Financial Data and Key Metrics Changes - The company reported net operating revenues of $21.3 billion for 2025, with consolidated Adjusted EBITDA of $4.57 billion, representing a 14% growth over 2024 [5][13] - The full-year Adjusted EBITDA margin improved by 200 basis points to 21.4% compared to the prior year [5][14] - In Q4 2025, total net operating revenues were $5.5 billion, with consolidated Adjusted EBITDA of $1.183 billion, a 13% increase year-over-year [12][13] Business Line Data and Key Metrics Changes - The USPI segment's Adjusted EBITDA grew 12% in 2025 to $2.026 billion, with same-facility revenues increasing by 7.2% [6][14] - The hospital segment's Adjusted EBITDA increased by 16% to $2.54 billion, with same-store revenues per adjusted admission up 5.3% [7][14] - Same facility revenues grew 7.5%, driven by double-digit growth in total joint replacements in ASCs [7] Market Data and Key Metrics Changes - The company experienced strong same-store revenue growth, exceeding the long-term goal of 3%-6% organic growth [7] - In Q4, exchange volumes accounted for approximately 7.5% of total admissions and over 6% of consolidated revenues [69] Company Strategy and Development Direction - The company plans to continue focusing on organic growth supplemented by M&A, with nearly $350 million invested in 2025 and 35 facilities added to the portfolio [7][8] - The company expects to tackle expense management more structurally, leveraging technology for sustainable cost reductions [27][28] - The company anticipates a gradual tailwind from the phase-out of the Inpatient Only List starting in 2026, with opportunities in high acuity procedures [9] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in achieving strong core earnings growth for 2026, despite anticipated headwinds from the expiration of enhanced premium tax credits [11][19] - The company expects full-year 2026 Adjusted EBITDA in the range of $4.485 billion to $4.785 billion, driven by ongoing demand strength and service line expansion [9][18] - Management acknowledged uncertainty regarding enrollment levels and effectuation rates, which could impact future performance [11][19] Other Important Information - The company repurchased approximately 22% of its outstanding shares for around $2.5 billion since the share repurchase program began in Q4 2022 [8][16] - The company generated $2.53 billion of free cash flow for the full year 2025, with $2.8 billion in cash on hand as of December 31, 2025 [15][16] Q&A Session Summary Question: Can you expand on the same-store hospital volume performance in the quarter? - Management noted that while acuity was good, the respiratory season was weaker than expected, impacting volumes [25] Question: What do you mean by tackling expense management more structurally? - Management explained that they are focusing on technology deployment for sustainable expense reductions, moving beyond traditional annual expense management [27][28] Question: Can you provide more details on the hospital admission growth guidance of 1%-2%? - Management indicated that the guidance reflects anticipated impacts from exchange exposure and investments in higher acuity capabilities [32] Question: Is the growth expected to be sustainable in future years? - Management expressed confidence in the sustainability of growth, citing a track record of acuity and revenue per case growth [39][40] Question: What is the payer mix for USPI in Q4? - Management reported a consistent payer mix, with net revenue per case growth of 5.5% and EBITDA margins above 40% [83]

Economic Outlook - The probability of a U.S. recession in 2025 is decreasing from a peak of 60% to below 50% due to the Trump administration easing aggressive tariff policies, which has allowed the S&P 500 to recover from a correction in March [1] Company Analysis Walmart (WMT) - Walmart has historically thrived during recessions due to its essential grocery offerings and reputation for affordability, attracting budget-conscious customers [3] - Approximately two-thirds of Walmart's inventory is produced in the U.S., providing a buffer against global trade tensions [4] - Over the past year, Walmart has achieved a 47% return, significantly outperforming the S&P 500's 10% return, with analysts optimistic about steady growth in the coming months [4] HCA Healthcare (HCA) - HCA Healthcare is the largest non-governmental hospital chain in the U.S. and has shown resilience during economic downturns, particularly in critical care sectors [5] - The company reported a remarkable growth of +236.97% and aims for a 29% market share by 2030 [5] - Cantor Fitzgerald raised its price target for HCA from $405 to $444, indicating a potential 16% upside from the stock's previous closing price [6] Waste Management (WM) - Waste Management has experienced a +135.87% growth over the past five years, as demand for waste collection and recycling services remains stable during recessions [9] - The waste management industry is projected to grow at a compound annual growth rate (CAGR) of 5.4% by 2030, driven by advancements in recycling technologies and increasing environmental awareness [10] - Recent evaluations by JPMorgan indicate optimism regarding WM's growth prospects, with a valuation of approximately 16x forward-year EV/EBITDA and a free cash flow yield of 3% [11]