Form 10-Q
Table of Contents

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

Form 10-Q

 

 

(Mark One)

x QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2012

Or

 

¨ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from              to             

Commission file number 1-11239

 

 

HCA Holdings, Inc.

(Exact name of registrant as specified in its charter)

 

 

 

Delaware   27-3865930

(State or other jurisdiction of

incorporation or organization)

 

(I.R.S. Employer

Identification No.)

One Park Plaza

Nashville, Tennessee

  37203
(Address of principal executive offices)   (Zip Code)

(615) 344-9551

(Registrant’s telephone number, including area code)

Not Applicable

(Former name, former address and former fiscal year, if changed since last report)

 

 

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    Yes  x     No   ¨

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).     Yes   x     No   ¨

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company. See the definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act.

 

Large accelerated filer   x    Accelerated filer   ¨
Non-accelerated filer   ¨ (Do not check if a smaller reporting company)    Smaller reporting company   ¨

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).     Yes   ¨     No   x

Indicate the number of shares outstanding of each of the issuer’s classes of common stock as of the latest practicable date.

 

Class of Common Stock

  

Outstanding at October 31, 2012

Voting common stock, $.01 par value

   441,493,600 shares

 

 

 


Table of Contents

HCA HOLDINGS, INC.

Form 10-Q

September 30, 2012

 

         Page of
Form 10-Q
 
Part I.   Financial Information       

Item 1.

  Financial Statements (Unaudited):   
 

Condensed Consolidated Comprehensive Statements of Operations  — for the quarters and nine months ended September 30, 2012 and 2011

     2   
 

Condensed Consolidated Balance Sheets — September 30, 2012 and December 31, 2011

     3   
 

Condensed Consolidated Statements of Cash Flows — for the nine months ended September  30, 2012 and 2011

     4   
  Notes to Condensed Consolidated Financial Statements      5   

Item 2.

 

Management’s Discussion and Analysis of Financial Condition and Results of Operations

     29   

Item 3.

  Quantitative and Qualitative Disclosures About Market Risk      50   

Item 4.

  Controls and Procedures      50   

Part II.

  Other Information   

Item 1.

  Legal Proceedings      50   

Item 1A.

  Risk Factors      52   

Item 6.

  Exhibits      52   
Signatures      54   

 

1


Table of Contents

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATED COMPREHENSIVE STATEMENTS OF OPERATIONS

FOR THE QUARTERS AND NINE MONTHS ENDED SEPTEMBER 30, 2012 AND 2011

Unaudited

(Dollars in millions, except per share amounts)

 

     Quarter     Nine Months  
     2012     2011     2012     2011  

Revenues before provision for doubtful accounts

   $ 8,893      $ 7,998      $ 27,245      $ 24,077   

Provision for doubtful accounts

     831        740        2,666        2,164   
  

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

     8,062        7,258        24,579        21,913   

Salaries and benefits

     3,781        3,333        11,224        9,948   

Supplies

     1,375        1,263        4,216        3,833   

Other operating expenses

     1,510        1,369        4,496        4,017   

Electronic health record incentive income

     (131     (51     (256     (90

Equity in earnings of affiliates

     (6     (68     (26     (217

Depreciation and amortization

     417        362        1,254        1,078   

Interest expense

     446        519        1,336        1,572   

Losses (gains) on sales of facilities

     (7     2        (4     3   

Losses on retirement of debt

            406               481   

Termination of management agreement

                          181   
  

 

 

   

 

 

   

 

 

   

 

 

 
     7,385        7,135        22,240        20,806   
  

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     677        123        2,339        1,107   

Provision (benefit) for income taxes

     222        (23     760        307   
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income

     455        146        1,579        800   

Net income attributable to noncontrolling interests

     95        85        288        270   
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to HCA Holdings, Inc.

   $ 360      $ 61      $ 1,291      $ 530   
  

 

 

   

 

 

   

 

 

   

 

 

 

Per share data:

        

Basic earnings per share

   $ 0.82      $ 0.12      $ 2.94      $ 1.08   

Diluted earnings per share

   $ 0.78      $ 0.11      $ 2.81      $ 1.04   

Cash dividends declared per share

   $      $      $ 2.00      $   

Shares used in earnings per share calculations (in thousands):

        

Basic

     440,899        508,417        439,441        489,924   

Diluted

     459,515        527,515        458,822        509,583   

Comprehensive income (loss) attributable to HCA Holdings, Inc.

   $ 369      $ (24   $ 1,291      $ 534   
  

 

 

   

 

 

   

 

 

   

 

 

 

 

See accompanying notes.

 

2


Table of Contents

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

Unaudited

(Dollars in millions)

 

     September 30,
2012
    December 31,
2011
 
ASSETS     

Current assets:

    

Cash and cash equivalents

   $ 472      $ 373   

Accounts receivable, less allowance for doubtful accounts of $4,475 and $4,106

     4,598        4,533   

Inventories

     1,052        1,054   

Deferred income taxes

     322        594   

Other

     828        679   
  

 

 

   

 

 

 
     7,272        7,233   

Property and equipment, at cost

     29,145        28,075   

Accumulated depreciation

     (16,185     (15,241
  

 

 

   

 

 

 
     12,960        12,834   

Investments of insurance subsidiaries

     473        548   

Investments in and advances to affiliates

     103        101   

Goodwill and other intangible assets

     5,460        5,251   

Deferred loan costs

     266        290   

Other

     768        641   
  

 

 

   

 

 

 
   $ 27,302      $ 26,898   
  

 

 

   

 

 

 
LIABILITIES AND STOCKHOLDERS’ DEFICIT     

Current liabilities:

    

Accounts payable

   $ 1,585      $ 1,597   

Accrued salaries

     1,027        965   

Other accrued expenses

     1,498        1,585   

Long-term debt due within one year

     1,751        1,407   
  

 

 

   

 

 

 
     5,861        5,554   

Long-term debt

     25,182        25,645   

Professional liability risks

     962        993   

Income taxes and other liabilities

     1,860        1,720   

Stockholders’ deficit:

    

Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 441,383,000 shares in 2012 and 437,477,900 shares in 2011

     4        4   

Capital in excess of par value

     1,680        1,601   

Accumulated other comprehensive loss

     (440     (440

Retained deficit

     (9,103     (9,423
  

 

 

   

 

 

 

Stockholders’ deficit attributable to HCA Holdings, Inc.

     (7,859     (8,258

Noncontrolling interests

     1,296        1,244   
  

 

 

   

 

 

 
     (6,563     (7,014
  

 

 

   

 

 

 
   $ 27,302      $ 26,898   
  

 

 

   

 

 

 

 

See accompanying notes.

 

3


Table of Contents

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2012 AND 2011

Unaudited

(Dollars in millions)

 

     2012     2011  

Cash flows from operating activities:

    

Net income

   $ 1,579      $ 800   

Adjustments to reconcile net income to net cash provided by operating activities:

    

Changes in operating assets and liabilities

     (2,923     (2,336

Provision for doubtful accounts

     2,666        2,164   

Depreciation and amortization

     1,254        1,078   

Income taxes

     250        348   

Losses (gains) on sales of facilities

     (4     3   

Losses on retirement of debt

            481   

Amortization of deferred loan costs

     44        56   

Share-based compensation

     39        24   

Pay-in-kind interest

            (78

Other

     7        6   
  

 

 

   

 

 

 

Net cash provided by operating activities

     2,912        2,546   
  

 

 

   

 

 

 

Cash flows from investing activities:

    

Purchase of property and equipment

     (1,268     (1,170

Acquisition of hospitals and health care entities

     (167     (209

Disposition of hospitals and health care entities

     17        55   

Change in investments

     73        80   

Other

     5        4   
  

 

 

   

 

 

 

Net cash used in investing activities

     (1,340     (1,240
  

 

 

   

 

 

 

Cash flows from financing activities:

    

Issuance of long-term debt

     1,350        5,000   

Net change in revolving credit facilities

     (875     (414

Repayment of long-term debt

     (689     (6,583

Distributions to noncontrolling interests

     (303     (281

Payment of debt issuance costs

     (20     (84

Issuance of common stock

            2,506   

Repurchase of common stock

            (1,503

Distributions to stockholders

     (983     (31

Income tax benefits

     82        54   

Other

     (35     (22
  

 

 

   

 

 

 

Net cash used in financing activities

     (1,473     (1,358
  

 

 

   

 

 

 

Change in cash and cash equivalents

     99        (52

Cash and cash equivalents at beginning of period

     373        411   
  

 

 

   

 

 

 

Cash and cash equivalents at end of period

   $ 472      $ 359   
  

 

 

   

 

 

 

Interest payments

   $ 1,404      $ 1,635   

Income tax payments (refunds), net

   $ 428      $ (95

 

See accompanying notes.

 

4


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

NOTE 1 — INTERIM CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

Reporting Entity

On November 17, 2006, HCA Inc. was acquired by a private investor group, including affiliates of, or funds sponsored by Bain Capital Partners, LLC, Kohlberg Kravis Roberts & Co., BAML Capital Partners and HCA founder, Dr. Thomas F. Frist Jr. (collectively, the “Investors”) and by members of management and certain other investors. The transaction was accounted for as a recapitalization in our financial statements, with no adjustments to the historical basis of our assets and liabilities.

On November 22, 2010, HCA Inc. reorganized by creating a new holding company structure (the “Corporate Reorganization”). HCA Holdings, Inc. became the new parent company, and HCA Inc. became HCA Holdings, Inc.’s wholly-owned direct subsidiary. As part of the Corporate Reorganization, HCA Inc.’s outstanding shares of common stock were automatically converted, on a share for share basis, into identical shares of HCA Holdings, Inc.’s common stock. As a result of the Corporate Reorganization, HCA Holdings, Inc. was deemed the successor registrant to HCA Inc. under the Exchange Act.

During March 2011, we completed the initial public offering of 87,719,300 shares of our common stock at a price of $30.00 per share (before deducting underwriter discounts, commissions and other related offering expenses). Certain of our stockholders also sold 57,410,700 shares of our common stock in this offering. We did not receive any proceeds from the shares sold by the selling stockholders. Our common stock is traded on the New York Stock Exchange (symbol “HCA”).

The Investors provided management and advisory services to the Company pursuant to a management agreement among HCA Inc. and the Investors executed in connection with the Investors’ acquisition of HCA Inc. in November 2006. The management agreement was terminated pursuant to its terms upon completion of the initial public offering of our common stock during March 2011, and the Company paid the Investors a final fee of $181 million.

HCA Holdings, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Holdings, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At September 30, 2012, these affiliates owned and operated 162 hospitals, 112 freestanding surgery centers and provided extensive outpatient and ancillary services. HCA Holdings, Inc.’s facilities are located in 20 states and England. The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicated by context, refer to HCA Inc. and its affiliates prior to the Corporate Reorganization and to HCA Holdings, Inc. and its affiliates after the Corporate Reorganization. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA.

Basis of Presentation

The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included and are of a normal and recurring nature.

The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $62 million and $53 million for the quarters

 

5


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 1 — INTERIM CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (continued)

 

Basis of Presentation (continued)

 

ended September 30, 2012 and 2011, respectively, and $174 million and $162 million for the nine months ended September 30, 2012 and 2011, respectively. Operating results for the quarter and the nine months ended September 30, 2012 are not necessarily indicative of the results that may be expected for the year ending December 31, 2012. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K for the year ended December 31, 2011.

Revenues are recorded during the period the health care services are provided, based upon the estimated amounts due from the patients and third-party payers. Third-party payers include federal and state agencies (under Medicare, Medicaid and other programs), managed care health plans, commercial insurance companies and employers. Estimates of contractual allowances under managed care health plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record a provision for doubtful accounts related to uninsured accounts to record the net self pay accounts receivable at the estimated amounts we expect to collect. Our revenues from third-party payers, the uninsured and other revenues for the quarters and nine months ended September 30, 2012 and 2011 are summarized in the following tables (dollars in millions):

 

     Quarter  
     2012     Ratio     2011     Ratio  

Medicare

   $ 1,949        24.2   $ 1,844        25.4

Managed Medicare

     720        8.9        610        8.4   

Medicaid

     378        4.7        453        6.2   

Managed Medicaid

     380        4.7        311        4.3   

Managed care and other insurers

     4,422        54.8        3,855        53.1   

International (managed care and other insurers)

     253        3.1        232        3.2   
  

 

 

   

 

 

   

 

 

   

 

 

 
     8,102        100.4        7,305        100.6   

Uninsured

     576        7.1        508        7.0   

Other

     215        2.7        185        2.5   
  

 

 

   

 

 

   

 

 

   

 

 

 

Revenues before provision for doubtful accounts

     8,893        110.2        7,998        110.1   

Provision for doubtful accounts

     (831     (10.2     (740     (10.1
  

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

   $ 8,062        100.0   $ 7,258        100.0
  

 

 

   

 

 

   

 

 

   

 

 

 
     Nine Months  
     2012     Ratio     2011     Ratio  

Medicare

   $ 6,251        25.4   $ 5,715        26.1

Managed Medicare

     2,199        8.9        1,806        8.2   

Medicaid

     1,188        4.8        1,440        6.6   

Managed Medicaid

     1,080        4.4        946        4.3   

Managed care and other insurers

     13,340        54.3        11,486        52.4   

International (managed care and other insurers)

     779        3.2        698        3.2   
  

 

 

   

 

 

   

 

 

   

 

 

 
     24,837        101.0        22,091        100.8   

Uninsured

     1,757        7.1        1,390        6.3   

Other

     651        2.7        596        2.7   
  

 

 

   

 

 

   

 

 

   

 

 

 

Revenues before provision for doubtful accounts

     27,245        110.8        24,077        109.8   

Provision for doubtful accounts

     (2,666     (10.8     (2,164     (9.8
  

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

   $ 24,579        100.0   $ 21,913        100.0
  

 

 

   

 

 

   

 

 

   

 

 

 

 

6


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 1 — INTERIM CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (continued)

 

Basis of Presentation (continued)

 

The increase in revenues for the nine months ended September 30, 2012 compared to the nine months ended September 30, 2011 includes two adjustments (Rural Floor Provision Settlement and Supplemental Security Income (“SSI”) ratios) related to Medicare revenues for prior periods. The net effect of the Medicare adjustments was an increase of $188 million to revenues. The Rural Floor Provision Settlement was signed on April 5, 2012. As a result of the agreement, we received additional Medicare payments of approximately $271 million during June 2012. This amount was recorded as an increase to Medicare revenues for the quarter ended March 31, 2012. During March 2012, the Centers for Medicare & Medicaid Services (“CMS”) issued new SSI ratios used for calculating Medicare Disproportionate Share Hospital (“DSH”) reimbursement for federal fiscal years ending September 30, 2006 through September 30, 2009. As a result, we recalculated our DSH reimbursement for all applicable periods. The cumulative impact of this retroactive adjustment was a reduction in Medicare revenues of approximately $83 million. This adjustment was recorded as a reduction to Medicare revenues during the quarter ended March 31, 2012. The net effect of these adjustments (and related expenses) added $170 million to income before income taxes, or $0.22 per diluted share, for the nine months ended September 30, 2012.

We previously reported $51 million and $90 million of Medicaid and Medicare electronic health record (“EHR”) incentives for the quarter and nine months ended September 30, 2011, respectively, in the line item “Revenues” in our condensed consolidated income statements. These amounts have been reclassified and are now included in the line item “Electronic health record incentive income” in our condensed consolidated comprehensive statements of operations for the quarter and nine months ended September 30, 2011.

