HCA Healthcare, Inc. (NYSE: HCA) today announced financial and operating results for the third quarter ended September 30, 2021.

Key third quarter metrics (all percentage changes compare 3Q 2021 to 3Q 2020 unless otherwise noted):

• Revenues totaled $15.276 billion

• Net income attributable to HCA Healthcare, Inc. totaled $2.269 billion, or $7.00 per diluted share

• Adjusted EBITDA totaled $3.224 billion

• Cash flows from operating activities totaled $2.277 billion

• Same facility admissions and same facility equivalent admissions increased 6.8 percent and 9.3 percent, respectively

"During the third quarter we experienced the most intense surge yet of the pandemic, and our colleagues and physicians delivered record levels of patient care to meet the demand caused by the Delta variant," said Sam Hazen, Chief Executive Officer of HCA Healthcare. "Once again, the disciplined operating culture and strong execution by our teams were on display. I want to thank them for their tremendous work and dedication to serving others."

Revenues in the third quarter of 2021 increased to $15.276 billion, compared to $13.311 billion in the third quarter of 2020. Net income attributable to HCA Healthcare, Inc. totaled $2.269 billion, or $7.00 per diluted share, compared to $668 million, or $1.95 per diluted share, in the third quarter of 2020. Results for the third quarter of 2021 include gains on sales of facilities of $1.047 billion, or $2.43 per diluted share, related to the sale of four hospitals in Georgia and other health care entity investments. Results for the third quarter of 2020 included a reversal of $822 million, or $1.72 per diluted share, in government stimulus income recorded in the second quarter of 2020 related to general distribution funds received from the Provider Relief Fund established by the Coronavirus Aid, Relief, and Economic Security ("CARES") Act and $14 million, or $0.03 per diluted share, of gains on sales of facilities.

For the third quarter of 2021, Adjusted EBITDA totaled $3.224 billion, compared to $2.053 billion in the third quarter of 2020. Adjusted EBITDA is a non-GAAP financial measure. A table providing supplemental information on Adjusted EBITDA and reconciling net income attributable to HCA Healthcare, Inc. to Adjusted EBITDA is included in this release.

Same facility admissions and equivalent admissions increased 6.8 percent and 9.3 percent, respectively, in the third quarter of 2021, compared to the prior year period. Same facility emergency room visits increased 31.2 percent in the third quarter of 2021, compared to the prior year period. Same facility inpatient surgeries declined 4.9 percent, and same facility outpatient surgeries increased 6.4 percent in the third quarter of 2021, compared to the same period of 2020. Same facility revenue per equivalent admission increased 5.2 percent in the third quarter of 2021, compared to the third quarter of 2020, due to increases in acuity of patients treated and favorable payer mix in the quarter.

Because of the pandemic-related impact on volumes in the third quarter of 2020, the Company believes a comparison of volume statistics to the comparable period in 2019 provides additional context to the improvement in operations during 2021. The following table provides a summary of statistical measures for the third quarter of 2021 compared to the same period in 2019 on a same facility basis.

Nine Months Ended September 30, 2021

Revenues for the nine months ended September 30, 2021 totaled $43.688 billion, compared to $37.240 billion in the same period of 2020. Net income attributable to HCA Healthcare, Inc. was $5.142 billion, or $15.43 per diluted share, compared to $2.328 billion, or $6.79 per diluted share, for the first nine months of 2020. Results through September 2021 include gains on sales of facilities of $1.057 billion, or $2.39 per diluted share, and losses on retirement of debt of $12 million, or $0.03 per diluted share. Results for the nine months ended September 30, 2020 included losses on sales of facilities of $6 million, or $0.03 per diluted share, and losses on retirement of debt of $295 million, or $0.66 per diluted share.

Balance Sheet and Cash Flows from Operations

As of September 30, 2021, HCA Healthcare, Inc.’s balance sheet reflected cash and cash equivalents of $1.027 billion, total debt of $32.299 billion, and total assets of $49.562 billion. During the third quarter of 2021, capital expenditures totaled $889 million, excluding acquisitions. Cash flows provided by operating activities in the third quarter totaled $2.277 billion, compared to $2.717 billion in the third quarter of 2020.

During the third quarter of 2021, the Company repurchased 9.605 million shares of its common stock at a cost of $2.329 billion. The Company had $2.658 billion remaining under its repurchase authorization as of September 30, 2021. As of September 30, 2021, the Company had $5.920 billion of availability under its credit facilities.

Dividend

HCA today announced that its Board of Directors declared a quarterly cash dividend of $0.48 per share on the Company’s common stock. The dividend will be paid on December 29, 2021 to stockholders of record at the close of business on December 14, 2021.

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.

2021 Revised Guidance

The 2021 guidance ranges for the year have been revised from our second quarter release and are as follows:

The Company’s 2021 guidance contains a number of assumptions, including, among others, the Company’s current expectations regarding the impact of the COVID-19 pandemic and related government legislation, and excludes the impact of items such as, but not limited to, gains or losses on sales of facilities, losses on retirement of debt, legal claims costs and impairment of long-lived assets.

Adjusted EBITDA is a non-GAAP financial measure. A table reconciling forecasted net income attributable to HCA Healthcare, Inc. to forecasted Adjusted EBITDA is included in this release.

The Company’s guidance is based on current plans and expectations and is subject to a number of known and unknown uncertainties and risks, including those set forth below in the Company’s "Forward-Looking Statements."

Earnings Conference Call

HCA Healthcare will host a conference call for investors at 9:00 a.m. Central Daylight Time today. All interested investors are invited to access a live audio broadcast of the call via webcast. The broadcast also will be available on a replay basis beginning this afternoon. The webcast can be accessed at: https://investor.hcahealthcare.com/events-and-presentations.