HCA HEALTHCARE, INC., 10-K filed on 2/10/2026
Annual Report
v3.25.4
Cover Page - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Jan. 31, 2026
Jun. 30, 2025
Cover [Abstract]      
Document Type 10-K    
Amendment Flag false    
Document Period End Date Dec. 31, 2025    
Document Fiscal Year Focus 2025    
Document Fiscal Period Focus FY    
Trading Symbol HCA    
Entity Registrant Name HCA Healthcare, Inc.    
Entity Central Index Key 0000860730    
Current Fiscal Year End Date --12-31    
Entity Current Reporting Status Yes    
Entity Filer Category Large Accelerated Filer    
Entity Shell Company false    
Entity Small Business false    
Entity Emerging Growth Company false    
Entity Common Stock, Shares Outstanding   223,622,200  
Entity Interactive Data Current Yes    
Entity File Number 1-11239    
Entity Incorporation, State or Country Code DE    
Entity Tax Identification Number 27-3865930    
Entity Address, Address Line One One Park Plaza    
Entity Address, City or Town Nashville    
Entity Address, State or Province TN    
Entity Address, Postal Zip Code 37203    
City Area Code 615    
Local Phone Number 344-9551    
Document Annual Report true    
Document Transition Report false    
Title of 12(b) Security Common Stock, $0.01 Par Value    
Security Exchange Name NYSE    
Entity Voluntary Filers No    
Entity Well-known Seasoned Issuer Yes    
Entity Public Float     $ 63,269
ICFR Auditor Attestation Flag true    
Auditor Firm ID 42    
Auditor Name Ernst & Young LLP    
Auditor Location Nashville, Tennessee, United States of America    
Auditor Opinion

Opinion on Internal Control Over Financial Reporting

We have audited HCA Healthcare, Inc.’s internal control over financial reporting as of December 31, 2025, based on criteria established in Internal Control—Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway Commission (2013 framework) (the COSO criteria). In our opinion, HCA Healthcare, Inc. (the Company) maintained, in all material respects, effective internal control over financial reporting as of December 31, 2025, based on the COSO criteria.

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the consolidated balance sheets of HCA Healthcare, Inc. as of December 31, 2025 and 2024, the related consolidated statements of income, comprehensive income, stockholders’ equity (deficit), and cash flows for each of the three years in the period ended December 31, 2025, and the related notes and our report dated February 10, 2026 expressed an unqualified opinion thereon.

Opinion on the Financial Statements

We have audited the accompanying consolidated balance sheets of HCA Healthcare, Inc. (the Company) as of December 31, 2025 and 2024, the related consolidated statements of income, comprehensive income, stockholders’ equity (deficit) and cash flows for each of the three years in the period ended December 31, 2025, and the related notes (collectively referred to as the “consolidated financial statements”). In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position of the Company at December 31, 2025 and 2024, and the results of its operations and its cash flows for each of the three years in the period ended December 31, 2025, in conformity with U.S. generally accepted accounting principles.

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the Company’s internal control over financial reporting as of December 31, 2025, based on criteria established in Internal Control-Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway Commission (2013 framework), and our report dated February 10, 2026 expressed an unqualified opinion thereon.

   
Document Financial Statement Error Correction [Flag] false    
Documents Incorporated by Reference

Portions of the Registrant’s definitive proxy materials for its 2026 Annual Meeting of Stockholders are incorporated by reference into Part III hereof.

   
v3.25.4
Consolidated Income Statements - USD ($)
shares in Thousands, $ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Income Statement [Abstract]      
Revenues $ 75,600 $ 70,603 $ 64,968
Salaries and benefits 32,859 31,170 29,487
Supplies 11,367 10,755 9,902
Other operating expenses 15,886 14,819 12,875
Equity in earnings of affiliates (78) (23) (22)
Depreciation and amortization 3,523 3,312 3,077
Interest expense 2,248 2,061 1,938
Losses (gains) on sales of facilities (37) (14) 5
Total expenses including equity in earnings of affiliates 65,768 62,080 57,262
Income before income taxes 9,832 8,523 7,706
Provision for income taxes 2,050 1,866 1,615
Net income 7,782 6,657 6,091
Net income attributable to noncontrolling interests 998 897 849
Net income attributable to HCA Healthcare, Inc. $ 6,784 $ 5,760 $ 5,242
Per share data:      
Basic earnings per share $ 28.7 $ 22.27 $ 19.25
Diluted earnings per share $ 28.33 $ 22 $ 18.97
Shares used in earnings per share calculations (in millions):      
Basic 236,413 258,603 272,404
Diluted 239,495 261,806 276,412
v3.25.4
Consolidated Comprehensive Income Statements - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Statement of Comprehensive Income [Abstract]      
Net income $ 7,782 $ 6,657 $ 6,091
Other comprehensive income (loss) before taxes:      
Foreign currency translation 64 (16) 41
Unrealized gains on available-for-sale securities 13 1 11
Gains included in other operating expenses 0 0 (1)
Total Unrealized losses on available-for-sale securities 13 1 10
Defined benefit plans 31 65 27
Pension (benefits) costs included in salaries and benefits (8) 1 3
Total defined benefit plans 23 66 30
Other comprehensive income before taxes 100 51 81
Income taxes related to other comprehensive income items 18 13 16
Other comprehensive income 82 38 65
Comprehensive income 7,864 6,695 6,156
Comprehensive income attributable to noncontrolling interests 998 897 849
Comprehensive income attributable to HCA Healthcare, Inc. $ 6,866 $ 5,798 $ 5,307
v3.25.4
Consolidated Balance Sheets - USD ($)
$ in Millions
Dec. 31, 2025
Dec. 31, 2024
Current assets:    
Cash and cash equivalents $ 1,040 $ 1,933
Accounts receivable 10,867 10,751
Inventories 1,652 1,738
Other 2,224 1,992
Total current assets 15,783 16,414
Property and equipment, at cost:    
Land 3,415 3,295
Buildings 23,726 22,691
Equipment 36,989 34,670
Construction in progress 2,145 1,858
Property and equipment, at cost 66,275 62,514
Accumulated depreciation (35,134) (33,100)
Property and equipment, net 31,141 29,414
Investments of insurance subsidiaries 485 569
Investments in and advances to affiliates 633 662
Goodwill and other intangible assets 10,293 10,093
Right-of-use operating lease assets 2,130 2,131
Other 255 230
Total assets 60,720 59,513
Current liabilities:    
Accounts payable 4,659 4,276
Accrued salaries 2,525 2,304
Other accrued expenses 4,277 3,899
Short-term borrowings and long-term debt due within one year 4,889 4,698
Total current liabilities 16,350 15,177
Long-term debt, less debt issuance costs and discounts of $436 and $369 41,603 38,333
Professional liability risks 1,466 1,544
Right-of-use operating lease obligations 1,853 1,863
Income taxes and other liabilities 2,219 2,041
Stockholders' (deficit) equity:    
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 224,605,100 shares - 2025 and 249,981,400 shares - 2024 2 3
Accumulated other comprehensive loss (305) (387)
Retained deficit (5,724) (2,115)
Stockholders' deficit attributable to HCA Healthcare, Inc. (6,027) (2,499)
Noncontrolling interests 3,256 3,054
Total stockholders' (deficit) equity (2,771) 555
Total liabilities and stockholders' (deficit) equity $ 60,720 $ 59,513
v3.25.4
Consolidated Balance Sheets (Parenthetical) - USD ($)
$ in Millions
Dec. 31, 2025
Dec. 31, 2024
Statement of Financial Position [Abstract]    
Debt issuance costs $ 436 $ 369
Common stock, par value $ 0.01 $ 0.01
Common stock, shares authorized 1,800,000,000 1,800,000,000
Common stock, shares issued not disclosed true true
Common stock, shares outstanding 224,605,100 249,981,400
v3.25.4
Consolidated Statements of Stockholders' Equity (Deficit) - USD ($)
shares in Thousands, $ in Millions
Total
Common Stock [Member]
Capital in Excess of Par Value [Member]
Accumulated Other Comprehensive Loss [Member]
Retained Deficit [Member]
Equity Attributable to Noncontrolling Interests [Member]
Balance at Dec. 31, 2022 $ (73) $ 3 $ 0 $ (490) $ (2,280) $ 2,694
Balance, shares at Dec. 31, 2022   277,378        
Comprehensive income 6,156     65 5,242 849
Repurchase of common stock (3,842)   (172)   (3,670)  
Repurchase of common stock, shares   (14,465)        
Share-based benefit plans 172   172      
Share-based benefit plans, shares   2,624        
Cash dividends declared (658)       (658)  
Distributions (640)         (640)
Other (55)       14 (69)
Balance at Dec. 31, 2023 1,060 $ 3 0 (425) (1,352) 2,834
Balance, shares at Dec. 31, 2023   265,537        
Comprehensive income 6,695     38 5,760 897
Repurchase of common stock (6,064)   (261)   (5,803)  
Repurchase of common stock, shares   (17,798)        
Share-based benefit plans 261   261      
Share-based benefit plans, shares   2,242        
Cash dividends declared (688)       (688)  
Distributions (711)         (711)
Other 2       (32) 34
Balance at Dec. 31, 2024 555 $ 3 0 (387) (2,115) 3,054
Balance, shares at Dec. 31, 2024   249,981        
Comprehensive income 7,864     82 6,784 998
Repurchase of common stock (10,110) $ (1) (417)   (9,692)  
Repurchase of common stock, shares   (26,739)        
Share-based benefit plans 417   417      
Share-based benefit plans, shares   1,363        
Cash dividends declared (684)       (684)  
Distributions (827)         (827)
Other 14       (17) 31
Balance at Dec. 31, 2025 $ (2,771) $ 2 $ 0 $ (305) $ (5,724) $ 3,256
Balance, shares at Dec. 31, 2025   224,605        
v3.25.4
Consolidated Statements of Stockholders' Equity (Deficit) (Parenthetical) - $ / shares
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Statement of Stockholders' Equity [Abstract]      
Cash dividends declared, per share $ 2.88 $ 2.64 $ 2.4
v3.25.4
Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Cash flows from operating activities:      
Net income $ 7,782 $ 6,657 $ 6,091
Increase (decrease) in cash from operating assets and liabilities:      
Accounts receivable (94) (799) (935)
Inventories and other assets (154) 334 (126)
Accounts payable and accrued expenses 666 359 604
Depreciation and amortization 3,523 3,312 3,077
Income taxes 310 22 229
Losses (gains) on sales of facilities (37) (14) 5
Amortization of debt issuance costs and discounts 44 35 35
Share-based compensation 401 360 262
Other 195 248 189
Net cash provided by operating activities 12,636 10,514 9,431
Cash flows from investing activities:      
Purchase of property and equipment (4,944) (4,875) (4,744)
Acquisition of hospitals and health care entities (397) (266) (635)
Sales of hospitals and health care entities 269 328 193
Change in investments 72 (115) (112)
Other 12 (5) (19)
Net cash used in investing activities (4,988) (4,933) (5,317)
Cash flows from financing activities:      
Issuances of long-term debt 8,474 7,495 3,224
Net change in short-term borrowings and revolving credit facilities 2,202 (1,880) (1,020)
Repayment of long-term debt (7,389) (2,410) (909)
Distributions to noncontrolling interests (827) (711) (640)
Payment of debt issuance costs (79) (67) (31)
Payment of dividends (679) (690) (661)
Repurchase of common stock (10,067) (6,042) (3,811)
Other (185) (277) (246)
Net cash used in financing activities (8,550) (4,582) (4,094)
Effect of exchange rate changes on cash and cash equivalents 9 (1) 7
Change in cash and cash equivalents (893) 998 27
Cash and cash equivalents at beginning of period 1,933 935 908
Cash and cash equivalents at end of period 1,040 1,933 935
Interest payments 2,207 1,938 1,892
Income tax payments, net $ 1,740 $ 1,844 $ 1,386
v3.25.4
Pay vs Performance Disclosure - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Pay vs Performance Disclosure      
Net Income (Loss) $ 6,784 $ 5,760 $ 5,242
v3.25.4
Insider Trading Arrangements
 3 Months Ended
Dec. 31, 2025
Trading Arrangements, by Individual  
Rule 10b5-1 Arrangement Adopted false
Non-Rule 10b5-1 Arrangement Adopted false
Rule 10b5-1 Arrangement Terminated false
Non-Rule 10b5-1 Arrangement Terminated false
v3.25.4
Insider Trading Policies and Procedures
 3 Months Ended
Dec. 31, 2025
Insider Trading Policies and Procedures [Line Items]  
Insider Trading Policies and Procedures Adopted true
v3.25.4
Cybersecurity Risk Management, Strategy, and Governance
 12 Months Ended
Dec. 31, 2025
Cybersecurity Risk Management, Strategy, and Governance [Line Items]  
Cybersecurity Risk Management Processes for Assessing, Identifying, and Managing Threats [Text Block]

Item 1C. Cybersecurity

Management is responsible for the day-to-day handling of risks facing our Company, while the Board of Directors, as a whole and through its committees, oversees risk management, including cybersecurity risks. The Board has delegated certain risk management responsibilities with respect to cybersecurity to our Audit and Compliance Committee.

The Audit and Compliance Committee periodically reviews our information technology systems, including cybersecurity processes and procedures regarding cybersecurity threats, data protection and privacy matters, AI, disaster recovery and critical business continuity, and reviews our programs and plans that management has established to monitor compliance with cybersecurity, data protection and privacy compliance programs and test emergency operations preparedness. The Audit and Compliance Committee also receives reports regarding risks associated with our information technology systems and management’s plans for monitoring and testing compliance with cybersecurity, data protection and privacy regulations.

The Audit and Compliance Committee meetings take place on a quarterly basis and include a report from our Chief Information Security Officer (“CISO”) regarding our security programs, including (i) the status on activities under way to support our security strategy, (ii) an overview of the current threat landscape, including emerging threats and trends that may affect us, (iii) key performance measures of security operations and (iv) general security program needs. The security program includes cybersecurity and information security risk management. Our senior security leadership team has an average of 20 years of data security experience, and each member has served in multiple roles within our security programs.

We seek to leverage a comprehensive risk management program aligned with the National Institute of Standards and Technology Cybersecurity Framework 2.0 that encompasses a structured approach to assess, identify, and manage cyber and information security risks. The internal processes for these activities are evaluated for alignment with our objectives and overall risk tolerance. This approach is consistent with our overall risk management efforts. The CISO participates with other senior officers, including the Chief Executive Officer, Chief Information Officer, Chief Financial Officer, Chief Legal and Administrative Officer, Chief Ethics and Compliance Officer, Senior Vice President - Internal Audit Services and others on our risk management committee, which develops and coordinates enterprise cybersecurity and information security policy and strategy, and provides guidance to senior management.

We utilize cross-functional teams and risk assessment tools and technologies to identify potential cybersecurity and information security threats and risks. These teams include representatives from various departments within our Company to promote a holistic view of the organization’s cybersecurity and information security risk landscape and to facilitate communication. We have implemented multiple layers of security measures designed to protect the confidentiality, integrity and availability of our data and the systems and devices that store and transmit such data. We also seek to embed security measures into software and system development processes and to use current security technologies. In addition, we engage third parties to actively monitor potential threats as well as our security defenses. The risk landscape is assessed to determine the likelihood and potential impact of identified risks. This assessment involves a combination of qualitative and quantitative analyses to help prioritize identified risks and determine the appropriate risk treatment. The effectiveness of the cybersecurity and information security program is tested through a combination of internal and external assessments. Updates are provided to senior management and the Audit and Compliance Committee for informed decision-making and are integrated into our broader enterprise risk management processes.

We also seek to oversee and identify potential cybersecurity and information security threats and risks relating to suppliers and third-party service providers. These efforts may include due diligence to assess the party’s cybersecurity practices, controls, and compliance with relevant statutes and regulations; the use of contractual agreements that outline certain cybersecurity requirements; and use of outside services to perform ongoing monitoring of select suppliers and third-party service providers. We also collaborate with select third-party suppliers to develop and align incident response plans.

To date, no risks from cybersecurity threats or previous cybersecurity incidents have materially affected our business strategy, results of operations, or financial condition. However, there can be no assurance that our controls and procedures in place to monitor and mitigate the risks of cybersecurity threats, including the remediation of critical information security and software vulnerabilities, will be sufficient and/or timely and that we will not suffer material losses or consequences in the future. Additionally, while we have in place insurance coverage designed to address certain aspects of cybersecurity risks, such insurance coverage may be insufficient to cover all insured losses or all types of claims that may arise.
Cybersecurity Risk Management Processes Integrated [Flag] true
Cybersecurity Risk Management Processes Integrated [Text Block] The effectiveness of the cybersecurity and information security program is tested through a combination of internal and external assessments. Updates are provided to senior management and the Audit and Compliance Committee for informed decision-making and are integrated into our broader enterprise risk management processes.
Cybersecurity Risk Management Third Party Engaged [Flag] true
Cybersecurity Risk Third Party Oversight and Identification Processes [Flag] true
Cybersecurity Risk Materially Affected or Reasonably Likely to Materially Affect Registrant [Flag] true
Cybersecurity Risk Materially Affected or Reasonably Likely to Materially Affect Registrant [Text Block] To date, no risks from cybersecurity threats or previous cybersecurity incidents have materially affected our business strategy, results of operations, or financial condition. However, there can be no assurance that our controls and procedures in place to monitor and mitigate the risks of cybersecurity threats, including the remediation of critical information security and software vulnerabilities, will be sufficient and/or timely and that we will not suffer material losses or consequences in the future.
Cybersecurity Risk Board of Directors Oversight [Text Block]

Management is responsible for the day-to-day handling of risks facing our Company, while the Board of Directors, as a whole and through its committees, oversees risk management, including cybersecurity risks. The Board has delegated certain risk management responsibilities with respect to cybersecurity to our Audit and Compliance Committee.

The Audit and Compliance Committee periodically reviews our information technology systems, including cybersecurity processes and procedures regarding cybersecurity threats, data protection and privacy matters, AI, disaster recovery and critical business continuity, and reviews our programs and plans that management has established to monitor compliance with cybersecurity, data protection and privacy compliance programs and test emergency operations preparedness. The Audit and Compliance Committee also receives reports regarding risks associated with our information technology systems and management’s plans for monitoring and testing compliance with cybersecurity, data protection and privacy regulations.

The Audit and Compliance Committee meetings take place on a quarterly basis and include a report from our Chief Information Security Officer (“CISO”) regarding our security programs, including (i) the status on activities under way to support our security strategy, (ii) an overview of the current threat landscape, including emerging threats and trends that may affect us, (iii) key performance measures of security operations and (iv) general security program needs. The security program includes cybersecurity and information security risk management. Our senior security leadership team has an average of 20 years of data security experience, and each member has served in multiple roles within our security programs.

We seek to leverage a comprehensive risk management program aligned with the National Institute of Standards and Technology Cybersecurity Framework 2.0 that encompasses a structured approach to assess, identify, and manage cyber and information security risks. The internal processes for these activities are evaluated for alignment with our objectives and overall risk tolerance. This approach is consistent with our overall risk management efforts. The CISO participates with other senior officers, including the Chief Executive Officer, Chief Information Officer, Chief Financial Officer, Chief Legal and Administrative Officer, Chief Ethics and Compliance Officer, Senior Vice President - Internal Audit Services and others on our risk management committee, which develops and coordinates enterprise cybersecurity and information security policy and strategy, and provides guidance to senior management.

