[Part I. Financial Information](index=2&type=section&id=Part%20I.%20Financial%20Information) [Financial Statements](index=3&type=section&id=Item%201.%20Financial%20Statements) This section presents HCA Healthcare's unaudited condensed consolidated financial statements for Q1 2025 and 2024, including income statements, balance sheets, cash flows, and supporting notes [Condensed Consolidated Income Statements](index=3&type=section&id=Condensed%20Consolidated%20Income%20Statements) Q1 2025 revenues increased to $18.321 billion, with net income attributable to HCA Healthcare rising slightly to $1.610 billion, or $6.45 per diluted share Q1 2025 vs Q1 2024 Income Statement Highlights | Metric | Q1 2025 (in millions) | Q1 2024 (in millions) | % Change | | :--- | :--- | :--- | :--- | | **Revenues** | $18,321 | $17,339 | 5.7% | | Income before income taxes | $2,327 | $2,247 | 3.6% | | **Net income attributable to HCA** | $1,610 | $1,591 | 1.2% | | **Diluted EPS** | $6.45 | $5.93 | 8.8% | [Condensed Consolidated Balance Sheets](index=5&type=section&id=Condensed%20Consolidated%20Balance%20Sheets) As of March 31, 2025, total assets slightly increased to $59.798 billion, while long-term debt rose to $41.057 billion and cash decreased Balance Sheet Summary | Metric | March 31, 2025 (in millions) | December 31, 2024 (in millions) | | :--- | :--- | :--- | | Cash and cash equivalents | $1,060 | $1,933 | | **Total Assets** | $59,798 | $59,513 | | Long-term debt | $41,057 | $38,333 | | **Total Liabilities** | $60,236 (derived) | $58,958 (derived) | | Stockholders' deficit attributable to HCA | ($3,519) | ($2,499) | [Condensed Consolidated Statements of Cash Flows](index=7&type=section&id=Condensed%20Consolidated%20Statements%20of%20Cash%20Flows) Net cash from operating activities significantly decreased to $1.651 billion in Q1 2025, while investing and financing activities both used more cash Q1 2025 vs Q1 2024 Cash Flow Summary | Metric | Q1 2025 (in millions) | Q1 2024 (in millions) | | :--- | :--- | :--- | | **Net cash provided by operating activities** | $1,651 | $2,469 | | Net cash used in investing activities | ($1,032) | ($903) | | **Net cash used in financing activities** | ($1,495) | ($1,216) | | Change in cash and cash equivalents | ($873) | $349 | [Notes to Condensed Consolidated Financial Statements](index=8&type=section&id=Notes%20to%20Condensed%20Consolidated%20Financial%20Statements) These notes provide detailed information on revenue recognition, acquisitions, debt refinancing, share repurchases, and segment performance, supporting the financial statements - As of March 31, 2025, HCA and its affiliates owned and operated **192 hospitals**, **125 freestanding surgery centers**, and **26 freestanding endoscopy centers** across 20 states and England[19](index=19&type=chunk) Revenues by Payer (Q1 2025 vs Q1 2024) | Payer | Q1 2025 Revenue (in millions) | Q1 2025 Ratio | Q1 2024 Revenue (in millions) | Q1 2024 Ratio | | :--- | :--- | :--- | :--- | :--- | | Medicare | $2,895 | 15.8% | $2,838 | 16.4% | | Managed Medicare | $3,299 | 18.0% | $3,026 | 17.4% | | Medicaid | $1,190 | 6.5% | $1,000 | 5.8% | | Managed Medicaid | $879 | 4.8% | $978 | 5.6% | | Managed care and insurers | $9,041 | 49.4% | $8,545 | 49.2% | | **Total Revenues** | **$18,321** | **100.0%** | **$17,339** | **100.0%** | - In Q1 2025, the company paid **$190 million** for two hospitals and **$37 million** for nonhospital entities, also receiving proceeds of **$157 million** from the sale of a hospital[27](index=27&type=chunk)[30](index=30&type=chunk) - In February 2025, the company entered into a new **$8.0 billion** senior unsecured revolving credit facility, repaid **$2.6 billion** in senior notes, and issued **$5.25 billion** in new senior notes[48](index=48&type=chunk)[49](index=49&type=chunk) - During Q1 2025, HCA repurchased **7.762 million shares** of common stock for approximately **$2.5 billion**, with **$8.259 billion** remaining available under the share repurchase authorization as of March 31, 2025[54](index=54&type=chunk) [Management's Discussion and Analysis of Financial Condition and Results of Operations (MD&A)](index=17&type=section&id=Item%202.