Certain prior year amounts have been reclassified to conform to the current year presentation.

NOTE 2 — INCOME TAXES

At September 30, 2012, we were contesting certain claimed deficiencies and adjustments proposed by the IRS Examination Division in connection with its audit of HCA Inc.’s 2005 and 2006 federal income tax returns. The disputed items include the timing of recognition of certain patient service revenues, the deductibility of certain debt retirement costs and our method for calculating the tax allowance for doubtful accounts. The IRS Examination Division began an audit of HCA Inc.’s 2007, 2008 and 2009 federal income tax returns in 2010. During the quarter ended September 30, 2011, we finalized a settlement with the IRS Examination Division resolving all outstanding issues for our 1997 through 2001 tax years.

Our liability for unrecognized tax benefits was $519 million, including accrued interest of $47 million, as of September 30, 2012 ($494 million and $62 million, respectively, as of December 31, 2011). Unrecognized tax benefits of $158 million ($173 million as of December 31, 2011) would affect the effective rate, if recognized. The provision for income taxes reflects $1 million and $66 million (none and $42 million, respectively, net of tax) of interest expense and reductions in interest expense, respectively, related to taxing authority examinations for the quarters ended September 30, 2012 and 2011, respectively, and $20 million and $92 million ($13 million and $58 million, respectively, net of tax) of reductions in interest expense related to taxing authority examinations for the nine months ended September 30, 2012 and 2011, respectively.

Depending on the resolution of the IRS disputes, the completion of examinations by federal, state or international taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible our liability for unrecognized tax benefits may significantly increase or decline within the next 12 months. However, we are currently unable to estimate the range of any possible change.

 

7


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 3 — EARNINGS PER SHARE

We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding stock options, stock appreciation rights and restricted share units, computed using the treasury stock method. During September 2011, we repurchased 80.8 million shares of our common stock.

The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2012 and 2011 (dollars in millions, except per share amounts, and shares in thousands):

 

     Quarter      Nine Months  
     2012      2011      2012      2011  

Net income attributable to HCA Holdings, Inc.

   $ 360       $ 61       $ 1,291       $ 530   

Weighted average common shares outstanding

     440,899         508,417         439,441         489,924   

Effect of dilutive securities

     18,616         19,098         19,381         19,659   
  

 

 

    

 

 

    

 

 

    

 

 

 

Shares used for diluted earnings per share

     459,515         527,515         458,822         509,583   
  

 

 

    

 

 

    

 

 

    

 

 

 

Earnings per share:

           

Basic earnings per share

   $ 0.82       $ 0.12       $ 2.94       $ 1.08   

Diluted earnings per share

   $ 0.78       $ 0.11       $ 2.81       $ 1.04   

NOTE 4 — INVESTMENTS OF INSURANCE SUBSIDIARIES

A summary of our insurance subsidiaries’ investments at September 30, 2012 and December 31, 2011 follows (dollars in millions):

 

     September 30, 2012  
     Amortized
Cost
     Unrealized
Amounts
    Fair
Value
 
        Gains      Losses    

Debt securities:

          

States and municipalities

   $ 349       $ 24       $      $ 373   

Auction rate securities

     76                 (5     71   

Asset-backed securities

     15                        15   

Money market funds

     67                        67   
  

 

 

    

 

 

    

 

 

   

 

 

 
     507         24         (5     526   

Equity securities

     7         1                8   
  

 

 

    

 

 

    

 

 

   

 

 

 
   $ 514       $ 25       $ (5     534   
  

 

 

    

 

 

    

 

 

   

Amounts classified as current assets

             (61
          

 

 

 

Investment carrying value

           $ 473   
          

 

 

 

 

8


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 4 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued)

 

     December 31, 2011  
     Amortized
Cost
     Unrealized
Amounts
    Fair
Value
 
        Gains      Losses    

Debt securities:

          

States and municipalities

   $     398       $     19       $     —      $     417   

Auction rate securities

     139                 (8     131   

Asset-backed securities

     20                        20   

Money market funds

     53                        53   
  

 

 

    

 

 

    

 

 

   

 

 

 
     610         19         (8     621   

Equity securities

     7         1         (1     7   
  

 

 

    

 

 

    

 

 

   

 

 

 
   $ 617       $ 20       $ (9     628   
  

 

 

    

 

 

    

 

 

   

Amounts classified as current assets

             (80
          

 

 

 

Investment carrying value

           $ 548   
          

 

 

 

At September 30, 2012 and December 31, 2011, the investments of our insurance subsidiaries were classified as “available-for-sale.” Changes in temporary unrealized gains and losses are recorded as adjustments to other comprehensive income. At both September 30, 2012 and December 31, 2011, $19 million of our investments were subject to restrictions included in insurance bond collateralization and assumed reinsurance contracts.

Scheduled maturities of investments in debt securities at September 30, 2012 were as follows (dollars in millions):

 

     Amortized
Cost
     Fair
Value
 

Due in one year or less

   $     72       $     72   

Due after one year through five years

     140         149   

Due after five years through ten years

     111         119   

Due after ten years

     93         100   
  

 

 

    

 

 

 
     416         440   

Auction rate securities

     76         71   

Asset-backed securities

     15         15   
  

 

 

    

 

 

 
   $ 507       $ 526   
  

 

 

    

 

 

 

The average expected maturity of the investments in debt securities at September 30, 2012 was 4.6 years, compared to the average scheduled maturity of 8.9 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to the scheduled maturity date. The average expected maturities for our auction rate and asset-backed securities were derived from valuation models of expected cash flows and involved management’s judgment. At September 30, 2012, the average expected maturities for our auction rate and asset-backed securities were 5.2 years and 4.1 years, respectively, compared to average scheduled maturities of 24.4 years and 24.1 years, respectively.

 

9


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 5 — LONG-TERM DEBT

A summary of long-term debt at September 30, 2012 and December 31, 2011, including related interest rates at September 30, 2012, follows (dollars in millions):

 

     September 30,
2012
     December 31,
2011
 

Senior secured asset-based revolving credit facility (effective interest rate of 1.7%)

   $ 1,280       $ 2,155   

Senior secured term loan facilities (effective interest rate of 5.0%)

     7,183         7,425   

Senior secured first lien notes (effective interest rate of 7.4%)

     8,436         7,081   

Other senior secured debt (effective interest rate of 6.8%)

     394         350   
  

 

 

    

 

 

 

First lien debt

     17,293         17,011   

Senior secured notes (effective interest rate of 11.0%)

     197         197   

Senior unsecured notes (effective interest rate of 7.3%)

     9,443         9,844   
  

 

 

    

 

 

 

Total debt (average life of 6.6 years, rates averaging 6.5%)

     26,933         27,052   

Less amounts due within one year

     1,751         1,407   
  

 

 

    

 

 

 
   $ 25,182       $ 25,645   
  

 

 

    

 

 

 

During April 2012, we extended $75 million of our term loan A-1 facility with a final maturity of November 2012 and $651 million of our term loan B-1 facility with a final maturity of November 2013 to term loan A-3 with a final maturity of February 2016.

During February 2012, we issued $1.350 billion aggregate principal amount of 5.875% senior secured first lien notes due 2022. After the payment of related fees and expenses, we used the proceeds for general corporate purposes.

During August 2011, we issued $5.000 billion aggregate principal amount of notes, comprised of $3.000 billion of 6.50% senior secured first lien notes due 2020 and $2.000 billion of 7.50% senior unsecured notes due 2022. After the payment of related fees and expenses, we used the net proceeds from these debt issuances to redeem all of our outstanding $1.578 billion 9 5/8%/10  3/8% senior secured second lien toggle notes due 2016, at a redemption price of 106.783% of the principal amount, and all of our outstanding $3.200 billion 9 1/4% senior secured second lien notes due 2016, at a redemption price of 106.513% of the principal amount. The pretax loss on retirement of debt related to these redemptions was $406 million.

During June 2011, we redeemed all $1.000 billion aggregate principal amount of our 9 1/8% senior secured second lien notes due 2014, at a redemption price of 104.563% of the principal amount, and $108 million aggregate principal amount of our 9 7/8% senior secured second lien notes due 2017, at a redemption price of 109.875% of the principal amount. The pretax losses on retirement of debt related to these redemptions were $75 million.

NOTE 6 — FINANCIAL INSTRUMENTS

Interest Rate Swap Agreements

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between two parties based on common notional principal amounts and maturity dates. Pay-fixed interest rate swaps effectively convert LIBOR indexed variable rate obligations to fixed interest rate obligations. The interest payments under these agreements are settled on a net basis. The net interest payments, based on the notional amounts in these agreements, generally

 

10


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 6 — FINANCIAL INSTRUMENTS (continued)

 

Interest Rate Swap Agreements (continued)

 

match the timing of the related liabilities. The notional amounts of the swap agreements represent amounts used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions.

The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at September 30, 2012 (dollars in millions):

 

     Notional
Amount
     Maturity Date      Fair
Value
 

Pay-fixed interest rate swaps

   $ 500         December 2014       $ (10

Pay-fixed interest rate swaps

     3,000         December 2016         (376

Pay-fixed interest rate swaps

     1,000         December 2017         (80

During the next 12 months, we estimate $126 million will be reclassified from other comprehensive income (“OCI”) to interest expense.

Cross Currency Swaps

The Company and certain subsidiaries have incurred obligations and entered into various intercompany transactions where such obligations are denominated in currencies, other than the functional currencies of the parties executing the trade. In order to mitigate the currency exposure risks and better match the cash flows of our obligations and intercompany transactions with cash flows from operations, we enter into various cross currency swaps. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions.

Our cross currency swap is not designated as a hedge, and changes in fair value are recognized in results of operations. The following table sets forth our cross currency swap agreement at September 30, 2012 (amounts in millions):

 

     Notional
Amount
     Maturity Date      Fair
Value
 

Euro — United States dollar currency swap

     266 Euro         November 2013       $ (22

Derivatives — Results of Operations

The following tables present the effect of our interest rate and cross currency swaps on our results of operations for the nine months ended September 30, 2012 (dollars in millions):

 

Derivatives in Cash Flow Hedging Relationships

   Amount of Loss
Recognized in OCI on
Derivatives, Net of  Tax
     Location of Loss
Reclassified from
Accumulated OCI
into Operations
     Amount of Loss
Reclassified from
Accumulated OCI
into Operations
 

Interest rate swaps

   $ 100         Interest expense       $ 90   

 

Derivatives Not Designated as Hedging Instruments

   Location of Loss Recognized
in Operations on Derivatives
     Amount of Loss
Recognized in
Operations on
Derivatives
 

Cross currency swap

     Other operating expenses       $ 6   

 

11


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 6 — FINANCIAL INSTRUMENTS (continued)

 

Credit-risk-related Contingent Features

We have agreements with each of our derivative counterparties that contain a provision where we could be declared in default on our derivative obligations if repayment of the underlying indebtedness is accelerated by the lender due to our default on the indebtedness. As of September 30, 2012, we have not been required to post any collateral related to these agreements. If we had breached these provisions at September 30, 2012, we would have been required to settle our obligations under the agreements at their aggregate, estimated termination value of $513 million.

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE

Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”) defines fair value, establishes a framework for measuring fair value and expands disclosures about fair value measurements. ASC 820 applies to reported balances that are required or permitted to be measured at fair value under existing accounting pronouncements.

ASC 820 emphasizes fair value is a market-based measurement, not an entity-specific measurement. Therefore, a fair value measurement should be determined based on the assumptions market participants would use in pricing the asset or liability. As a basis for considering market participant assumptions in fair value measurements, ASC 820 establishes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).

Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment, and considers factors specific to the asset or liability.

Cash Traded Investments

Our cash traded investments are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. Certain types of cash traded instruments are classified within Level 3 of the fair value hierarchy because they trade infrequently and therefore have little or no price transparency. The transaction price is initially used as the best estimate of fair value.

Our wholly-owned insurance subsidiaries had investments in tax-exempt auction rate securities (“ARS”), which are backed by student loans substantially guaranteed by the federal government, of $71 million ($76 million par value) at September 30, 2012. We do not currently intend to attempt to sell the ARS as the

 

12


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

 

Cash Traded Investments (continued)

 

liquidity needs of our insurance subsidiaries are expected to be met by other investments in their investment portfolios. During 2011 and the nine months ended September 30, 2012, certain issuers and their broker/dealers redeemed or repurchased $112 million and $63 million, respectively, of our ARS at par value. The valuation of these securities involved management’s judgment, after consideration of market factors and the absence of market transparency, market liquidity and observable inputs. Our valuation models derived a fair market value compared to tax-equivalent yields of other student loan backed variable rate securities of similar credit worthiness and similar effective maturities.

Derivative Financial Instruments

We have entered into interest rate and cross currency swap agreements to manage our exposure to fluctuations in interest rates and foreign currency risks. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves, foreign exchange rates and implied volatilities. To comply with the provisions of ASC 820 and ASU No. 2011-04, Fair Value Measurement (Topic 820): Amendments to Achieve Common Fair Value Measurement and Disclosure Requirements in U.S. GAAP and IFRSs (“ASU 2011-04”), we incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements. We have made the accounting policy election to use the exception under ASU 2011-04 (commonly referred to as the “portfolio exception”) with respect to measuring counterparty credit risk for derivative instruments.

Although we determined the majority of the inputs used to value our derivatives fall within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with our derivatives utilize Level 3 inputs, such as estimates of current credit spreads to evaluate the likelihood of default by us and our counterparties. We assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions, and at September 30, 2012 and December 31, 2011, we determined the credit valuation adjustments were not significant to the overall valuation of our derivatives.

 

13


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

 

The following table summarizes our assets and liabilities measured at fair value on a recurring basis as of September 30, 2012 and December 31, 2011, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

 

     September 30, 2012  
           Fair Value Measurements Using  
     Fair Value     Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
    Significant Other
Observable Inputs
(Level 2)
     Significant
Unobservable Inputs
(Level 3)
 

Assets:

         

Investments of insurance subsidiaries:

         

Debt securities:

         

States and municipalities

   $ 373      $      $ 373       $  —   

Auction rate securities

     71                       71   

Asset-backed securities

     15               15           

Money market funds

     67        67                  
  

 

 

   

 

 

   

 

 

    

 

 

 
     526        67        388         71   

Equity securities

     8        2        5         1   
  

 

 

   

 

 

   

 

 

    

 

 

 

Investments of insurance subsidiaries

     534        69        393         72   

Less amounts classified as current assets

     (61     (61               
  

 

 

   

 

 

   

 

 

    

 

 

 
   $ 473      $ 8      $ 393       $ 72   
  

 

 

   

 

 

   

 

 

    

 

 

 

Liabilities:

         

Cross currency swap (Income taxes and other liabilities)

   $ 22      $      $ 22       $   

Interest rate swaps (Income taxes and other liabilities)

     466               466           

 

14


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

 

     December 31, 2011  
     Fair Value     Fair Value Measurements Using  
       Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
    Significant Other
Observable Inputs
(Level 2)
    Significant
Unobservable Inputs
(Level 3)
 

Assets:

        

Investments of insurance subsidiaries:

        

Debt securities:

        

States and municipalities

   $ 417      $      $ 417      $   

Auction rate securities

     131                      131   

Asset-backed securities

     20               20          

Money market funds

     53        53                 
  

 

 

   

 

 

   

 

 

   

 

 

 
     621        53        437        131   

Equity securities

     7        1        5        1   
  

 

 

   

 

 

   

 

 

   

 

 

 

Investments of insurance subsidiaries

     628        54        442        132   

Less amounts classified as current assets

     (80     (54     (26       
  

 

 

   

 

 

   

 

 

   

 

 

 
   $ 548      $      $ 416      $ 132   
  

 

 

   

 

 

   

 

 

   

 

 

 

Liabilities:

        

Cross currency swap (Income taxes and other liabilities)

   $ 16      $      $ 16      $   

Interest rate swaps (Income taxes and other liabilities)

     399               399          

The following table summarizes the activity related to the auction rate and equity securities investments of our insurance subsidiaries which have fair value measurements based on significant unobservable inputs (Level 3) during the nine months ended September 30, 2012 (dollars in millions):

 

Asset balances at December 31, 2011

   $     132   

Unrealized gains included in other comprehensive income

     3   

Settlements

     (63
  

 

 

 

Asset balances at September 30, 2012

   $ 72   
  

 

 

 

The estimated fair value of our long-term debt was $28.706 billion and $27.199 billion at September 30, 2012 and December 31, 2011, respectively, compared to carrying amounts aggregating $26.933 billion and $27.052 billion, respectively. The estimates of fair value are generally based upon the quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities.