Cybersecurity Risk Board Committee or Subcommittee Responsible for Oversight [Text Block] The Board has delegated certain risk management responsibilities with respect to cybersecurity to our Audit and Compliance Committee.
Cybersecurity Risk Process for Informing Board Committee or Subcommittee Responsible for Oversight [Text Block] The Audit and Compliance Committee periodically reviews our information technology systems, including cybersecurity processes and procedures regarding cybersecurity threats, data protection and privacy matters, AI, disaster recovery and critical business continuity, and reviews our programs and plans that management has established to monitor compliance with cybersecurity, data protection and privacy compliance programs and test emergency operations preparedness. The Audit and Compliance Committee also receives reports regarding risks associated with our information technology systems and management’s plans for monitoring and testing compliance with cybersecurity, data protection and privacy regulations.
Cybersecurity Risk Role of Management [Text Block]

Management is responsible for the day-to-day handling of risks facing our Company, while the Board of Directors, as a whole and through its committees, oversees risk management, including cybersecurity risks. The Board has delegated certain risk management responsibilities with respect to cybersecurity to our Audit and Compliance Committee.

The Audit and Compliance Committee periodically reviews our information technology systems, including cybersecurity processes and procedures regarding cybersecurity threats, data protection and privacy matters, AI, disaster recovery and critical business continuity, and reviews our programs and plans that management has established to monitor compliance with cybersecurity, data protection and privacy compliance programs and test emergency operations preparedness. The Audit and Compliance Committee also receives reports regarding risks associated with our information technology systems and management’s plans for monitoring and testing compliance with cybersecurity, data protection and privacy regulations.

Cybersecurity Risk Management Positions or Committees Responsible [Flag] true
Cybersecurity Risk Management Positions or Committees Responsible [Text Block] The CISO participates with other senior officers, including the Chief Executive Officer, Chief Information Officer, Chief Financial Officer, Chief Legal and Administrative Officer, Chief Ethics and Compliance Officer, Senior Vice President - Internal Audit Services and others on our risk management committee, which develops and coordinates enterprise cybersecurity and information security policy and strategy, and provides guidance to senior management.
Cybersecurity Risk Management Expertise of Management Responsible [Text Block] Our senior security leadership team has an average of 20 years of data security experience, and each member has served in multiple roles within our security programs.
Cybersecurity Risk Process for Informing Management or Committees Responsible [Text Block] The Audit and Compliance Committee meetings take place on a quarterly basis and include a report from our Chief Information Security Officer (“CISO”) regarding our security programs, including (i) the status on activities under way to support our security strategy, (ii) an overview of the current threat landscape, including emerging threats and trends that may affect us, (iii) key performance measures of security operations and (iv) general security program needs.
Cybersecurity Risk Management Positions or Committees Responsible Report to Board [Flag] true
v3.25.4
Accounting Policies
 12 Months Ended
Dec. 31, 2025
Accounting Policies [Abstract]  
Accounting Policies

NOTE 1 — ACCOUNTING POLICIES

Reporting Entity

HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At December 31, 2025 these affiliates owned and operated 190 hospitals, 121 freestanding surgery centers, 31 freestanding endoscopy centers and provided extensive outpatient and ancillary services. HCA Healthcare, Inc.’s facilities are located in 19 states and England. The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicated by context, refer to HCA Healthcare, Inc. and its affiliates. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA.

Basis of Presentation

The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates.

The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. The accounts of acquired entities are included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method.

The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative include our corporate office costs, which were $548 million, $421 million and $353 million for the years ended December 31, 2025, 2024 and 2023, respectively.

Revenues

Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges), and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals.

NOTE 1 — ACCOUNTING POLICIES (continued)

Revenues (continued)

Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured and other discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Our revenues by primary third-party payer classification and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions):

 

 

 

Years Ended December 31,

 

 

 

2025

 

 

Ratio

 

 

2024

 

 

Ratio

 

 

2023

 

 

Ratio

 

Medicare

 

$

11,273

 

 

 

14.9

%

 

$

10,780

 

 

 

15.3

%

 

$

10,585

 

 

 

16.3

%

Managed Medicare

 

 

13,435

 

 

 

17.8

 

 

 

11,987

 

 

 

17.0

 

 

 

10,496

 

 

 

16.2

 

Medicaid

 

 

5,909

 

 

 

7.8

 

 

 

4,678

 

 

 

6.6

 

 

 

3,606

 

 

 

5.6

 

Managed Medicaid

 

 

3,693

 

 

 

4.9

 

 

 

3,980

 

 

 

5.6

 

 

 

3,879

 

 

 

6.0

 

Managed care and other insurers

 

 

36,968

 

 

 

48.9

 

 

 

34,954

 

 

 

49.5

 

 

 

31,819

 

 

 

49.0

 

International (managed care and other insurers)

 

 

1,864

 

 

 

2.5

 

 

 

1,682

 

 

 

2.4

 

 

 

1,509

 

 

 

2.3

 

Other

 

 

2,458

 

 

 

3.2

 

 

 

2,542

 

 

 

3.6

 

 

 

3,074

 

 

 

4.6

 

Revenues

 

$

75,600

 

 

 

100.0

%

 

$

70,603

 

 

 

100.0

%

 

$

64,968

 

 

 

100.0

%

Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement and disproportionate-share amounts, related primarily to cost reports filed during the respective year, resulted in net increases to revenues of $31 million, $42 million and $84 million in 2025, 2024 and 2023, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in net increases to revenues of $32 million in 2025, $78 million in 2024 and $58 million in 2023.

The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive.

Patients treated at hospitals for non-elective care, who have income at or below 400% of the federal poverty level, are eligible for charity care, and we limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. Patients treated at hospitals for non-elective care, who have income above 400% of the federal poverty level, are eligible for certain other discounts which limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. We apply additional discounts to limit patient responsibility for certain emergency services. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. We may provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied.

NOTE 1 — ACCOUNTING POLICIES (continued)

Revenues (continued)

The collection of outstanding receivables from Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the age of those accounts. Accounts are written off when all reasonable collection efforts have been performed.

The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period comparisons of our revenues. At December 31, 2025 and 2024, estimated implicit price concessions of $7.674 billion and $7.773 billion, respectively, had been recorded to adjust our revenues and accounts receivable to the estimated amounts we expect to collect.

To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions):

 

 

2025

 

 

2024

 

 

2023

 

Patient care costs (salaries and benefits, supplies, other operating
   expenses and depreciation and amortization)

 

$

63,635

 

 

$

60,056

 

 

$

55,341

 

Cost-to-charges ratio (patient care costs as percentage of gross
   patient charges)

 

 

9.6

%

 

 

10.1

%

 

 

10.5

%

Total uncompensated care

 

$

47,966

 

 

$

43,231

 

 

$

35,426

 

Multiply by the cost-to-charges ratio

 

 

9.6

%

 

 

10.1

%

 

 

10.5

%

Estimated cost of total uncompensated care

 

$

4,605

 

 

$

4,366

 

 

$

3,720

 

The total uncompensated care amounts include charity care of $16.499 billion, $15.942 billion and $14.425 billion for the years ended December 31, 2025, 2024 and 2023, respectively. The estimated cost of charity care was $1.584 billion, $1.610 billion and $1.515 billion for the years ended December 31, 2025, 2024 and 2023, respectively.

Cash and Cash Equivalents

Cash and cash equivalents include highly liquid investments with a maturity of three months or less when purchased. Our insurance subsidiaries’ cash equivalent investments in excess of the amounts required to pay estimated professional liability claims during the next twelve months are not included in cash and cash equivalents as these funds are not available for general corporate purposes. Carrying values of cash and cash equivalents approximate fair value due to the short-term nature of these instruments.

NOTE 1 — ACCOUNTING POLICIES (continued)

Accounts Receivable

We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. Days revenues in accounts receivable were 51 days, 54 days and 53 days at December 31, 2025, 2024 and 2023, respectively. Changes in general economic conditions, revenue cycle service center operations, payer mix, payer claim processing, or federal, state and private employer health care coverage could affect our collection of accounts receivable, cash flows and results of operations.

Inventories

Inventories are stated at the lower of cost (first-in, first-out) or market.

Property and Equipment

Depreciation expense, computed using the straight-line method, was $3.508 billion in 2025, $3.294 billion in 2024 and $3.052 billion in 2023. Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four to 10 years.

When events, circumstances or operating results indicate the carrying values of certain property and equipment expected to be held and used might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar assets and independent appraisals.

Property and equipment to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers.

Investments of Insurance Subsidiaries

At December 31, 2025 and 2024, the investment securities held by our insurance subsidiaries were classified as “available-for-sale” as defined in Accounting Standards Codification (“ASC”) No. 320, Investments — Debt Securities and are recorded at fair value. The investment securities are held for the purpose of providing a funding source to pay liability claims covered by the insurance subsidiaries. We perform quarterly assessments of individual investment securities to determine whether declines in fair value are due to credit-related or noncredit-related factors. Our investment securities evaluation process involves subjective judgments, often involves estimating the outcome of future events, and requires a significant level of professional judgment in determining whether a credit-related impairment has occurred. We evaluate, among other things, the financial position and near-term prospects of the issuer, conditions in the issuer’s industry, liquidity of the investment, changes in the amount or timing of expected future cash flows from the investment, and recent downgrades of the issuer by a rating agency, to determine if, and when, a decline in the fair value of an investment below amortized cost is considered to be a credit-related impairment. The extent to which the fair value of the investment is less than amortized cost and our ability and intent to retain the investment, to allow for any anticipated recovery of the investment’s fair value, are important components of our investment securities evaluation process.

NOTE 1 — ACCOUNTING POLICIES (continued)

Goodwill and Intangible Assets

Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, an impairment loss is recognized. Fair value is estimated based upon internal evaluations of each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2025, 2024 or 2023.

During 2025, goodwill increased by $218 million related to acquisitions and declined by $6 million related to foreign currency translation and other adjustments. During 2024, goodwill increased by $170 million related to acquisitions and declined by $6 million related to foreign currency translation and other adjustments.

During 2025 and 2024, identifiable intangible assets declined by $12 million and $16 million, respectively, due to amortization and other adjustments. Identifiable intangible assets with finite lives are amortized over estimated lives ranging generally from three to 10 years. The gross carrying amount of amortizable identifiable intangible assets at both December 31, 2025 and 2024 was $274 million and accumulated amortization was $256 million and $244 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2025 and 2024 was $293 million. Indefinite-lived identifiable intangible assets are not amortized but are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist.

Debt Issuance Costs and Discounts

Debt issuance costs and discounts are amortized based upon the terms of the respective debt obligations. The gross carrying amounts of debt issuance costs and discounts at December 31, 2025 and 2024 were $639 million and $608 million, respectively, and accumulated amortization was $203 million and $239 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $44 million, $35 million and $35 million for 2025, 2024 and 2023, respectively.

Professional Liability Reserves

Reserves for professional liability risks were $2.044 billion and $2.131 billion at December 31, 2025 and 2024, respectively. The current portion of the reserves, $578 million and $587 million at December 31, 2025 and 2024, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $651 million, $627 million and $619 million for 2025, 2024 and 2023, respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. Loss and loss expense reserves represent the estimated ultimate cost of all reported and unreported losses incurred and unpaid through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,360 and 2,120 individual claims at December 31, 2025 and 2024, respectively, and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During 2025 and 2024, $702 million and $600 million, respectively, of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates.

NOTE 1 — ACCOUNTING POLICIES (continued)

Professional Liability Reserves (continued)

A portion of our professional liability risks is insured through one of our insurance subsidiaries. Subject, in most cases, to a $15 million per occurrence self-insured retention, our facilities are insured by our insurance subsidiary for losses up to $110 million per occurrence ($120 million effective January 1, 2026). The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of either $25 million or $35 million per occurrence, depending on the jurisdiction for the related claim. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary.

The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts were $38 million and $35 million at December 31, 2025 and 2024, respectively, recorded in “other assets,” and $9 million and $45 million at December 31, 2025 and 2024, respectively, recorded in “other current assets.”

Noncontrolling Interests in Consolidated Entities

The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities.

Reclassifications

Certain prior year amounts have been reclassified to conform to the current year presentation.
v3.25.4
Share-Based Compensation
 12 Months Ended
Dec. 31, 2025
Share-Based Payment Arrangement [Abstract]  
Share-Based Compensation

NOTE 2 — SHARE-BASED COMPENSATION

Stock Incentive Plans

Our stock incentive plans are designed to promote the long-term financial interests and growth of the Company by attracting and retaining management and other personnel, motivating them to achieve long range goals and aligning their interests with those of our stockholders. Stock appreciation right (“SAR”) and restricted share unit (“RSU”) grants vest solely based upon continued employment over a specific period of time, and performance share unit (“PSU”) grants vest based upon both continued employment over a specific period of time and the achievement of predetermined financial targets over a specific period of time. During 2025, the Company’s stockholders approved certain amendments to the 2020 Stock Incentive Plan for Key Employees of HCA Healthcare, Inc. and its Affiliates, including an increase in the number of shares available for issuance under the plan by 13.150 million shares. At December 31, 2025 there were 18.794 million shares available for future grants under the plan.

Employee Stock Purchase Plan

Our employee stock purchase plan (“ESPP”) provides our participating employees an opportunity to obtain shares of our common stock at a discount (through payroll deductions over three-month periods). At December 31, 2025, 9.119 million shares of common stock were reserved for ESPP issuances. During 2025, 2024 and 2023, the Company recognized $19 million, $18 million and $17 million, respectively, of compensation expense related to the ESPP.

SAR, RSU and PSU Activity

The fair value of each SAR award is estimated on the grant date, using valuation models and the weighted average assumptions indicated in the following table. Awards under our stock incentive plans generally vest based on continued employment (“Time SARs” and “RSUs”) or based upon continued employment and the achievement of certain financial targets (“PSUs”). PSUs have a three-year cumulative earnings per share target, and the number of PSUs earned can vary from zero (for actual performance less than 85% of target for 2025 grants and 90% of target for 2024 and prior grants) to two times the original PSU grant (for actual performance of 110% or more of target). Each grant is valued as a single award with an expected term equal to the average expected term of the component vesting tranches. The expected term of the share-based award is limited by the contractual term. We use historical exercise behavior data and other factors to estimate the expected term of the SARs.

NOTE 2 — SHARE-BASED COMPENSATION (continued)

SAR, RSU and PSU Activity (continued)

Compensation cost is recognized on the straight-line attribution method. The straight-line attribution method requires that total compensation expense recognized must at least equal the vested portion of the grant-date fair value. The expected volatility is derived using historical stock price information for our common stock and the volatility implied by the trading of options to purchase our stock on open-market exchanges. The risk-free interest rate is the approximate yield on United States Treasury Strips having a life equal to the expected share-based award life on the date of grant. The expected life is an estimate of the number of years a share-based award will be held before it is exercised. The expected dividend yield is estimated based on the assumption that the dividend yield at date of grant will be maintained over the expected life of the grant.

 

 

 

2025

 

 

2024

 

 

2023

 

Risk-free interest rate

 

 

4.33

%

 

 

3.94

%

 

 

3.69

%

Expected volatility

 

 

33

%

 

 

33

%

 

 

36

%

Expected life, in years

 

 

5.28

 

 

 

5.23

 

 

 

5.14

 

Expected dividend yield

 

 

0.88

%

 

 

0.87

%

 

 

0.95

%

Information regarding Time SAR and Performance SAR activity during 2025, 2024 and 2023 is summarized below (share amounts in thousands):

 

 

Time
SARs

 

 

Performance
SARs

 

 

Total
SARs

 

 

Weighted
Average
Exercise
Price

 

 

Weighted
Average
Remaining
Contractual Term

 

Aggregate
Intrinsic Value
(dollars in millions)

 

SARs outstanding, December 31, 2022

 

 

5,960

 

 

 

127

 

 

 

6,087

 

 

$

126.38

 

 

 

 

 

 

Granted

 

 

580

 

 

 

—

 

 

 

580

 

 

 

253.49

 

 

 

 

 

 

Exercised

 

 

(1,156

)

 

 

(83

)

 

 

(1,239

)

 

 

95.29

 

 

 

 

 

 

Cancelled

 

 

(59

)

 

 

—

 

 

 

(59

)

 

 

202.05

 

 

 

 

 

 

SARs outstanding, December 31, 2023

 

 

5,325

 

 

 

44

 

 

 

5,369

 

 

 

146.46

 

 

 

 

 

 

Granted

 

 

491

 

 

 

—

 

 

 

491

 

 

 

305.44

 

 

 

 

 

 

Exercised

 

 

(1,128

)

 

 

(44

)

 

 

(1,172

)

 

 

111.02

 

 

 

 

 

 

Cancelled

 

 

(101

)

 

 

—

 

 

 

(101

)

 

 

246.78

 

 

 

 

 

 

SARs outstanding, December 31, 2024

 

 

4,587

 

 

 

—

 

 

 

4,587

 

 

 

170.31

 

 

 

 

 

 

Granted

 

 

418

 

 

 

—

 

 

 

418

 

 

 

329.80

 

 

 

 

 

 

Exercised

 

 

(859

)

 

 

—

 

 

 

(859

)

 

 

125.10

 

 

 

 

 

 

Cancelled

 

 

(40

)

 

 

—

 

 

 

(40

)

 

 

308.57

 

 

 

 

 

 

SARs outstanding, December 31, 2025

 

 

4,106

 

 

 

—

 

 

 

4,106

 

 

$

194.62

 

 

5.1 years

 

$

1,118

 

SARs exercisable, December 31, 2025

 

 

3,012

 

 

 

—

 

 

 

3,012

 

 

$

158.20

 

 

4.0 years

 

$

930

 

 

The weighted average fair values of SARs granted during 2025, 2024 and 2023 were $114.39, $102.65 and $87.47 per share, respectively. The intrinsic values of SARs exercised during 2025, 2024 and 2023 were $226 million, $257 million and $207 million, respectively. As of December 31, 2025, the unrecognized compensation cost related to nonvested SARs was $47 million.

NOTE 2 — SHARE-BASED COMPENSATION (continued)

SAR, RSU and PSU Activity (continued)

Information regarding RSU and PSU activity during 2025, 2024 and 2023 is summarized below (share amounts in thousands):

 

 

RSUs

 

 

PSUs

 

 

Total RSUs
and PSUs

 

 

Weighted
Average
Grant
Date Fair
Value

 

RSUs and PSUs outstanding, December 31, 2022

 

 

1,784

 

 

 

1,715

 

 

 

3,499

 

 

$

179.18

 

Granted

 

 

609

 

 

 

479

 

 

 

1,088

 

 

 

253.85

 

Performance adjustment

 

 

—

 

 

 

697

 

 

 

697

 

 

 

144.42

 

Vested

 

 

(717

)

 

 

(1,393

)

 

 

(2,110

)

 

 

152.50

 

Cancelled

 

 

(125

)

 

 

(88

)

 

 

(213

)

 

 

217.78

 

RSUs and PSUs outstanding, December 31, 2023

 

 

1,551

 

 

 

1,410

 

 

 

2,961

 

 

 

214.71

 

Granted

 

 

582

 

 

 

434

 

 

 

1,016

 

 

 

305.97

 

Performance adjustment

 

 

—

 

 

 

566

 

 

 

566

 

 

 

174.55

 

Vested

 

 

(639

)

 

 

(1,132

)

 

 

(1,771

)

 

 

181.81

 

Cancelled

 

 

(138

)

 

 

(103

)

 

 

(241

)

 

 

260.96

 

RSUs and PSUs outstanding, December 31, 2024

 

 

1,356

 

 

 

1,175

 

 

 

2,531

 

 

 

260.95

 

Granted

 

 

492

 

 

 

367

 

 

 

859

 

 

 

330.72

 

Performance adjustment

 

 

—

 

 

 

(175

)

 

 

(175

)

 

 

235.81

 

Vested

 

 

(526

)

 

 

(191

)

 

 

(717

)

 

 

237.46

 

Cancelled

 

 

(94

)

 

 

(71

)

 

 

(165

)

 

 

298.81

 

RSUs and PSUs outstanding, December 31, 2025

 

 

1,228

 

 

 

1,105

 

 

 

2,333

 

 

$

293.03

 

 

The fair values of RSUs and PSUs that vested during 2025, 2024 and 2023 were $238 million, $539 million and $550 million, respectively. As of December 31, 2025, the unrecognized compensation cost related to RSUs and PSUs was $387 million.

v3.25.4
Acquisitions and Dispositions
 12 Months Ended
Dec. 31, 2025
Business Combination [Abstract]  
Acquisitions and Dispositions

NOTE 3 — ACQUISITIONS AND DISPOSITIONS

During 2025, we paid $189 million to acquire two hospital facilities in New Hampshire and Florida and $208 million to acquire nonhospital health care entities. During 2024, we paid $112 million to acquire three hospital facilities in Texas and $154 million to acquire nonhospital health care entities. During 2023, we paid $229 million to acquire four hospital facilities in Texas and $406 million to acquire nonhospital health care entities. Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values. The purchase price paid in excess of the fair value of identifiable net assets of these acquired entities aggregated $218 million, $170 million and $362 million in 2025, 2024 and 2023, respectively. The consolidated financial statements include the accounts and operations of the acquired entities subsequent to the respective acquisition dates. The pro forma effects of these acquired entities on our results of operations for periods prior to the respective acquisition dates were not significant.

