  |  | — |  |  | (18 | ) |  |  | 2 |  |  | (2 | ) |  | (49 | )
|  | 3,863 |  |  | 4,603 |  |  | 4,714 |  |  |  | 11,420 |  |  | 13,730 |  |  | 14,010 |
Adjusted segment EBITDA | $ | 1,068 |  | $ | 1,135 |  | $ | 1,364 |  |  | $ | 3,202 |  | $ | 3,699 |  | $ | 4,095 |
|  | Quarter |  |  | Nine Months |
|  | 2025 |  |  | 2024 |  |  | 2025 |  |  | 2024 |
Adjusted segment EBITDA: |  |  |  |  |  |  |  |  |  |  |  |
National Group |  | $ | 1,348 |  |  | $ | 1,068 |  |  | $ | 3,751 |  |  | $ | 3,202 |
Atlantic Group |  |  | 1,339 |  |  |  | 1,135 |  |  |  | 4,153 |  |  |  | 3,699 |
American Group |  |  | 1,580 |  |  |  | 1,364 |  |  |  | 4,576 |  |  |  | 4,095 |
|  |  | 4,267 |  |  |  | 3,567 |  |  |  | 12,480 |  |  |  | 10,996 |
Adjustments to reconcile Total Adjusted segment EBITDA to consolidated Income before income taxes: |  |  |  |  |  |  |  |  |  |  |  |
Corporate and Other |  |  | 397 |  |  |  | 300 |  |  |  | 1,028 |  |  |  | 826 |
Depreciation and amortization |  |  | 889 |  |  |  | 842 |  |  |  | 2,612 |  |  |  | 2,456 |
Interest expense |  |  | 561 |  |  |  | 515 |  |  |  | 1,676 |  |  |  | 1,533 |
Losses (gains) on sales of facilities |  |  | 2 |  |  |  | 4 |  |  |  | 4 |  |  |  | (209 | )
Income before income taxes |  | $ | 2,418 |  |  | $ | 1,906 |  |  | $ | 7,160 |  |  | $ | 6,390 |
|  | Quarter |  |  | Nine Months |
|  | 2025 |  |  | 2024 |  |  | 2025 |  |  | 2024 |
Revenues: |  |  |  |  |  |  |  |  |  |  |  |
National Group |  | $ | 5,525 |  |  | $ | 4,931 |  |  | $ | 15,790 |  |  | $ | 14,622 |
Atlantic Group |  |  | 6,142 |  |  |  | 5,738 |  |  |  | 18,431 |  |  |  | 17,429 |
American Group |  |  | 6,688 |  |  |  | 6,078 |  |  |  | 19,512 |  |  |  | 18,105 |
Corporate and other |  |  | 806 |  |  |  | 740 |  |  |  | 2,354 |  |  |  | 2,162 |
|  | $ | 19,161 |  |  | $ | 17,487 |  |  | $ | 56,087 |  |  | $ | 52,318 |
Depreciation and amortization: |  |  |  |  |  |  |  |  |  |  |  |
National Group |  | $ | 226 |  |  | $ | 214 |  |  | $ | 675 |  |  | $ | 637 |
Atlantic Group |  |  | 281 |  |  |  | 271 |  |  |  | 830 |  |  |  | 790 |
American Group |  |  | 283 |  |  |  | 277 |  |  |  | 839 |  |  |  | 799 |
Corporate and other |  |  | 99 |  |  |  | 80 |  |  |  | 268 |  |  |  | 230 |
|  | $ | 889 |  |  | $ | 842 |  |  | $ | 2,612 |  |  | $ | 2,456 |
|  | September 30, 2025 |  |  | December 31, 2024 |
Assets: |  |  |  |  |  |
National Group |  | $ | 13,274 |  |  | $ | 12,855 |
Atlantic Group |  |  | 17,573 |  |  |  | 17,168 |
American Group |  |  | 20,889 |  |  |  | 20,714 |
Corporate and other |  |  | 8,011 |  |  |  | 8,776 |
|  | $ | 59,747 |  |  | $ | 59,513 |

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- Definition Tabular disclosure of the profit or loss and total assets for each reportable segment. An entity discloses certain information on each reportable segment if the amounts (a) are included in the measure of segment profit or loss reviewed by the chief operating decision maker or (b) are otherwise regularly provided to the chief operating decision maker, even if not included in that measure of segment profit or loss. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 25 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482810/280-10-50-25 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 22 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482810/280-10-50-22 Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 30 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482810/280-10-50-30 + Details
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