%20Management%27s%20Discussion%20and%20Analysis%20of%20Financial%20Condition%20and%20Results%20of%20Operations) Management discusses Q1 2025 financial results, highlighting revenue growth driven by increased patient volumes, analyzing operating expenses, and detailing changes in cash flow, capital resources, and financing activities [Results of Operations](index=18&type=section&id=Results%20of%20Operations) Q1 2025 revenue grew 5.7% to $18.321 billion due to higher patient volumes, while salaries and benefits decreased as a percentage of revenue and the effective tax rate increased - Consolidated revenues increased **5.7%** in Q1 2025, driven by a **3.1%** increase in equivalent admissions and a **2.5%** increase in revenue per equivalent admission[64](index=64&type=chunk) Key Volume Metrics (Consolidated, YoY Change) | Metric | Q1 2025 vs Q1 2024 | | :--- | :--- | | Admissions | +2.8% | | Inpatient surgical volumes | +0.3% | | Outpatient surgical volumes | -2.5% | | Emergency department visits | +3.7% | - Salaries and benefits as a percentage of revenues decreased from **44.4%** in Q1 2024 to **43.6%** in Q1 2025[85](index=85&type=chunk) - The estimated cost of total uncompensated care (charity care, uninsured discounts, and implicit price concessions) rose to **$1.055 billion** in Q1 2025 from **$1.010 billion** in Q1 2024[70](index=70&type=chunk) [Liquidity and Capital Resources](index=23&type=section&id=Liquidity%20and%20Capital%20Resources) Cash from operations declined to $1.651 billion in Q1 2025 due to working capital changes, while the company engaged in significant debt issuance and share repurchases, with total debt at $44.576 billion - Cash provided by operating activities decreased by **$818 million** in Q1 2025 compared to Q1 2024, primarily due to a **$1.157 billion** negative net impact from working capital changes[93](index=93&type=chunk) - Planned capital expenditures for 2025 are expected to be between **$5.0 billion** and **$5.2 billion**[94](index=94&type=chunk) - As of March 31, 2025, the company had **$7.766 billion** available under its new senior unsecured credit facility[99](index=99&type=chunk) [Quantitative and Qualitative Disclosures About Market Risk](index=27&type=section&id=Item%203.%20Quantitative%20and%20Qualitative%20Disclosures%20About%20Market%20Risk) The company faces market risks from interest rate changes on its variable-rate debt and fluctuations in the value of insurance subsidiary investments, with a 1% rate increase potentially reducing pretax earnings by $5 million - The company is exposed to interest rate risk, with approximately **$520 million** of its long-term debt subject to variable rates as of March 31, 2025[105](index=105&type=chunk) - A hypothetical **1% increase** in interest rates would lead to a potential annualized reduction of approximately **$5 million** in future pretax earnings[106](index=106&type=chunk) - Investments held by insurance subsidiaries, valued at **$657 million**, are exposed to market risk, with net unrealized losses of **$21 million** reported at quarter-end[103](index=103&type=chunk) [Controls and Procedures](index=27&type=section&id=Item%204.%20Controls%20and%20Procedures) Management concluded that the company's disclosure controls and procedures were effective as of March 31, 2025, with no material changes to internal control over financial reporting during the quarter - Based on an evaluation as of March 31, 2025, the CEO and CFO concluded that HCA's disclosure controls and procedures were effective[113](index=113&type=chunk) - There were no material changes in the company's internal control over financial reporting during the first quarter of 2025[114](index=114&type=chunk) [Part II. Other Information](index=27&type=section&id=Part%20II.%20Other%20Information) [Legal Proceedings](index=27&type=section&id=Item%201.%20Legal%20Proceedings) The company operates in a highly regulated and litigious industry, facing various lawsuits, claims, and governmental investigations, with details referenced in Note 8 of the financial statements - The company is subject to various lawsuits, claims, and legal and regulatory proceedings, including government inquiries and whistleblower suits under the False Claims Act[50](index=50&type=chunk)[52](index=52&type=chunk) [Risk Factors](index=28&type=section&id=Item%201A.