During 2025, we received proceeds of $230 million and recognized a pretax gain of $41 million ($31 million net of tax) related to the sales of two hospital facilities in California and Indiana. We also received proceeds of $39 million and recognized a pretax loss of $4 million ($3 million after tax) related to sales of real estate and other health care entity investments. During 2024, we received proceeds of $295 million and recognized a pretax gain of $189 million ($145 million net of tax) related to the sale of a hospital facility in California. We also received proceeds of $33 million and recognized a pretax loss of $5 million ($4 million after tax) related to sales of real estate and other health care entity investments. In addition, we recognized a pretax loss of $170 million ($130 million after tax) related to a hospital facility in California that we sold in 2025. During 2023, we received proceeds of $162 million for the sale of two hospital facilities in Louisiana. We also received proceeds of $31 million related to sales of real estate and other health care entity investments. We recognized a pretax loss of $5 million for these transactions.
v3.25.4
Income Taxes
 12 Months Ended
Dec. 31, 2025
Income Tax Disclosure [Abstract]  
Income Taxes

NOTE 4 — INCOME TAXES

Effective January 1, 2025, we adopted Accounting Standards Update 2023-09, Improvements to Income Tax Disclosures (“ASU 2023-09”), with a retrospective approach to all prior periods presented. Pretax income including income attributable to noncontrolling interests consists of the following (dollars in millions):

 

2025

 

 

2024

 

 

2023

 

Domestic

$

9,720

 

 

$

8,444

 

 

$

7,621

 

Foreign

 

112

 

 

 

79

 

 

 

85

 

$

9,832

 

 

$

8,523

 

 

$

7,706

 

 

Income taxes paid consist of the following (dollars in millions):

 

 

2025

 

 

2024

 

 

2023

 

  Federal

 

$

1,466

 

 

$

1,625

 

 

$

1,187

 

  State

 

 

 

 

 

 

 

 

 

        Florida

 

 

98

 

 

 

72

 

 

 

85

 

        All other

 

 

157

 

 

 

134

 

 

 

105

 

  Foreign

 

 

19

 

 

 

13

 

 

 

9

 

 

 

$

1,740

 

 

$

1,844

 

 

$

1,386

 

 

The provision for income taxes consists of the following (dollars in millions):

 

 

 

2025

 

 

2024

 

 

2023

 

Current:

 

 

 

 

 

 

 

 

 

Federal

 

$

1,551

 

 

$

1,202

 

 

$

1,118

 

State

 

 

248

 

 

 

212

 

 

 

213

 

Foreign

 

 

13

 

 

 

20

 

 

 

3

 

Deferred:

 

 

 

 

 

 

 

 

 

Federal

 

 

201

 

 

 

394

 

 

 

241

 

State

 

 

31

 

 

 

31

 

 

 

21

 

Foreign

 

 

6

 

 

 

7

 

 

 

19

 

 

 

$

2,050

 

 

$

1,866

 

 

$

1,615

 

 

Our provision for income taxes for the years ended December 31, 2025, 2024 and 2023 included tax benefits of $61 million, $102 million and $93 million, respectively, related to the settlement of employee equity awards. The provision for income taxes reflects a $27 million and $61 million reduction in interest (net of tax) and penalty expense and $36 million of interest expense (net of tax) for the years ended December 31, 2025, 2024 and 2023, respectively. During 2024, we derecognized deferred tax assets and increased our tax provision by $276 million due to an internal restructuring of certain affiliates.

NOTE 4 — INCOME TAXES (continued)

A reconciliation of the federal statutory rate to the effective income tax rate follows (dollars in millions):

 

 

2025

 

 

2024

 

 

2023

 

 

 

Amount

 

 

Percent

 

 

Amount

 

 

Percent

 

 

Amount

 

 

Percent

 

U.S. federal statutory tax rate

 

$

2,065

 

 

 

21.0

%

 

$

1,790

 

 

 

21.0

%

 

$

1,618

 

 

 

21.0

%

State and local taxes, net of federal income tax
   effect (1)

 

 

228

 

 

 

2.3

 

 

 

206

 

 

 

2.4

 

 

 

179

 

 

 

2.3

 

Foreign tax effects

 

 

(4

)

 

 

—

 

 

 

10

 

 

 

0.1

 

 

 

4

 

 

 

0.1

 

Nontaxable or nondeductible items

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     Noncontrolling interest

 

 

(210

)

 

 

(2.1

)

 

 

(188

)

 

 

(2.2

)

 

 

(178

)

 

 

(2.3

)

     Share-based payment awards

 

 

(55

)

 

 

(0.6

)

 

 

(91

)

 

 

(1.1

)

 

 

(84

)

 

 

(1.1

)

     Other nontaxable or nondeductible items

 

 

41

 

 

 

0.5

 

 

 

50

 

 

 

0.6

 

 

 

43

 

 

 

0.6

 

Changes in unrecognized tax benefits

 

 

(18

)

 

 

(0.2

)

 

 

(177

)

 

 

(2.1

)

 

 

33

 

 

 

0.4

 

Other Adjustments

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     Internal restructuring of affiliates

 

 

—

 

 

 

—

 

 

 

265

 

 

 

3.2

 

 

 

—

 

 

 

—

 

     Other adjustments, net

 

 

3

 

 

 

—

 

 

 

1

 

 

 

—

 

 

 

—

 

 

 

—

 

Effective tax rate on income before income taxes

 

$

2,050

 

 

 

20.9

%

 

$

1,866

 

 

 

21.9

%

 

$

1,615

 

 

 

21.0

%

(1) State taxes in Florida and Texas made up the majority (greater than 50%) of the tax effect in this category.

The 2025 Federal Budget Act (the "FBA"), which was enacted on July 4, 2025, makes numerous tax changes, including reinstatement of 100% bonus depreciation for qualifying property placed in service after January 19, 2025, changing the timing of cash tax payments in 2025 and expected timing of cash tax payments for future years. We do not expect the tax provisions of the FBA will have a material impact on our effective tax rate.

A summary of the items comprising our deferred tax assets and liabilities at December 31 follows (dollars in millions):

 

 

2025

 

 

2024

 

 

 

Assets

 

 

Liabilities

 

 

Assets

 

 

Liabilities

 

Depreciation and fixed asset basis differences

 

$

—

 

 

$

1,357

 

 

$

—

 

 

$

1,139

 

Allowances for professional liability and other risks

 

 

440

 

 

 

—

 

 

 

395

 

 

 

—

 

Accounts receivable

 

 

427

 

 

 

—

 

 

 

418

 

 

 

—

 

Compensation

 

 

322

 

 

 

—

 

 

 

285

 

 

 

—

 

Right-of-use lease assets and obligations

 

 

476

 

 

 

459

 

 

 

478

 

 

 

462

 

Other

 

 

268

 

 

 

1,036

 

 

 

297

 

 

 

932

 

 

 

$

1,933

 

 

$

2,852

 

 

$

1,873

 

 

$

2,533

 

At December 31, 2025, state net operating loss carryforwards (expiring in years 2026 through 2044) available to offset future taxable income approximated $24 million. Utilization of net operating loss carryforwards in any one year may be limited.

NOTE 4 — INCOME TAXES (continued)

The following table summarizes the activity related to our gross unrecognized tax benefits, excluding accrued interest and penalties of $78 million and $115 million as of December 31, 2025 and 2024, respectively (dollars in millions):

 

 

2025

 

 

2024

 

Balance at January 1

 

$

504

 

 

$

639

 

Additions based on tax positions related to the current year

 

 

21

 

 

 

40

 

Additions for tax positions of prior years

 

 

25

 

 

 

63

 

Reductions for tax positions of prior years

 

 

(3

)

 

 

(206

)

Settlements

 

 

(1

)

 

 

(17

)

Lapse of applicable statutes of limitations

 

 

(27

)

 

 

(15

)

Balance at December 31

 

$

519

 

 

$

504

 

 

Unrecognized tax benefits of $274 million as of December 31, 2025 ($295 million as of December 31, 2024) would affect the effective rate, if recognized.

During 2025, the Internal Revenue Service (“IRS”) concluded its examination of the Company’s 2022 and 2023 income tax returns resolving all federal income tax matters for those years. Completion of the examination had no material impact on our results of operations or financial position. During 2024, the IRS completed its examination of our 2016, 2017 and 2018 income tax returns, resolving all federal income tax matters for those years. In 2024, we reduced our tax provision by $254 million, including interest of $118 million (net of tax). Of this amount, $181 million, including $47 million of interest (net of tax) related to the tax rate changes under the 2017 Tax Cuts and Jobs Act. At December 31, 2025, the IRS was examining the 2019 tax returns of certain affiliates of the Company. We are subject to examination by the IRS for years after 2023, as well as by state and foreign taxing authorities.
v3.25.4
Earnings Per Share
 12 Months Ended
Dec. 31, 2025
Earnings Per Share [Abstract]  
Earnings Per Share

NOTE 5 — EARNINGS PER SHARE

We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding plus the dilutive effect of outstanding SARs, RSUs and PSUs, computed using the treasury stock method. During 2025, 2024 and 2023, we repurchased 26.739 million shares, 17.798 million shares and 14.465 million shares, respectively, of our common stock.

The following table sets forth the computations of basic and diluted earnings per share for the years ended December 31, 2025, 2024 and 2023 (dollars and shares in millions, except per share amounts):

 

 

 

2025

 

 

2024

 

 

2023

 

Net income attributable to HCA Healthcare, Inc.

 

$

6,784

 

 

$

5,760

 

 

$

5,242

 

 

 

 

 

 

 

 

 

 

 

Weighted average common shares outstanding

 

 

236.413

 

 

 

258.603

 

 

 

272.404

 

Effect of dilutive incremental shares

 

 

3.082

 

 

 

3.203

 

 

 

4.008

 

Shares used for diluted earnings per share

 

 

239.495

 

 

 

261.806

 

 

 

276.412

 

Earnings per share:

 

 

 

 

 

 

 

 

 

Basic earnings per share

 

$

28.70

 

 

$

22.27

 

 

$

19.25

 

Diluted earnings per share

 

$

28.33

 

 

$

22.00

 

 

$

18.97

 
v3.25.4
Investments of Insurance Subsidiaries
 12 Months Ended
Dec. 31, 2025
Investments, Debt and Equity Securities [Abstract]  
Investments of Insurance Subsidiaries

NOTE 6 — INVESTMENTS OF INSURANCE SUBSIDIARIES

A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions):

 

 

2025

 

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

342

 

 

$

1

 

 

$

(15

)

 

$

328

 

Money market funds and other

 

 

260

 

 

 

—

 

 

 

—

 

 

 

260

 

 

 

$

602

 

 

$

1

 

 

$

(15

)

 

 

588

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(103

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

485

 

 

 

2024

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

388

 

 

$

—

 

 

$

(27

)

 

$

361

 

Money market funds and other

 

 

296

 

 

 

—

 

 

 

—

 

 

 

296

 

 

$

684

 

 

$

—

 

 

$

(27

)

 

 

657

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(88

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

569

 

 

At December 31, 2025 and 2024, the investments in debt securities of our insurance subsidiaries were classified as “available-for-sale.” Changes in unrealized gains and losses that are not credit-related are recorded as adjustments to other comprehensive income (loss).

 

Scheduled maturities of investments in debt securities at December 31, 2025 were as follows (dollars in millions):

 

 

 

Amortized
Cost

 

 

Fair
Value

 

Due in one year or less

 

$

29

 

 

$

29

 

Due after one year through five years

 

 

145

 

 

 

140

 

Due after five years through ten years

 

 

111

 

 

 

104

 

Due after ten years

 

 

57

 

 

 

55

 

 

 

$

342

 

 

$

328

 

 

The average expected maturity of the investments in debt securities at December 31, 2025 was 3.7 years, compared to the average scheduled maturity of 7.8 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to their scheduled maturity date.

v3.25.4
Assets and Liabilities Measured at Fair Value
 12 Months Ended
Dec. 31, 2025
Fair Value Disclosures [Abstract]  
Assets and Liabilities Measured at Fair Value

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE

Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”) emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).

Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment.

The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency.

The following tables summarize the investments of our insurance subsidiaries measured at fair value on a recurring basis as of December 31, 2025 and 2024, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

 

 

2025

 

 

 

 

 

 

Fair Value Measurements Using

 

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Debt securities

 

$

328

 

 

$

1

 

 

$

327

 

 

$

—

 

Money market funds and other

 

 

260

 

 

 

260

 

 

 

—

 

 

 

—

 

Investments of insurance subsidiaries

 

 

588

 

 

 

261

 

 

 

327

 

 

 

—

 

Less amounts classified as current assets

 

 

(103

)

 

 

(103

)

 

 

—

 

 

 

—

 

 

 

$

485

 

 

$

158

 

 

$

327

 

 

$

—

 

 

 

2024

 

 

 

 

 

Fair Value Measurements Using

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Debt securities

 

$

361

 

 

$

—

 

 

$

361

 

 

$

—

 

Money market funds and other

 

 

296

 

 

 

296

 

 

 

—

 

 

 

—

 

Investments of insurance subsidiaries

 

 

657

 

 

 

296

 

 

 

361

 

 

 

—

 

Less amounts classified as current assets

 

 

(88

)

 

 

(88

)

 

 

—

 

 

 

—

 

 

$

569

 

 

$

208

 

 

$

361

 

 

$

—

 

 

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

The estimated fair value of our long-term debt was $45.911 billion and $40.845 billion at December 31, 2025 and 2024, respectively, compared to carrying amounts, gross of debt issuance costs, premiums and discounts, aggregating $46.928 billion and $43.400 billion, respectively. The estimates of fair value are generally based on Level 2 inputs, including quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities.

v3.25.4
Debt
 12 Months Ended
Dec. 31, 2025
Debt Disclosure [Abstract]  
Debt

NOTE 8 — DEBT

A summary of our debt at December 31, 2025 and December 31, 2024, including related interest rates at December 31, 2025, follows (dollars in millions):

 

 

2025

 

 

2024

 

Short-term borrowings:

 

 

 

 

 

 

Commercial paper (average life of 18 days, weighted average rate of 4.3%)

 

$

2,207

 

 

$

—

 

Long-term debt:

 

 

 

 

 

 

Senior secured term loan facility

 

 

—

 

 

 

1,238

 

Other senior secured debt (effective interest rate of 4.6%)

 

 

1,021

 

 

 

1,046

 

Senior unsecured credit facilities

 

 

—

 

 

 

—

 

Senior unsecured notes payable through 2095 (effective interest rate of 5.1%)

 

 

43,700

 

 

 

41,116

 

Debt issuance costs and discounts

 

 

(436

)

 

 

(369

)

Total long-term debt (average life of 11.9 years, rates averaging 5.1%)

 

 

44,285

 

 

 

43,031

 

Total debt

 

 

46,492

 

 

 

43,031

 

Less amounts due within one year

 

 

4,889

 

 

 

4,698

 

 

$

41,603

 

 

$

38,333

 

2025 Financing Activities

We issued $5.250 billion aggregate principal amount of senior notes comprised of (i) $700 million aggregate principal amount of 5.000% senior notes due 2028, (ii) $300 million aggregate principal amount of floating rate senior notes due 2028, (iii) $750 million aggregate principal amount of 5.250% senior notes due 2030, (iv) $750 million aggregate principal amount of 5.500% senior notes due 2032, (v) $1.500 billion aggregate principal amount of 5.750% senior notes due 2035 and (vi) $1.250 billion aggregate principal amount of 6.200% senior notes due 2055. We used the net proceeds to repay borrowings under the senior unsecured credit facility and for general corporate purposes.

We also issued $3.250 billion aggregate principal amount of senior notes comprised of (i) $500 million aggregate principal amount of 4.300% senior notes due 2030, (ii) $1.000 billion aggregate principal amount of 4.600% senior notes due 2032, (iii) $1.000 billion aggregate principal amount of 4.900% senior notes due 2035 and (iv) $750 million aggregate principal amount of 5.700% senior notes due 2055. We used the net proceeds to repay borrowings under the commercial paper program and for general corporate purposes.

We repaid at maturity all $2.600 billion aggregate principal amount of 5.375% senior notes, all $1.400 billion aggregate principal amount of 5.25% senior notes, $291 million aggregate principal amount of 7.69% senior notes and $125 million aggregate principal amount of 7.58% medium-term notes. We also redeemed all $1.500 billion aggregate principal amount of 5.875% senior notes due 2026.

Senior Unsecured Credit Facility And Other Senior Secured Debt

During 2025, we entered into a new credit agreement that provides for $8.000 billion of senior unsecured revolving credit commitments with a term of five years (“senior unsecured credit facility”). Borrowings under the senior unsecured credit facility bear interest at a rate equal to the Secured Overnight Financing Rate plus 1.125% (plus, until October 23, 2025, a 0.10% credit spread adjustment, as the unsecured credit facility was amended on that date to remove the credit spread adjustment). We terminated our $4.500 billion senior secured asset-based revolving credit facility, our $3.500 billion senior secured revolving cash flow credit facility and our senior secured term loan facility of $1.238 billion. Finance leases and other secured debt totaled $1.021 billion at December 31, 2025.

NOTE 8 — DEBT (continued)

Commercial Paper Program

During 2025, we established a commercial paper program under which we may issue unsecured commercial paper notes from time to time up to a maximum aggregate face or principal amount of $4.000 billion outstanding at any time. Amounts available under the program may be borrowed, repaid and reborrowed from time to time. The maturities of the commercial paper notes borrowings may vary, but will not exceed 397 days from the date of issue, and the proceeds from the program will be used for general corporate purposes. In connection with the commercial paper program, we intend to maintain a minimum available borrowing capacity under our $8.000 billion senior unsecured credit facility equal to the aggregate amount outstanding under the commercial paper program. At December 31, 2025, we had $2.207 billion of commercial paper outstanding, and there were no borrowings outstanding under our senior unsecured credit facility.

Senior Unsecured Notes

Senior unsecured notes consist of (i) $43.250 billion aggregate principal amount of senior notes with maturities ranging from 2026 to 2064 and (ii) an aggregate principal amount of $450 million debentures with maturities ranging from 2027 to 2095.

General Debt Information

Maturities of long-term debt in years 2027 through 2030 are $2.547 billion, $3.645 billion, $3.577 billion and $4.021 billion, respectively.
v3.25.4
Leases
 12 Months Ended
Dec. 31, 2025
Leases [Abstract]  
Leases

NOTE 9 — LEASES

We lease property and equipment under finance and operating leases. For leases with terms greater than 12 months, we record the related assets and obligations at the present value of lease payments over the term. Many of our leases include rental escalation clauses and renewal options that are factored into our determination of lease payments, when appropriate. We do not separate lease and nonlease components of contracts. Generally, we use our estimated incremental borrowing rate to discount the lease payments, as most of our leases do not provide a readily determinable implicit interest rate.

