01—Abstract
Summary
Summary of the 10-K filed February 14, 2025. Cited figures are marked; the original filing is the authoritative source.
HCA Healthcare's 2024 10-K shows a company with strong top-line growth and cash generation, but a balance sheet that is heavily levered and a shareholder-return program funded largely by debt.
Revenues rose 8.7% to $70.603 billiona, driven by a 5.3% increase in equivalent admissions and a 3.2% increase in revenue per equivalent admission. Net income attributable to HCA was $5.760 billion, or $22.00 per diluted share, up from $18.97 in 2023. Operating cash flow reached $10.514 billion, up $1.083 billion, and capital expenditures were $4.875 billion.
Management plans $5.0 to $5.2 billionb of capex in 2025. The balance sheet is the main investor concern. Total debt rose to $43.031 billion from $39.593 billion, and interest expense climbed to $2.061 billion.
Stockholders' equity attributable to HCA is negative at $(2.499) billion. Management repurchased $6.042 billionc of stock in 2024 and paid $690 million in dividends, funded in part by $4.5 billion of new senior notes and $3.0 billion of further issuance. The board authorized a new $10 billion repurchase program in January 2025, and the quarterly dividend was raised to $0.72 from $0.66.
Risk factors center on payer mix and government policy. Medicare and Medicaid together provided about 44.5%d of 2024 revenues.
Florida and Texas generated 52% of revenues, and the company is exposed to hurricanes, as Helene and Milton cost roughly $250 million in 2024. Other watch items include the expiration of enhanced ACA premium tax credits after 2025, a rising uninsured emergency room volume (up 13.8%), and Medicaid supplemental payment programs that reached about $4.9 billion in 2024 but face federal rule changes.
02—Key points
Key Highlights
- Revenue grew 8.7% to $70.603 billion, with equivalent admissions up 5.3% and revenue per equivalent admission up 3.2%.
- Net income attributable to HCA rose 9.9% to $5.760 billion, or $22.00 per diluted share, versus $18.97 in 2023.
- Operating cash flow of $10.514 billion grew $1.083 billion year over year, with capital expenditures of $4.875 billion.
- Total debt increased to $43.031 billion, interest expense rose to $2.061 billion, and stockholders' equity attributable to HCA was a deficit of $(2.499) billion.
- The company repurchased $6.042 billion of common stock in 2024, and the board authorized a new $10 billion program in January 2025.
- Medicare and Medicaid represented 44.5% of revenues, and Florida and Texas accounted for 52% of revenues, creating concentration and policy risk.
- Hurricanes Helene and Milton cost an estimated $250 million ($0.73 per diluted share) in 2024, and uncompensated care rose to $4.366 billion.
03—One dollar
04—Financials
Financial Highlights
Figures from 10-KFY2024filed February 14, 2025Financial Statements
FY2024 against FY2023
| Line item | FY2024FY2023 | Change |
|---|---|---|
| Revenue | $70.60B$64.97B | +8.7% |
| Operating Expenses | $62.08B$57.26B | +8.4% |
| Interest Expense | $2.06B$1.94B | +6.3% |
| Net Income | $5.76B$5.24B | +9.9% |
| EPS (Basic) | $22.27$19.25 | +15.7% |
| EPS (Diluted) | $22.00$18.97 | +16.0% |
| Shares Outstanding (Basic) | 258.60M272.40M | −5.1% |
| Shares Outstanding (Diluted) | 261.81M276.41M | −5.3% |
05—Questions
Frequently Asked Questions
How much debt does HCA carry, and how is it affecting earnings?
Total debt was $43.031 billion at year-end 2024, up from $39.593 billion. Interest expense rose $123 million to $2.061 billion, mainly because the average debt balance increased to $41.388 billion. The average effective interest rate on long-term debt was 5.0%. Of the debt, $1.238 billion is variable-rate, so a hypothetical 1% rate increase would reduce pretax earnings by only about $12 million.
Is HCA's negative stockholders' equity a concern?
Stockholders' deficit attributable to HCA was $(2.499) billion at year-end 2024, versus $(1.774) billion in 2023. The deficit reflects cumulative share repurchases and dividends exceeding retained earnings, not operating losses, since net income was positive. Total equity including noncontrolling interests was $555 million. Investors should focus on cash flow coverage of debt and buybacks rather than book equity.
How dependent is HCA on government payers and the uninsured?
Medicare and Medicaid together produced 44.5% of 2024 revenues, and managed Medicare and managed Medicaid add further exposure. Uninsured emergency room visits rose 13.5% on a same-facility basis, and uncompensated care cost $4.366 billion. Enhanced ACA premium tax credits are scheduled to expire after 2025, which management expects to increase the uninsured rate.
What are the main geographic and weather risks?
Florida and Texas generated 52% of 2024 revenues and 59% of admissions, with 100 of 190 hospitals in those two states. Both states are exposed to hurricanes, and Helene and Milton cost roughly $250 million in 2024. Property insurance is generally self-insured above $110 million per occurrence, so large storms can produce unrecovered losses.
What is management's capital return outlook for 2025?
The board declared a quarterly dividend of $0.72 per share, up from $0.66, payable March 31, 2025. It also authorized a new $10 billion share repurchase program in January 2025, adding to $764 million remaining under the 2024 authorization at year-end. Capex is planned at $5.0 to $5.2 billion for 2025. Because operating cash flow of $10.5 billion must cover capex, dividends, and buybacks, the pace of repurchases will depend heavily on continued debt issuance.
06—Continue