NOTE 8 — CONTINGENCIES

We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations or financial position.

 

15


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 8 — CONTINGENCIES (continued)

 

Health care companies are subject to numerous investigations by various governmental agencies. Under the Federal False Claims act (“FCA”) private parties have the right to bring qui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received government inquiries from federal and state agencies and our facilities may receive such inquiries in future periods. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our results of operations or financial position.

We are subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us which may not be covered by insurance. It is management’s opinion that the ultimate resolution of these pending claims and legal proceedings will not have a material, adverse effect on our results of operations or financial position.

As initially disclosed in 2010, the Civil Division of the Department of Justice (“DOJ”) has contacted the Company in connection with its nationwide review of whether, in certain cases, hospital charges to the federal government relating to implantable cardio-defibrillators (“ICDs”) met the CMS criteria. In connection with this nationwide review, the DOJ has indicated that it will be reviewing certain ICD billing and medical records at 95 HCA hospitals; the review covers the period from October 2003 to the present. In August 2012, HCA, along with non-HCA hospitals subject to the DOJ’s review, received from the DOJ a proposed framework for resolving the DOJ’s review of ICDs. The Company is cooperating in the review. The review could potentially give rise to claims against the Company under the federal FCA or other statutes, regulations or laws. At this time, we cannot predict what effect, if any, this review or any resulting claims could have on the Company.

In July 2012, the Civil Division of the U.S. Attorney’s Office in Miami requested information on reviews assessing the medical necessity of interventional cardiology services provided at any Company facility (other than peer reviews). The Company is cooperating with the government’s request and is currently producing medical records associated with particular reviews at eight hospitals, located primarily in Florida. At this time, we cannot predict what effect, if any, the request or any resulting claims, including any potential claims under the FCA, other statutes, regulations or laws, could have on the Company.

On October 28, 2011, a shareholder action was filed in the United States District Court for the Middle District of Tennessee. The case seeks to include, as a class, all persons who acquired the Company’s stock pursuant or traceable to the Company’s Registration Statement and Prospectus issued in connection with the March 9, 2011 initial public offering. The lawsuit asserts a claim under Section 11 of the Securities Act of 1933 against the Company, certain members of the board of directors, and certain underwriters in the offering. It further asserts a claim under Section 15 of the Securities Act of 1933 against the same members of the board of directors. The action alleged various deficiencies in the Company’s disclosures in the Registration Statement. Subsequently, two additional class action complaints setting forth substantially similar claims were filed in the same federal court. All three cases were consolidated. On July 13, 2012, the lead plaintiff filed an amended complaint asserting claims under Sections 11 and 12(a)(2) of the Securities Act of 1933 against the Company, certain members of the board of directors, and certain underwriters in the offering. It further asserts a claim under Section 15 of the Securities Act of 1933 against the same members of the board of directors and Hercules Holdings II, LLC, a majority shareholder of the Company. The consolidated complaint alleges deficiencies in the Company’s disclosures in the Registration Statement and Prospectus relating to: (1) the accounting for the Company’s 2006 recapitalization and 2010 reorganization; (2) the Company’s failure to maintain effective

 

16


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 8 — CONTINGENCIES (continued)

 

internal controls relating to its accounting for such transactions; and (3) the Company’s Medicare and Medicaid revenue growth rates. The Company and other defendants moved to dismiss the amended complaint on September 11, 2012.

NOTE 9 — COMPREHENSIVE INCOME AND CAPITAL STRUCTURE

The components of comprehensive income, net of related taxes, for the quarters and nine months ended September 30, 2012 and 2011 are only attributable to HCA Holdings, Inc. and are as follows (dollars in millions):

 

     Quarter     Nine Months  
     2012     2011     2012     2011  

Net income attributable to HCA Holdings, Inc.

   $     360      $     61      $     1,291      $     530   

Change in fair value of derivative instruments

     (17     (72     (42     (3

Change in fair value of available-for-sale securities

     2        1        5          

Foreign currency translation adjustments

     20        (18     24        (4

Defined benefit plans

     4        4        13        11   
  

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income (loss)

   $ 369      $ (24   $ 1,291      $ 534   
  

 

 

   

 

 

   

 

 

   

 

 

 

The components of accumulated other comprehensive loss, net of related taxes, are as follows (dollars in millions):

 

     September 30,
2012
     December 31,
2011
 

Change in fair value of derivative instruments

   $     (295)       $     (253)   

Change in fair value of available-for-sale securities

     12         7   

Foreign currency translation adjustments

     (1)         (25)   

Defined benefit plans

     (156)         (169)   
  

 

 

    

 

 

 

Accumulated other comprehensive loss

   $ (440)       $ (440)   
  

 

 

    

 

 

 

The changes in stockholders’ deficit, including changes in stockholders’ deficit attributable to HCA Holdings, Inc. and changes in equity attributable to noncontrolling interests, are as follows (dollars in millions):

 

    Equity (Deficit) Attributable to HCA Holdings, Inc.     Equity
Attributable to
Noncontrolling
Interests
    Total  
    Common Stock     Capital in
Excess of
Par
Value
    Accumulated
Other
Comprehensive
Loss
    Retained
Deficit
     
    Shares
(000)
    Par
Value
           

Balances, December 31, 2011

    437,478      $ 4      $ 1,601      $ (440   $ (9,423   $ 1,244      $ (7,014

Net income

                                1,291        288        1,579   

Other comprehensive loss

                                                

Distributions

                                (971     (303     (1,274

Share-based benefit plans

    3,905               83                             83   

Adjustment to the acquired controlling interest in equity investment

                                       30        30   

Other

                  (4                   37        33   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Balances, September 30, 2012

    441,383      $ 4      $ 1,680      $ (440   $ (9,103   $ 1,296      $ (6,563
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

On February 3, 2012, our Board of Directors declared a distribution to the Company’s stockholders and holders of vested stock awards. The distribution was $2.00 per share and vested stock award, or $971 million in the aggregate, and was paid on February 29, 2012 to holders of record on February 16, 2012. The distribution was funded using funds available under our senior secured credit facilities.

 

17


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

18

NOTE 10 — SEGMENT AND GEOGRAPHIC INFORMATION

We operate in one line of business, which is operating hospitals and related health care entities. Our operations are structured into three geographically organized groups: the National, Southwest and Central Groups. At September 30, 2012, the National Group includes 63 hospitals located in Florida, South Carolina, southern Georgia, Alaska, California, Nevada, Utah and Idaho, the Southwest Group includes 47 hospitals located in Colorado, Texas, Oklahoma and the Wichita, Kansas market, and the Central Group includes 46 hospitals located in Louisiana, Indiana, Kentucky, Tennessee, Virginia, New Hampshire, northern Georgia and the Kansas City market. We also operate six hospitals in England, and these facilities are included in the Corporate and other group.

Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses (gains) on sales of facilities, losses on retirement of debt, termination of management agreement, 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 Southwest Group’s increases in revenues, adjusted segment EBITDA and depreciation and amortization, and the declines in equity in earnings of affiliates, for the quarter and nine months ended September 30, 2012 compared to the quarter and nine months ended September 30, 2011 are primarily attributable to the financial consolidation of our 2011 acquisition of our partner’s interest in the HCA-HealthONE LLC venture for periods subsequent to our acquisition of controlling interests during October 2011. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2012 and 2011 are summarized in the following table (dollars in millions):

 

     Quarter     Nine Months  
     2012     2011     2012     2011  

Revenues:

        

National Group

   $     3,108      $     3,002      $     9,539      $     9,119   

Southwest Group

     2,864        2,239        8,618        6,724   

Central Group

     1,765        1,730        5,429        5,216   

Corporate and other

     325        287        993        854   
  

 

 

   

 

 

   

 

 

   

 

 

 
   $ 8,062      $ 7,258      $ 24,579      $ 21,913   
  

 

 

   

 

 

   

 

 

   

 

 

 

Equity in earnings of affiliates:

        

National Group

   $ 1      $ (3   $ (6   $ (5

Southwest Group

     (6     (64     (20     (212

Central Group

                   (1       

Corporate and other

     (1     (1     1          
  

 

 

   

 

 

   

 

 

   

 

 

 
   $ (6   $ (68   $ (26   $ (217
  

 

 

   

 

 

   

 

 

   

 

 

 

Adjusted segment EBITDA:

        

National Group

   $ 630      $ 587      $ 2,031      $ 1,835   

Southwest Group

     656        552        2,049        1,714   

Central Group

     323        298        1,052        949   

Corporate and other

     (76     (25     (207     (76
  

 

 

   

 

 

   

 

 

   

 

 

 
   $ 1,533      $ 1,412      $ 4,925      $ 4,422   
  

 

 

   

 

 

   

 

 

   

 

 

 


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 10 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

     Quarter      Nine Months  
     2012     2011      2012     2011  

Depreciation and amortization:

         

National Group

   $ 136      $ 129       $ 419      $ 381   

Southwest Group

     151        111         447        332   

Central Group

     90        86         265        263   

Corporate and other

     40        36         123        102   
  

 

 

   

 

 

    

 

 

   

 

 

 
   $ 417      $ 362       $ 1,254      $ 1,078   
  

 

 

   

 

 

    

 

 

   

 

 

 

Adjusted segment EBITDA

   $ 1,533      $ 1,412       $ 4,925      $ 4,422   

Depreciation and amortization

     417        362         1,254        1,078   

Interest expense

     446        519         1,336        1,572   

Losses (gains) on sales of facilities

     (7     2         (4     3   

Losses on retirement of debt

            406                481   

Termination of management agreement

                           181   
  

 

 

   

 

 

    

 

 

   

 

 

 

Income before income taxes

   $ 677      $ 123       $ 2,339      $ 1,107   
  

 

 

   

 

 

    

 

 

   

 

 

 

NOTE 11 — ACQUISITIONS AND DISPOSITIONS

During the nine months ended September 30, 2012, we paid $58 million, assumed liabilities of $33 million and recorded goodwill of $53 million related to the acquisition of a hospital facility in the Southwest Group. During the nine months ended September 30, 2011, we paid $136 million to acquire a hospital in the National Group. During the nine months ended September 30, 2012 and 2011, we paid $109 million and $73 million, respectively, to acquire nonhospital health care entities. During the nine months ended September 30, 2012, we recorded final adjustments to the purchase price allocation related to our 2011 acquisition of our partner’s interest in the HCA-HealthONE LLC joint venture. These adjustments resulted in a $30 million increase to noncontrolling interests, a $26 million reduction to property and equipment and a $56 million increase to goodwill.

During the nine months ended September 30, 2012, we received proceeds of $17 million and recognized a net pretax gain of $4 million related to sales of real estate investments. During the nine months ended September 30, 2011, we received proceeds of $55 million and recognized a net pretax loss of $3 million related to the sales of a hospital facility and our investment in a hospital joint venture.

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION

On November 22, 2010, HCA Inc. reorganized by creating a new holding company structure. HCA Holdings, Inc. became the new parent company, and HCA Inc. is now HCA Holdings, Inc.’s wholly-owned direct subsidiary. On November 23, 2010, HCA Holdings, Inc. issued $1.525 billion aggregate principal amount of 7 3/4% senior unsecured notes due 2021. These notes are senior unsecured obligations and are not guaranteed by any of our subsidiaries.

Our senior secured credit facilities and senior secured notes are fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, wholly-owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our senior secured asset-based revolving credit facility).

 

19


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

Our summarized condensed consolidating comprehensive income statements for the quarters and nine months ended September 30, 2012 and 2011, condensed consolidating balance sheets at September 30, 2012 and December 31, 2011 and condensed consolidating statements of cash flows for the nine months ended September 30, 2012 and 2011, segregating HCA Holdings, Inc. issuer, HCA Inc. issuer, the subsidiary guarantors, the subsidiary non-guarantors and eliminations, follow:

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE QUARTER ENDED SEPTEMBER 30, 2012

(Dollars in millions)

 

     HCA
Holdings, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues before provision for doubtful accounts

   $     —      $     —      $     4,672      $     4,221      $     —      $     8,893   

Provision for doubtful accounts

                   484        347               831   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

                   4,188        3,874               8,062   

Salaries and benefits

                   1,995        1,786               3,781   

Supplies

                   711        664               1,375   

Other operating expenses

            3        761        746               1,510   

Electronic health record incentive income

                   (85     (46            (131

Equity in earnings of affiliates

     (379            (1     (5     379        (6

Depreciation and amortization

                   205        212               417   

Interest expense

     30        545        (98     (31            446   

Gains on sales of facilities

                          (7            (7

Management fees

                   (170     170                 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
     (349     548        3,318        3,489        379        7,385   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

     349        (548     870        385        (379     677   

Provision (benefit) for income taxes

     (11     (208     325        116               222   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss)

     360        (340     545        269        (379     455   

Net income attributable to noncontrolling interests

                   18        77               95   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss) attributable to HCA Holdings, Inc.

   $ 360      $ (340   $ 527      $ 192      $ (379   $ 360   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income (loss) attributable to HCA Holdings, Inc.

   $ 360      $ (357   $ 531      $ 214      $ (379   $ 369   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

20


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE STATEMENT OF OPERATIONS

FOR THE QUARTER ENDED SEPTEMBER 30, 2011

(Dollars in millions)

 

     HCA
Holdings, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues before provision for doubtful accounts

   $     —      $     —      $     4,530      $     3,468      $     —      $     7,998   

Provision for doubtful accounts

                   424        316               740   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

                   4,106        3,152               7,258   

Salaries and benefits

                   1,901        1,432               3,333   

Supplies

                   702        561               1,263   

Other operating expenses

            1        697        671               1,369   

Electronic health record incentive income

                   (39     (12            (51

Equity in earnings of affiliates

     (77            (24     (44     77        (68

Depreciation and amortization

                   193        169               362   

Interest expense

     20        776        (245     (32            519   

Losses on sales of facilities

                   2                      2   

Losses on retirement of debt

            406                             406   

Management fees

                   (128     128                 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
     (57     1,183        3,059        2,873        77        7,135   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

     57        (1,183     1,047        279        (77     123   

Provision (benefit) for income taxes

     (4     (357     293        45               (23
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss)

     61        (826     754        234        (77     146   

Net income attributable to noncontrolling interests

                   16        69               85   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss) attributable to HCA Holdings, Inc.

   $ 61      $ (826   $ 738      $ 165      $ (77   $ 61   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income (loss) attributable to HCA Holdings, Inc.