The following table presents our lease-related assets and liabilities at December 31, 2025 and 2024 (dollars in millions):

 

Balance Sheet Classification

2025

 

2024

 

Assets:

 

 

 

 

 

Operating leases

Right-of-use operating lease assets

$

2,130

 

$

2,131

 

Finance leases

Property and equipment

 

607

 

 

646

 

Total lease assets

 

$

2,737

 

$

2,777

 

Liabilities:

 

 

 

 

 

Current:

 

 

 

 

 

Operating leases

Other accrued expenses

$

352

 

$

343

 

Finance leases

Short-term borrowings and long-term debt due within one year

 

133

 

 

162

 

Noncurrent:

 

 

 

 

 

Operating leases

Right-of-use operating lease obligations

 

1,853

 

 

1,863

 

Finance leases

Long-term debt

 

625

 

 

624

 

Total lease liabilities

 

$

2,963

 

$

2,992

 

Weighted-average remaining term:

 

 

 

 

 

Operating leases

 

11.4 years

 

11.3 years

 

Finance leases

 

11.1 years

 

10.5 years

 

Weighted-average discount rate:

 

 

 

 

 

Operating leases

 

 

5.3

%

 

5.1

%

Finance leases

 

 

5.6

%

 

5.3

%

 

NOTE 9 — LEASES (continued)

The following table presents certain information related to expenses for finance and operating leases for the years ended December 31, 2025, 2024 and 2023 (dollars in millions):

 

 

2025

 

 

2024

 

 

2023

 

Finance lease expense:

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

$

182

 

 

$

159

 

 

$

164

 

Interest

 

 

41

 

 

 

37

 

 

 

31

 

Operating leases(1)

 

 

516

 

 

 

503

 

 

 

495

 

Short-term lease expense(1)

 

 

317

 

 

 

365

 

 

 

337

 

Variable lease expense(1)

 

 

197

 

 

 

181

 

 

 

162

 

 

 

$

1,253

 

 

$

1,245

 

 

$

1,189

 

 

(1)
Expenses are included in “other operating expenses” in our consolidated income statements.

The following table presents supplemental cash flow information for the years ended December 31, 2025, 2024 and 2023 (dollars in millions):

 

 

 

2025

 

 

2024

 

 

2023

 

Cash paid for amounts included in the measurement of lease liabilities:

 

 

 

 

 

 

 

 

 

Operating cash flows for operating leases

 

$

501

 

 

$

490

 

 

$

479

 

Operating cash flows for finance leases

 

 

41

 

 

 

37

 

 

 

31

 

Financing cash flows for finance leases

 

 

173

 

 

 

172

 

 

 

140

 

Maturities of Lease Liabilities

The following table reconciles the undiscounted minimum lease payment amounts to the operating and finance lease liabilities recorded on the balance sheet at December 31, 2025 and 2024 (dollars in millions):

 

 

 

2025

 

 

2024

 

 

 

Operating
Leases

 

 

Finance
Leases

 

 

Operating
Leases

 

 

Finance
Leases

 

Year 1

 

$

474

 

 

$

173

 

 

$

455

 

 

$

197

 

Year 2

 

 

413

 

 

 

126

 

 

 

405

 

 

 

146

 

Year 3

 

 

343

 

 

 

100

 

 

 

344

 

 

 

99

 

Year 4

 

 

276

 

 

 

85

 

 

 

281

 

 

 

81

 

Year 5

 

 

214

 

 

 

62

 

 

 

221

 

 

 

71

 

Thereafter

 

 

1,499

 

 

 

532

 

 

 

1,460

 

 

 

497

 

Total minimum lease payments

 

 

3,219

 

 

 

1,078

 

 

 

3,166

 

 

 

1,091

 

Less: amount of lease payments representing interest

 

 

(1,014

)

 

 

(320

)

 

 

(960

)

 

 

(305

)

Present value of future minimum lease payments

 

 

2,205

 

 

 

758

 

 

 

2,206

 

 

 

786

 

Less: current lease obligations

 

 

(352

)

 

 

(133

)

 

 

(343

)

 

 

(162

)

Long-term lease obligations

 

$

1,853

 

 

$

625

 

 

$

1,863

 

 

$

624

 
v3.25.4
Contingencies
 12 Months Ended
Dec. 31, 2025
Commitments and Contingencies Disclosure [Abstract]  
Contingencies

NOTE 10 — CONTINGENCIES

We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us, which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity.

NOTE 10 — CONTINGENCIES (continued)

Government Investigations, Claims and Litigation

Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our results of operations, financial position or liquidity.

We accrue for such contingencies to the extent that it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. If we are a party to any proceeding that, either individually or in the aggregate, is probable or reasonably possible of having a material, adverse effect on the business, our results of operations, financial position or liquidity, we disclose a summary of such contingencies and the amount or range of reasonably possible losses in excess of recorded amounts or that we are unable to reasonably estimate the amount or range of losses.
v3.25.4
Capital Stock
 12 Months Ended
Dec. 31, 2025
Federal Home Loan Banks [Abstract]  
Capital Stock

NOTE 11 — CAPITAL STOCK

The amended and restated certificate of incorporation authorizes the Company to issue up to 1,800,000,000 shares of common stock, and our amended and restated by-laws set the number of directors constituting the board of directors of the Company at not less than three members, the exact number to be determined from time to time by resolution adopted by the affirmative vote of a majority of the total number of directors then in office.

On February 6, 2026, the Company entered into an Exchange Agreement with an entity controlled by the Company’s founder, Dr. Thomas F. Frist, Jr. and certain of his affiliates. Under the Exchange Agreement, the Company exchanged 36,629,188 shares of our common stock delivered to the Company for 36,557,141 new shares of our common stock (the “Exchange”). Upon receipt of the exchanged shares, the Company retired and canceled the shares, which ceased to be outstanding and returned to the status of authorized but unissued shares. As a result, the net effect of the Exchange is a decrease of 72,047 shares of our outstanding common stock.

Share Repurchase Transactions

During January 2026, January 2025, January 2024, January 2023 and January 2022, our Board of Directors authorized share repurchase programs for up to $10 billion, $10 billion, $6 billion, $3 billion and $8 billion, respectively, of the Company’s outstanding common stock.

During 2025, we repurchased 26.739 million shares of our common stock at an average price of $374.54 per share through market purchases pursuant to the January 2024 authorization (which was completed during 2025) and the January 2025 authorization. At December 31, 2025, we had $750 million of repurchase authorization available under the January 2025 authorization. During 2024, we repurchased 17.798 million shares of our common stock at an average price of $337.74 per share through market purchases pursuant to the January 2023 authorization (which was completed during 2024) and the January 2024 authorization. During 2023, we repurchased 14.465 million shares of our common stock at an average price of $263.47 per share through market purchases pursuant to the January 2022 authorization (which was completed during 2023) and the January 2023 authorization.
v3.25.4
Employee Benefit Plans
 12 Months Ended
Dec. 31, 2025
Retirement Benefits [Abstract]  
Employee Benefit Plans

NOTE 12 — EMPLOYEE BENEFIT PLANS

We maintain defined contribution benefit plans that are available to employees who meet certain minimum requirements. The plans require that we match participant contributions up to certain maximum levels (generally, 100% of the first 3% to 9%, depending upon years of vesting service, of compensation deferred by participants). Benefits expense under these plans totaled $744 million for 2025, $689 million for 2024 and $659 million for 2023. Our matching contributions are funded during the year following the participant contributions.

We maintain the noncontributory, nonqualified Restoration Plan to provide retirement benefits for eligible employees. Eligibility for the Restoration Plan is based upon earning eligible compensation in excess of a base amount and attaining 1,000 or more hours of service during the plan year. Company credits to participants’ hypothetical account balances (the Restoration Plan is not funded) depend upon participants’ compensation, years of vesting service, hypothetical investment returns (gains or losses) and certain IRS limitations. Benefits expense under the plan was $40 million for 2025, $31 million for 2024 and $40 million for 2023. Accrued benefits liabilities under the plan totaled $237 million at December 31, 2025 and $229 million at December 31, 2024.

We maintain a Supplemental Executive Retirement Plan (“SERP”) for certain executives (the SERP is not funded). The plan is designed to ensure that upon retirement the participant receives the value of a prescribed life annuity from the combination of the SERP and our other benefit plans. Benefits expense under the plan was $8 million for 2025, $7 million for 2024 and $10 million for 2023. Accrued benefits liabilities under this plan totaled $126 million at December 31, 2025 and $109 million at December 31, 2024.

We maintain defined benefit pension plans which resulted from certain hospital acquisitions in prior years. The amount recognized under these plans was a $7 million credit for 2025, $6 million credit for 2024 and $2 million expense for 2023. Net assets available for benefits in excess of the projected benefit obligation under these plans were $165 million and $118 million at December 31, 2025 and 2024, respectively.

v3.25.4
Segment and Geographic Information
 12 Months Ended
Dec. 31, 2025
Segment Reporting [Abstract]  
Segment and Geographic Information

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION

We operate in one line of business, which is operating hospitals and related health care entities. We operate in three geographically organized groups: the National, Atlantic and American Groups. At December 31, 2025, the National Group included 53 hospitals located in Alaska, California, Idaho, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah and Virginia; the Atlantic Group included 63 hospitals located in Florida, Georgia, Northern Kansas, Missouri and South Carolina; and the American Group included 66 hospitals located in Colorado, Central Kansas, Louisiana and Texas. The eight hospitals we operate in England are included in the Corporate and other group.

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses and gains on sales of facilities, losses on retirement of debt, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, salaries and benefits, supplies, other operating expenses, equity in earnings or losses of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets that are provided to the Chief Operating Decision Maker, which is the Chief Executive Officer, are summarized in the following tables (dollars in millions) and represent the operating segments at December 31, 2025:

 

 

 

For the Year Ended December 31, 2025

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

21,278

 

 

$

24,709

 

 

$

26,445

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,812

 

 

 

9,023

 

 

 

8,992

 

Supplies

 

 

3,043

 

 

 

3,689

 

 

 

4,263

 

Other operating expenses

 

 

5,321

 

 

 

6,358

 

 

 

6,962

 

Equity in (earnings) losses of affiliates

 

 

(1

)

 

 

(3

)

 

 

(68

)

 

 

 

16,175

 

 

 

19,067

 

 

 

20,149

 

Adjusted segment EBITDA

 

$

5,103

 

 

$

5,642

 

 

$

6,296

 

 

 

 

For the Year Ended December 31, 2024

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

19,656

 

 

$

23,380

 

 

$

24,668

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,542

 

 

 

8,686

 

 

 

8,599

 

Supplies

 

 

2,812

 

 

 

3,553

 

 

 

4,035

 

Other operating expenses

 

 

4,908

 

 

 

6,206

 

 

 

6,367

 

Equity in (earnings) losses of affiliates

 

 

2

 

 

 

(3

)

 

 

(62

)

 

 

 

15,264

 

 

 

18,442

 

 

 

18,939

 

Adjusted segment EBITDA

 

$

4,392

 

 

$

4,938

 

 

$

5,729

 

 

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

 

 

For the Year Ended December 31, 2023

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

18,105

 

 

$

21,167

 

 

$

22,318

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,196

 

 

 

8,058

 

 

 

8,080

 

Supplies

 

 

2,658

 

 

 

3,331

 

 

 

3,616

 

Other operating expenses

 

 

4,253

 

 

 

5,289

 

 

 

5,473

 

Equity in (earnings) losses of affiliates

 

 

(2

)

 

 

(3

)

 

 

(59

)

 

 

 

14,105

 

 

 

16,675

 

 

 

17,110

 

Adjusted segment EBITDA

 

$

4,000

 

 

$

4,492

 

 

$

5,208

 

 

 

 

For the Year Ended December 31,

 

 

 

2025

 

 

2024

 

 

2023

 

Adjusted segment EBITDA:

 

 

 

 

 

 

 

 

 

National Group

 

$

5,103

 

 

$

4,392

 

 

$

4,000

 

Atlantic Group

 

 

5,642

 

 

 

4,938

 

 

 

4,492

 

American Group

 

 

6,296

 

 

 

5,729

 

 

 

5,208

 

 

 

 

17,041

 

 

 

15,059

 

 

 

13,700

 

Adjustments to reconcile Total Adjusted segment
  EBITDA to consolidated Income before income taxes:

 

 

 

 

 

 

 

 

 

Corporate and Other

 

 

1,475

 

 

 

1,177

 

 

 

974

 

Depreciation and amortization

 

 

3,523

 

 

 

3,312

 

 

 

3,077

 

Interest expense

 

 

2,248

 

 

 

2,061

 

 

 

1,938

 

Losses (gains) on sales of facilities

 

 

(37

)

 

 

(14

)

 

 

5

 

Income before income taxes

 

$

9,832

 

 

$

8,523

 

 

$

7,706

 

 

 

 

For the Year Ended December 31,

 

 

 

2025

 

 

2024

 

 

2023

 

Revenues:

 

 

 

 

 

 

 

 

 

National Group

 

$

21,278

 

 

$

19,656

 

 

$

18,105

 

Atlantic Group

 

 

24,709

 

 

 

23,380

 

 

 

21,167

 

American Group

 

 

26,445

 

 

 

24,668

 

 

 

22,318

 

Corporate and other

 

 

3,168

 

 

 

2,899

 

 

 

3,378

 

 

 

$

75,600

 

 

$

70,603

 

 

$

64,968

 

 

 

 

 

 

 

 

 

 

 

Depreciation and amortization:

 

 

 

 

 

 

 

 

 

National Group

 

$

905

 

 

$

857

 

 

$

834

 

Atlantic Group

 

 

1,122

 

 

 

1,061

 

 

 

989

 

American Group

 

 

1,131

 

 

 

1,083

 

 

 

971

 

Corporate and other

 

 

365

 

 

 

311

 

 

 

283

 

 

 

$

3,523

 

 

$

3,312

 

 

$

3,077

 

 

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

 

 

December 31,

 

 

 

2025

 

 

2024

 

 

2023

 

Assets:

 

 

 

 

 

 

 

 

 

National Group

 

$

13,596

 

 

$

12,855

 

 

$

12,487

 

Atlantic Group

 

 

17,945

 

 

 

17,168

 

 

 

16,098

 

American Group

 

 

21,217

 

 

 

20,714

 

 

 

19,786

 

Corporate and other

 

 

7,962

 

 

 

8,776

 

 

 

7,840

 

 

 

$

60,720

 

 

$

59,513

 

 

$

56,211

 

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

 

Corporate
and Other

 

 

Total

 

Goodwill and other intangible assets:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at December 31, 2022

 

$

1,244

 

 

$

2,057

 

 

$

5,152

 

 

$

1,200

 

 

$

9,653

 

Acquisitions

 

 

—

 

 

 

8

 

 

 

326

 

 

 

28

 

 

 

362

 

Foreign currency translation, amortization and other

 

 

(3

)

 

 

(1

)

 

 

—

 

 

 

(66

)

 

 

(70

)

Balance at December 31, 2023

 

 

1,241

 

 

 

2,064

 

 

 

5,478

 

 

 

1,162

 

 

 

9,945

 

Acquisitions

 

 

—

 

 

 

61

 

 

 

105

 

 

 

4

 

 

 

170

 

Foreign currency translation, amortization and other

 

 

(4

)

 

 

(1

)

 

 

3

 

 

 

(20

)

 

 

(22

)

Balance at December 31, 2024

 

 

1,237

 

 

 

2,124

 

 

 

5,586

 

 

 

1,146

 

 

 

10,093

 

Acquisitions

 

 

21

 

 

 

90

 

 

 

101

 

 

 

6

 

 

 

218

 

Foreign currency translation, amortization and other

 

 

(24

)

 

 

—

 

 

 

1

 

 

 

5

 

 

 

(18

)

Balance at December 31, 2025

 

$

1,234

 

 

$

2,214

 

 

$

5,688

 

 

$

1,157

 

 

$

10,293

 
v3.25.4
Other Comprehensive (Loss) Income
 12 Months Ended
Dec. 31, 2025
Equity [Abstract]  
Other Comprehensive (Loss) Income

NOTE 14 — OTHER COMPREHENSIVE (LOSS) INCOME

The components of accumulated other comprehensive loss are as follows (dollars in millions):

 

 

 

Unrealized
Gains (Losses) on
Available-
for-Sale
Securities

 

 

Foreign
Currency
Translation
Adjustments

 

 

Defined
Benefit
Plans

 

 

Total

 

Balances at December 31, 2022

 

$

(30

)

 

$

(373

)

 

$

(87

)

 

$

(490

)

Unrealized gains on available-for-sale securities, net
   of $2 income taxes

 

 

9

 

 

 

 

 

 

 

 

 

9

 

Foreign currency translation adjustments, net of $7
   income taxes

 

 

 

 

 

34

 

 

 

 

 

 

34

 

Defined benefit plans, net of $6 of income taxes

 

 

 

 

 

 

 

 

21

 

 

 

21

 

Expense (benefit) reclassified into operations from
   other comprehensive income, net of none of income
   taxes and $1 income tax benefit, respectively

 

 

(1

)

 

 

 

 

 

2

 

 

 

1

 

Balances at December 31, 2023

 

 

(22

)

 

 

(339

)

 

 

(64

)

 

 

(425

)

Unrealized gains on available-for-sale securities

 

 

1

 

 

 

 

 

 

 

 

 

1

 

Foreign currency translation adjustments, net of $2
   income tax benefit

 

 

 

 

 

(14

)

 

 

 

 

 

(14

)

Defined benefit plans, net of $15 of income taxes

 

 

 

 

 

 

 

 

50

 

 

 

50

 

Expense reclassified into operations from
   other comprehensive income

 

 

 

 

 

 

 

 

1

 

 

 

1

 

Balances at December 31, 2024

 

 

(21

)

 

 

(353

)

 

 

(13

)

 

 

(387

)

Unrealized gains on available-for-sale securities, net
   of $3 income taxes

 

 

10

 

 

 

 

 

 

 

 

 

10

 

Foreign currency translation adjustments, net of $10
   income taxes

 

 

 

 

 

54

 

 

 

 

 

 

54

 

Defined benefit plans, net of $7 of income taxes

 

 

 

 

 

 

 

 

24

 

 

 

24

 

Benefits reclassified into operations from
   other comprehensive income, net of $2 of income taxes

 

 

 

 

 

 

 

 

(6

)

 

 

(6

)

Balances at December 31, 2025

 

$

(11

)

 

$

(299

)

 

$

5

 

 

$

(305

)
v3.25.4
Accrued Expenses
 12 Months Ended
Dec. 31, 2025
Text Block [Abstract]  
Other Accrued Expenses

NOTE 15 — OTHER ACCRUED EXPENSES

A summary of other accrued expenses at December 31 follows (dollars in millions):

 

 

2025

 

 

2024

 

Professional liability risks

 

$

578

 

 

$

587

 

Defined contribution benefit plans

 

 

763

 

 

 

704

 

Right-of-use operating leases

 

 

352

 

 

 

343

 

Taxes other than income

 

 

504

 

 

 

419

 

Interest

 

 

499

 

 

 

502

 

Employee medical benefits

 

 

216

 

 

 

206

 

Other

 

 

1,365

 

 

 

1,138

 

 

 

$

4,277

 

 

$

3,899

 
v3.25.4
Accounting Policies (Policies)
 12 Months Ended
Dec. 31, 2025
Accounting Policies [Abstract]  
Basis of Presentation

Basis of Presentation

The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates.

The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. The accounts of acquired entities are included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method.

