01—Abstract
Summary
Summary of the 10-K filed February 10, 2026. Cited figures are marked; the original filing is the authoritative source.
HCA Healthcare reported a strong 2025, with revenues rising 7.1% to $75.6 billiona and net income attributable to HCA of $6.784 billion, or $28.33 per diluted share, up from $22.00 in 2024.
Growth was driven by a 2.9% increase in equivalent admissions and a 4.0% increase in revenue per equivalent admission. Operating cash flow rose to $12.6 billionb, funding $4.9 billion of capital expenditures and $10.1 billion of share repurchases. Same-facility revenue grew 6.6%, and Medicaid state directed and supplemental payments contributed about $6.2 billion.
Balance sheet leverage increased. Total debt rose to $46.5 billionc from $43.0 billion, and interest expense climbed 9% to $2.25 billion. Stockholders' deficit widened to $(2.8) billion, a consequence of heavy buybacks and retained deficits rather than operating weakness.
Working capital turned negative, partly because of $2.2 billiond of commercial paper, and the company established a $4.0 billion commercial paper program. The outlook carries meaningful policy risk. Management expects SDP revenues to decline in 2026 absent new approvals, and it cites the expiration of enhanced ACA premium tax credits, the 2025 Federal Budget Act (FBA) Medicaid and provider-tax changes, and Medicare site-neutral and inpatient-only list phase-outs as headwinds.
Florida and Texas account for 51% of revenues, and the company is implementing a new EHR platform. Planned 2026 capex is $5.0 to $5.5 billion, and the quarterly dividend was raised to $0.78.
02—Key points
Key Highlights
- Revenue grew 7.1% to $75.6 billion, with same-facility revenue up 6.6%, driven by a 2.9% rise in equivalent admissions and a 4.0% rise in revenue per equivalent admission.
- Diluted EPS rose 28.8% to $28.33 (from $22.00), helped by a 17.8% increase in net income attributable to HCA to $6.78 billion and a sharply lower diluted share count of 239.5 million (from 261.8 million).
- Operating cash flow increased 20% to $12.64 billion, while capital expenditures were $4.94 billion, leaving substantial free cash flow.
- Total debt rose to $46.5 billion (from $43.0 billion), with interest expense up 9% to $2.25 billion; the company issued $8.5 billion of long-term debt and repaid $7.4 billion.
- Share repurchases totaled $10.1 billion in 2025 (26.7 million shares); $750 million remains under the January 2025 authorization, and a new $10 billion program was authorized in January 2026.
- Medicaid state directed and supplemental payments reached about $6.2 billion, but management expects SDP revenue to decline in 2026 excluding new CMS approvals because of FBA limits.
- Concentration risk is high: 190 hospitals, with 102 in Florida and Texas generating 51% of revenues; the 2026 dividend is $0.78 per quarter, up from $0.72.
03—One dollar
04—Financials
Financial Highlights
Figures from 10-KFY2025filed February 10, 2026Financial Statements
FY2025 against FY2024
| Line item | FY2025FY2024 | Change |
|---|---|---|
| Revenue | $75.60B$70.60B | +7.1% |
| Operating Expenses | $65.77B$62.08B | +5.9% |
| Interest Expense | $2.25B$2.06B | +9.1% |
| Net Income | $6.78B$5.76B | +17.8% |
| EPS (Basic) | $28.70$22.27 | +28.9% |
| EPS (Diluted) | $28.33$22.00 | +28.8% |
| Shares Outstanding (Basic) | 236.41M258.60M | −8.6% |
| Shares Outstanding (Diluted) | 239.50M261.81M | −8.5% |
05—Questions
Frequently Asked Questions
How strong was HCA's 2025 financial performance?
Revenue rose 7.1% to $75.6 billion, and net income attributable to HCA increased 17.8% to $6.78 billion, or $28.33 per diluted share. Operating margin improved, with income before taxes rising 15.4% to $9.83 billion. Results benefited from both volume growth and higher revenue per admission, and 2024 included roughly $250 million of hurricane-related costs.
What are the main policy risks to HCA's revenue in 2026?
The main risks are the FBA's Medicaid changes, including limits on provider taxes and state directed payments, which management expects to reduce SDP revenues in 2026. The expiration of enhanced ACA premium tax credits at the end of 2025 is expected to increase the uninsured rate and reduce Exchange enrollment. Medicare site-neutral expansion, the phase-out of the inpatient-only list, and 340B-related outpatient payment reductions could also pressure revenue.
Is HCA's balance sheet becoming more leveraged?
Yes. Total debt increased to $46.5 billion from $43.0 billion, and the stockholders' deficit widened to $(2.8) billion from a positive $555 million a year earlier. Much of the increase reflects debt-funded buybacks and the $2.2 billion of commercial paper outstanding. Management states that cash flows and its credit facility are sufficient for expected liquidity needs, and the company has no borrowings under its $8.0 billion revolver.
How is HCA returning capital to shareholders?
HCA repurchased $10.1 billion of stock in 2025 and paid $679 million in dividends, at $0.72 per quarter for the year. In January 2026 the board authorized a new $10 billion repurchase program and raised the quarterly dividend to $0.78. Investors should note that buybacks are being funded partly with borrowed money.
Are there governance considerations for investors?
Yes. Entities affiliated with founder Dr. Thomas F. Frist Jr. hold roughly 31% of outstanding common stock and retain the right to nominate certain board members under a stockholders' agreement. In February 2026 HCA completed an exchange of 36.6 million shares with Frist-affiliated entities as part of estate and charitable planning. This could influence corporate decisions and the composition of the board.
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