   $ 61      $ (898   $ 742      $ 148      $ (77   $ (24
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

21


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2012

(Dollars in millions)

 

     HCA
Holdings, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues before provision for doubtful accounts

   $     —      $     —      $     14,328      $     12,917      $     —      $     27,245   

Provision for doubtful accounts

                   1,505        1,161               2,666   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

                   12,823        11,756               24,579   

Salaries and benefits

                   5,928        5,296               11,224   

Supplies

                   2,202        2,014               4,216   

Other operating expenses

            7        2,241        2,248               4,496   

Electronic health record incentive income

                   (174     (82            (256

Equity in earnings of affiliates

     (1,348            (4     (22     1,348        (26

Depreciation and amortization

                   614        640               1,254   

Interest expense

     90        1,603        (274     (83            1,336   

Losses (gains) on sales of facilities

                   3        (7            (4

Management fees

                   (498     498                 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
     (1,258     1,610        10,038        10,502        1,348        22,240   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

     1,258        (1,610     2,785        1,254        (1,348     2,339   

Provision (benefit) for income taxes

     (33     (597     1,014        376               760   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss)

     1,291        (1,013     1,771        878        (1,348     1,579   

Net income attributable to noncontrolling interests

                   51        237               288   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss) attributable to HCA Holdings, Inc.

   $ 1,291      $ (1,013   $ 1,720      $ 641      $ (1,348   $ 1,291   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income (loss) attributable to HCA Holdings, Inc.

   $ 1,291      $ (1,055   $ 1,733      $ 670      $ (1,348   $ 1,291   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

22


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING COMPREHENSIVE INCOME STATEMENT

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2011

(Dollars in millions)

 

     HCA
Holdings, Inc.
Issuer
    HCA
Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Revenues before provision for doubtful accounts

   $     —      $     —      $     13,602      $     10,475      $     —      $     24,077   

Provision for doubtful accounts

                   1,298        866               2,164   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

                   12,304        9,609               21,913   

Salaries and benefits

                   5,669        4,279               9,948   

Supplies

                   2,133        1,700               3,833   

Other operating expenses

            5        2,064        1,948               4,017   

Electronic health record incentive income

                   (60     (30            (90

Equity in earnings of affiliates

     (581            (84     (133     581        (217

Depreciation and amortization

                   582        496               1,078   

Interest expense

     80        2,208        (561     (155            1,572   

Losses (gains) on sales of facilities

                   18        (15            3   

Losses on retirement of debt

            481                             481   

Termination of management agreement

            181                             181   

Management fees

                   (381     381                 
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
     (501     2,875        9,380        8,471        581        20,806   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) before income taxes

     501        (2,875     2,924        1,138        (581     1,107   

Provision (benefit) for income taxes

     (29     (1,055     1,055        336               307   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss)

     530        (1,820     1,869        802        (581     800   

Net income attributable to noncontrolling interests

                   47        223               270   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net income (loss) attributable to HCA Holdings, Inc.

   $ 530      $ (1,820   $ 1,822      $ 579      $ (581   $ 530   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Comprehensive income (loss) attributable to HCA Holdings, Inc.

   $ 530      $ (1,823   $ 1,833      $ 575      $ (581   $ 534   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

23


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

SEPTEMBER 30, 2012

(Dollars in millions)

 

    HCA
Holdings, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 
ASSETS            

Current assets:

           

Cash and cash equivalents

  $     —      $     —      $     149      $     323      $     —      $ 472   

Accounts receivable, net

                  2,392        2,206               4,598   

Inventories

                  602        450               1,052   

Deferred income taxes

    322                                    322   

Other

    14               368        446               828   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    336               3,511        3,425               7,272   

Property and equipment, net

                  7,226        5,734               12,960   

Investments of insurance subsidiaries

                         473               473   

Investments in and advances to affiliates

                  16        87               103   

Goodwill and other intangible assets

                  1,666        3,794               5,460   

Deferred loan costs

    21        245                             266   

Investments in and advances to subsidiaries

    18,173                             (18,173       

Other

    552               29        187               768   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
  $ 19,082      $ 245      $ 12,448      $ 13,700      $ (18,173   $ 27,302   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY            

Current liabilities:

           

Accounts payable

  $      $      $ 1,019      $ 566      $      $ 1,585   

Accrued salaries

                  588        439               1,027   

Other accrued expenses

    44        237        453        764               1,498   

Long-term debt due within one year

           1,686        34        31               1,751   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    44        1,923        2,094        1,800               5,861   

Long-term debt

    1,525        22,989        151        517               25,182   

Intercompany balances

    24,805        (11,642     (16,722     3,559                 

Professional liability risks

                         962               962   

Income taxes and other liabilities

    567        489        568        236               1,860   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    26,941        13,759        (13,909     7,074               33,865   

Stockholders’ (deficit) equity attributable to HCA Holdings, Inc.

    (7,859     (13,514     26,254        5,433        (18,173     (7,859

Noncontrolling interests

                  103        1,193               1,296   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    (7,859     (13,514     26,357        6,626        (18,173     (6,563
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
  $ 19,082      $ 245      $ 12,448      $ 13,700      $ (18,173   $ 27,302   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

24


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING BALANCE SHEET

DECEMBER 31, 2011

(Dollars in millions)

 

    HCA
Holdings, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 
ASSETS            

Current assets:

           

Cash and cash equivalents

  $      $      $ 115      $ 258      $      $ 373   

Accounts receivable, net

                  2,429        2,104               4,533   

Inventories

                  602        452               1,054   

Deferred income taxes

    594                                    594   

Other

    50               184        445               679   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    644               3,330        3,259               7,233   

Property and equipment, net

                  7,088        5,746               12,834   

Investments of insurance subsidiaries

                         548               548   

Investments in and advances to affiliates

                  15        86               101   

Goodwill and other intangible assets

                  1,605        3,646               5,251   

Deferred loan costs

    22        268                             290   

Investments in and advances to subsidiaries

    16,825                             (16,825       

Other

    450               21        170               641   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
  $ 17,941      $ 268      $ 12,059      $ 13,455      $ (16,825   $ 26,898   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY            

Current liabilities:

           

Accounts payable

  $      $      $ 899      $ 698      $      $ 1,597   

Accrued salaries

                  568        397               965   

Other accrued expenses

    15        367        449        754               1,585   

Long-term debt due within one year

           1,347        28        32               1,407   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    15        1,714        1,944        1,881               5,554   

Long-term debt

    1,525        23,454        110        556               25,645   

Intercompany balances

    24,121        (12,814     (15,183     3,876                 

Professional liability risks

                         993               993   

Income taxes and other liabilities

    538        415        556        211               1,720   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    26,199        12,769        (12,573     7,517               33,912   

Stockholders’ (deficit) equity attributable to HCA Holdings, Inc.

    (8,258     (12,501     24,534        4,792        (16,825     (8,258

Noncontrolling interests

                  98        1,146               1,244   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
    (8,258     (12,501     24,632        5,938        (16,825     (7,014
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 
  $ 17,941      $ 268      $ 12,059      $ 13,455      $ (16,825   $ 26,898   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

25


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2012

(Dollars in millions)

 

    HCA
Holdings, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Cash flows from operating activities:

           

Net income (loss)

  $         1,291      $ (1,013   $         1,771      $         878      $ (1,348   $ 1,579   

Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:

           

Changes in operating assets and liabilities

    30        (131     (1,475     (1,347            (2,923

Provision for doubtful accounts

                  1,505        1,161               2,666   

Depreciation and amortization

                  614        640               1,254   

Income taxes

    250                                    250   

Losses (gains) on sales of facilities

                  3        (7            (4

Amortization of deferred loan costs

    1        43                             44   

Share-based compensation

    39                                    39   

Equity in earnings of affiliates

    (1,348                          1,348          

Other

           11               (4            7   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) operating activities

    263        (1,090     2,418        1,321               2,912   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from investing activities:

           

Purchase of property and equipment

                  (685     (583            (1,268

Acquisition of hospitals and health care entities

                  (72     (95            (167

Disposition of hospitals and health care entities

                  1        16               17   

Change in investments

                  (9     82               73   

Other

                  (1     6               5   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash used in investing activities

                  (766     (574            (1,340
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from financing activities:

           

Issuance of long-term debt

           1,350                             1,350   

Net change in revolving bank credit facilities

           (875                          (875

Repayment of long-term debt

           (604     (16     (69            (689

Distributions to noncontrolling interests

                  (46     (257            (303

Payment of debt issuance costs

           (20                          (20

Distributions to stockholders

    (983                                 (983

Changes in intercompany balances with affiliates, net

    675        1,239        (1,556     (358              

Income tax benefits

    82                                    82   

Other

    (37                   2               (35
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash (used in) provided by financing activities

    (263     1,090        (1,618     (682            (1,473
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Change in cash and cash equivalents

                  34        65               99   

Cash and cash equivalents at beginning of period

                  115        258               373   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash and cash equivalents at end of period

  $      $      $ 149      $ 323      $      $ 472   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

26


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

NOTE 12 — SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION (continued)

 

HCA HOLDINGS, INC.

CONDENSED CONSOLIDATING STATEMENT OF CASH FLOWS

FOR THE NINE MONTHS ENDED SEPTEMBER 30, 2011

(Dollars in millions)

 

    HCA
Holdings, Inc.
Issuer
    HCA Inc.
Issuer
    Subsidiary
Guarantors
    Subsidiary
Non-
Guarantors
    Eliminations     Condensed
Consolidated
 

Cash flows from operating activities:

           

Net income (loss)

  $ 530      $ (1,820   $ 1,869      $ 802      $ (581   $ 800   

Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:

           

Changes in operating assets and liabilities

    34        (61     (1,442     (867            (2,336

Provision for doubtful accounts

                  1,298        866               2,164   

Depreciation and amortization

                  582        496               1,078   

Income taxes

    348                                    348   

Losses (gains) on sales of facilities

                  18        (15            3   

Losses on retirement of debt

           481                             481   

Amortization of deferred loan costs

           56                             56   

Share-based compensation

    24                                    24   

Pay-in-kind interest

           (78                          (78

Equity in earnings of affiliates

    (581                          581          

Other

           7               (1            6   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) operating activities

    355        (1,415     2,325        1,281               2,546   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from investing activities:

           

Purchase of property and equipment

                  (594     (576            (1,170

Acquisition of hospitals and health care entities

                  (136     (73            (209

Disposition of hospitals and health care entities

                  1        54               55   

Change in investments

                  31        49               80   

Other

                         4               4   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash used in investing activities

                  (698     (542            (1,240
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash flows from financing activities:

           

Issuance of long-term debt

           5,000                             5,000   

Net change in revolving bank credit facilities

           (414                          (414

Repayment of long-term debt

           (6,529     (8     (46            (6,583

Distributions to noncontrolling interests

                  (55     (226            (281

Changes in intercompany balances with affiliates, net

    (1,358     3,442        (1,625     (459              

Payment of debt issuance costs

           (84                          (84

Issuances of common stock

    2,506                                    2,506   

Repurchase of common stock

    (1,503                                 (1,503

Distributions to stockholders

    (31                                 (31

Income tax benefits

    54                                    54   

Other

    (29                   7               (22
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash (used in) provided by financing activities

    (361     1,415        (1,688     (724            (1,358
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Change in cash and cash equivalents

    (6            (61     15               (52

Cash and cash equivalents at beginning of period

    6               156        249               411   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash and cash equivalents at end of period

  $      $      $ 95      $ 264      $      $ 359   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

27


Table of Contents

HCA HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

 

28

NOTE 13 — SUBSEQUENT EVENT

On October 23, 2012, our Board of Directors declared a distribution to the Company’s stockholders and holders of certain vested stock awards. The distribution declared is $2.50 per share and vested stock award (subject to limitations for certain awards), or approximately $1.2 billion in the aggregate, including certain deferred distribution amounts. The distribution is expected to be paid on November 16, 2012 to holders of record on November 2, 2012. The distribution is expected to be funded using our existing senior secured credit facilities. Pursuant to the terms of our stock award plans, the holders of nonvested stock options and stock appreciation rights will receive a $2.50 per share reduction to the exercise price of their share-based awards (subject to certain limitations for certain stock awards that result in deferred distributions for a portion of the declared distribution, which will be paid upon the vesting of the applicable stock award). The holders of any nonvested restricted share units will be paid $2.50 per unit upon the vesting of the applicable restricted share units.


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS

Forward-Looking Statements

This quarterly report on Form 10-Q includes certain disclosures which contain “forward-looking statements.” Forward-looking statements include statements regarding estimated EHR incentive income and related EHR operating expenses, expected capital expenditures and expected net claim payments and all other statements that do not relate solely to historical or current facts, and can be identified by the use of words like “may,” “believe,” “will,” “expect,” “project,” “estimate,” “anticipate,” “plan,” “initiative” or “continue.” These forward-looking statements are based on our current plans and expectations and are subject to a number of known and unknown uncertainties and risks, many of which are beyond our control, which could significantly affect current plans and expectations and our future financial position and results of operations. These factors include, but are not limited to, (1) the impact of our substantial indebtedness and the ability to refinance such indebtedness on acceptable terms, (2) the effects related to the enactment and implementation of the Budget Control Act of 2011 (“BCA”) and the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act (collectively, the “Health Reform Law”), the possible enactment of additional federal or state health care reforms and possible changes to the Health Reform Law and other federal, state or local laws or regulations affecting the health care industry, (3) increases in the amount and risk of collectibility of uninsured accounts and deductibles and copayment amounts for insured accounts, (4) the ability to achieve operating and financial targets, and attain expected levels of patient volumes and control the costs of providing services, (5) possible changes in the Medicare, Medicaid and other state programs, including Medicaid upper payment limit (“UPL”) programs or waiver programs, that may impact reimbursements to health care providers and insurers, (6) the highly competitive nature of the health care business, (7) changes in service mix, revenue mix and surgical volumes, including potential declines in the population covered under managed care agreements, the ability to enter into and renew managed care provider agreements on acceptable terms and the impact of consumer driven health plans and physician utilization trends and practices, (8) the efforts of insurers, health care providers and others to contain health care costs, (9) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (10) increases in wages and the ability to attract and retain qualified management and personnel, including affiliated physicians, nurses and medical and technical support personnel, (11) the availability and terms of capital to fund the expansion of our business and improvements to our existing facilities, (12) changes in accounting practices, (13) changes in general economic conditions nationally and regionally in our markets, (14) future divestitures which may result in charges and possible impairments of long-lived assets, (15) changes in business strategy or development plans, (16) delays in receiving payments for services provided, (17) the outcome of pending and any future tax audits, appeals and litigation associated with our tax positions, (18) potential adverse impact of known and unknown government investigations, litigation and other claims that may be made against us, (19) our ongoing ability to demonstrate meaningful use of certified electronic health record technology and recognize income for the related Medicare or Medicaid incentive payments, and (20) other risk factors described in our annual report on Form 10-K for the year ended December 31, 2011 and our other filings with the Securities and Exchange Commission. As a consequence, current plans, anticipated actions and future financial position and results of operations may differ from those expressed in any forward-looking statements made by or on behalf of HCA. You are cautioned not to unduly rely on such forward-looking statements when evaluating the information presented in this report, which forward-looking statements reflect management’s views only as of the date of this report. We undertake no obligation to revise or update any forward-looking statements, whether as a result of new information, future events or otherwise.