The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative include our corporate office costs, which were $548 million, $421 million and $353 million for the years ended December 31, 2025, 2024 and 2023, respectively.

Revenues

Revenues

Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges), and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals.

NOTE 1 — ACCOUNTING POLICIES (continued)

Revenues (continued)

Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured and other discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Our revenues by primary third-party payer classification and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions):

 

 

 

Years Ended December 31,

 

 

 

2025

 

 

Ratio

 

 

2024

 

 

Ratio

 

 

2023

 

 

Ratio

 

Medicare

 

$

11,273

 

 

 

14.9

%

 

$

10,780

 

 

 

15.3

%

 

$

10,585

 

 

 

16.3

%

Managed Medicare

 

 

13,435

 

 

 

17.8

 

 

 

11,987

 

 

 

17.0

 

 

 

10,496

 

 

 

16.2

 

Medicaid

 

 

5,909

 

 

 

7.8

 

 

 

4,678

 

 

 

6.6

 

 

 

3,606

 

 

 

5.6

 

Managed Medicaid

 

 

3,693

 

 

 

4.9

 

 

 

3,980

 

 

 

5.6

 

 

 

3,879

 

 

 

6.0

 

Managed care and other insurers

 

 

36,968

 

 

 

48.9

 

 

 

34,954

 

 

 

49.5

 

 

 

31,819

 

 

 

49.0

 

International (managed care and other insurers)

 

 

1,864

 

 

 

2.5

 

 

 

1,682

 

 

 

2.4

 

 

 

1,509

 

 

 

2.3

 

Other

 

 

2,458

 

 

 

3.2

 

 

 

2,542

 

 

 

3.6

 

 

 

3,074

 

 

 

4.6

 

Revenues

 

$

75,600

 

 

 

100.0

%

 

$

70,603

 

 

 

100.0

%

 

$

64,968

 

 

 

100.0

%

Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement and disproportionate-share amounts, related primarily to cost reports filed during the respective year, resulted in net increases to revenues of $31 million, $42 million and $84 million in 2025, 2024 and 2023, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in net increases to revenues of $32 million in 2025, $78 million in 2024 and $58 million in 2023.

The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive.

Patients treated at hospitals for non-elective care, who have income at or below 400% of the federal poverty level, are eligible for charity care, and we limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. Patients treated at hospitals for non-elective care, who have income above 400% of the federal poverty level, are eligible for certain other discounts which limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. We apply additional discounts to limit patient responsibility for certain emergency services. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. We may provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied.

NOTE 1 — ACCOUNTING POLICIES (continued)

Revenues (continued)

The collection of outstanding receivables from Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the age of those accounts. Accounts are written off when all reasonable collection efforts have been performed.

The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period comparisons of our revenues. At December 31, 2025 and 2024, estimated implicit price concessions of $7.674 billion and $7.773 billion, respectively, had been recorded to adjust our revenues and accounts receivable to the estimated amounts we expect to collect.

To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions):

 

 

2025

 

 

2024

 

 

2023

 

Patient care costs (salaries and benefits, supplies, other operating
   expenses and depreciation and amortization)

 

$

63,635

 

 

$

60,056

 

 

$

55,341

 

Cost-to-charges ratio (patient care costs as percentage of gross
   patient charges)

 

 

9.6

%

 

 

10.1

%

 

 

10.5

%

Total uncompensated care

 

$

47,966

 

 

$

43,231

 

 

$

35,426

 

Multiply by the cost-to-charges ratio

 

 

9.6

%

 

 

10.1

%

 

 

10.5

%

Estimated cost of total uncompensated care

 

$

4,605

 

 

$

4,366

 

 

$

3,720

 

The total uncompensated care amounts include charity care of $16.499 billion, $15.942 billion and $14.425 billion for the years ended December 31, 2025, 2024 and 2023, respectively. The estimated cost of charity care was $1.584 billion, $1.610 billion and $1.515 billion for the years ended December 31, 2025, 2024 and 2023, respectively.

Cash and Cash Equivalents

Cash and Cash Equivalents

Cash and cash equivalents include highly liquid investments with a maturity of three months or less when purchased. Our insurance subsidiaries’ cash equivalent investments in excess of the amounts required to pay estimated professional liability claims during the next twelve months are not included in cash and cash equivalents as these funds are not available for general corporate purposes. Carrying values of cash and cash equivalents approximate fair value due to the short-term nature of these instruments.
Accounts Receivable

Accounts Receivable

We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. Days revenues in accounts receivable were 51 days, 54 days and 53 days at December 31, 2025, 2024 and 2023, respectively. Changes in general economic conditions, revenue cycle service center operations, payer mix, payer claim processing, or federal, state and private employer health care coverage could affect our collection of accounts receivable, cash flows and results of operations.

Inventories

Inventories

Inventories are stated at the lower of cost (first-in, first-out) or market.

Property and Equipment

Property and Equipment

Depreciation expense, computed using the straight-line method, was $3.508 billion in 2025, $3.294 billion in 2024 and $3.052 billion in 2023. Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four to 10 years.

When events, circumstances or operating results indicate the carrying values of certain property and equipment expected to be held and used might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar assets and independent appraisals.

Property and equipment to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers.

Investments of Insurance Subsidiaries

Investments of Insurance Subsidiaries

At December 31, 2025 and 2024, the investment securities held by our insurance subsidiaries were classified as “available-for-sale” as defined in Accounting Standards Codification (“ASC”) No. 320, Investments — Debt Securities and are recorded at fair value. The investment securities are held for the purpose of providing a funding source to pay liability claims covered by the insurance subsidiaries. We perform quarterly assessments of individual investment securities to determine whether declines in fair value are due to credit-related or noncredit-related factors. Our investment securities evaluation process involves subjective judgments, often involves estimating the outcome of future events, and requires a significant level of professional judgment in determining whether a credit-related impairment has occurred. We evaluate, among other things, the financial position and near-term prospects of the issuer, conditions in the issuer’s industry, liquidity of the investment, changes in the amount or timing of expected future cash flows from the investment, and recent downgrades of the issuer by a rating agency, to determine if, and when, a decline in the fair value of an investment below amortized cost is considered to be a credit-related impairment. The extent to which the fair value of the investment is less than amortized cost and our ability and intent to retain the investment, to allow for any anticipated recovery of the investment’s fair value, are important components of our investment securities evaluation process.

Goodwill and Intangible Assets

Goodwill and Intangible Assets

Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, an impairment loss is recognized. Fair value is estimated based upon internal evaluations of each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2025, 2024 or 2023.

During 2025, goodwill increased by $218 million related to acquisitions and declined by $6 million related to foreign currency translation and other adjustments. During 2024, goodwill increased by $170 million related to acquisitions and declined by $6 million related to foreign currency translation and other adjustments.

During 2025 and 2024, identifiable intangible assets declined by $12 million and $16 million, respectively, due to amortization and other adjustments. Identifiable intangible assets with finite lives are amortized over estimated lives ranging generally from three to 10 years. The gross carrying amount of amortizable identifiable intangible assets at both December 31, 2025 and 2024 was $274 million and accumulated amortization was $256 million and $244 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2025 and 2024 was $293 million. Indefinite-lived identifiable intangible assets are not amortized but are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist.

Debt Issuance Costs and Discounts

Debt Issuance Costs and Discounts

Debt issuance costs and discounts are amortized based upon the terms of the respective debt obligations. The gross carrying amounts of debt issuance costs and discounts at December 31, 2025 and 2024 were $639 million and $608 million, respectively, and accumulated amortization was $203 million and $239 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $44 million, $35 million and $35 million for 2025, 2024 and 2023, respectively.

Professional Liability Reserves

Professional Liability Reserves

Reserves for professional liability risks were $2.044 billion and $2.131 billion at December 31, 2025 and 2024, respectively. The current portion of the reserves, $578 million and $587 million at December 31, 2025 and 2024, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $651 million, $627 million and $619 million for 2025, 2024 and 2023, respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. Loss and loss expense reserves represent the estimated ultimate cost of all reported and unreported losses incurred and unpaid through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,360 and 2,120 individual claims at December 31, 2025 and 2024, respectively, and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During 2025 and 2024, $702 million and $600 million, respectively, of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates.

NOTE 1 — ACCOUNTING POLICIES (continued)

Professional Liability Reserves (continued)

A portion of our professional liability risks is insured through one of our insurance subsidiaries. Subject, in most cases, to a $15 million per occurrence self-insured retention, our facilities are insured by our insurance subsidiary for losses up to $110 million per occurrence ($120 million effective January 1, 2026). The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of either $25 million or $35 million per occurrence, depending on the jurisdiction for the related claim. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary.

The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts were $38 million and $35 million at December 31, 2025 and 2024, respectively, recorded in “other assets,” and $9 million and $45 million at December 31, 2025 and 2024, respectively, recorded in “other current assets.”

Noncontrolling Interests in Consolidated Entities

Noncontrolling Interests in Consolidated Entities

The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities
Earning Per Share We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding plus the dilutive effect of outstanding SARs, RSUs and PSUs, computed using the treasury stock method.
Fair Value Measurements and Disclosures

Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”) emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).

Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment.

Investment Securities

The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency.

Government Investigations, Claims and Litigation

Government Investigations, Claims and Litigation

Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our results of operations, financial position or liquidity.

We accrue for such contingencies to the extent that it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. If we are a party to any proceeding that, either individually or in the aggregate, is probable or reasonably possible of having a material, adverse effect on the business, our results of operations, financial position or liquidity, we disclose a summary of such contingencies and the amount or range of reasonably possible losses in excess of recorded amounts or that we are unable to reasonably estimate the amount or range of losses.
Reclassifications

Reclassifications

Certain prior year amounts have been reclassified to conform to the current year presentation.
v3.25.4
Accounting Policies (Tables)
 12 Months Ended
Dec. 31, 2025
Accounting Policies [Abstract]  
Schedule of Revenues from Third Party Payers, Uninsured and Other Payers Our revenues by primary third-party payer classification and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions):

 

 

 

Years Ended December 31,

 

 

 

2025

 

 

Ratio

 

 

2024

 

 

Ratio

 

 

2023

 

 

Ratio

 

Medicare

 

$

11,273

 

 

 

14.9

%

 

$

10,780

 

 

 

15.3

%

 

$

10,585

 

 

 

16.3

%

Managed Medicare

 

 

13,435

 

 

 

17.8

 

 

 

11,987

 

 

 

17.0

 

 

 

10,496

 

 

 

16.2

 

Medicaid

 

 

5,909

 

 

 

7.8

 

 

 

4,678

 

 

 

6.6

 

 

 

3,606

 

 

 

5.6

 

Managed Medicaid

 

 

3,693

 

 

 

4.9

 

 

 

3,980

 

 

 

5.6

 

 

 

3,879

 

 

 

6.0

 

Managed care and other insurers

 

 

36,968

 

 

 

48.9

 

 

 

34,954

 

 

 

49.5

 

 

 

31,819

 

 

 

49.0

 

International (managed care and other insurers)

 

 

1,864

 

 

 

2.5

 

 

 

1,682

 

 

 

2.4

 

 

 

1,509

 

 

 

2.3

 

Other

 

 

2,458

 

 

 

3.2

 

 

 

2,542

 

 

 

3.6

 

 

 

3,074

 

 

 

4.6

 

Revenues

 

$

75,600

 

 

 

100.0

%

 

$

70,603

 

 

 

100.0

%

 

$

64,968

 

 

 

100.0

%
Schedule of Estimated Cost of Uncompensated Care A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions):

 

 

2025

 

 

2024

 

 

2023

 

Patient care costs (salaries and benefits, supplies, other operating
   expenses and depreciation and amortization)

 

$

63,635

 

 

$

60,056

 

 

$

55,341

 

Cost-to-charges ratio (patient care costs as percentage of gross
   patient charges)

 

 

9.6

%

 

 

10.1

%

 

 

10.5

%

Total uncompensated care

 

$

47,966

 

 

$

43,231

 

 

$

35,426

 

Multiply by the cost-to-charges ratio

 

 

9.6

%

 

 

10.1

%

 

 

10.5

%

Estimated cost of total uncompensated care

 

$

4,605

 

 

$

4,366

 

 

$

3,720

 
v3.25.4
Share-Based Compensation (Tables)
 12 Months Ended
Dec. 31, 2025
Share-Based Payment Arrangement [Abstract]  
Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models The expected dividend yield is estimated based on the assumption that the dividend yield at date of grant will be maintained over the expected life of the grant.

 

 

 

2025

 

 

2024

 

 

2023

 

Risk-free interest rate

 

 

4.33

%

 

 

3.94

%

 

 

3.69

%

Expected volatility

 

 

33

%

 

 

33

%

 

 

36

%

Expected life, in years

 

 

5.28

 

 

 

5.23

 

 

 

5.14

 

Expected dividend yield

 

 

0.88

%

 

 

0.87

%

 

 

0.95

%
Schedule of Stock Appreciation Rights Activity

Information regarding Time SAR and Performance SAR activity during 2025, 2024 and 2023 is summarized below (share amounts in thousands):

 

 

Time
SARs

 

 

Performance
SARs

 

 

Total
SARs

 

 

Weighted
Average
Exercise
Price

 

 

Weighted
Average
Remaining
Contractual Term

 

Aggregate
Intrinsic Value
(dollars in millions)

 

SARs outstanding, December 31, 2022

 

 

5,960

 

 

 

127

 

 

 

6,087

 

 

$

126.38

 

 

 

 

 

 

Granted

 

 

580

 

 

 

—

 

 

 

580

 

 

 

253.49

 

 

 

 

 

 

Exercised

 

 

(1,156

)

 

 

(83

)

 

 

(1,239

)

 

 

95.29

 

 

 

 

 

 

Cancelled

 

 

(59

)

 

 

—

 

 

 

(59

)

 

 

202.05

 

 

 

 

 

 

SARs outstanding, December 31, 2023

 

 

5,325

 

 

 

44

 

 

 

5,369

 

 

 

146.46

 

 

 

 

 

 

Granted

 

 

491

 

 

 

—

 

 

 

491

 

 

 

305.44

 

 

 

 

 

 

Exercised

 

 

(1,128

)

 

 

(44

)

 

 

(1,172

)

 

 

111.02

 

 

 

 

 

 

Cancelled

 

 

(101

)

 

 

—

 

 

 

(101

)

 

 

246.78

 

 

 

 

 

 

SARs outstanding, December 31, 2024

 

 

4,587

 

 

 

—

 

 

 

4,587

 

 

 

170.31

 

 

 

 

 

 

Granted

 

 

418

 

 

 

—

 

 

 

418

 

 

 

329.80

 

 

 

 

 

 

Exercised

 

 

(859

)

 

 

—

 

 

 

(859

)

 

 

125.10

 

 

 

 

 

 

Cancelled

 

 

(40

)

 

 

—

 

 

 

(40

)

 

 

308.57

 

 

 

 

 

 

SARs outstanding, December 31, 2025

 

 

4,106

 

 

 

—

 

 

 

4,106

 

 

$

194.62

 

 

5.1 years

 

$

1,118

 

SARs exercisable, December 31, 2025

 

 

3,012

 

 

 

—

 

 

 

3,012

 

 

$

158.20

 

 

4.0 years

 

$

930

 
Schedule of Restricted Stock Units Activity

Information regarding RSU and PSU activity during 2025, 2024 and 2023 is summarized below (share amounts in thousands):

 

 

RSUs

 

 

PSUs

 

 

Total RSUs
and PSUs

 

 

Weighted
Average
Grant
Date Fair
Value

 

RSUs and PSUs outstanding, December 31, 2022

 

 

1,784

 

 

 

1,715

 

 

 

3,499

 

 

$

179.18

 

Granted

 

 

609

 

 

 

479

 

 

 

1,088

 

 

 

253.85

 

Performance adjustment

 

 

—

 

 

 

697

 

 

 

697

 

 

 

144.42

 

Vested

 

 

(717

)

 

 

(1,393

)

 

 

(2,110

)

 

 

152.50

 

Cancelled

 

 

(125

)

 

 

(88

)

 

 

(213

)

 

 

217.78

 

RSUs and PSUs outstanding, December 31, 2023

 

 

1,551

 

 

 

1,410

 

 

 

2,961

 

 

 

214.71

 

Granted

 

 

582

 

 

 

434

 

 

 

1,016

 

 

 

305.97

 

Performance adjustment

 

 

—

 

 

 

566

 

 

 

566

 

 

 

174.55

 

Vested

 

 

(639

)

 

 

(1,132

)

 

 

(1,771

)

 

 

181.81

 

Cancelled

 

 

(138

)

 

 

(103

)

 

 

(241

)

 

 

260.96

 

RSUs and PSUs outstanding, December 31, 2024

 

 

1,356

 

 

 

1,175

 

 

 

2,531

 

 

 

260.95

 

Granted

 

 

492

 

 

 

367

 

 

 

859

 

 

 

330.72

 

Performance adjustment

 

 

—

 

 

 

(175

)

 

 

(175

)

 

 

235.81

 

Vested

 

 

(526

)

 

 

(191

)

 

 

(717

)

 

 

237.46

 

Cancelled

 

 

(94

)

 

 

(71

)

 

 

(165

)

 

 

298.81

 

RSUs and PSUs outstanding, December 31, 2025

 

 

1,228

 

 

 

1,105

 

 

 

2,333

 

 

$

293.03

 
v3.25.4
Income Taxes (Tables)
 12 Months Ended
Dec. 31, 2025
Income Tax Disclosure [Abstract]  
Schedule of Pretax Income including Income Attributable to Noncontrolling Interests Pretax income including income attributable to noncontrolling interests consists of the following (dollars in millions):

 

2025

 

 

2024

 

 

2023

 

Domestic

$

9,720

 

 

$

8,444

 

 

$

7,621

 

Foreign

 

112

 

 

 

79

 

 

 

85

 

$

9,832

 

 

$

8,523

 

 

$

7,706

 
Schedule of Income Taxed Paid

Income taxes paid consist of the following (dollars in millions):

 

 

2025

 

 

2024

 

 

2023

 

  Federal

 

$

1,466

 

 

$

1,625

 

 

$

1,187

 

  State

 

 

 

 

 

 

 

 

 

        Florida

 

 

98

 

 

 

72

 

 

 

85

 

        All other

 

 

157

 

 

 

134

 

 

 

105

 

  Foreign

 

 

19

 

 

 

13

 

 

 

9

 

 

 

$

1,740

 

 

$

1,844

 

 

$

1,386

 
Schedule of Provision for Income Taxes

The provision for income taxes consists of the following (dollars in millions):

 

 

 

2025

 

 

2024

 

 

2023

 

Current:

 

 

 

 

 

 

 

 

 

Federal

 

$

1,551

 

 

$

1,202

 

 

$

1,118

 

State

 

 

248

 

 

 

212

 

 

 

213

 

Foreign

 

 

13

 

 

 

20

 

 

 

3

 

Deferred:

 

 

 

 

 

 

 

 

 

Federal

 

 

201

 

 

 

394

 

 

 

241

 

State

 

 

31

 

 

 

31

 

 

 

21

 

Foreign

 

 

6

 

 

 

7

 

 

 

19

 

 

 

$

2,050

 

 

$

1,866

 

 

$

1,615

 
Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate

A reconciliation of the federal statutory rate to the effective income tax rate follows (dollars in millions):

 

 

2025

 

 

2024

 

 

2023

 

 

 

Amount

 

 

Percent

 

 

Amount

 

 

Percent

 

 

Amount

 

 

Percent

 

U.S. federal statutory tax rate

 

$

2,065

 

 

 

21.0

%

 

$

1,790

 

 

 

21.0

%

 

$

1,618

 

 

 

21.0

%

State and local taxes, net of federal income tax
   effect (1)

 

 

228

 

 

 

2.3

 

 

 

206

 

 

 

2.4

 

 

 

