Why did GAAP EPS decline in the fourth quarter even though Adjusted EBITDA grew?

GAAP diluted EPS fell to $5.63 from $5.93 mainly because of a $195 million loss on sales of facilities, primarily tied to a pending California hospital sale, which cost $0.59 per share. Hurricanes Helene and Milton also reduced results by an estimated $0.60 per share. Adjusted EBITDA excludes facility gains and losses, so it rose 2.6% to $3.712 billion.

How much is HCA returning to shareholders?

In 2024 HCA repurchased $6.042 billion of common stock and paid $690 million in dividends. The Board also authorized a new $10 billion repurchase program with no time limit, and the quarterly dividend is $0.72 per share.

What does the 2025 guidance imply for growth?

The midpoint of 2025 revenue guidance is about $74.3 billion, roughly 5% above 2024's $70.6 billion. The Adjusted EBITDA midpoint of about $14.7 billion is roughly 6% above 2024's $13.9 billion. The midpoint EPS of about $24.95 is roughly 13% above 2024's GAAP EPS of $22.00, which benefited from lower share count and fewer one-time items. Guidance assumes a mostly stable operating environment.

What are the main risks to the outlook?

Key risks include HCA's heavy debt load of about $43 billion, changes in Medicaid supplemental payments and other public policy, the expiration of enhanced premium tax credits that could raise uninsured volumes, labor and supply cost pressures, and ongoing hurricane-related costs. The company also flagged possible federal government shutdowns and sequestration-related Medicare cuts.

Is the company's balance sheet a concern?

Leverage is significant. Total debt was $43.031 billion against $1.933 billion of cash, and stockholders' deficit attributable to HCA was $(2.499) billion. HCA's operating cash flow of $10.5 billion in 2024 and $7.986 billion of credit facility availability provide liquidity, but debt refinancing terms and interest expense of $2.061 billion for the year deserve monitoring.

HCA 8-K: Earnings & Results & Regulation FD

01—Abstract

Summary

Summary of the 8-K filed January 24, 2025. Cited figures are marked; the original filing is the authoritative source.

HCA Healthcare reported fourth-quarter 2024 revenues of $18.285 billion^a, up from $17.303 billion a year earlier, and net income attributable to HCA of $1.438 billion, or $5.63 per diluted share, versus $5.93 in 4Q 2023.

The GAAP decline is driven largely by a $195 million^b ($0.59 per share) loss on sales of facilities, primarily tied to the pending sale of a California hospital, and an estimated $0.60 per share hit from Hurricanes Helene and Milton. Adjusted EBITDA rose 2.6% to $3.712 billion, though the margin contracted to 20.3% from 20.9%. Operating volumes were solid: same facility admissions grew 3.0% and same facility equivalent admissions grew 3.1%, while outpatient surgeries fell 1.3%.

For full-year 2024, revenue reached $70.603 billion^c, GAAP diluted EPS was $22.00, and Adjusted EBITDA was $13.882 billion. Capital return is a major theme. HCA repurchased $1.700 billion of stock in the fourth quarter, full-year repurchases totaled $6.042 billion, and the Board authorized a new $10 billion buyback with no time limit.

The quarterly dividend was set at $0.72^d per share, payable March 31, 2025. Balance sheet leverage remains substantial, with total debt of $43.031 billion against cash of $1.933 billion, and the company held $7.986 billion of credit facility availability. For 2025, management guided to revenue of $72.8 to $75.8 billion, Adjusted EBITDA of $14.3 to $15.1 billion, and diluted EPS of $24.05 to $25.85 on 243 million shares.

Capital expenditures are expected at $5.0 to $5.2 billion. The guidance assumes a mostly stable operating environment and excludes gains or losses on facility sales, debt retirement costs, legal claims, and impairments. Investors should weigh the strong cash generation and buyback capacity against heavy debt, regulatory exposure (including Medicaid supplemental payments and expiring enhanced premium tax credits), and continued hurricane-related costs.

02—Key points

Key Highlights

4Q 2024 revenue rose 5.7% to $18.285 billion, and same facility admissions grew 3.0%.
4Q 2024 GAAP diluted EPS was $5.63, down from $5.93, reflecting a $0.59 per share loss on facility sales and a roughly $0.60 per share hurricane impact.
Adjusted EBITDA grew to $3.712 billion from $3.618 billion, but the margin narrowed to 20.3% from 20.9%.
HCA authorized a new $10 billion share repurchase program and bought back $6.042 billion of stock in 2024.
Quarterly dividend declared at $0.72 per share, payable March 31, 2025 to holders of record on March 17, 2025.
2025 guidance calls for revenue of $72.8–$75.8 billion, Adjusted EBITDA of $14.3–$15.1 billion, and diluted EPS of $24.05–$25.85.
Total debt of $43.031 billion remains a key risk, with $4.698 billion of long-term debt due within one year.

03—Questions

Frequently Asked Questions

Why did GAAP EPS decline in the fourth quarter even though Adjusted EBITDA grew?
GAAP diluted EPS fell to $5.63 from $5.93 mainly because of a $195 million loss on sales of facilities, primarily tied to a pending California hospital sale, which cost $0.59 per share. Hurricanes Helene and Milton also reduced results by an estimated $0.60 per share. Adjusted EBITDA excludes facility gains and losses, so it rose 2.6% to $3.712 billion.
How much is HCA returning to shareholders?
In 2024 HCA repurchased $6.042 billion of common stock and paid $690 million in dividends. The Board also authorized a new $10 billion repurchase program with no time limit, and the quarterly dividend is $0.72 per share.
What does the 2025 guidance imply for growth?
The midpoint of 2025 revenue guidance is about $74.3 billion, roughly 5% above 2024's $70.6 billion. The Adjusted EBITDA midpoint of about $14.7 billion is roughly 6% above 2024's $13.9 billion. The midpoint EPS of about $24.95 is roughly 13% above 2024's GAAP EPS of $22.00, which benefited from lower share count and fewer one-time items. Guidance assumes a mostly stable operating environment.
What are the main risks to the outlook?
Key risks include HCA's heavy debt load of about $43 billion, changes in Medicaid supplemental payments and other public policy, the expiration of enhanced premium tax credits that could raise uninsured volumes, labor and supply cost pressures, and ongoing hurricane-related costs. The company also flagged possible federal government shutdowns and sequestration-related Medicare cuts.
Is the company's balance sheet a concern?
Leverage is significant. Total debt was $43.031 billion against $1.933 billion of cash, and stockholders' deficit attributable to HCA was $(2.499) billion. HCA's operating cash flow of $10.5 billion in 2024 and $7.986 billion of credit facility availability provide liquidity, but debt refinancing terms and interest expense of $2.061 billion for the year deserve monitoring.

04—Continue

← View all 8-K filings