Health Care Reform

As enacted, the Health Reform Law will change how health care services are covered, delivered and reimbursed through expanded coverage of uninsured individuals, reduced growth in Medicare program spending, reductions in Medicare and Medicaid Disproportionate Share Hospital (“DSH”) payments, and the establishment of programs in which reimbursement is tied to quality and integration. In addition, the Health Reform Law

 

29


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Health Care Reform (continued)

 

reforms certain aspects of health insurance, expands existing efforts to tie Medicare and Medicaid payments to performance and quality, and contains provisions intended to strengthen fraud and abuse enforcement. Numerous lawsuits have challenged the constitutionality of the Health Reform Law. On June 28, 2012, the United States Supreme Court upheld the constitutionality of the individual mandate provisions of the Health Reform Law but struck down the provisions that would have allowed the Department of Health and Human Services (“HHS”) to penalize states that do not implement the Medicaid expansion provisions with the loss of existing federal Medicaid funding. States that choose not to implement the Medicaid expansion will forego funding established by the Health Reform Law to cover most of the expansion costs. It is unclear how many states will decline to implement the Medicaid expansion. Further, repeal or modification of the Health Reform Law has become a theme in political campaigns during the 2012 election year. Due to these factors, we are unable to predict with any reasonable certainty or otherwise quantify the likely impact of the Health Reform Law on our business model, financial condition or result of operations.

Third Quarter 2012 Operations Summary

Revenues increased to $8.062 billion in the third quarter of 2012 from $7.258 billion in the third quarter of 2011. Net income attributable to HCA Holdings, Inc. totaled $360 million, or $0.78 per diluted share, for the quarter ended September 30, 2012, compared to $61 million, or $0.11 per diluted share, for the quarter ended September 30, 2011. Third quarter 2012 results include net gains on sales of facilities of $7 million, or $0.01 per diluted share. Third quarter 2011 results include losses on retirement of debt of $406 million, or $0.49 per diluted share. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 459.5 million shares for the quarter ended September 30, 2012 and 527.5 million shares for the quarter ended September 30, 2011. During September 2011, we repurchased 80.8 million shares of our common stock.

Revenues increased 11.1% on a consolidated basis and increased 3.3% on a same facility basis for the quarter ended September 30, 2012, compared to the quarter ended September 30, 2011. The increase in consolidated revenues can be attributed primarily to the combined impact of a 2.5% increase in revenue per equivalent admission and a 8.3% increase in equivalent admissions. The same facility revenues increase resulted primarily from the combined net impact of a 0.7% increase in same facility revenue per equivalent admission and a 2.6% increase in same facility equivalent admissions. The increase in consolidated revenues (and consolidated volume metrics) for the third quarter of 2012 compared to the third quarter of 2011 is related primarily to the impact of the financial consolidation of the HCA-HealthONE LLC venture for periods subsequent to our acquisition of controlling interests during October 2011. The HealthONE venture’s operating results and volume metrics are not included in our same facility amounts.

During the quarter ended September 30, 2012, consolidated admissions and same facility admissions increased 7.0% and 2.1%, respectively, compared to the quarter ended September 30, 2011. Inpatient surgeries increased 3.0% on a consolidated basis and declined 2.1% on a same facility basis during the quarter ended September 30, 2012, compared to the quarter ended September 30, 2011. Outpatient surgeries increased 9.3% on a consolidated basis and declined 0.8% on a same facility basis during the quarter ended September 30, 2012, compared to the quarter ended September 30, 2011. Emergency department visits increased 12.0% on a consolidated basis and 7.4% on a same facility basis during the quarter ended September 30, 2012, compared to the quarter ended September 30, 2011.

For the quarter ended September 30, 2012, the provision for doubtful accounts increased $91 million, compared to the quarter ended September 30, 2011. The self-pay revenue deductions for charity care and uninsured discounts increased $127 million and $448 million, respectively, during the third quarter of 2012,

 

30


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Third Quarter 2012 Operations Summary (continued)

 

compared to the third quarter of 2011. The sum of the provision for doubtful accounts, uninsured discounts and charity care, as a percentage of the sum of revenues, provision for doubtful accounts, uninsured discounts and charity care, was 30.5% for the third quarter of 2012, compared to 28.4% for the third quarter of 2011. Same facility uninsured admissions increased 7.3% and same facility uninsured emergency room visits increased 7.9% for the quarter ended September 30, 2012, compared to the quarter ended September 30, 2011.

Interest expense declined $73 million to $446 million for the quarter ended September 30, 2012 from $519 million for the quarter ended September 30, 2011. The decline in interest expense was due to a decline in the average effective interest rate.

Cash flows from operating activities declined $225 million from $880 million for the third quarter of 2011 to $655 million for the third quarter of 2012. The decline is primarily related to the combined impact of the decline from changes in working capital items of $145 million and the increase in income taxes of $107 million.

Results of Operations

Revenue/Volume Trends

Our revenues depend upon inpatient occupancy levels, the ancillary services and therapy programs ordered by physicians and provided to patients, the volume of outpatient procedures and the charge and negotiated payment rates for such services. Gross charges typically do not reflect what our facilities are actually paid. Our facilities have entered into agreements with third-party payers, including government programs and managed care health plans, under which the facilities are paid based upon the cost of providing services, predetermined rates per diagnosis, fixed per diem rates or discounts from gross charges. We do not pursue collection of amounts related to patients who meet our guidelines to qualify for charity care; therefore, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. These discounts are similar to those provided to many local managed care plans. After the discounts are applied, we are still unable to collect a significant portion of uninsured patients’ accounts, and we record significant provisions for doubtful accounts (based upon our historical collection experience) related to uninsured patients in the period the services are provided.

 

31


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

Revenue/Volume Trends (continued)

 

Revenues increased 11.1% from $7.258 billion in the third quarter of 2011 to $8.062 billion in the third quarter of 2012. Revenues are recorded during the period the health care services are provided, based upon the estimated amounts due from the patients and third-party payers. Third-party payers include federal and state agencies (under Medicare, Medicaid and other programs), managed care health plans, commercial insurance companies and employers. Estimates of contractual allowances under managed care health plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record a provision for doubtful accounts related to uninsured accounts to record the net self pay accounts receivable at the estimated amounts we expect to collect. Our revenues from our third-party payers, the uninsured and other revenues for the quarters and nine months ended September 30, 2012 and 2011 are summarized in the following tables (dollars in millions):

 

     Quarter  
     2012     Ratio     2011     Ratio  

Medicare

   $ 1,949        24.2   $ 1,844        25.4

Managed Medicare

     720        8.9        610        8.4   

Medicaid

     378        4.7        453        6.2   

Managed Medicaid

     380        4.7        311        4.3   

Managed care and other insurers

     4,422        54.8        3,855        53.1   

International (managed care and other insurers)

     253        3.1        232        3.2   
  

 

 

   

 

 

   

 

 

   

 

 

 
     8,102        100.4        7,305        100.6   

Uninsured

     576        7.1        508        7.0   

Other

     215        2.7        185        2.5   
  

 

 

   

 

 

   

 

 

   

 

 

 

Revenues before provision for doubtful accounts

     8,893        110.2        7,998        110.1   

Provision for doubtful accounts

     (831     (10.2     (740     (10.1
  

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

   $ 8,062        100.0   $ 7,258        100.0
  

 

 

   

 

 

   

 

 

   

 

 

 
     Nine Months  
     2012     Ratio     2011     Ratio  

Medicare

   $ 6,251        25.4   $ 5,715        26.1

Managed Medicare

     2,199        8.9        1,806        8.2   

Medicaid

     1,188        4.8        1,440        6.6   

Managed Medicaid

     1,080        4.4        946        4.3   

Managed care and other insurers

     13,340        54.3        11,486        52.4   

International (managed care and other insurers)

     779        3.2        698        3.2   
  

 

 

   

 

 

   

 

 

   

 

 

 
     24,837        101.0        22,091        100.8   

Uninsured

     1,757        7.1        1,390        6.3   

Other

     651        2.7        596        2.7   
  

 

 

   

 

 

   

 

 

   

 

 

 

Revenues before provision for doubtful accounts

     27,245        110.8        24,077        109.8   

Provision for doubtful accounts

     (2,666     (10.8     (2,164     (9.8
  

 

 

   

 

 

   

 

 

   

 

 

 

Revenues

   $ 24,579        100.0   $ 21,913        100.0
  

 

 

   

 

 

   

 

 

   

 

 

 

 

32


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

Revenue/Volume Trends (continued)

 

The increase in revenues for the first nine months of 2012 compared to the first nine months of 2011 includes two adjustments (Rural Floor Provision Settlement and SSI ratios) related to Medicare revenues for prior periods. The net effect of the Medicare adjustments was an increase of $188 million to revenues. The Rural Floor Provision Settlement was signed on April 5, 2012. As a result of the agreement, we received additional Medicare payments of approximately $271 million during June 2012. This amount was recorded as an increase to Medicare revenues during the first quarter of 2012. During March 2012, the Centers for Medicare & Medicaid Services (“CMS”) issued new SSI ratios used for calculating Medicare DSH reimbursement for federal fiscal years ending September 30, 2006 through September 30, 2009. As a result, we recalculated our DSH reimbursement for all applicable periods. The cumulative impact of this retroactive adjustment was a reduction in Medicare revenues of approximately $83 million. This adjustment was recorded as a reduction to Medicare revenues during the first quarter of 2012.

We previously reported $51 million and $90 million, respectively, of Medicaid and Medicare electronic health record (“EHR”) incentives for the quarter and nine months ended September 30, 2011 in the line item “Revenues” in our condensed consolidated income statements. These amounts have been reclassified and are now included in the line item “Electronic health record incentive income” in our condensed consolidated comprehensive statements of operations for the quarter and nine months ended September 30, 2011.

Consolidated and same facility revenue per equivalent admission increased 2.5% and 0.7%, respectively, in the third quarter of 2012, compared to the third quarter of 2011. Consolidated and same facility equivalent admissions increased 8.3% and 2.6%, respectively, in the third quarter of 2012, compared to the third quarter of 2011. Consolidated and same facility admissions increased 7.0% and 2.1%, respectively, in the third quarter of 2012, compared to the third quarter of 2011. Consolidated and same facility outpatient surgeries increased 9.3% and declined 0.8%, respectively, in the third quarter of 2012, compared to the third quarter of 2011. Consolidated and same facility inpatient surgeries increased 3.0% and declined 2.1%, respectively, in the third quarter of 2012, compared to the third quarter of 2011. Consolidated and same facility emergency department visits increased 12.0% and 7.4%, respectively, in the third quarter of 2012, compared to the third quarter of 2011.

To quantify the total impact of and trends related to uninsured accounts, we believe it is beneficial to view the direct uninsured revenue deductions and provision for doubtful accounts in combination, rather than each separately. At September 30, 2012, our allowance for doubtful accounts represented approximately 92% of the $4.891 billion total patient due accounts receivable balance. The patient due accounts receivable balance represents the estimated uninsured portion of our accounts receivable. A summary of these adjustments to revenues amounts, related to uninsured accounts, for the quarters and nine months ended September 30, 2012 and 2011 follows (dollars in millions):

 

     Quarter     Nine Months  
     2012      Ratio     2011      Ratio     2012      Ratio     2011      Ratio  

Charity care

   $ 809         23   $ 682         24   $ 2,340         23   $ 1,974         24

Uninsured discounts

     1,905         54        1,457         50        5,164         51        4,072         50   

Provision for doubtful accounts

     831         23        740         26        2,666         26        2,164         26   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

 

Totals

   $ 3,545         100   $ 2,879         100   $ 10,170         100   $ 8,210         100
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

   

 

 

    

 

 

 

Same facility uninsured admissions increased by 2,263 admissions, or 7.3%, in the third quarter of 2012, compared to the third quarter of 2011. Same facility uninsured admissions in 2012, compared to 2011, increased

 

33


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

Revenue/Volume Trends (continued)

 

8.9% in the second quarter of 2012 and increased 11.6% in the first quarter of 2012. Same facility uninsured admissions in 2011, compared to 2010, increased by 5.2% in the fourth quarter of 2011, 8.8% in the third quarter of 2011, 10.6% in the second quarter of 2011 and 4.7% in the first quarter of 2011.

The approximate percentages of our admissions related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and other insurers and the uninsured for the quarters and nine months ended September 30, 2012 and 2011 are set forth in the following table.

 

     Quarter     Nine
Months
 
     2012     2011     2012     2011  

Medicare

     32     33     33     34

Managed Medicare

     12        11        12        11   

Medicaid

     8        9        8        9   

Managed Medicaid

     9        8        9        8   

Managed care and other insurers

     31        31        30        31   

Uninsured

     8        8        8        7   
  

 

 

   

 

 

   

 

 

   

 

 

 
     100     100     100     100
  

 

 

   

 

 

   

 

 

   

 

 

 

The approximate percentages of our inpatient revenues, before provision for doubtful accounts, related to Medicare, managed Medicare, Medicaid, managed Medicaid, managed care and other insurers and the uninsured for the quarters and nine months ended September 30, 2012 and 2011 are set forth in the following table.

 

     Quarter     Nine
Months
 
     2012     2011     2012     2011  

Medicare

     30     31     31     31

Managed Medicare

     10        9        10        9   

Medicaid

     6        8        6        9   

Managed Medicaid

     4        4        4        4   

Managed care and other insurers

     46        45        45        44   

Uninsured

     4        3        4        3   
  

 

 

   

 

 

   

 

 

   

 

 

 
     100     100     100     100
  

 

 

   

 

 

   

 

 

   

 

 

 

At September 30, 2012, we had 74 hospitals in the states of Texas and Florida. During the third quarter of 2012, 57% of our admissions and 47% of our revenues were generated by these hospitals. Uninsured admissions in Texas and Florida represented 61% of our uninsured admissions during the third quarter of 2012.

We receive a significant portion of our revenues from government health programs, principally Medicare and Medicaid, which are highly regulated and subject to frequent and substantial changes. We provide indigent care services in several communities in the state of Texas, in affiliation with other hospitals. The state of Texas has been involved in efforts to increase the indigent care provided by private hospitals. As a result of additional indigent care being provided by private hospitals, public hospital districts or counties in Texas have available funds that were previously devoted to indigent care. The public hospital districts or counties are under no contractual or legal obligation to provide such indigent care. The public hospital districts or counties have elected

 

34


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

Revenue/Volume Trends (continued)

 

to transfer some portion of these available funds to the state’s Medicaid program. Such action is at the sole discretion of the public hospital districts or counties. It is anticipated that these contributions to the state will be matched with federal Medicaid funds. The state then may make supplemental payments to hospitals in the state for Medicaid services rendered. Hospitals receiving Medicaid supplemental payments may include those that are providing additional indigent care services. Our Texas Medicaid revenues included $110 million and $123 million during the third quarters of 2012 and 2011, respectively, and $350 million and $424 million during the first nine months of 2012 and 2011, respectively, of Medicaid supplemental payments. In addition, we receive supplemental payments in several other states. We are aware these supplemental payment programs are currently being reviewed by certain state agencies and some states have made waiver requests to CMS to replace their existing supplemental payment programs. It is possible these reviews and waiver requests will result in the restructuring of such supplemental payment programs and could result in the payment programs being reduced or eliminated. In 2011, CMS approved a Medicaid waiver that allows Texas to continue receiving supplemental Medicaid reimbursement while expanding its Medicaid managed care program, thus Texas is operating pursuant to a waiver program. However, we cannot predict whether the Texas private supplemental Medicaid reimbursement program will continue or guarantee that revenues recognized for the program will not decline. Because deliberations about these programs are ongoing, we are unable to estimate the financial impact the program structure modifications, if any, may have on our results of operations.