179

 

 

 

2.3

 

Foreign tax effects

 

 

(4

)

 

 

—

 

 

 

10

 

 

 

0.1

 

 

 

4

 

 

 

0.1

 

Nontaxable or nondeductible items

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     Noncontrolling interest

 

 

(210

)

 

 

(2.1

)

 

 

(188

)

 

 

(2.2

)

 

 

(178

)

 

 

(2.3

)

     Share-based payment awards

 

 

(55

)

 

 

(0.6

)

 

 

(91

)

 

 

(1.1

)

 

 

(84

)

 

 

(1.1

)

     Other nontaxable or nondeductible items

 

 

41

 

 

 

0.5

 

 

 

50

 

 

 

0.6

 

 

 

43

 

 

 

0.6

 

Changes in unrecognized tax benefits

 

 

(18

)

 

 

(0.2

)

 

 

(177

)

 

 

(2.1

)

 

 

33

 

 

 

0.4

 

Other Adjustments

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     Internal restructuring of affiliates

 

 

—

 

 

 

—

 

 

 

265

 

 

 

3.2

 

 

 

—

 

 

 

—

 

     Other adjustments, net

 

 

3

 

 

 

—

 

 

 

1

 

 

 

—

 

 

 

—

 

 

 

—

 

Effective tax rate on income before income taxes

 

$

2,050

 

 

 

20.9

%

 

$

1,866

 

 

 

21.9

%

 

$

1,615

 

 

 

21.0

%

(1) State taxes in Florida and Texas made up the majority (greater than 50%) of the tax effect in this category.
Schedule of Deferred Tax Assets and Liabilities

A summary of the items comprising our deferred tax assets and liabilities at December 31 follows (dollars in millions):

 

 

2025

 

 

2024

 

 

 

Assets

 

 

Liabilities

 

 

Assets

 

 

Liabilities

 

Depreciation and fixed asset basis differences

 

$

—

 

 

$

1,357

 

 

$

—

 

 

$

1,139

 

Allowances for professional liability and other risks

 

 

440

 

 

 

—

 

 

 

395

 

 

 

—

 

Accounts receivable

 

 

427

 

 

 

—

 

 

 

418

 

 

 

—

 

Compensation

 

 

322

 

 

 

—

 

 

 

285

 

 

 

—

 

Right-of-use lease assets and obligations

 

 

476

 

 

 

459

 

 

 

478

 

 

 

462

 

Other

 

 

268

 

 

 

1,036

 

 

 

297

 

 

 

932

 

 

 

$

1,933

 

 

$

2,852

 

 

$

1,873

 

 

$

2,533

 
Schedule of Activity Related to our Gross Unrecognized Tax Benefits

The following table summarizes the activity related to our gross unrecognized tax benefits, excluding accrued interest and penalties of $78 million and $115 million as of December 31, 2025 and 2024, respectively (dollars in millions):

 

 

2025

 

 

2024

 

Balance at January 1

 

$

504

 

 

$

639

 

Additions based on tax positions related to the current year

 

 

21

 

 

 

40

 

Additions for tax positions of prior years

 

 

25

 

 

 

63

 

Reductions for tax positions of prior years

 

 

(3

)

 

 

(206

)

Settlements

 

 

(1

)

 

 

(17

)

Lapse of applicable statutes of limitations

 

 

(27

)

 

 

(15

)

Balance at December 31

 

$

519

 

 

$

504

 

 
v3.25.4
Earnings Per Share (Tables)
 12 Months Ended
Dec. 31, 2025
Earnings Per Share [Abstract]  
Schedule of Computations of Basic and Diluted Earnings Per Share

The following table sets forth the computations of basic and diluted earnings per share for the years ended December 31, 2025, 2024 and 2023 (dollars and shares in millions, except per share amounts):

 

 

 

2025

 

 

2024

 

 

2023

 

Net income attributable to HCA Healthcare, Inc.

 

$

6,784

 

 

$

5,760

 

 

$

5,242

 

 

 

 

 

 

 

 

 

 

 

Weighted average common shares outstanding

 

 

236.413

 

 

 

258.603

 

 

 

272.404

 

Effect of dilutive incremental shares

 

 

3.082

 

 

 

3.203

 

 

 

4.008

 

Shares used for diluted earnings per share

 

 

239.495

 

 

 

261.806

 

 

 

276.412

 

Earnings per share:

 

 

 

 

 

 

 

 

 

Basic earnings per share

 

$

28.70

 

 

$

22.27

 

 

$

19.25

 

Diluted earnings per share

 

$

28.33

 

 

$

22.00

 

 

$

18.97

 
v3.25.4
Investments of Insurance Subsidiaries (Tables)
 12 Months Ended
Dec. 31, 2025
Investments, Debt and Equity Securities [Abstract]  
Schedule of Investments

A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions):

 

 

2025

 

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

342

 

 

$

1

 

 

$

(15

)

 

$

328

 

Money market funds and other

 

 

260

 

 

 

—

 

 

 

—

 

 

 

260

 

 

 

$

602

 

 

$

1

 

 

$

(15

)

 

 

588

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(103

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

485

 

 

 

2024

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

388

 

 

$

—

 

 

$

(27

)

 

$

361

 

Money market funds and other

 

 

296

 

 

 

—

 

 

 

—

 

 

 

296

 

 

$

684

 

 

$

—

 

 

$

(27

)

 

 

657

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(88

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

569

 
Schedule of Maturities of Investments

Scheduled maturities of investments in debt securities at December 31, 2025 were as follows (dollars in millions):

 

 

 

Amortized
Cost

 

 

Fair
Value

 

Due in one year or less

 

$

29

 

 

$

29

 

Due after one year through five years

 

 

145

 

 

 

140

 

Due after five years through ten years

 

 

111

 

 

 

104

 

Due after ten years

 

 

57

 

 

 

55

 

 

 

$

342

 

 

$

328

 
v3.25.4
Assets and Liabilities Measured at Fair Value (Tables)
 12 Months Ended
Dec. 31, 2025
Fair Value Disclosures [Abstract]  
Summary of Investments of Insurance Subsidiaries Measured at Fair Value on Recurring Basis

The following tables summarize the investments of our insurance subsidiaries measured at fair value on a recurring basis as of December 31, 2025 and 2024, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

 

 

2025

 

 

 

 

 

 

Fair Value Measurements Using

 

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Debt securities

 

$

328

 

 

$

1

 

 

$

327

 

 

$

—

 

Money market funds and other

 

 

260

 

 

 

260

 

 

 

—

 

 

 

—

 

Investments of insurance subsidiaries

 

 

588

 

 

 

261

 

 

 

327

 

 

 

—

 

Less amounts classified as current assets

 

 

(103

)

 

 

(103

)

 

 

—

 

 

 

—

 

 

 

$

485

 

 

$

158

 

 

$

327

 

 

$

—

 

 

 

2024

 

 

 

 

 

Fair Value Measurements Using

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Debt securities

 

$

361

 

 

$

—

 

 

$

361

 

 

$

—

 

Money market funds and other

 

 

296

 

 

 

296

 

 

 

—

 

 

 

—

 

Investments of insurance subsidiaries

 

 

657

 

 

 

296

 

 

 

361

 

 

 

—

 

Less amounts classified as current assets

 

 

(88

)

 

 

(88

)

 

 

—

 

 

 

—

 

 

$

569

 

 

$

208

 

 

$

361

 

 

$

—

 
v3.25.4
Debt (Tables)
 12 Months Ended
Dec. 31, 2025
Debt Disclosure [Abstract]  
Schedule of Debt

A summary of our debt at December 31, 2025 and December 31, 2024, including related interest rates at December 31, 2025, follows (dollars in millions):

 

 

2025

 

 

2024

 

Short-term borrowings:

 

 

 

 

 

 

Commercial paper (average life of 18 days, weighted average rate of 4.3%)

 

$

2,207

 

 

$

—

 

Long-term debt:

 

 

 

 

 

 

Senior secured term loan facility

 

 

—

 

 

 

1,238

 

Other senior secured debt (effective interest rate of 4.6%)

 

 

1,021

 

 

 

1,046

 

Senior unsecured credit facilities

 

 

—

 

 

 

—

 

Senior unsecured notes payable through 2095 (effective interest rate of 5.1%)

 

 

43,700

 

 

 

41,116

 

Debt issuance costs and discounts

 

 

(436

)

 

 

(369

)

Total long-term debt (average life of 11.9 years, rates averaging 5.1%)

 

 

44,285

 

 

 

43,031

 

Total debt

 

 

46,492

 

 

 

43,031

 

Less amounts due within one year

 

 

4,889

 

 

 

4,698

 

 

$

41,603

 

 

$

38,333

 

2025 Financing Activities

W
v3.25.4
Leases (Tables)
 12 Months Ended
Dec. 31, 2025
Leases [Abstract]  
Schedule of lease-related assets and liabilities

The following table presents our lease-related assets and liabilities at December 31, 2025 and 2024 (dollars in millions):

 

Balance Sheet Classification

2025

 

2024

 

Assets:

 

 

 

 

 

Operating leases

Right-of-use operating lease assets

$

2,130

 

$

2,131

 

Finance leases

Property and equipment

 

607

 

 

646

 

Total lease assets

 

$

2,737

 

$

2,777

 

Liabilities:

 

 

 

 

 

Current:

 

 

 

 

 

Operating leases

Other accrued expenses

$

352

 

$

343

 

Finance leases

Short-term borrowings and long-term debt due within one year

 

133

 

 

162

 

Noncurrent:

 

 

 

 

 

Operating leases

Right-of-use operating lease obligations

 

1,853

 

 

1,863

 

Finance leases

Long-term debt

 

625

 

 

624

 

Total lease liabilities

 

$

2,963

 

$

2,992

 

Weighted-average remaining term:

 

 

 

 

 

Operating leases

 

11.4 years

 

11.3 years

 

Finance leases

 

11.1 years

 

10.5 years

 

Weighted-average discount rate:

 

 

 

 

 

Operating leases

 

 

5.3

%

 

5.1

%

Finance leases

 

 

5.6

%

 

5.3

%

 
Schedule of lease expense for finance and operating leases

 

 

2025

 

 

2024

 

 

2023

 

Finance lease expense:

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

$

182

 

 

$

159

 

 

$

164

 

Interest

 

 

41

 

 

 

37

 

 

 

31

 

Operating leases(1)

 

 

516

 

 

 

503

 

 

 

495

 

Short-term lease expense(1)

 

 

317

 

 

 

365

 

 

 

337

 

Variable lease expense(1)

 

 

197

 

 

 

181

 

 

 

162

 

 

 

$

1,253

 

 

$

1,245

 

 

$

1,189

 

 

Expenses are included in “other operating expenses” in our consolidated income statements.
Schedule of supplemental cash flow information

The following table presents supplemental cash flow information for the years ended December 31, 2025, 2024 and 2023 (dollars in millions):

 

 

 

2025

 

 

2024

 

 

2023

 

Cash paid for amounts included in the measurement of lease liabilities:

 

 

 

 

 

 

 

 

 

Operating cash flows for operating leases

 

$

501

 

 

$

490

 

 

$

479

 

Operating cash flows for finance leases

 

 

41

 

 

 

37

 

 

 

31

 

Financing cash flows for finance leases

 

 

173

 

 

 

172

 

 

 

140

 
Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities recorded on balance sheet

The following table reconciles the undiscounted minimum lease payment amounts to the operating and finance lease liabilities recorded on the balance sheet at December 31, 2025 and 2024 (dollars in millions):

 

 

 

2025

 

 

2024

 

 

 

Operating
Leases

 

 

Finance
Leases

 

 

Operating
Leases

 

 

Finance
Leases

 

Year 1

 

$

474

 

 

$

173

 

 

$

455

 

 

$

197

 

Year 2

 

 

413

 

 

 

126

 

 

 

405

 

 

 

146

 

Year 3

 

 

343

 

 

 

100

 

 

 

344

 

 

 

99

 

Year 4

 

 

276

 

 

 

85

 

 

 

281

 

 

 

81

 

Year 5

 

 

214

 

 

 

62

 

 

 

221

 

 

 

71

 

Thereafter

 

 

1,499

 

 

 

532

 

 

 

1,460

 

 

 

497

 

Total minimum lease payments

 

 

3,219

 

 

 

1,078

 

 

 

3,166

 

 

 

1,091

 

Less: amount of lease payments representing interest

 

 

(1,014

)

 

 

(320

)

 

 

(960

)

 

 

(305

)

Present value of future minimum lease payments

 

 

2,205

 

 

 

758

 

 

 

2,206

 

 

 

786

 

Less: current lease obligations

 

 

(352

)

 

 

(133

)

 

 

(343

)

 

 

(162

)

Long-term lease obligations

 

$

1,853

 

 

$

625

 

 

$

1,863

 

 

$

624

 
v3.25.4
Segment and Geographic Information (Tables)
 12 Months Ended
Dec. 31, 2025
Segment Reporting [Abstract]  
Schedule Of Geographic Distributions Of Revenues, Salaries And Benefits, Supplies, Other Operating Expenses, Equity In Earnings Of Affiliates, Adjusted Segment EBITDA, Depreciation And Amortization, Assets And Goodwill And Other Intangible Assets The geographic distributions of our revenues, salaries and benefits, supplies, other operating expenses, equity in earnings or losses of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets that are provided to the Chief Operating Decision Maker, which is the Chief Executive Officer, are summarized in the following tables (dollars in millions) and represent the operating segments at December 31, 2025:

 

 

 

For the Year Ended December 31, 2025

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

21,278

 

 

$

24,709

 

 

$

26,445

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,812

 

 

 

9,023

 

 

 

8,992

 

Supplies

 

 

3,043

 

 

 

3,689

 

 

 

4,263

 

Other operating expenses

 

 

5,321

 

 

 

6,358

 

 

 

6,962

 

Equity in (earnings) losses of affiliates

 

 

(1

)

 

 

(3

)

 

 

(68

)

 

 

 

16,175

 

 

 

19,067

 

 

 

20,149

 

Adjusted segment EBITDA

 

$

5,103

 

 

$

5,642

 

 

$

6,296

 

 

 

 

For the Year Ended December 31, 2024

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

19,656

 

 

$

23,380

 

 

$

24,668

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,542

 

 

 

8,686

 

 

 

8,599

 

Supplies

 

 

2,812

 

 

 

3,553

 

 

 

4,035

 

Other operating expenses

 

 

4,908

 

 

 

6,206

 

 

 

6,367

 

Equity in (earnings) losses of affiliates

 

 

2

 

 

 

(3

)

 

 

(62

)

 

 

 

15,264

 

 

 

18,442

 

 

 

18,939

 

Adjusted segment EBITDA

 

$

4,392

 

 

$

4,938

 

 

$

5,729

 

 

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

 

 

For the Year Ended December 31, 2023

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

18,105

 

 

$

21,167

 

 

$

22,318

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,196

 

 

 

8,058

 

 

 

8,080

 

Supplies

 

 

2,658

 

 

 

3,331

 

 

 

3,616

 

Other operating expenses

 

 

4,253

 

 

 

5,289

 

 

 

5,473

 

Equity in (earnings) losses of affiliates

 

 

(2

)

 

 

(3

)

 

 

(59

)

 

 

 

14,105

 

 

 

16,675

 

 

 

17,110

 

Adjusted segment EBITDA

 

$

4,000

 

 

$

4,492

 

 

$

5,208

 

 

 

 

For the Year Ended December 31,

 

 

 

2025

 

 

2024

 

 

2023

 

Adjusted segment EBITDA:

 

 

 

 

 

 

 

 

 

National Group

 

$

5,103

 

 

$

4,392

 

 

$

4,000

 

Atlantic Group

 

 

5,642

 

 

 

4,938

 

 

 

4,492

 

American Group

 

 

6,296

 

 

 

5,729

 

 

 

5,208

 

 

 

 

17,041

 

 

 

15,059

 

 

 

13,700

 

Adjustments to reconcile Total Adjusted segment
  EBITDA to consolidated Income before income taxes:

 

 

 

 

 

 

 

 

 

Corporate and Other

 

 

1,475

 

 

 

1,177

 

 

 

974

 

Depreciation and amortization

 

 

3,523

 

 

 

3,312

 

 

 

3,077

 

Interest expense

 

 

2,248

 

 

 

2,061

 

 

 

1,938

 

Losses (gains) on sales of facilities

 

 

(37

)

 

 

(14

)

 

 

5

 

Income before income taxes

 

$

9,832

 

 

$

8,523

 

 

$

7,706

 

 

 

 

For the Year Ended December 31,

 

 

 

2025

 

 

2024

 

 

2023

 

Revenues:

 

 

 

 

 

 

 

 

 

National Group

 

$

21,278

 

 

$

19,656

 

 

$

18,105

 

Atlantic Group

 

 

24,709

 

 

 

23,380

 

 

 

21,167

 

American Group

 

 

26,445

 

 

 

24,668

 

 

 

22,318

 

Corporate and other

 

 

3,168

 

 

 

2,899

 

 

 

3,378

 

 

 

$

75,600

 

 

$

70,603

 

 

$

64,968

 

 

 

 

 

 

 

 

 

 

 

Depreciation and amortization:

 

 

 

 

 

 

 

 

 

National Group

 

$

905

 

 

$

857

 

 

$

834

 

Atlantic Group

 

 

1,122

 

 

 

1,061

 

 

 

989

 

American Group

 

 

1,131

 

 

 

1,083

 

 

 

971

 

Corporate and other

 

 

365

 

 

 

311

 

 

 

283

 

 

 

$

3,523

 

 

$

3,312

 

 

$

3,077

 

 

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

 

 

December 31,

 

 

 

2025

 

 

2024

 

 

2023

 

Assets:

 

 

 

 

 

 

 

 

 

National Group

 

$

13,596

 

 

$

12,855

 

 

$

12,487

 

Atlantic Group

 

 

17,945

 

 

 

17,168

 

 

 

16,098

 

American Group

 

 

21,217

 

 

 

20,714

 

 

 

19,786

 

Corporate and other

 

 

7,962

 

 

 

8,776

 

 

 

7,840

 

 

 

$

60,720

 

 

$

59,513

 

 

$

56,211

 

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

 

Corporate
and Other

 

 

Total

 

Goodwill and other intangible assets:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at December 31, 2022

 

$

1,244

 

 

$

2,057

 

 

$

5,152

 

 

$

1,200

 

 

$

9,653

 

Acquisitions

 

 

—

 

 

 

8

 

 

 

326

 

 

 

28

 

 

 

362

 

Foreign currency translation, amortization and other

 

 

(3

)

 

 

(1

)

 

 

—

 

 

 

(66

)

 

 

(70

)

Balance at December 31, 2023

 

 

1,241

 

 

 

2,064

 

 

 

5,478

 

 

 

1,162

 

 

 

9,945

 

Acquisitions

 

 

—

 

 

 

61

 

 

 

105

 

 

 

4

 

 

 

170

 

Foreign currency translation, amortization and other

 

 

(4

)

 

 

(1

)

 

 

3

 

 

 

(20

)

 

 

(22

)

Balance at December 31, 2024

 

 

1,237

 

 

 

2,124

 

 

 

5,586

 

 

 

1,146

 

 

 

10,093

 

Acquisitions

 

 

21

 

 

 

90

 

 

 

101

 

 

 

6

 

 

 

218

 

Foreign currency translation, amortization and other

 

 

(24

)

 

 

—

 

 

 

1

 

 

 

5

 

 

 

(18

)

Balance at December 31, 2025

 

$

1,234

 

 

$

2,214

 

 

$

5,688

 

 

$

1,157

 

 

$

10,293

 
v3.25.4
Other Comprehensive (Loss) Income (Tables)
 12 Months Ended
Dec. 31, 2025
Equity [Abstract]  
Components of Accumulated Other Comprehensive Loss

