HCA Healthcare, Inc. announced financial and operating results for the third quarter ended September 30, 2018.

Key third quarter metrics (all percentage changes compare 3Q 2018 to 3Q 2017 unless noted):

• Revenues increased 7.1 percent to $11.451 billion

• Net income attributable to HCA Healthcare, Inc. totaled $759 million, or $2.15 per diluted share

• Adjusted EBITDA totaled $2.096 billion

• Cash flows from operations totaled $1.721 billion

• Same facility equivalent admissions increased 3.4 percent, while same facility admissions increased 3.1 percent

• Same facility revenue per equivalent admission increased 3.9 percent

• Same facility emergency room visits declined 0.4 percent

Revenues in the third quarter of 2018 increased to $11.451 billion, compared to $10.696 billion in the third quarter of 2017. Net income attributable to HCA Healthcare, Inc. totaled $759 million, or $2.15 per diluted share, compared to $426 million, or $1.15 per diluted share, in the third quarter of 2017. The third quarter 2018 results include gains on sales of facilities of $6 million, or $0.01 per diluted share, and losses on retirement of debt of $9 million, or $0.02 per diluted share, compared to gains on sales of facilities of $7 million, or $0.01 per diluted share, and losses on retirement of debt of $39 million, or $0.07 per diluted share, in the third quarter of 2017. For the quarter, the Company recognized a tax benefit of $132 million, or $0.37 per diluted share, due to a reduction in its effective tax rate related to the impact of the Tax Cuts and Jobs Act. Results for the third quarter of 2018 also include a $23 million tax benefit, or $0.07 per diluted share, compared to a $4 million tax benefit, or $0.01 per diluted share, for the third quarter of 2017, related to employee equity award settlements.

Adjusted EBITDA totaled $2.096 billion compared to $1.776 billion in the third quarter of 2017. Adjusted EBITDA is a non-GAAP financial measure. A table reconciling net income attributable to HCA Healthcare, Inc. to Adjusted EBITDA is included in this release.

Results for the third quarter of 2018 include a reduction in the Company’s reserves for professional liability risks of $70 million, or $0.15 per diluted share. The Company’s provisions for professional liability risks are based upon actuarially determined estimates and are included in “other operating expenses” in our consolidated income statements.

During the third quarter of 2017, the Company incurred additional expenses and experienced losses of revenues estimated at approximately $140 million, or $0.24 per diluted share, associated with hurricanes Harvey and Irma’s impact on our Corpus Christi, Houston, Florida, Georgia and South Carolina facilities. This amount was prior to any insurance recoveries.

Operating results for the third quarter of 2017 also included a negative impact related to the Texas Medicaid waiver program of approximately $50 million, or $0.08 per diluted share. This reflected settlement amounts related to the program year ended September 30, 2017.

Same facility equivalent admissions increased 3.4 percent in the third quarter of 2018 compared to the prior year period. Same facility admissions increased 3.1 percent compared to the prior year period. Same facility emergency room visits declined 0.4 percent in the third quarter of 2018, compared to the prior year period. Same facility inpatient surgeries increased 1.6 percent, while same facility outpatient surgeries increased 4.2 percent in the third quarter of 2018 compared to the same period of 2017. Same facility revenue per equivalent admission increased 3.9 percent in the third quarter of 2018, compared to the third quarter of 2017.

During the third quarter of 2018, salaries and benefits, supplies and other operating expenses totaled $9.364 billion, or 81.8 percent of revenues, compared to $8.933 billion, or 83.5 percent of revenues, in the third quarter of 2017. On a same facility basis, salaries and benefits, supplies and other operating expenses totaled $8.707 billion, or 79.6 percent of revenues, during for the third quarter of 2018, compared to $8.268 billion, or 81.2 percent of revenues, on a same facility basis for the same period of 2017.