Electronic Health Record Incentive Payments

The American Recovery and Reinvestment Act of 2009 provides for Medicare and Medicaid incentive payments for eligible hospitals and professionals that adopt and meaningfully use certified EHR technology. We recognize income related to Medicare and Medicaid incentive payments using a gain contingency model that is based upon when our eligible hospitals have demonstrated meaningful use of certified EHR technology for the applicable period and the cost report information for the full cost report year that will determine the final calculation of the incentive payment is available.

Medicaid EHR incentive calculations and related payment amounts are based upon prior period cost report information available at the time our eligible hospitals adopt, implement or demonstrate meaningful use of certified EHR technology for the applicable period, and are not subject to revision for cost report data filed for a subsequent period. Thus, incentive income recognition occurs at the point our eligible hospitals adopt, implement or demonstrate meaningful use of certified EHR technology for the applicable period, as the cost report information for the full cost report year that will determine the final calculation of the incentive payment is known at that time.

Medicare EHR incentive calculations and related initial payment amounts are based upon the most current filed cost report information available at the time our eligible hospitals demonstrate meaningful use of certified EHR technology for the applicable period. However, unlike Medicaid, this initial payment amount will be adjusted based upon an updated calculation using the annual cost report information for the cost report period that began during the applicable payment year. Thus, incentive income recognition occurs at the point our eligible hospitals demonstrate meaningful use of certified EHR technology for the applicable period and the cost report information for the full cost report year that will determine the final calculation of the incentive payment is available.

We recognized $131 million ($52 million Medicare and $79 million Medicaid) of electronic health record incentive income during the third quarter of 2012, and we recognized $51 million ($17 million of Medicare and

 

35


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

Electronic Health Record Incentive Payments (continued)

 

$34 million of Medicaid) of electronic health record incentive income during the third quarter of 2011. We recognized $256 million ($174 million Medicare and $82 million Medicaid) and $90 million ($17 million Medicare and $73 million Medicaid) of electronic health record incentive income during the first nine months of 2012 and 2011, respectively.

We have incurred and will continue to incur both capital costs and operating expenses in order to implement our certified EHR technology and meet meaningful use requirements. These expenses are ongoing and are projected to continue over all stages of implementation of meaningful use. The timing of recognition of the expenses may not correlate with the receipt of the incentive payments and the recognition of income. We incurred $24 million and $14 million during the third quarters of 2012 and 2011, respectively, and $61 million and $58 million during the first nine months of 2012 and 2011, respectively, of operating expenses to implement our certified EHR technology and meet meaningful use.

For 2012, we estimate EHR incentive income will be recognized in the range of $325 million to $350 million and that related EHR operating expenses will be in the range of $75 million to $100 million. Actual EHR incentive income and EHR operating expenses could vary from these estimates due to certain factors, including the availability of federal funding for both Medicare and Medicaid incentive payments and our ability to continue to demonstrate meaningful use of certified EHR technology. The failure of any of these factors to occur could have a material, adverse effect on our results of operations.

 

36


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

Operating Results Summary

The following is a comparative summary of results from operations for the quarters and nine months ended September 30, 2012 and 2011 (dollars in millions):

 

     Quarter  
     2012     2011  
     Amount     Ratio     Amount     Ratio  

Revenues before provision for doubtful accounts

   $ 8,893        $ 7,998     

Provision for doubtful accounts

     831          740     
  

 

 

     

 

 

   

Revenues

     8,062        100.0        7,258        100.0   

Salaries and benefits

     3,781        46.9        3,333        45.9   

Supplies

     1,375        17.1        1,263        17.4   

Other operating expenses

     1,510        18.7        1,369        18.8   

Electronic health record incentive income

     (131     (1.6     (51     (0.7

Equity in earnings of affiliates

     (6     (0.1     (68     (0.9

Depreciation and amortization

     417        5.2        362        5.0   

Interest expense

     446        5.5        519        7.2   

Losses (gains) on sales of facilities

     (7     (0.1     2          

Losses on retirement of debt

                   406        5.6   
  

 

 

   

 

 

   

 

 

   

 

 

 
     7,385        91.6        7,135        98.3   
  

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     677        8.4        123        1.7   

Provision (benefit) for income taxes

     222        2.8        (23     (0.3
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income

     455        5.6        146        2.0   

Net income attributable to noncontrolling interests

     95        1.1        85        1.2   
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to HCA Holdings, Inc.

   $ 360        4.5      $ 61        0.8   
  

 

 

   

 

 

   

 

 

   

 

 

 

% changes from prior year:

        

Revenues

     11.1       4.8  

Income before income taxes

     450.6          (73.7  

Net income attributable to HCA Holdings, Inc.

     493.2          (75.0  

Admissions(a)

     7.0          4.8     

Equivalent admissions(b)

     8.3          5.4     

Revenue per equivalent admission

     2.5          (0.5  

Same facility % changes from prior year(c):

        

Revenues

     3.3          3.0     

Admissions(a)

     2.1          3.2     

Equivalent admissions(b)

     2.6          3.8     

Revenue per equivalent admission

     0.7          (0.8  

 

37


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

Operating Results Summary (continued)

 

 

     Nine Months  
     2012     2011  
     Amount     Ratio     Amount     Ratio  

Revenues before provision for doubtful accounts

   $ 27,245        $ 24,077     

Provision for doubtful accounts

     2,666          2,164     
  

 

 

     

 

 

   

Revenues

     24,579        100.0        21,913        100.0   

Salaries and benefits

     11,224        45.7        9,948        45.4   

Supplies

     4,216        17.2        3,833        17.5   

Other operating expenses

     4,496        18.2        4,017        18.3   

Electronic health record incentive income

     (256     (1.0     (90     (0.4

Equity in earnings of affiliates

     (26     (0.1     (217     (1.0

Depreciation and amortization

     1,254        5.1        1,078        4.9   

Interest expense

     1,336        5.4        1,572        7.2   

Losses (gains) on sales of facilities

     (4            3          

Losses on retirement of debt

                   481        2.2   

Termination of management agreement

                   181        0.8   
  

 

 

   

 

 

   

 

 

   

 

 

 
     22,240        90.5        20,806        94.9   
  

 

 

   

 

 

   

 

 

   

 

 

 

Income before income taxes

     2,339        9.5        1,107        5.1   

Provision for income taxes

     760        3.1        307        1.5   
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income

     1,579        6.4        800        3.6   

Net income attributable to noncontrolling interests

     288        1.1        270        1.2   
  

 

 

   

 

 

   

 

 

   

 

 

 

Net income attributable to HCA Holdings, Inc.

   $ 1,291        5.3      $ 530        2.4   
  

 

 

   

 

 

   

 

 

   

 

 

 

% changes from prior year:

        

Revenues

     12.2       5.0  

Income before income taxes

     111.3          (33.6  

Net income attributable to HCA Holdings, Inc.

     143.6          (42.6  

Admissions(a)

     7.9          3.3     

Equivalent admissions(b)

     9.8          4.2     

Revenue per equivalent admission

     2.2          0.8     

Same facility % changes from prior year(c):

        

Revenues

     4.1          3.6     

Admissions(a)

     2.6          2.2     

Equivalent admissions(b)

     3.8          3.0     

Revenue per equivalent admission

     0.3          0.6     

 

(a) Represents the total number of patients admitted to our hospitals and is used by management and certain investors as a general measure of inpatient volume.
(b) Equivalent admissions are used by management and certain investors as a general measure of combined inpatient and outpatient volume. Equivalent admissions are computed by multiplying admissions (inpatient volume) by the sum of gross inpatient revenues and gross outpatient revenues and then dividing the resulting amount by gross inpatient revenues. The equivalent admissions computation “equates” outpatient revenues to the volume measure (admissions) used to measure inpatient volume, resulting in a general measure of combined inpatient and outpatient volume.
(c) Same facility information excludes the operations of hospitals and their related facilities which were either acquired or divested during the current and prior period.

 

38


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

 

Quarters Ended September 30, 2012 and 2011

Net income attributable to HCA Holdings, Inc. totaled $360 million, or $0.78 per diluted share, for the third quarter of 2012 compared to $61 million, or $0.11 per diluted share, for the third quarter of 2011. Third quarter 2012 results include net gains on sales of facilities of $7 million, or $0.01 per diluted share. Third quarter 2011 results include losses on retirement of debt of $406 million, or $0.49 per diluted share. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 459.5 million shares and 527.5 million shares for the quarters ended September 30, 2012 and 2011, respectively.

For the third quarter of 2012, consolidated and same facility admissions increased 7.0% and 2.1%, respectively, compared to the third quarter of 2011. Consolidated and same facility outpatient surgical volumes increased 9.3% and declined 0.8%, respectively, during the third quarter of 2012, compared to the third quarter of 2011. Consolidated and same facility inpatient surgeries increased 3.0% and declined 2.1%, respectively, in the third quarter of 2012, compared to the third quarter of 2011. Consolidated and same facility emergency department visits increased 12.0% and 7.4%, respectively, during the quarter ended September 30, 2012, compared to the quarter ended September 30, 2011.

Revenues before provision for doubtful accounts increased 11.2% for the third quarter of 2012 compared to the third quarter of 2011. Provision for doubtful accounts increased $91 million from $740 million in the third quarter of 2011 to $831 million in the third quarter of 2012. The provision for doubtful accounts relates primarily to uninsured amounts due directly from patients, including copayment and deductible amounts for patients who have health care coverage. The self-pay revenue deductions for charity care and uninsured discounts increased $127 million and $448 million, respectively, during the third quarter of 2012, compared to the third quarter of 2011. The sum of the provision for doubtful accounts, uninsured discounts and charity care, as a percentage of the sum of revenues, the provision for doubtful accounts, uninsured discounts and charity care, was 30.5% for the third quarter of 2012, compared to 28.4% for the third quarter of 2011. At September 30, 2012, our allowance for doubtful accounts represented approximately 92% of the $4.891 billion total patient due accounts receivable balance, including accounts, net of estimated contractual discounts, related to patients for which eligibility for Medicaid coverage or uninsured discounts was being evaluated.

Revenues increased 11.1% primarily due to the combined impact of revenue per equivalent admission growth of 2.5% and an increase of 8.3% in equivalent admissions for the third quarter of 2012 compared to the third quarter of 2011. Same facility revenues increased 3.3% due to the combined impact of a 0.7% increase in same facility revenue per equivalent admission and a 2.6% increase in same facility equivalent admissions for the third quarter of 2012 compared to the third quarter of 2011. The increase in revenues for the third quarter of 2012 compared to the third quarter of 2011 is related primarily to the financial consolidation of our 2011 acquisition of our partner’s interest in the HCA-HealthONE LLC venture for periods subsequent to our acquisition of controlling interests during October 2011 (HealthONE revenues are not included in same facility amounts).

Salaries and benefits, as a percentage of revenues, were 46.9% in the third quarter of 2012 and 45.9% in the third quarter of 2011. Salaries and benefits per equivalent admission increased 4.7% in the third quarter of 2012 compared to the third quarter of 2011. Same facility labor rate increases averaged 1.6% for the third quarter of 2012 compared to the third quarter of 2011.

 

39


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

Quarters Ended September 30, 2012 and 2011 (continued)

 

Supplies, as a percentage of revenues, were 17.1% in the third quarter of 2012 and 17.4% in the third quarter of 2011. Supply cost per equivalent admission increased 0.6% in the third quarter of 2012 compared to the third quarter of 2011. Supply costs per equivalent admission increased 1.3% for medical devices and 0.7% for general medical and surgical items and declined 1.3% for pharmacy supplies and 8.5% for blood products in the third quarter of 2012 compared to the third quarter of 2011.

Other operating expenses, as a percentage of revenues, declined to 18.7% in the third quarter of 2012 from 18.8% in the third quarter of 2011. Other operating expenses is primarily comprised of contract services, professional fees, repairs and maintenance, rents and leases, utilities, insurance (including professional liability insurance) and nonincome taxes. Other operating expenses include $77 million and $78 million of indigent care costs in certain Texas markets during the third quarters of 2012 and 2011, respectively. Provisions for losses related to professional liability risks were $59 million and $62 million for the third quarters of 2012 and 2011, respectively.

We recognized $131 million ($52 million Medicare and $79 million Medicaid) and $51 million ($17 million Medicare and $34 million Medicaid) of electronic health record incentive income during the third quarters of 2012 and 2011, respectively. We recognize income related to Medicare and Medicaid incentive payments using a gain contingency model that is based upon when our eligible hospitals have demonstrated meaningful use of certified EHR technology for the applicable period and the cost report information for the full cost report year that will determine the final calculation of the incentive payment is available.

Equity in earnings of affiliates was $6 million and $68 million in the third quarters of 2012 and 2011, respectively. Equity in earnings of affiliates for the third quarter of 2011 relates primarily to our Denver, Colorado market (HealthONE) joint venture, which effective November 1, 2011, we began consolidating due to our acquisition of our partner’s ownership interest.

Depreciation and amortization increased $55 million, from $362 million in the third quarter of 2011 to $417 million in the third quarter of 2012. The increase was primarily related to the consolidation of HealthONE.

Interest expense declined from $519 million in the third quarter of 2011 to $446 million in the third quarter of 2012 due to a decline in the average effective interest rate. Our average debt balance was $26.685 billion for the third quarter of 2012 compared to $25.600 billion for the third quarter of 2011. The average effective interest rate for our long term debt declined from 8.0% for the quarter ended September 30, 2011 to 6.6% for the quarter ended September 30, 2012 due primarily to debt refinancing transactions completed during 2011.

During the third quarter of 2012, we recorded net gains on sales of facilities of $7 million. During the third quarter of 2011, we recorded net losses on sales of facilities of $2 million.

During the third quarter of 2011, we recorded losses on retirement of debt of $406 million related to the redemptions of all of our outstanding $1.578 billion 9 5/8%/10 3/8% second lien toggle notes due 2016, at a redemption price of 106.783% and all of our outstanding $3.200 billion 9 1/4% second lien notes due 2016, at a redemption price of 106.513%.

The effective tax rates were a provision of 38.2% and a benefit of 60.0% for the third quarters of 2012 and 2011, respectively. The effective tax rate computations exclude net income attributable to noncontrolling interests as it relates to consolidated partnerships. Our provision for income taxes for the third quarter of 2011

 

40


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

Quarters Ended September 30, 2012 and 2011 (continued)

 

was reduced by $42 million for reductions in interest expense related to taxing authority examinations and increased by $5 million related to certain state tax adjustments. Excluding the effect of these adjustments, the effective tax rate for the third quarter of 2011 would have been 36.7%.

Net income attributable to noncontrolling interests increased from $85 million for the third quarter of 2011 to $95 million for the third quarter of 2012.

Nine Months Ended September 30, 2012 and 2011

Net income attributable to HCA Holdings, Inc. totaled $1.291 billion, or $2.81 per diluted share, in the nine months ended September 30, 2012 compared to $530 million, or $1.04 per diluted share, in the nine months ended September 30, 2011. The first nine months of 2012 results include two Medicare adjustments (and related expenses) that added $170 million to income before income taxes, or $0.22 per diluted share. The first nine months of 2011 results include a charge of $181 million, or $0.29 per diluted share, related to the termination of the management agreement between HCA and the Investors upon the completion of our initial public offering and $481 million, or $0.60 per diluted share, of losses on retirement of debt. All “per diluted share” disclosures are based upon amounts net of the applicable income taxes. Shares used for diluted earnings per share were 458.8 million shares and 509.6 million shares for the nine months ended September 30, 2012 and 2011, respectively.