%20Risk%20Factors) While no material changes to risk factors from the 2024 10-K are noted, this section elaborates on risks from the company's significant $44.576 billion indebtedness, which could impact financial flexibility - As of March 31, 2025, the company's total indebtedness was **$44.576 billion**[119](index=119&type=chunk) - Significant indebtedness poses several risks, including increased vulnerability to economic downturns, dedication of cash flow to debt service, exposure to interest rate risk, and limitations on strategic acquisitions and financing[124](index=124&type=chunk) - Debt agreements contain restrictive covenants that limit the company's ability to incur additional debt, create liens, and engage in certain other transactions, where a breach could lead to default and acceleration of debt repayment[126](index=126&type=chunk)[130](index=130&type=chunk) [Issuer Purchases of Equity Securities](index=29&type=section&id=Item%202.%20Unregistered%20Sales%20of%20Equity%20Securities%20and%20Use%20of%20Proceeds) In Q1 2025, HCA repurchased 7.762 million shares for approximately $2.5 billion, with $8.259 billion remaining for future repurchases, and declared a quarterly dividend of $0.72 per share Share Repurchases in Q1 2025 | Period | Total Shares Purchased | Average Price Paid per Share | | :--- | :--- | :--- | | Jan 2025 | 1,901,781 | $316.08 | | Feb 2025 | 2,992,516 | $323.80 | | Mar 2025 | 2,867,300 | $326.32 | | **Total Q1** | **7,761,597** | **$322.84** | - As of March 31, 2025, the company had **$8.259 billion** of repurchase authorization available under its January 2025 program[127](index=127&type=chunk) - On April 24, 2025, the Board of Directors declared a quarterly dividend of **$0.72 per share**[131](index=131&type=chunk) [Exhibits](index=31&type=section&id=Item%206.%20Exhibits) This section lists exhibits filed with the Form 10-Q, including supplemental indentures, the new credit agreement, executive compensation plans, and CEO/CFO certifications - Exhibits filed include the new Credit Agreement dated February 20, 2025, and various supplemental indentures for the senior notes issued in February 2025[134](index=134&type=chunk)

Core Viewpoint - Growth investors are interested in stocks with above-average financial growth, but identifying such stocks can be challenging due to their inherent risks and volatility [1] Group 1: HCA Healthcare Overview - HCA Healthcare is recommended as a strong growth stock based on its favorable Growth Score and top Zacks Rank [2] - The company has a historical EPS growth rate of 18.7%, with projected EPS growth of 14.8% this year, surpassing the industry average of 14.1% [4] Group 2: Key Growth Metrics - HCA's asset utilization ratio is 1.21, indicating that the company generates $1.21 in sales for every dollar in assets, compared to the industry average of 0.9 [5] - The company's sales are expected to grow by 5.6% this year, significantly higher than the industry average of 1% [6] Group 3: Earnings Estimate Revisions - There has been a positive trend in earnings estimate revisions for HCA, with the Zacks Consensus Estimate for the current year increasing by 1.1% over the past month [7] Group 4: Investment Positioning - HCA has achieved a Growth Score of A and a Zacks Rank of 2 due to positive earnings estimate revisions, positioning it well for potential outperformance [9]

Industry Overview - The Zacks Medical-Hospital industry consists of for-profit hospital companies providing various healthcare services, including acute care, rehabilitation, and psychiatric care [3] - Revenue generation is influenced by inpatient occupancy levels, medical services ordered, and outpatient procedure volumes [3] - Payments for services come from government programs like Medicare and Medicaid, managed care plans, private insurers, and directly from patients [3] Key Trends Shaping the Hospital Industry - Growing patient volumes are driven by the resumption of elective procedures post-pandemic, with the 65+ age group projected to increase from 17.3% in 2022 to 22.8% by 2050 [4] - Health spending is