Nine Months Ended September 30, 2018

Revenues for the nine months ended September 30, 2018 totaled $34.403 billion, compared to $32.052 billion in the same period of 2017. Net income attributable to HCA Healthcare, Inc. was $2.723 billion, or $7.65 per diluted share, compared to $1.742 billion, or $4.64 per diluted share, for the first nine months of 2017. Results for the nine months ended September 30, 2018 include gains on sales of facilities of $420 million, or $0.89 per diluted share, and losses on retirement of debt of $9 million, or $0.02 per diluted share. Results for the nine months ended September 30, 2017 included gains on sales of facilities of $10 million, or $0.02 per diluted share, and losses on retirement of debt of $39 million, or $0.07 per diluted share.

The Company recognized a tax benefit of $316 million, or $0.89 per diluted share, on net income attributable to HCA Healthcare, Inc., excluding gains on sales of facilities and losses on retirement of debt, for the nine months ended September 30, 2018, due to a reduction in its effective tax rate related to the impact of the Tax Cuts and Jobs Act. Results for the nine months ended September 30, 2018 also include a $119 million tax benefit, or $0.33 per diluted share, compared to $80 million, or $0.21 per diluted share, for the same period of 2017, related to employee equity award settlements.

During the nine months ended September 30, 2017, the Company incurred additional expenses and experienced losses of revenues estimated at approximately $140 million, or $0.24 per diluted share, associated with the impact of hurricanes. Also in the nine months ended September 30, 2017, the Company incurred a negative impact to results related to the Texas Medicaid waiver program of approximately $50 million, or $0.08 per diluted share.

Balance Sheet and Cash Flows from Operations

As of September 30, 2018, HCA Healthcare, Inc.’s balance sheet reflected cash and cash equivalents of $578 million, total debt of $33.107 billion, and total assets of $38.044 billion. During the third quarter of 2018, capital expenditures totaled $846 million, excluding acquisitions. Cash flows provided by operating activities in the third quarter totaled $1.721 billion, compared to $1.008 billion in the third quarter of 2017.

As of September 30, 2018, HCA’s leverage ratio as measured by Total Debt/Adjusted EBITDA was 3.76x, compared to 4.02x as of December 31, 2017.

During the third quarter of 2018, the Company repurchased 2.518 million shares of its common stock at a cost of $302 million, and during the nine months ended September 30, 2018, repurchased 11.558 million shares of its common stock at a cost of $1.195 billion. The Company had $607 million remaining under its existing repurchase authorization as of September 30, 2018.

As of September 30, 2018, HCA operated 179 hospitals and approximately 1,800 sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics, in 20 states and the United Kingdom.

Dividend

HCA today announced that its Board of Directors declared a quarterly cash dividend of $0.35 per share on the Company’s common stock. The dividend will be paid on December 28, 2018 to stockholders of record at the close of business on December 3, 2018.

The declaration and payment of any future dividend will be subject to the discretion of the Board of Directors and will depend on a variety of factors, including the Company’s financial condition and results of operations and contractual restrictions. Future dividends are expected to be funded by cash balances and future cash flows from operations.

2018 Guidance

The 2018 guidance ranges for the year have been revised from our second quarter 2018 release and are as follows:

The Company’s 2018 guidance contains a number of assumptions, including:

• 2018 guidance for EPS (diluted) includes an estimated $125 million income tax benefit, or $0.35 per diluted share, for excess tax benefits related to employee equity award settlements recorded as a component of the provision for income taxes. The timing and amounts related to employee equity award settlements are difficult to project and may vary from this estimate.

• 2018 guidance reflects the sale of the Company’s Oklahoma facilities which closed February 1, 2018. These facilities had annual revenues of approximately $1 billion and Adjusted EBITDA of approximately $180 million in 2017.

• 2018 guidance includes an estimated impact of $1.25 earnings per diluted share related to the Tax Cuts and Jobs Act.

• 2018 guidance excludes any acquisitions that have not been completed as of September 30, 2018.

• 2018 guidance excludes any hurricane insurance recoveries the Company may receive.

• 2018 guidance excludes any changes in our estimates of the impact of the Tax Cuts and Jobs Act on our deferred tax assets and liabilities.

• 2018 guidance excludes the impact of items such as, but not limited to, gains or losses on sales of facilities, losses on retirement of debt, legal claim costs and impairments of long-lived assets.