The components of accumulated other comprehensive loss are as follows (dollars in millions):

 

 

 

Unrealized
Gains (Losses) on
Available-
for-Sale
Securities

 

 

Foreign
Currency
Translation
Adjustments

 

 

Defined
Benefit
Plans

 

 

Total

 

Balances at December 31, 2022

 

$

(30

)

 

$

(373

)

 

$

(87

)

 

$

(490

)

Unrealized gains on available-for-sale securities, net
   of $2 income taxes

 

 

9

 

 

 

 

 

 

 

 

 

9

 

Foreign currency translation adjustments, net of $7
   income taxes

 

 

 

 

 

34

 

 

 

 

 

 

34

 

Defined benefit plans, net of $6 of income taxes

 

 

 

 

 

 

 

 

21

 

 

 

21

 

Expense (benefit) reclassified into operations from
   other comprehensive income, net of none of income
   taxes and $1 income tax benefit, respectively

 

 

(1

)

 

 

 

 

 

2

 

 

 

1

 

Balances at December 31, 2023

 

 

(22

)

 

 

(339

)

 

 

(64

)

 

 

(425

)

Unrealized gains on available-for-sale securities

 

 

1

 

 

 

 

 

 

 

 

 

1

 

Foreign currency translation adjustments, net of $2
   income tax benefit

 

 

 

 

 

(14

)

 

 

 

 

 

(14

)

Defined benefit plans, net of $15 of income taxes

 

 

 

 

 

 

 

 

50

 

 

 

50

 

Expense reclassified into operations from
   other comprehensive income

 

 

 

 

 

 

 

 

1

 

 

 

1

 

Balances at December 31, 2024

 

 

(21

)

 

 

(353

)

 

 

(13

)

 

 

(387

)

Unrealized gains on available-for-sale securities, net
   of $3 income taxes

 

 

10

 

 

 

 

 

 

 

 

 

10

 

Foreign currency translation adjustments, net of $10
   income taxes

 

 

 

 

 

54

 

 

 

 

 

 

54

 

Defined benefit plans, net of $7 of income taxes

 

 

 

 

 

 

 

 

24

 

 

 

24

 

Benefits reclassified into operations from
   other comprehensive income, net of $2 of income taxes

 

 

 

 

 

 

 

 

(6

)

 

 

(6

)

Balances at December 31, 2025

 

$

(11

)

 

$

(299

)

 

$

5

 

 

$

(305

)
v3.25.4
Accrued Expenses (Tables)
 12 Months Ended
Dec. 31, 2025
Text Block [Abstract]  
Summary of Other Accrued Expenses

A summary of other accrued expenses at December 31 follows (dollars in millions):

 

 

2025

 

 

2024

 

Professional liability risks

 

$

578

 

 

$

587

 

Defined contribution benefit plans

 

 

763

 

 

 

704

 

Right-of-use operating leases

 

 

352

 

 

 

343

 

Taxes other than income

 

 

504

 

 

 

419

 

Interest

 

 

499

 

 

 

502

 

Employee medical benefits

 

 

216

 

 

 

206

 

Other

 

 

1,365

 

 

 

1,138

 

 

 

$

4,277

 

 