For the first nine months of 2012, consolidated and same facility admissions increased 7.9% and 2.6%, respectively, compared to the first nine months of 2011. Consolidated and same facility outpatient surgical volumes increased 10.8% and 0.6%, respectively, during the first nine months of 2012, compared to the first nine months of 2011. Consolidated and same facility inpatient surgeries increased 5.2% and declined 0.4%, respectively, in the first nine months of 2012, compared to the first nine months of 2011. Consolidated and same facility emergency department visits increased 12.0% and 7.2%, respectively, during the nine months ended September 30, 2012, compared to the nine months ended September 30, 2011.

Revenues before provision for doubtful accounts increased 13.2% for the first nine months of 2012 compared to the first nine months of 2011. Provision for doubtful accounts increased $502 million from $2.164 billion in the first nine months of 2011 to $2.666 billion in the first nine months of 2012. The provision for doubtful accounts relates primarily to uninsured amounts due directly from patients, including copayment and deductible amounts for patients who have health care coverage. The self-pay revenue deductions for charity care and uninsured discounts increased $366 million and $1.092 billion, respectively, during the first nine months of 2012, compared to the first nine months of 2011. The sum of the provision for doubtful accounts, uninsured discounts and charity care, as a percentage of the sum of revenues, the provision for doubtful accounts, uninsured discounts and charity care, was 29.3% for the first nine months of 2012, compared to 27.3% for the first nine months of 2011. At September 30, 2012, our allowance for doubtful accounts represented approximately 92% of the $4.891 billion total patient due accounts receivable balance, including accounts, net of estimated contractual discounts, related to patients for which eligibility for Medicaid coverage or uninsured discounts was being evaluated.

Revenues increased 12.2% primarily due to the combined impact of revenue per equivalent admission growth of 2.2% and an increase of 9.8% in equivalent admissions for the first nine months of 2012 compared to the first nine months of 2011. Same facility revenues increased 4.1% due to the combined impact of a 0.3%

 

41


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

Nine Months Ended September 30, 2012 and 2011 (continued)

 

increase in same facility revenue per equivalent admission and a 3.8% increase in same facility equivalent admissions for the first nine months of 2012 compared to the first nine months of 2011. The increase in revenues for the first nine months of 2012 compared to the first nine months of 2011 is related primarily to the combined impact of the financial consolidation of our 2011 acquisition of our partner’s interest in the HCA-HealthONE LLC venture for periods subsequent to our acquisition of controlling interests during October 2011 (HealthONE revenues are not included in same facility amounts) and two adjustments (Rural Floor Provision Settlement and SSI ratios) related to Medicare revenues for prior periods. The net effect of the Medicare adjustments was an increase of $188 million to revenues.

Salaries and benefits, as a percentage of revenues, were 45.7% in the first nine months of 2012 and 45.4% in the first nine months of 2011. Salaries and benefits per equivalent admission increased 2.8% in the first nine months of 2012 compared to the first nine months of 2011. Same facility labor rate increases averaged 1.6% for the first nine months of 2012 compared to the first nine months of 2011.

Supplies, as a percentage of revenues, were 17.2% in the first nine months of 2012 and 17.5% in the first nine months of 2011. Supply cost per equivalent admission increased 0.2% in the first nine months of 2012 compared to the first nine months of 2011. Supply costs per equivalent admission increased 1.1% for medical devices and 0.1% for general medical and surgical items and declined 1.5% for pharmacy supplies and 6.7% for blood products in the first nine months of 2012 compared to the first nine months of 2011.

Other operating expenses, as a percentage of revenues, declined to 18.2% in the first nine months of 2012 from 18.3% in the first nine months of 2011. Other operating expenses is primarily comprised of contract services, professional fees, repairs and maintenance, rents and leases, utilities, insurance (including professional liability insurance) and nonincome taxes. Other operating expenses include $228 million and $248 million of indigent care costs in certain Texas markets during the first nine months of 2012 and 2011, respectively. Provisions for losses related to professional liability risks were $230 million and $183 million for the first nine months of 2012 and 2011, respectively.

We recognized $256 million ($174 million Medicare and $82 million Medicaid) and $90 million ($17 million Medicare and $73 million Medicaid) of electronic health record incentive income during the first nine months of 2012 and 2011, respectively. We recognize income related to Medicare and Medicaid incentive payments using a gain contingency model that is based upon when our eligible hospitals have demonstrated meaningful use of certified EHR technology for the applicable period and the cost report information for the full cost report year that will determine the final calculation of the incentive payment is available.

Equity in earnings of affiliates was $26 million and $217 million in the first nine months of 2012 and 2011, respectively. Equity in earnings of affiliates for the first nine months of 2011 relates primarily to our Denver, Colorado market (HealthONE) joint venture, which effective November 1, 2011, we began consolidating due to our acquisition of our partner’s ownership interest.

Depreciation and amortization increased $176 million, from $1.078 billion in the first nine months of 2011 to $1.254 billion in the first nine months of 2012. The consolidation of HealthONE for periods subsequent to November 1, 2011 represents $104 million of the increase in depreciation and amortization.

Interest expense declined from $1.572 billion in the first nine months of 2011 to $1.336 billion in the first nine months of 2012 due to a decline in the average effective interest rate. Our average debt balance was

 

42


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Results of Operations (continued)

 

Nine Months Ended September 30, 2012 and 2011 (continued)

 

$27.211 billion for the first nine months of 2012 compared to $26.289 billion for the first nine months of 2011. The average effective interest rate for our long term debt declined from 8.0% for the nine months ended September 30, 2011 to 6.6% for the nine months ended September 30, 2012 due primarily to debt refinancing transactions completed during 2011.

During the first nine months of 2012, we recorded net gains on sales of facilities of $4 million. During the first nine months of 2011, we recorded net losses on sales of facilities of $3 million.

During the first nine months of 2011, we recorded losses on retirement of debt of $481 million related to the redemptions of all $1.000 billion aggregate principal amount of our 9 1/8% senior secured notes due 2014, at a redemption price of 104.563% of the principal amount; $108 million aggregate principal amount of our 9 7/8% senior secured notes due 2017, at a redemption price of 109.875% of the principal amount; all of our outstanding $1.578 billion 9 5/8%/10 3/8% second lien toggle notes due 2016, at a redemption price of 106.783% and all of our outstanding $3.200 billion 9 1/4% second lien notes due 2016, at a redemption price of 106.513%. There were no losses on retirement of debt during the first nine months of 2012.

Our Investors provided management and advisory services to the Company, pursuant to a management agreement among HCA and the Investors executed in connection with the Investors’ acquisition of HCA in November 2006. In March 2011, the management agreement was terminated pursuant to its terms upon completion of the initial public offering of our common stock, and the Investors were paid a final fee of $181 million.

The effective tax rates were 37.1% and 36.7% for the first nine months of 2012 and 2011, respectively. The effective tax rate computations exclude net income attributable to noncontrolling interests as it relates to consolidated partnerships.

Net income attributable to noncontrolling interests increased from $270 million for the first nine months of 2011 to $288 million for the first nine months of 2012.

Liquidity and Capital Resources

Cash provided by operating activities totaled $2.912 billion in the first nine months of 2012 compared to $2.546 billion in the first nine months of 2011. The $366 million increase in cash provided by operating activities in the first nine months of 2012 compared to the first nine months of 2011 related primarily to the combined impact of the increase in net income of $298 million, excluding the losses on retirement of debt of $481 million in the first nine months of 2011, an increase of $176 million from depreciation and amortization and a reduction of $98 million from income taxes. The combined interest payments and net tax payments (refunds) in the first nine months of 2012 and 2011 were $1.832 billion and $1.540 billion, respectively. Working capital totaled $1.411 billion at September 30, 2012 and $1.679 billion at December 31, 2011.

Cash used in investing activities was $1.340 billion in the first nine months of 2012 compared to $1.240 billion in the first nine months of 2011. Excluding acquisitions, capital expenditures were $1.268 billion in the first nine months of 2012 and $1.170 billion in the first nine months of 2011. We expended $58 million for the acquisition of a hospital facility and $109 million to acquire nonhospital health care facilities during the first nine months of 2012. We expended $136 million for the acquisition of a hospital facility and $73 million to acquire nonhospital health care facilities during the first nine months of 2011. Capital expenditures are expected

 

43


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Liquidity and Capital Resources (continued)

 

to approximate $1.83 billion in 2012. At September 30, 2012, there were projects under construction which had estimated additional costs to complete and equip over the next five years of approximately $1.44 billion. We expect to finance capital expenditures with internally generated and borrowed funds. We received $17 million and $55 million from sales of health care entities during the first nine months of 2012 and 2011, respectively. We received net cash flows from our investments of $73 million and $80 million in the first nine months of 2012 and 2011, respectively.

Cash used in financing activities totaled $1.473 billion during the first nine months of 2012 compared to $1.358 billion during the first nine months of 2011. During the first nine months of 2012, net cash flows used in financing activities included net debt repayments of $214 million, distributions to noncontrolling interests of $303 million, distributions to stockholders of $983 million, payments of debt issuance costs of $20 million and receipts of $82 million of income tax benefits for certain items (primarily distributions to holders of our stock options). During the first nine months of 2011, net cash flows used in financing activities included reductions in net borrowings of $1.997 billion, net proceeds of $2.506 billion related to the issuance of common stock in conjunction with our initial public offering, repurchase of common stock of $1.503 billion, distributions to noncontrolling interests of $281 million, distributions to stockholders of $31 million, payments of debt issuance costs of $84 million and receipts of $54 million of income tax benefits for certain items (primarily distributions to holders of our stock options).

We are a highly leveraged company with significant debt service requirements. Our debt totaled $26.933 billion at September 30, 2012. Our interest expense was $1.336 billion for the first nine months of 2012 and $1.572 billion for the first nine months of 2011. The decline in interest expense was related to a decline in the average effective interest rate.

In addition to cash flows from operations, available sources of capital include amounts available under our senior secured credit facilities ($3.155 billion and $4.255 billion available as of September 30, 2012 and October 31, 2012, respectively) and anticipated access to public and private debt markets.

During October 2012, our Board of Directors declared a distribution to the Company’s stockholders and holders of certain vested stock awards. The distribution declared was $2.50 per share and vested stock award (subject to limitations for certain awards), or approximately $1.2 billion in the aggregate.

During October 2012, we issued $2.500 billion aggregate principal amount of notes, comprised of $1.250 billion of 4.75% senior secured first lien notes due 2023 and $1.250 billion of 5.875% senior unsecured notes due 2023. After the payment of related fees and expenses, we used the net proceeds for general corporate purposes, which included the repayment of an existing term loan due November 2013 and providing a financing source for the declared distribution to our stockholders.

During October 2012, we replaced our $2.000 billion senior secured revolving credit facility maturing on November 17, 2015, with a new facility on substantially the same terms other than foregoing a scheduled increase in interest rates and extending the maturity date to November 17, 2016.

During February 2012, our Board of Directors declared a distribution to the Company’s stockholders and holders of vested stock awards. The distribution of $2.00 per share and vested stock award, or approximately $971 million in the aggregate, was paid during February 2012.

During February 2012, we issued $1.350 billion aggregate principal amount of 5.875% senior secured notes due 2022. After the payment of related fees and expenses, we used the proceeds for general corporate purposes.

 

44


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Liquidity and Capital Resources (continued)

 

Investments of our insurance subsidiaries, to maintain statutory equity and pay claims, totaled $534 million and $628 million at September 30, 2012 and December 31, 2011, respectively. An insurance subsidiary maintained net reserves for professional liability risks of $361 million and $410 million at September 30, 2012 and December 31, 2011, respectively. Our facilities are insured by a wholly-owned insurance subsidiary for losses up to $50 million per occurrence; however, this coverage is subject to a $5 million per occurrence self-insured retention. Net reserves for the self-insured professional liability risks retained were $875 million and $842 million at September 30, 2012 and December 31, 2011, respectively. Claims payments, net of reinsurance recoveries, during the next 12 months are expected to approximate $290 million. We estimate that approximately $229 million of the expected net claim payments during the next 12 months will relate to claims subject to the self-insured retention.

Management believes that cash flows from operations, amounts available under our senior secured credit facilities and our anticipated access to public and private debt markets will be sufficient to meet expected liquidity needs during the next 12 months.

Market Risk

We are exposed to market risk related to changes in market values of securities. The investments in debt and equity securities of our wholly-owned insurance subsidiaries were $526 million and $8 million, respectively, at September 30, 2012. These investments are carried at fair value, with changes in unrealized gains and losses being recorded as adjustments to other comprehensive income. At September 30, 2012, we had a net unrealized gain of $20 million on the insurance subsidiaries’ investment securities.

We are exposed to market risk related to market illiquidity. Investments in debt and equity securities of our wholly-owned insurance subsidiaries could be impaired by the inability to access the capital markets. Should the wholly-owned insurance subsidiaries require significant amounts of cash in excess of normal cash requirements to pay claims and other expenses on short notice, we may have difficulty selling these investments in a timely manner or be forced to sell them at a price less than what we might otherwise have been able to in a normal market environment. At September 30, 2012, our wholly-owned insurance subsidiaries had invested $71 million ($76 million par value) in tax-exempt student loan auction rate securities that continue to experience market illiquidity. It is uncertain if auction-related market liquidity will resume for these securities. We may be required to recognize other-than-temporary impairments on these long-term investments in future periods should issuers default on interest payments or should the fair market valuations of the securities deteriorate due to ratings downgrades or other issue specific factors.

We are also exposed to market risk related to changes in interest rates, and we periodically enter into interest rate swap agreements to manage our exposure to these fluctuations. Our interest rate swap agreements involve the exchange of fixed and variable rate interest payments between two parties, based on common notional principal amounts and maturity dates. The notional amounts of the swap agreements represent balances used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions. The interest payments under these agreements are settled on a net basis. These derivatives have been recognized in the financial statements at their respective fair values. Changes in the fair value of these derivatives, which are designated as cash flow hedges, are included in other comprehensive income, and changes in the fair value of derivatives which have not been designated as hedges are recorded in operations.

 

45


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Liquidity and Capital Resources (continued)

 

Market Risk (continued)

 

With respect to our interest-bearing liabilities, approximately $3.965 billion of long-term debt at September 30, 2012 was subject to variable rates of interest, while the remaining balance in long-term debt of $22.968 billion at September 30, 2012 was subject to fixed rates of interest. Both the general level of interest rates and, for the senior secured credit facilities, our leverage affect our variable interest rates. Our variable debt is comprised primarily of amounts outstanding under the senior secured credit facilities. Borrowings under the senior secured credit facilities bear interest at a rate equal to an applicable margin plus, at our option, either (a) a base rate determined by reference to the higher of (1) the federal funds rate plus 0.50% and (2) the prime rate of Bank of America, or (b) a LIBOR rate for the currency of such borrowing for the relevant interest period. The applicable margin for borrowings under the senior secured credit facilities may fluctuate according to a leverage ratio. The average effective interest rate for our long-term debt declined from 8.0% for the nine months ended September 30, 2011 to 6.6% for the nine months ended September 30, 2012.

The estimated fair value of our total long-term debt was $28.706 billion at September 30, 2012. The estimates of fair value are based upon the quoted market prices for the same or similar issues of long-term debt with the same maturities. Based on a hypothetical 1% increase in interest rates, the potential annualized reduction to future pretax earnings would be approximately $40 million. To mitigate the impact of fluctuations in interest rates, we generally target a portion of our debt portfolio to be maintained at fixed rates.