expected to reach $5.3 trillion by 2025, indicating strong demand for healthcare services [4] - Rising costs are a concern, but programs like the Affordable Care Act are anticipated to support continued growth [4] Managing Cost Pressures - Hospitals are facing rising expenses due to increased patient volumes and higher supply, labor, and benefit costs [5] - Strategies to counter these pressures include improving labor productivity, adopting cost-saving technologies, and enhancing operational efficiency [5] - Stabilizing patient volumes and renegotiated supplier contracts are expected to strengthen cost control [5] Embracing the Digital Shift - The healthcare sector is accelerating the adoption of AI, automation, and real-time analytics to enhance patient care and streamline operations [6] - Telehealth and telemedicine have become essential components of modern healthcare delivery, especially post-pandemic [6] Rising M&A Activity - Mergers and acquisitions are a key growth catalyst, with the industry expected to see continued deal activity driven by capacity expansion and efficiency goals [7] - Economic stabilization is likely to boost confidence in consolidation efforts within the fragmented industry [7] Zacks Industry Rank Shows Promise - The Zacks Medical-Hospital industry currently holds a Zacks Industry Rank of 27, placing it in the top 11% of nearly 250 Zacks industries [9] - Positive earnings outlook and revisions indicate optimism about the industry's growth potential [10] Industry Performance - The Zacks Medical-Hospital industry has outperformed the Zacks Medical sector and the S&P 500, gaining 3% year-to-date compared to the sector's 3.3% decline and the S&P 500's 6.4% fall [12] Industry's Current Valuation - The industry trades at a trailing 12-month EV/EBITDA ratio of 7.48X, significantly lower than the S&P 500's 16.31X and the sector's 10.48X [15] - Over the past five years, the industry has seen an EV/EBITDA range of 6.16X to 9.55X, with a median of 7.99X [15] Company Highlights - **Universal Health Services**: Focuses on acute care hospitals and outpatient centers, with growth driven by rising patient days and an expanding care network [18] - **Tenet Healthcare Corporation**: Operates a broad network of hospitals, with strong revenue growth in its Ambulatory Care segment [22] - **HCA Healthcare**: Positioned for growth with rising patient volumes and expansion into telemedicine [26] - **Community Health Systems**: Focuses on telehealth and hospital acquisitions to enhance specialty services and improve cost efficiency [28]

Financial Data and Key Metrics Changes - In the first quarter of 2025, diluted earnings per share, as adjusted, increased more than 20% year-over-year to $6.45 [9] - Adjusted EBITDA grew 11.3% over the prior year quarter, with an adjusted EBITDA margin improvement of 110 basis points [20][22] - Cash flow from operations was $1.65 billion in the quarter, impacted by working capital changes [24] Business Line Data and Key Metrics Changes - Inpatient admissions grew 2.6% year-over-year, equivalent admissions increased 2.8%, and emergency room visits rose 4% [10] - Same facilities revenue grew almost 6%, driven by volume increases and approximately 3% higher revenue per equivalent admission [11] - Surgical volumes were mixed, with inpatient surgeries slightly up and outpatient cases down [10][33] Market Data and Key Metrics Changes - Same-facility managed care equivalent admissions increased by 5.4% compared to the prior year quarter, while same-facility equivalent exchange admissions surged 22.4% [20] - Exchange volume represented about 8% of equivalent admissions and approximately 10% of revenues for the quarter [108] Company Strategy and Development Direction - The company is focused on maintaining operational discipline while continuing to invest in its strategic agenda, including increasing the number of facilities by 3.3% [12][13] - Capital allocation strategy includes $991 million in capital expenditures, $225 million in share repurchases, and $180 million in dividends [25] - The company is investing heavily in technology and digital transformation to improve operational efficiency and clinical care [132][133] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the overall demand for healthcare services and the company's ability to navigate through uncertain policy environments [14][18] - The company is developing plans to address potential adverse impacts from health policy changes and tariffs, drawing from experiences during the COVID-19 pandemic [17][75] - Management noted that the labor market remains stable, with initiatives in place to support workforce development [45][80] Other Important Information - The company reaffirmed its guidance ranges for the full-year 2025, indicating confidence in its operational performance [26] - The company reported an $18 million increase in net benefits related to Medicaid in the first quarter of 2025 compared to the prior year quarter [23] Q&A Session Summary Question: Any major changes in assumptions embedded in the guidance? - Management stated that the first quarter performance was solid, and guidance for 2025 remains appropriate [31][32] Question: How to achieve productivity and manage turnover? - Management highlighted that operating leverage is created by pushing more volume through the organization, and turnover rates are lower year-over-year [42][44] Question: Clarification on revenue per adjusted admission increase? - Management noted that the increase was driven by payer mix trends and outpatient revenue growth, despite a decline in outpatient surgery case volumes [53][55] Question: Changes in Medicare Advantage behavior and length of stay? - Management indicated that Medicare Advantage continues to run a bit higher on length of stay compared to traditional Medicare, but no significant changes were observed [68] Question: Impact of tariffs on supply sourcing? - Management mentioned that 70% of supply expenses are contracted with firm pricing for 2025, and 75% of supply expenses come from the U.S., Canada, or Mexico [73][75] Question: Competitive environment and CapEx priorities? - Management noted no substantial changes in competitors' behaviors, but the company is positioned to gain market share if competitors face challenges [100][101]

Core Viewpoint - HCA Healthcare, Inc. reported strong first-quarter 2025 results with adjusted earnings per share (EPS) of $6.45, exceeding estimates and showing a year-over-year increase of 20.3% [1]. Financial Performance - Revenues for the first quarter reached $18.3 billion, reflecting a 5.7% year-over-year growth and slightly surpassing consensus estimates by 0.1% [1]. - Adjusted EBITDA increased to $3.7 billion from $3.4 billion in the previous year [4]. Operational Metrics - Same-facility equivalent admissions rose by 2.6% year over year, while same-facility admissions increased by 2.8%, both falling short of growth estimates [3]. - Same-facility revenue per equivalent admission grew by 2.9% year over year, missing the growth estimate of 3% [3]. - Same-facility inpatient surgeries saw a minor increase of 0.2% year over year, below the expected 2.2% growth, while outpatient surgeries decreased by 2.1% [4]. - Emergency room visits increased by 4% year over year [4]. Expense Overview - Salaries and benefits, supplies, and other operating expenses rose by 4.4% year over year to $14.6 billion, which was lower than the estimated $14.8 billion [4]. Cash Flow and Capital Deployment - Cash generated from operations was $1.7 billion, down from $2.5 billion in the previous year [8]. - The company repurchased shares worth $2.5 billion in the first quarter, with an available buyback capacity of $8.3 billion [9]. Financial Position - As of March 31, 2025, HCA Healthcare had cash and cash equivalents of $1 billion, down from $1.9 billion at the end of 2024 [6]. - Total assets increased to $59.8 billion from $59.5 billion at the end of 2024, while long-term debt rose to $41.1 billion from $38.3 billion [6]. Guidance - HCA Healthcare anticipates annual revenues between $72.8 billion and $75.8 billion for 2025, indicating a 5.2% rise from 2024 [10]. - Adjusted EBITDA is expected to range from $14.3 billion to $15.1 billion, reflecting a 5.9% growth from the previous year [10]. - EPS is forecasted to be between $24.05 and $25.85, implying a 13.6% increase from 2024 [11].

Financial Data and Key Metrics Changes - In the first quarter of 2025, diluted earnings per share, as adjusted, increased more than 20% year-over-year to $6.45 [9] - Adjusted EBITDA grew 11.3% over the prior year quarter, with an adjusted EBITDA margin improvement of 110 basis points [20][22] - Cash flow from operations was $1.65 billion in the quarter, with a decrease attributed to working capital changes [24] Business Line Data and Key Metrics Changes - Inpatient admissions grew 2.6% year-over-year, equivalent admissions increased 2.8%, and emergency room visits rose by 4% [10] - Same facilities revenue grew almost 6%, driven by volume increases and approximately 3% higher revenue per equivalent admission [11] - Surgical volumes were mixed, with inpatient surgeries slightly up and outpatient cases down [10][33] Market Data and Key Metrics Changes - Same-facility managed care equivalent admissions increased by 5.4% compared to the prior year quarter, while same-facility equivalent exchange admissions surged by 22.4% [20] - Exchange volume represented about 8% of equivalent admissions and approximately 10% of revenues for the quarter [108] Company Strategy and Development Direction - The company is focused on maintaining operational discipline while continuing to invest in its strategic agenda, including increasing the number of facilities by 3.3% [12][13] - Capital allocation strategy includes $991 million in capital expenditures, $225 million in share repurchases, and $180 million in dividends [25] - The company is investing heavily in technology and digital transformation to improve operational efficiency and clinical care [132][133] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the overall demand for healthcare services and the company's ability to navigate through uncertain policy environments [14][18] - The company is developing plans to address potential adverse impacts from health policy changes and tariffs, drawing from experiences during the COVID-19 pandemic [17][75] - Management remains optimistic about maintaining market share gains and operational efficiencies despite competitive pressures [100][101] Other Important Information - The company reaffirmed its guidance ranges for the full-year 2025, indicating confidence in its operational performance [26] - The company reported an $18 million increase in net benefits related to Medicaid in the first quarter of 2025 compared to the prior year quarter [23] Q&A Session Summary Question: Any major changes in assumptions embedded in the reiteration of guidance? - Management stated that the first quarter performance was solid, and guidance for 2025 remains appropriate [31] Question: How do you get that much leverage this quarter? - Management explained that operating leverage is created by pushing more volume through the organization, which improves profitability and margins [42] Question: Can you clarify the revenue per adjusted admission increase? - Management noted that the increase was driven by payer mix trends and improved acuity, with managed care positioning improving year-over-year [55][59] Question: Any changes with MA plan behavior denials? - Management indicated that there were no significant changes in denials and underpayments that materially impacted financial results [68] Question: How is the surgical schedule and block time utilization looking? - Management believes that demand for healthcare will remain strong, with expectations for surgical volumes to recover [126] Question: Can you speak to your technology agenda? - Management highlighted significant investments in technology and digital transformation to enhance operational efficiency and clinical care [132][133]

HCA Healthcare (HCA) reported $18.32 billion in revenue for the quarter ended March 2025, representing a year-over-year increase of 5.7%. EPS of $6.45 for the same period compares to $5.36 a year ago.The reported revenue represents a surprise of +0.08% over the Zacks Consensus Estimate of $18.31 billion. With the consensus EPS estimate being $5.77, the EPS surprise was +11.79%.While investors scrutinize revenue and earnings changes year-over-year and how they compare with Wall Street expectations to determi ...

Group 1 - HCA Healthcare reported quarterly earnings of $6.45 per share, exceeding the Zacks Consensus Estimate of $5.77 per share, and up from $5.36 per share a year ago, representing an earnings surprise of 11.79% [1] - The company posted revenues of $18.32 billion for the quarter ended March 2025, surpassing the Zacks Consensus Estimate by 0.08%, and an increase from $17.34 billion year-over-year [2] - HCA shares have increased approximately 13.8% since the beginning of the year, contrasting with the S&P 500's decline of -6.8% [3] Group 2 - The current consensus EPS estimate for the upcoming quarter is $6.18 on revenues of $18.45 billion, and for the current fiscal year, it is $24.98 on revenues of $74.69 billion [7] - The Medical - Hospital industry, to which HCA belongs, is currently ranked in the top 10% of over 250 Zacks industries, indicating strong performance potential [8] Group 3 - HCA has surpassed consensus EPS estimates in all four of the last quarters, indicating consistent performance [2] - The estimate revisions trend for HCA is currently mixed, resulting in a Zacks Rank 3 (Hold) for the stock, suggesting it is expected to perform in line with the market in the near future [6]