Our international operations and foreign currency denominated loans expose us to market risks associated with foreign currencies. In order to mitigate the currency exposure related to foreign currency denominated debt service obligations, we have entered into cross currency swap agreements. A cross currency swap is an agreement between two parties to exchange a stream of principal and interest payments in one currency for a stream of principal and interest payments in another currency over a specified period. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions.

Pending IRS Disputes

We are contesting certain claimed deficiencies and adjustments proposed by the IRS Examination Division in connection with its audit of HCA Inc.’s 2005 and 2006 federal income tax returns. The disputed items include the timing of recognition of certain patient service revenues, the deductibility of certain debt retirement costs and our method for calculating the tax allowance for doubtful accounts. The IRS Examination Division began an audit of HCA Inc.’s 2007, 2008 and 2009 federal income tax returns in 2010.

Management believes HCA Holdings, Inc., its predecessors and affiliates properly reported taxable income and paid taxes in accordance with applicable laws and agreements established with the IRS, and final resolution of these disputes will not have a material, adverse effect on our results of operations or financial position. However, if payments due upon final resolution of these issues exceed our recorded estimates, such resolutions could have a material, adverse effect on our results of operations or financial position.

 

46


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Operating Data

 

     2012      2011  

Number of hospitals in operation at:

     

March 31

     164         156   

June 30

     163         157   

September 30

     162         157   

December 31

        163   

Number of freestanding outpatient surgical centers in operation at:

     

March 31

     109         98   

June 30

     110         98   

September 30

     112         98   

December 31

        108   

Licensed hospital beds at(a):

     

March 31

     41,815         39,075   

June 30

     41,817         39,472   

September 30

     41,884         39,526   

December 31

        41,594   

Weighted average licensed beds(b):

     

Quarter:

     

First

     41,740         39,061   

Second

     41,789         39,356   

Third

     41,873         39,509   

Fourth

        40,994   

Year

        39,735   

Average daily census(c):

     

Quarter:

     

First

     23,284         22,002   

Second

     22,113         20,764   

Third

     22,122         20,528   

Fourth

        21,213   

Year

        21,123   

Admissions(d):

     

Quarter:

     

First

     443,300         406,900   

Second

     428,200         397,500   

Third

     430,500         402,300   

Fourth

        413,700   

Year

        1,620,400   

Equivalent admissions(e):

     

Quarter:

     

First

     711,100         638,400   

Second

     700,800         638,900   

Third

     705,200         650,900   

Fourth

        667,700   

Year

        2,595,900   

 

47


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Operating Data—(Continued)

 

     2012     2011  

Average length of stay (days)(f):

    

Quarter:

    

First

     4.8        4.9   

Second

     4.7        4.8   

Third

     4.7        4.7   

Fourth

       4.7   

Year

       4.8   

Emergency room visits(g):

    

Quarter:

    

First

     1,688,400        1,527,600   

Second

     1,714,200        1,512,000   

Third

     1,724,000        1,539,500   

Fourth

       1,564,400   

Year

       6,143,500   

Outpatient surgeries(h):

    

Quarter:

    

First

     217,500        193,000   

Second

     219,800        199,100   

Third

     212,300        194,300   

Fourth

       212,800   

Year

       799,200   

Inpatient surgeries(i):

    

Quarter:

    

First

     128,300        119,700   

Second

     126,700        120,200   

Third

     124,700        121,100   

Fourth

       123,500   

Year

       484,500   

Days revenues in accounts receivable(j):

    

Quarter:

    

First

     53        49   

Second

     50        50   

Third

     52        50   

Fourth

       52   

Year

       53   

Gross patient revenues(k) (dollars in millions):

    

Quarter:

    

First

   $ 41,377      $ 34,764   

Second

     40,327        34,242   

Third

     40,125        34,288   

Fourth

       38,222   

Year

       141,516   

Outpatient revenues as a % of patient revenues(l):

    

Quarter:

    

First

     37     36

Second

     39     37

Third

     38     37

Fourth

       38

Year

       37

 

48


Table of Contents

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS (continued)

 

Operating Data—(Continued)

 

BALANCE SHEET DATA

 

     % of Accounts Receivable  
     Under 91 Days     91 — 180 Days     Over 180 Days  

Accounts receivable aging at September 30, 2012 (m):

      

Medicare and Medicaid

     13     1     1

Managed care and other discounted

     23        5        4   

Uninsured

     18        8        27   
  

 

 

   

 

 

   

 

 

 

Total

     54     14     32
  

 

 

   

 

 

   

 

 

 

 

(a) Licensed beds are those beds for which a facility has been granted approval to operate from the applicable state licensing agency.
(b) Represents the average number of licensed beds, weighted based on periods owned.
(c) Represents the average number of patients in our hospital beds each day.
(d) Represents the total number of patients admitted to our hospitals and is used by management and certain investors as a general measure of inpatient volume.
(e) Equivalent admissions are used by management and certain investors as a general measure of combined inpatient and outpatient volume. Equivalent admissions are computed by multiplying admissions (inpatient volume) by the sum of gross inpatient revenues and gross outpatient revenues and then dividing the resulting amount by gross inpatient revenues. The equivalent admissions computation “equates” outpatient revenues to the volume measure (admissions) used to measure inpatient volume resulting in a general measure of combined inpatient and outpatient volume.
(f) Represents the average number of days admitted patients stay in our hospitals.
(g) Represents the number of patients treated in our emergency rooms.
(h) Represents the number of surgeries performed on patients who were not admitted to our hospitals. Pain management and endoscopy procedures are not included in outpatient surgeries.
(i) Represents the number of surgeries performed on patients who have been admitted to our hospitals. Pain management and endoscopy procedures are not included in inpatient surgeries.
(j) Revenues per day is calculated by dividing the revenues for the period by the days in the period. Days revenues in accounts receivable is then calculated as accounts receivable, net of allowance for doubtful accounts, at the end of the period divided by the revenues per day.
(k) Gross patient revenues are based upon our standard charge listing. Gross charges/revenues typically do not reflect what our hospital facilities are paid. Gross charges/revenues are reduced by contractual adjustments, discounts and charity care to determine reported revenues.
(l) Represents the percentage of patient revenues related to patients who are not admitted to our hospitals.
(m) Accounts receivable aging data is based upon consolidated gross accounts receivable of $9.073 billion (each 1% is equivalent to approximately $91 million of gross accounts receivable).

 

49


Table of Contents
ITEM 3. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

The information called for by this item is provided under the caption “Market Risk” under Item 2, “Management’s Discussion and Analysis of Financial Condition and Results of Operations.”

 

ITEM 4. CONTROLS AND PROCEDURES

Evaluation of Disclosure Controls and Procedures

HCA’s chief executive officer and chief financial officer have reviewed and evaluated the effectiveness of HCA’s disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) promulgated under the Securities Exchange Act of 1934 (the “Exchange Act”)) as of the end of the period covered by this quarterly report. Based on that evaluation, the chief executive officer and chief financial officer have concluded HCA’s disclosure controls and procedures were effective.

Changes in Internal Control Over Financial Reporting

During the period covered by this report, there have been no changes in our internal control over financial reporting that have materially affected or are reasonably likely to materially affect our internal control over financial reporting.

PART II. OTHER INFORMATION

 

ITEM 1. LEGAL PROCEEDINGS

We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. The resolution of any such lawsuits, claims or legal and regulatory proceedings could materially and adversely affect our results of operations and financial position in a given period.

Government Investigations, Claims and Litigation

Health care companies are subject to numerous investigations by various governmental agencies. Further, under the federal FCA, private parties have the right to bring qui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our financial position, results of operations and liquidity.

As initially disclosed in 2010, the DOJ has contacted the Company in connection with its nationwide review of whether, in certain cases, hospital charges to the federal government relating to implantable cardio-defibrillators (“ICDs”) met the CMS criteria. In connection with this nationwide review, the DOJ has indicated that it will be reviewing certain ICD billing and medical records at 95 HCA hospitals; the review covers the period from October 2003 to the present. In August 2012, HCA, along with non-HCA hospitals across the country subject to the DOJ’s review, received from the DOJ a proposed framework for resolving the DOJ’s review of ICDs. The Company is cooperating in the review. The review could potentially give rise to claims against the Company under the federal FCA or other statutes, regulations or laws. At this time, we cannot predict what effect, if any, this review or any resulting claims could have on the Company.

In July 2012, the Civil Division of the U.S. Attorney’s Office in Miami requested information on reviews assessing the medical necessity of interventional cardiology services provided at any Company facility (other than peer reviews). The Company is cooperating with the government’s request and is currently producing medical records associated with particular reviews at eight hospitals, located primarily in Florida. At this time,

 

50


Table of Contents

we cannot predict what effect, if any, the request or any resulting claims, including any potential claims under the federal False Claims Act, other statutes, regulations or laws, could have on the Company.

New Hampshire Hospital Litigation

In 2006, the Foundation for Seacoast Health (the “Foundation”) filed suit against HCA in state court in New Hampshire. The Foundation alleged that both the 2006 recapitalization transaction and a prior 1999 intra-corporate transaction violated a 1983 agreement that placed certain restrictions on transfers of the Portsmouth Regional Hospital. In May 2007, the trial court ruled against the Foundation on all its claims. On appeal, the New Hampshire Supreme Court affirmed the ruling on the 2006 recapitalization, but remanded to the trial court the claims based on the 1999 intra-corporate transaction. The trial court ruled in December 2009 that the 1999 intra-corporate transaction breached the transfer restriction provisions of the 1983 agreement. In September of 2011, the trial court issued its remedies phase decision and held that the only remedy to which the Foundation was entitled was rescission of the intra-corporate transfer that breached the transfer restriction (the Company has complied with the Court’s order, and it is not expected that such compliance will have any material effect on our operations or financial position). The Court awarded the Foundation, under the terms of the Asset Purchase Agreement, a “fraction” of its attorney fees. The Foundation appealed the remedy phase ruling, and the Company cross-appealed the liability determination. On October 31, 2011, the New Hampshire Supreme Court, on its own, raised the question whether the appeal needed to await the trial court’s further ruling on attorney fees. On November 21, 2011, after the parties briefed the issue, the New Hampshire Supreme Court dismissed the appeal as premature and remanded the case to the trial court. In February 2012, the trial court certified the case for a possible interlocutory appeal without addressing the attorney fees issue. The New Hampshire Supreme Court rejected the request for an interlocutory appeal. The parties subsequently reached a stipulation regarding the attorney fees. The trial court accepted the parties’ stipulation regarding attorneys fees and entered final judgment on liability and remedies on May 4, 2012. Both sides filed appeals with the New Hampshire Supreme Court and briefing has been scheduled.

Securities Class Action Litigation

On October 28, 2011, a shareholder action, Schuh v. HCA Holdings, Inc. et al., was filed in the United States District Court for the Middle District of Tennessee seeking monetary relief. The case sought to include as a class all persons who acquired the Company’s stock pursuant or traceable to the Company’s Registration Statement issued in connection with the March 9, 2011 initial public offering. The lawsuit asserted a claim under Section 11 of the Securities Act of 1933 against the Company, certain members of the board of directors, and certain underwriters in the offering. It further asserted a claim under Section 15 of the Securities Act of 1933 against the same members of the board of directors. The action alleged various deficiencies in the Company’s disclosures in the Registration Statement. Subsequently, two additional class action complaints, Kishtah v. HCA Holdings, Inc. et al. and Daniels v. HCA Holdings, Inc. et al., setting forth substantially similar claims against substantially the same defendants were filed in the same federal court on November 16, 2011 and December 12, 2011, respectively. All three of the cases were consolidated. On May 3, 2012, the court appointed New England Teamsters & Trucking Industry Pension Fund as Lead Plaintiff for the consolidated action. On July 13, 2012, the lead plaintiff filed an amended complaint asserting claims under Sections 11 and 12(a)(2) of the Securities Act of 1933 against the Company, certain members of the board of directors, and certain underwriters in the offering. It further asserts a claim under Section 15 of the Securities Act of 1933 against the same members of the board of directors and Hercules Holdings II, LLC, a majority shareholder of the Company. The consolidated complaint alleges deficiencies in the Company’s disclosures in the Registration Statement and Prospectus relating to: (1) the accounting for the Company’s 2006 recapitalization and 2010 reorganization; (2) the Company’s failure to maintain effective internal controls relating to its accounting for such transactions; and (3) the Company’s Medicare and Medicaid revenue growth rates. The Company and other defendants moved to dismiss the amended compliant on September 11, 2012.

In addition to the above described shareholder class actions, on December 8, 2011, a federal shareholder derivative action, Sutton v. Bracken, et al., putatively initiated in the name of the Company, was filed in the

 

51


Table of Contents

United States District Court for the Middle District of Tennessee against certain officers and present and former directors of the Company seeking monetary relief. The action alleges breaches of fiduciary duties by the named officers and directors in connection with the accounting and earnings claims set forth in the shareholder class actions. Setting forth substantially similar claims against substantially the same defendants, an additional federal derivative action, Schroeder v. Bracken, et al., was filed in the United States District Court for the Middle District of Tennessee on December 16, 2011, and a state derivative action, Bagot v. Bracken, et al., was filed in Tennessee state court in the Davidson County Circuit Court on December 20, 2011. The federal derivative actions have been consolidated in the Middle District of Tennessee and the parties have agreed that those cases shall be stayed pending developments in the shareholder class actions. The state derivative action has also been stayed pending developments in the shareholder class actions.

General Liability and Other Claims

We are subject to claims for additional income taxes and related interest by the IRS Examination Division. For a description of those proceedings, see Part I, Item 2, “Management’s Discussion and Analysis of Financial Condition and Results of Operations — Pending IRS Disputes” and Note 2 to our condensed consolidated financial statements.

We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or for wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants have asked for punitive damages against us, which may not be covered by insurance. In the opinion of management, the ultimate resolution of these pending claims and legal proceedings will not have a material, adverse effect on our results of operations or financial position.

 

ITEM 1A: RISK FACTORS

Reference is made to the factors set forth under the caption “Forward-Looking Statements” in Part I, Item 2 of this Form 10-Q and other risk factors described in our annual report on Form 10-K for the year ended December 31, 2011, which are incorporated herein by reference. There have not been any material changes to the risk factors previously disclosed in our annual report on Form 10-K for the year ended December 31, 2011 and our quarterly report on Form 10-Q for the quarter ended June 30, 2012.

 

ITEM 6. EXHIBITS

(a) List of Exhibits:

 

    31.1          Certification of Chief Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
    31.2       —      Certification of Chief Financial Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
    32       —      Certification Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
  101       —      The following financial information from our quarterly report on Form 10-Q for the quarters and nine months ended September 30, 2012 and 2011, filed with the SEC on November 6, 2012, formatted in Extensible Business Reporting Language (XBRL): (i) the condensed consolidated balance sheets at September 30, 2012 and December 31, 2011, (ii) the condensed consolidated comprehensive income statements for the quarters and nine months ended September 30, 2012 and 2011, (iii) the condensed consolidated statements of cash flows for the nine months ended September 30, 2012 and 2011 and (iv) the notes to condensed consolidated financial statements.(1)

 

52


Table of Contents

 

(1) The XBRL related information in Exhibit 101 to this quarterly report on Form 10-Q shall not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended, or otherwise subject to liability of that section and shall not be incorporated by reference into any filing or other document pursuant to the Securities Act of 1933, as amended, except as shall be expressly set forth by specific reference in such filing or document.

 

53


Table of Contents

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

 

HCA Holdings, Inc.
By:  

/S/    R. MILTON JOHNSON        

  R. Milton Johnson
  President and Chief Financial Officer

Date: November 6, 2012

 

54