Core Insights - HCA Healthcare reported strong Q1 2025 results, exceeding market expectations in both earnings and revenue [1] - The company achieved an adjusted EPS of $6.45, surpassing the anticipated $5.75, and reported revenue of $18.32 billion, slightly above the expected $18.26 billion [1][2] Financial Performance - Adjusted EPS for Q1 2025 was $6.45, a 20.3% increase from Q1 2024's $5.93 [2] - Revenue reached $18.32 billion, reflecting a 5.7% year-over-year growth from $17.34 billion in Q1 2024 [2] - Net income was reported at $1.61 billion, a 1.2% increase from $1.59 billion in Q1 2024 [2] - Adjusted EBITDA for the quarter was $3.73 billion, up 11.3% from $3.35 billion in Q1 2024 [2] - Cash flows from operations decreased to $1.65 billion, down 33.1% from $2.47 billion in Q1 2024 [2] Company Overview - HCA Healthcare is a leading for-profit operator of healthcare facilities in the U.S., managing hospitals, surgery centers, and emergency care centers [3] - The company focuses on patient care and invests in technology and staff to drive growth [3] - Key success factors include adapting to regulatory changes and optimizing healthcare delivery through digital transformation [3] Operational Challenges - The company faces challenges in maintaining profitability due to rising labor costs and reimbursement pressures [4] - Despite these challenges, operational efficiency was strong, supported by increased demand for healthcare services [5] - Regulatory challenges persist, particularly due to reliance on Medicare and Medicaid [6] - Same-facility equivalent admissions increased by 2.8%, while outpatient surgeries declined by 2.1% in Q1 2025 [6] Human Capital Management - Improvements in human capital management were noted, with salaries and benefits as a percentage of revenue decreasing from 44.4% in Q1 2024 to 43.6% in Q1 2025 [7] - The company expanded its operational footprint, increasing the number of hospitals to 190 and outpatient centers to approximately 2,400 [7] Future Outlook - HCA management reaffirmed guidance for full-year 2025 revenue between $72.8 billion and $75.8 billion, with adjusted EBITDA projected between $14.3 billion and $15.1 billion [8] - The company will continue to monitor regulatory changes and labor market dynamics, with strategic investments in technology and human capital expected to support operational capabilities [9]

Financial Performance - Revenues for Q1 2025 totaled $18.321 billion, a 5.7% increase from $17.339 billion in Q1 2024[2] - Net income attributable to HCA Healthcare, Inc. was $1.610 billion, or $6.45 per diluted share, compared to $1.591 billion, or $5.93 per diluted share in Q1 2024[2][17] - Adjusted EBITDA for Q1 2025 was $3.733 billion, up from $3.353 billion in Q1 2024[3] - Adjusted EBITDA for Q1 2025 was $3,733 million, representing a margin of 20.4%, compared to $3,353 million and a margin of 19.3% in Q1 2024[25] - The forecast for total revenues for the year ending December 31, 2025, is between $72,800 million and $75,800 million[30] - The projected net income attributable to HCA Healthcare, Inc. for 2025 is between $5,850 million and $6,290 million[30] Operational Metrics - Same facility admissions increased by 2.6% and same facility equivalent admissions rose by 2.8% compared to the prior year[4][5] - Admissions in Q1 2025 were 576,361, reflecting a 2.8% increase from 560,869 in Q1 2024[22] - The number of hospitals increased to 192 in Q1 2025 from 188 in Q1 2024, and licensed beds rose to 50,571 from 49,724[22] - The average length of stay in Q1 2025 was 4.922 days, slightly down from 4.959 days in Q1 2024[22] - The company reported a decrease in outpatient surgery cases by 2.5% in Q1 2025 compared to Q1 2024[22] Cash Flow and Debt - Cash flows from operating activities in Q1 2025 totaled $1.651 billion, down from $2.469 billion in Q1 2024[6] - As of March 31, 2025, total debt was $44.576 billion, with cash and cash equivalents of $1.060 billion[6] - Cash and cash equivalents at the end of Q1 2025 were $1,060 million, down from $1,933 million at the end of Q4 2024[20] Shareholder Returns - The company repurchased 7.762 million shares at a cost of $2.506 billion during Q1 2025[7] - A quarterly cash dividend of $0.72 per share was declared, payable on June 30, 2025[8] Guidance and Future Outlook - The company reaffirmed its 2025 estimated guidance ranges, expecting stable operating conditions and volume growth[10][11] - The Company does not forecast the impact of items such as losses on sales of facilities and legal claim costs due to the inability to predict these items accurately[33] Adjusted EBITDA - Adjusted EBITDA is not a measure of financial performance under GAAP but is considered important for discussions and analysis of operational results[33] - Management relies on Adjusted EBITDA as a primary measure to review and assess the operating performance of its health care facilities[33]