$

3,899

 
v3.25.4
Accounting Policies - Additional Information (Detail)
 1 Months Ended 12 Months Ended
Jan. 01, 2026
USD ($)
Nov. 30, 2017
Dec. 31, 2025
USD ($)
Hospital
SurgeryCenter
EndoscopyCenter
State
Claim
Dec. 31, 2024
USD ($)
Claim
Dec. 31, 2023
USD ($)
Summary Of Significant Accounting Policies [Line Items]          
Number of owned and operated hospitals | Hospital     190    
Number of freestanding surgery centers | SurgeryCenter     121    
Number of freestanding endoscopy centers | EndoscopyCenter     31    
Number of facilities locations | State     19    
General and administrative expense     $ 548,000,000 $ 421,000,000 $ 353,000,000
Adjustments to estimated reimbursement filed during respective year     31,000,000 42,000,000 84,000,000
Adjustments to estimated reimbursement filed during previous years     32,000,000 78,000,000 58,000,000
Estimated implicit price concessions recorded as reductions to revenues and accounts receivable     7,674,000,000 7,773,000,000  
Charity care amount     16,499,000,000 15,942,000,000 14,425,000,000
Estimated costs of charity care     $ 1,584,000,000 $ 1,610,000,000 $ 1,515,000,000
Days revenues in accounts receivable     51 days 54 days 53 days
Depreciation expense     $ 3,508,000,000 $ 3,294,000,000 $ 3,052,000,000.000
Goodwill impairments     0 0 0
Goodwill acquired during period     218,000,000 170,000,000  
Intangible assets decreased due to amortization and other adjustments     12,000,000 16,000,000  
Gross carrying amount of intangible assets     274,000,000 274,000,000  
Accumulated amortization of intangible assets     256,000,000 244,000,000  
Gross carrying amount of indefinite-lived intangible assets     293,000,000 293,000,000  
Deferred loan costs     639,000,000 608,000,000  
Deferred loan costs, accumulated amortization     203,000,000 239,000,000  
Amortization of debt issuance costs     44,000,000 35,000,000 35,000,000
Reserves for professional liability risks     2,044,000,000.000 2,131,000,000  
Current portion of professional liability risks reserves     578,000,000 587,000,000  
Provisions for losses related to professional liability risks     $ 651,000,000 $ 627,000,000 $ 619,000,000
Reserves for professional liability risks cover individual claims | Claim     2,360 2,120  
Net payments of professional and general liability claims     $ 702,000,000 $ 600,000,000  
Self-insured retention amount per occurrence     15,000,000    
Maximum amount losses per occurrence     110,000,000    
Reinsurance for professional liability risks retention minimum level of amount per occurrence     25,000,000    
Reinsurance for professional liability risks retention level of amount per occurrence     35,000,000    
Amounts receivable under reinsurance contracts recorded in other assets     38,000,000 35,000,000  
Amounts receivable under reinsurance contracts recorded in other current assets     9,000,000 45,000,000  
Foreign Currency Translation And Other [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Goodwill increase (decrease)     $ 6,000,000 $ 6,000,000  
Subsequent Event [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Maximum amount losses per occurrence $ 120,000,000        
Inpatient Services [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Performance obligations for inpatient/ outpatient services satisfied period     Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges    
Maximum [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Percentage of income of federal poverty level eligible for charity care   400.00%      
Finite lived intangible asset useful life     10 years    
Maximum [Member] | Outpatient Services [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Performance obligations for inpatient/ outpatient services satisfied period     Our performance obligations for outpatient services are generally satisfied over a period of less than one day    
Maximum [Member] | Building and Improvements [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Estimated useful lives in years     40 years    
Maximum [Member] | Equipment [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Estimated useful lives in years     10 years    
Minimum [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Finite lived intangible asset useful life     3 years    
Minimum [Member] | Building and Improvements [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Estimated useful lives in years     10 years    
Minimum [Member] | Equipment [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Estimated useful lives in years     4 years    
v3.25.4
Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Revenues From Third Party Payers [Line Items]      
Revenues $ 75,600 $ 70,603 $ 64,968
Revenues ratio from third party payers 100.00% 100.00% 100.00%
Medicare [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 11,273 $ 10,780 $ 10,585
Revenues from third party payers, Ratio 15.30% 14.90% 16.30%
Managed Medicare [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 13,435 $ 11,987 $ 10,496
Revenues from third party payers, Ratio 17.00% 17.80% 16.20%
Medicaid [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 5,909 $ 4,678 $ 3,606
Revenues from third party payers, Ratio 6.60% 7.80% 5.60%
Managed Medicaid [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 3,693 $ 3,980 $ 3,879
Revenues from third party payers, Ratio 5.60% 4.90% 6.00%
Managed Care and Other Insurers [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 36,968 $ 34,954 $ 31,819
Revenues from third party payers, Ratio 49.50% 48.90% 49.00%
International (Managed Care and Other Insurers) [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 1,864 $ 1,682 $ 1,509
Revenues from third party payers, Ratio 2.40% 2.50% 2.30%
Other [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues $ 2,458 $ 2,542 $ 3,074
Other, Ratio 3.60% 3.20% 4.60%
v3.25.4
Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Accounting Policies [Abstract]      
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 63,635 $ 60,056 $ 55,341
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) 9.60% 10.10% 10.50%
Total uncompensated care $ 47,966 $ 43,231 $ 35,426
Multiply by the cost-to-charges ratio 9.60% 10.10% 10.50%
Estimated cost of total uncompensated care $ 4,605 $ 4,366 $ 3,720
v3.25.4
Share-Based Compensation - Additional Information (Detail) - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Employee Stock Purchase Plan ("ESPP") [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Common stock were reserved for issuance 9,119,000    
Compensation expense $ 19 $ 18 $ 17
2020 Stock Incentive Plan      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Increase in number of shares available for issuance 13,150,000    
Stock Appreciation Rights (SARs)      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Shares Available for Future Grants 18,794,000    
Weighted Average Fair Value of SARs Options Granted $ 114.39 $ 102.65 $ 87.47
Total Intrinsic Value of SARs $ 226 $ 257 $ 207
Unrecognized Compensation Cost Related to Nonvested Awards 47    
Restricted Stock Units and Performance Stock Units [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
RSUs and PSUs, Vested, value 238 $ 539 $ 550
Unrecognized Compensation Cost Related to Nonvested Awards $ 387    
v3.25.4
Share-Based Compensation - Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models (Detail)
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]      
Risk-free interest rate 4.33% 3.94% 3.69%
Expected volatility 33.00% 33.00% 36.00%
Expected life, in years 5 years 3 months 10 days 5 years 2 months 23 days 5 years 1 month 20 days
Expected dividend yield 0.88% 0.87% 0.95%
v3.25.4
Share-Based Compensation - Schedule of Stock Appreciation Rights Activity (Detail) - USD ($)
$ / shares in Units, shares in Thousands, $ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options outstanding, Weighted Average Exercise Price, Beginning Balance $ 170.31 $ 146.46 $ 126.38
Granted, Weighted Average Exercise Price 329.8 305.44 253.49
Exercised, Weighted Average Exercise Price 125.1 111.02 95.29
Cancelled, Weighted Average Exercise Price 308.57 246.78 202.05
SARs Options outstanding, Weighted Average Exercise Price, Ending Balance 194.62 $ 170.31 $ 146.46
SARs Options exercisable, Weighted Average Exercise Price $ 158.2    
SARs Options outstanding, Weighted Average Remaining Contractual Term 5 years 1 month 6 days    
SARs Options exercisable, Weighted Average Remaining Contractual Term 4 years    
SARs Options outstanding, Aggregate Intrinsic Value $ 1,118    
SARs Options exercisable, Aggregate Intrinsic Value $ 930    
Time SARs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options Outstanding, Beginning Balance 4,587 5,325 5,960
Granted, SARs Options 418 491 580
Exercised, SARs Options (859) (1,128) (1,156)
Cancelled, SARs Options (40) (101) (59)
SARs Options Outstanding, Ending Balance 4,106 4,587 5,325
SARs Options Exercisable, Ending Balance 3,012    
Performance SARs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options Outstanding, Beginning Balance 0 44 127
Granted, SARs Options 0 0 0
Exercised, SARs Options 0 (44) (83)
Cancelled, SARs Options 0 0 0
SARs Options Outstanding, Ending Balance 0 0 44
SARs Options Exercisable, Ending Balance 0    
Total SARs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options Outstanding, Beginning Balance 4,587 5,369 6,087
Granted, SARs Options 418 491 580
Exercised, SARs Options (859) (1,172) (1,239)
Cancelled, SARs Options (40) (101) (59)
SARs Options Outstanding, Ending Balance 4,106 4,587 5,369
SARs Options Exercisable, Ending Balance 3,012    
v3.25.4
Share-Based Compensation - Schedule of Restricted Stock Units Activity (Detail) - $ / shares
shares in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Restricted Stock Units (RSUs) [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
RSUs and PSUs Outstanding, Beginning Balance 1,356 1,551 1,784
RSUs and PSUs, Granted 492 582 609
Performance adjustment 0 0 0
RSUs and PSUs, Vested (526) (639) (717)
RSUs and PSUs, Cancelled (94) (138) (125)
RSUs and PSUs Outstanding, Ending Balance 1,228 1,356 1,551
Performance Shares PSUs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
RSUs and PSUs Outstanding, Beginning Balance 1,175 1,410 1,715
RSUs and PSUs, Granted 367 434 479
Performance adjustment (175) 566 697
RSUs and PSUs, Vested (191) (1,132) (1,393)
RSUs and PSUs, Cancelled (71) (103) (88)
RSUs and PSUs Outstanding, Ending Balance 1,105 1,175 1,410
Restricted Stock Units and Performance Stock Units [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
RSUs and PSUs Outstanding, Beginning Balance 2,531 2,961 3,499
RSUs and PSUs, Granted 859 1,016 1,088
Performance adjustment (175) 566 697
RSUs and PSUs, Vested (717) (1,771) (2,110)
RSUs and PSUs, Cancelled (165) (241) (213)
RSUs and PSUs Outstanding, Ending Balance 2,333 2,531 2,961
Weighted Average Grant Date Fair Value, RSUs and PSUs, Beginning balance $ 260.95 $ 214.71 $ 179.18
Weighted Average Grant Date Fair Value, RSUs and PSUs, Granted 330.72 305.97 253.85
Performance adjustment 235.81 174.55 144.42
Weighted Average Grant Date Fair Value, RSUs and PSUs, Vested 237.46 181.81 152.5
Weighted Average Grant Date Fair Value, RSUs and PSUs, Cancelled 298.81 260.96 217.78
Weighted Average Grant Date Fair Value, RSUs and PSUs, Ending balance $ 293.03 $ 260.95 $ 214.71
v3.25.4
Acquisitions and Dispositions - Additional Information (Detail)
$ in Millions
 12 Months Ended
Dec. 31, 2025
USD ($)
Hospital
Dec. 31, 2024
USD ($)
Hospital
Dec. 31, 2023
USD ($)
Hospital
Business Acquisition [Line Items]      
Pretax gain (loss) before tax     $ (5)
Proceeds from sale of business $ 269 $ 328 193
Real Estate and Other Investments [Member]      
Business Acquisition [Line Items]      
Pretax gain (loss) before tax (4) (5)  
Gain (loss) after tax $ (3) $ (4)  
Discontinued Operation, Gain (Loss) on Disposal, Statement of Income or Comprehensive Income [Extensible Enumeration] Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property  
Proceeds from sale of business $ 39 $ 33 31
Hospital Facility [Member]      
Business Acquisition [Line Items]      
Aggregate purchase price $ 189 $ 112 $ 229
Number of hospitals purchased | Hospital 2 3 4
Pretax gain (loss) before tax $ 41 $ 189  
Gain (loss) after tax $ 31 $ 145  
Discontinued Operation, Gain (Loss) on Disposal, Statement of Income or Comprehensive Income [Extensible Enumeration] Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property  
Proceeds from sale of business $ 230 $ 295 $ 162
Number of hospitals sold | Hospital 2 1 2
Hospital Facility [Member] | CALIFORNIA      
Business Acquisition [Line Items]      
Pretax gain (loss) before tax   $ (170)  
Gain (loss) after tax   $ (130)  
Discontinued Operation, Gain (Loss) on Disposal, Statement of Income or Comprehensive Income [Extensible Enumeration]   Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property  
Nonhospital Health Care [Member]      
Business Acquisition [Line Items]      
Aggregate purchase price $ 208 $ 154 $ 406
Other [Member]      
Business Acquisition [Line Items]      
Goodwill $ 218 $ 170 $ 362
v3.25.4
Income Taxes - Schedule of Pretax Income including Income Attributable to Noncontrolling Interests (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Income Tax Contingency [Line Items]      
Income before income taxes $ 9,832 $ 8,523 $ 7,706
Domestic [Member]      
Income Tax Contingency [Line Items]      
Income before income taxes 9,720 8,444 7,621
Foreign [Member]      
Income Tax Contingency [Line Items]      
Income before income taxes $ 112 $ 79 $ 85
v3.25.4
Income Taxes - Schedule of Income Taxes Paid (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Income Tax Contingency [Line Items]      
Income taxes paid $ 1,740 $ 1,844 $ 1,386
Federal [Member]      
Income Tax Contingency [Line Items]      
Income taxes paid 1,466 1,625 1,187
Florida [Member]      
Income Tax Contingency [Line Items]      
Income taxes paid 98 72 85
All Other [Member]      
Income Tax Contingency [Line Items]      
Income taxes paid 157 134 105
Foreign [Member]      
Income Tax Contingency [Line Items]      
Income taxes paid $ 19 $ 13 $ 9
v3.25.4
Income Taxes - Schedule of Provision for Income Taxes (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Income Tax Disclosure [Abstract]      
Current, Federal $ 1,551 $ 1,202 $ 1,118
Current, State 248 212 213
Current, Foreign 13 20 3
Deferred, Federal 201 394 241
Deferred, State 31 31 21
Deferred, Foreign 6 7 19
Provision for income taxes $ 2,050 $ 1,866 $ 1,615
v3.25.4
Income Taxes - Additional Information (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Income Tax Contingency [Line Items]      
Provision for tax benefits related to settlement of employee awards $ 61 $ 102 $ 93
Income taxes interest and penalty expense 27 61 $ 36
Increase in tax provision, due to internal restructuring of certain affiliates   276  
State net operating loss carryforwards 24    
Unrecognized tax benefits, accrued interest 78 115  
Unrecognized tax benefits that would impact effective tax rate $ 274 295  
Reduced Tax Provision   254  
Income tax examination interest expense net of tax   118  
Tax cuts and jobs act of 2017 income tax examination change in tax rate   181  
Tax cuts and jobs act of 2017 income tax examination interest expense net of tax   $ 47  
State and Local Jurisdiction [Member] | Minimum [Member]      
Income Tax Contingency [Line Items]      
Net operating loss carryforwards, expiration date 2026    
State and Local Jurisdiction [Member] | Maximum [Member]      
Income Tax Contingency [Line Items]      
Net operating loss carryforwards, expiration date 2044    
Domestic [Member]      
Income Tax Contingency [Line Items]      
Open tax year 2024 2025    
v3.25.4
Income Taxes - Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Income Tax Disclosure [Abstract]      
U.S. federal statutory tax rate $ 2,065 $ 1,790 $ 1,618
State and local taxes, net of federal income tax effect [1] 228 206 179
Foreign tax effects (4) 10 4
Noncontrolling interest (210) (188) (178)
Share-based payment awards (55) (91) (84)
Other nontaxable or nondeductible items 41 50 43
Changes in unrecognized tax benefits (18) (177) 33
Internal restructuring of affiliates 0 265 0
Other adjustments, net 3 1 0
Provision for income taxes $ 2,050 $ 1,866 $ 1,615
U.S. federal statutory tax rate 21.00% 21.00% 21.00%
State and local taxes, net of federal income tax effect [1] 2.30% 2.40% 2.30%
Foreign tax effects 0.00% 0.10% 0.10%
Noncontrolling interest (2.10%) (2.20%) (2.30%)
Share-based payment awards (0.60%) (1.10%) (1.10%)
Other nontaxable or nondeductible items 0.50% 0.60% 0.60%
Changes in unrecognized tax benefits (0.20%) (2.10%) 0.40%
Internal restructuring of affiliates 0.00% 3.20% 0.00%
Other adjustments, net 0.00% 0.00% 0.00%
Effective tax rate on income before income taxes 20.90% 21.90% 21.00%
[1] State taxes in Florida and Texas made up the majority (greater than 50%) of the tax effect in this category.
v3.25.4
Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) - USD ($)
$ in Millions
Dec. 31, 2025
Dec. 31, 2024
Income Tax Disclosure [Abstract]    
Depreciation and fixed asset basis differences, Assets $ 0 $ 0
Allowances for professional liability and other risks, Assets 440 395
Accounts receivable, Assets 427 418
Compensation, Assets 322 285
Right-of-use lease obligations 476 478
Other, Assets 268 297
Deferred tax assets 1,933 1,873
Depreciation and fixed asset basis differences, Liabilities 1,357 1,139
Allowances for professional liability and other risks, Liabilities 0 0
Accounts receivable, Liabilities 0 0
Compensation, Liabilities 0 0
Right-of-use lease assets and obligations 459 462
Other, Liabilities 1,036 932
Deferred tax liabilities $ 2,852 $ 2,533
v3.25.4
Income Taxes - Schedule of Activity Related to Unrecognized Tax Benefits (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Income Tax Disclosure [Abstract]    
Beginning Balance $ 504 $ 639
Additions based on tax positions related to the current year 21 40
Additions for tax positions of prior years 25 63
Reductions for tax positions of prior years (3) (206)
Settlements (1) (17)
Lapse of applicable statutes of limitations (27) (15)
Ending Balance $ 519 $ 504
v3.25.4
Earnings Per Share - Additional information (Detail) - shares
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Earnings Per Share [Abstract]      
Repurchase of common stock, shares 26,739,000 17,798,000 14,465,000
v3.25.4
Earnings Per Share - Schedule of Computations of Basic and Diluted Earnings Per Share (Detail) - USD ($)
$ / shares in Units, shares in Thousands, $ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Earnings Per Share [Abstract]      
Net income attributable to HCA Healthcare, Inc. $ 6,784 $ 5,760 $ 5,242
Weighted average common shares outstanding 236,413 258,603 272,404
Effect of dilutive incremental shares 3,082 3,203 4,008
Shares used for diluted earnings per share 239,495 261,806 276,412
Basic earnings per share $ 28.7 $ 22.27 $ 19.25
Diluted earnings per share $ 28.33 $ 22 $ 18.97
v3.25.4
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($)
$ in Millions
Dec. 31, 2025
Dec. 31, 2024
Debt Securities, Available-for-sale [Line Items]    
Amounts classified as current assets $ (103) $ (88)
Investment carrying value 485 569
Money market funds and other, Amortized Cost 260 296
Money market funds and other, Unrealized Gains 0 0
Money market funds and other, Unrealized Losses 0 0
Money market funds and other, Fair Value 260 296
Investment Owned, at Cost, Total 602 684
Investment Gains 1 0
Investment Losses (15) (27)
Investment Fiar Value 588 657
Debt Securities [Member]    
Debt Securities, Available-for-sale [Line Items]    
Amortized Cost 342 388
Unrealized Amounts, Gains 1 0
Unrealized Amounts, Losses (15) (27)
Fair Value $ 328 $ 361
v3.25.4
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail)
$ in Millions
Dec. 31, 2025
USD ($)
Investments, Debt and Equity Securities [Abstract]  
Due in one year or less, Amortized Cost $ 29
Due after one year through five years, Amortized Cost 145
Due after five years through ten years, Amortized Cost 111
Due after ten years, Amortized Cost 57
Amortized Cost, Total 342
Due in one year or less, Fair Value 29
Due after one year through five years, Fair Value 140
Due after five years through ten years, Fair Value 104
Due after ten years, Fair Value 55
Fair Value, Total $ 328
v3.25.4
Investments of Insurance Subsidiaries - Additional Information (Detail)
 12 Months Ended
Dec. 31, 2025
Investments, Debt and Equity Securities [Abstract]  
Available for sale securities expected maturity of debt securities 3 years 8 months 12 days
Available for sale securities average scheduled maturity 7 years 9 months 18 days
v3.25.4
Assets and Liabilities Measured at Fair Value - Summary of Investments of Insurance Subsidiaries Measured at Fair Value on Recurring Basis (Detail) - USD ($)
$ in Millions
Dec. 31, 2025
Dec. 31, 2024
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Money market funds and other $ 260 $ 296
Investments of insurance subsidiaries 588 657
Less amounts classified as current assets (103) (88)
Asset fair value 485 569
Quoted Prices in Active Markets for Identical Assets (Level 1) [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Money market funds and other 260 296
Investments of insurance subsidiaries 261 296
Less amounts classified as current assets (103) (88)
Asset fair value 158 208
Significant Other Observable Inputs (Level 2) [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Investments of insurance subsidiaries 327 361
Asset fair value 327 361
Debt Securities [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Debt securities 328 361
Debt Securities [Member] | Quoted Prices in Active Markets for Identical Assets (Level 1) [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Debt securities 1  
Debt Securities [Member] | Significant Other Observable Inputs (Level 2) [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Debt securities $ 327 $ 361
v3.25.4
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($)
$ in Millions
Dec. 31, 2025
Dec. 31, 2024
Fair Value Disclosures [Abstract]    
Estimated fair value of long-term debt $ 45,911 $ 40,845
Carrying amounts of long-term debt $ 46,928 $ 43,400
v3.25.4
Debt - Schedule of Debt (Detail) - USD ($)
$ in Millions
Dec. 31, 2025
Dec. 31, 2024
Debt Instrument [Line Items]    
Debt issuance costs and discounts $ (436) $ (369)
Total long-term debt (average life of 11.9 years, rates averaging 5.1%) 44,285 43,031
Total debt 46,492 43,031
Less amounts due within one year 4,889 4,698
Long-term debt 41,603 38,333
Commercial Paper [Member]    
Debt Instrument [Line Items]    
Short-term borrowings 2,207 0
Senior Secured Term Loan Facility [Member]    
Debt Instrument [Line Items]    
Senior secured debt 0 1,238
Other Senior Secured Debt [Member]    
Debt Instrument [Line Items]    
Other senior secured debt 1,021 1,046
Senior Unsecured Credit Facilities [Member]    
Debt Instrument [Line Items]    
Senior unsecured debt 0 0
Senior Unsecured Notes Payable Through 2095 [Member]    
Debt Instrument [Line Items]    
Senior unsecured debt $ 43,700 $ 41,116
v3.25.4
Debt - Schedule of Debt (Parenthetical) (Detail)
 12 Months Ended
Dec. 31, 2025
Debt Instrument [Line Items]  
Total debt average term 11 years 10 months 24 days
Total debt average rate 5.10%
Other Senior Secured Debt [Member]  
Debt Instrument [Line Items]  
Effective interest rate 4.60%
Senior Unsecured Notes Payable Through 2095 [Member]  
Debt Instrument [Line Items]  
Payable year 2095
Effective interest rate 5.10%
Commercial Paper [Member]  
Debt Instrument [Line Items]  
Short term debt average term 18 days
Weighted average rate 4.30%
v3.25.4
Debt - Additional Information (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Debt Instrument [Line Items]      
Repayments of debt $ 7,389 $ 2,410 $ 909
Maturity of long-term debt in 2027 2,547    
Maturity of long-term debt in 2028 3,645    
Maturity of long-term debt in 2029 3,577    
Maturity of long-term debt in 2030 $ 4,021    
Minimum [Member]      
Debt Instrument [Line Items]      
Debt instrument, maturities range 2027    
Maximum [Member]      
Debt Instrument [Line Items]      
Debt instrument, maturities range 2030    
Senior Unsecured Note Maturities Ranging 2026 to 2064 [Member] | Minimum [Member]      
Debt Instrument [Line Items]      
Debt instrument, maturities range 2026    
Senior Unsecured Note Maturities Ranging 2026 to 2064 [Member] | Maximum [Member]      
Debt Instrument [Line Items]      
Debt instrument, maturities range 2064    
Debentures Maturities Ranging 2027 to 2095 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 450    
Debentures Maturities Ranging 2027 to 2095 [Member] | Minimum [Member]      
Debt Instrument [Line Items]      
Debt instrument, maturities range 2027    
Debentures Maturities Ranging 2027 to 2095 [Member] | Maximum [Member]      
Debt Instrument [Line Items]      
Debt instrument, maturities range 2095    
5.375% Senior Notes [Member]      
Debt Instrument [Line Items]      
Debt instrument, stated interest 5.375%    
Repayments of debt $ 2,600    
5.25% Senior Notes [Member]      
Debt Instrument [Line Items]      
Debt instrument, stated interest 5.25%    
Repayments of debt $ 1,400    
7.69% Senior Notes [Member]      
Debt Instrument [Line Items]      
Debt instrument, stated interest 7.69%    
Repayments of debt $ 291    
7.58% Medium Term Notes [Member]      
Debt Instrument [Line Items]      
Debt instrument, stated interest 7.58%    
Repayments of debt $ 125    
5.875% Senior Notes Due 2026 [Member]      
Debt Instrument [Line Items]      
Debt instrument, redeemed amount $ 1,500    
Debt instrument, percentage of principal amount redeemed 5.875%    
Commercial Paper [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 4,000    
Short-term borrowings $ 2,207 0  
Commercial Paper [Member] | Maximum [Member]      
Debt Instrument [Line Items]      
Debt maturities, term 397 days    
Senior Notes [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 5,250    
Senior Notes [Member] | Senior Secured Notes Due 2030 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 750    
Debt instrument, stated interest 5.25%    
Senior Notes [Member] | Senior Secured Notes Due 2032 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 750    
Debt instrument, stated interest 5.50%    
Senior Notes [Member] | Senior Secured Notes Due 2035 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 1,500    
Debt instrument, stated interest 5.75%    
Senior Notes [Member] | Senior Secured Notes Due 2055 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 1,250    
Debt instrument, stated interest 6.20%    
Senior Notes [Member] | Senior Unsecured Note Maturities Ranging 2026 to 2064 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 43,250    
Senior Notes [Member] | Senior Notes Due 2028 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 700    
Debt instrument, stated interest 5.00%    
Floating Rate Senior Notes [Member] | Senior Notes Due 2028 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 300    
Senior Unsecured Revolving Credit Facility [Member]      
Debt Instrument [Line Items]      
Senior unsecured $ 8,000    
Senior unsecured revolving credit commitments term 5 years    
Total committed capacity of senior unsecured credit facility $ 8,000    
Borrowings outstanding $ 0    
Basis spread on variable interest rate (as percent) 1.125%    
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration] us-gaap:SecuredOvernightFinancingRateSofrMember    
Credit spread adjustment 0.10%    
Investment, Variable Interest Rate, Type [Extensible Enumeration] us-gaap:SecuredOvernightFinancingRateSofrMember    
Senior Secured Asset-Based Revolving Credit Facility [Member]      
Debt Instrument [Line Items]      
Repayments of debt $ 4,500    
Senior Secured Revolving Credit Facility [Member]      
Debt Instrument [Line Items]      
Repayments of debt 3,500    
Senior Secured Term Loan Facilities [Member]      
Debt Instrument [Line Items]      
Repayments of debt 1,238    
Other Senior Secured Debt [Member]      
Debt Instrument [Line Items]      
Finance leases and other secured debt 1,021    
Senior Unsecured Notes [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount 3,250    
Senior unsecured 43,700 $ 41,116  
Senior Unsecured Notes [Member] | Senior Secured Notes Due 2030 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 500    
Debt instrument, stated interest 4.30%    
Senior Unsecured Notes [Member] | Senior Secured Notes Due 2032 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 1,000    
Debt instrument, stated interest 4.60%    
Senior Unsecured Notes [Member] | Senior Secured Notes Due 2035 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 1,000    
Debt instrument, stated interest 4.90%    
Senior Unsecured Notes [Member] | Senior Secured Notes Due 2055 [Member]      
Debt Instrument [Line Items]      
Debt instrument, principal amount $ 750    
Debt instrument, stated interest 5.70%    
v3.25.4
Leases - Schedule Of Lease-Related Assets And Liabilities (Detail) - USD ($)
$ in Millions
Dec. 31, 2025
Dec. 31, 2024
Assets:    
Operating leases $ 2,130 $ 2,131
Finance leases 607 646
Total lease assets $ 2,737 $ 2,777
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration] Property, Plant and Equipment, Net Property, Plant and Equipment, Net
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration] Operating leases Operating leases
Liabilities    
Operating leases $ 352 $ 343
Finance leases 133 162
Right-of-use operating lease obligations 1,853 1,863
Finance leases 625 624
Total lease liabilities $ 2,963 $ 2,992
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration] Short-term borrowings and long-term debt due within one year Short-term borrowings and long-term debt due within one year
Operating Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration] Other Accrued Liabilities, Current Other Accrued Liabilities, Current
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration] Long-Term Debt, Excluding Current Maturities Long-Term Debt, Excluding Current Maturities
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration] Right-of-use operating lease obligations Right-of-use operating lease obligations
Weighted-average remaining term:    
Operating leases 11 years 4 months 24 days 11 years 3 months 18 days
Finance leases 11 years 1 month 6 days 10 years 6 months
Weighted-average discount rate:    
Operating leases 5.30% 5.10%
Finance leases 5.60% 5.30%
v3.25.4
Leases - Schedule Of Lease Expense For Finance And Operating Leases (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Finance lease expense:      
Depreciation and amortization $ 182 $ 159 $ 164
Interest 41 37 31
Operating leases [1] 516 503 495
Short-term lease expense [1] 317 365 337
Variable lease expense [1] 197 181 162
Total lease expense $ 1,253 $ 1,245 $ 1,189
[1] Expenses are included in “other operating expenses” in our consolidated income statements.
v3.25.4
Leases - Schedule Of Supplemental Cash Flow Information (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Cash Paid For Amounts Included In Measurement Of Lease Liabilities [Abstract]      
Operating cash flows for operating leases $ 501 $ 490 $ 479
Operating cash flows for finance leases 41 37 31
Financing cash flows for finance leases $ 173 $ 172 $ 140
v3.25.4
Leases - Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities (Detail) - USD ($)
$ in Millions
Dec. 31, 2025
Dec. 31, 2024
Operating Lease Liabilities, Payments Due [Abstract]    
Year 1 $ 474 $ 455
Year 2 413 405
Year 3 343 344
Year 4 276 281
Year 5 214 221
Thereafter 1,499 1,460
Total minimum lease payments 3,219 3,166
Less: amount of lease payments representing interest (1,014) (960)
Present value of future minimum lease payments 2,205 2,206
Less: current obligations under leases (352) (343)
Long-term lease obligations 1,853 1,863
Finance Lease Liabilities, Payments, Due [Abstract]    
Year 1 173 197
Year 2 126 146
Year 3 100 99
Year 4 85 81
Year 5 62 71
Thereafter 532 497
Total minimum lease payments 1,078 1,091
Less: amount of lease payments representing interest (320) (305)
Present value of future minimum lease payments 758 786
Less: current obligations under leases (133) (162)
Long-term lease obligations $ 625 $ 624
v3.25.4
Capital Stock - Additional Information (Detail)
$ / shares in Units, $ in Millions
 12 Months Ended
Feb. 06, 2026
shares
Dec. 31, 2025
USD ($)
$ / shares
Directors
shares
Dec. 31, 2024
$ / shares
shares
Dec. 31, 2023
$ / shares
shares
Jan. 31, 2026
USD ($)
Jan. 31, 2025
USD ($)
Jan. 31, 2024
USD ($)
Jan. 31, 2023
USD ($)
Jan. 31, 2022
USD ($)
Capital Structure [Line Items]                  
Common stock, shares authorized   1,800,000,000 1,800,000,000            
Common stock, shares outstanding   224,605,100 249,981,400            
Repurchase of common stock, shares   26,739,000 17,798,000 14,465,000          
Repurchase price of common stock, per share | $ / shares   $ 374.54 $ 337.74 $ 263.47          
Board of Directors Chairman [Member]                  
Capital Structure [Line Items]                  
Share repurchase program authorized amount | $   $ 750       $ 10,000 $ 6,000 $ 3,000 $ 8,000
Frisco, Inc [Member] | Subsequent Event [Member]                  
Capital Structure [Line Items]                  
Common stock, shares outstanding 72,047                
Frisco, Inc [Member] | Subsequent Event [Member] | Common Stock [Member]                  
Capital Structure [Line Items]                  
Number of shares exchanged 36,629,188                
New shares of common stock 36,557,141                
Minimum [Member]                  
Capital Structure [Line Items]                  
Number of directors as per the amended and restated by-laws | Directors   3              
Maximum [Member] | Subsequent Event [Member] | Board of Directors Chairman [Member]                  
Capital Structure [Line Items]                  
Share repurchase program authorized amount | $         $ 10,000        
v3.25.4
Employee Benefit Plans - Additional Information (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Defined Contribution Benefit Plans [Member]      
Pension Plans, Postretirement and Other Employee Benefits [Line Items]      
Percentage of employer contribution to match participant contribution in defined contribution plan, net 100.00%    
Benefits expense of defined benefit plans $ 744 $ 689 $ 659
Defined benefit plan cost (credit) (7) (6) 2
Defined benefit plan, projected benefit obligation in excess of plan assets $ 165 118  
Defined Contribution Benefit Plans [Member] | Minimum [Member]      
Pension Plans, Postretirement and Other Employee Benefits [Line Items]      
Percentage of employer contribution to match participant contribution in defined contribution plan 3.00%    
Defined Contribution Benefit Plans [Member] | Maximum [Member]      
Pension Plans, Postretirement and Other Employee Benefits [Line Items]      
Percentage of employer contribution to match participant contribution in defined contribution plan 9.00%    
Restoration Plan [Member]      
Pension Plans, Postretirement and Other Employee Benefits [Line Items]      
Number of hours of service required to qualify for the plan 1,000 or more    
Noncontributory and nonqualified plan, benefit expense (credit) $ 40 31 40
Noncontributory and nonqualified plan, accrued benefits liabilities 237 229  
Supplemental Executive Retirement Plan [Member]      
Pension Plans, Postretirement and Other Employee Benefits [Line Items]      
Defined benefit plan cost (credit) 8 7 $ 10
Defined benefit plan obligation $ 126 $ 109  
v3.25.4
Segment and Geographic Information - Additional Information (Detail)
 12 Months Ended
Dec. 31, 2025
Hospital
Segment Reporting Information [Line Items]  
Number of geographically organized groups 3
Number of owned and operated hospitals 190
Reorganization Group [Member] | National Group [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 53
Reorganization Group [Member] | American Group [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 66
Reorganization Group [Member] | Atlantic Group [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 63
Reorganization Group [Member] | Corporate and Other [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 8
v3.25.4
Segment and Geographic Information - Schedule Of Geographic Distributions Of Revenues, Salaries And Benefits, Supplies, Other Operating Expenses, Equity In Earnings Of Affiliates, Adjusted Segment EBITDA, Depreciation And Amortization, Assets And Goodwill And Other Intangible Assets (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Segment Reporting Information [Line Items]      
Revenues $ 75,600 $ 70,603 $ 64,968
Salaries and benefits 32,859 31,170 29,487
Supplies 11,367 10,755 9,902
Other operating expenses 15,886 14,819 12,875
Equity in (earnings) losses of affiliates (78) (23) (22)
Depreciation and amortization 3,523 3,312 3,077
Interest expense 2,248 2,061 1,938
Losses (gains) on sales of facilities (37) (14) 5
Income before income taxes 9,832 8,523 7,706
Assets 60,720 59,513 56,211
Goodwill and other intangible assets, Beginning Balance 10,093 9,945 9,653
Goodwill and other intangible assets, Acquisitions 218 170 362
Foreign Currency Translation Amortization And Other (18) (22) (70)
Goodwill and other intangible assets, Ending Balance 10,293 10,093 9,945
Operating Segments [Member]      
Segment Reporting Information [Line Items]      
Adjusted segment EBITDA 17,041 15,059 13,700
Eliminations and Reconciling Items [Member]      
Segment Reporting Information [Line Items]      
Corporate and Other 1,475 1,177 974
Depreciation and amortization 3,523 3,312 3,077
Interest expense 2,248 2,061 1,938
Losses (gains) on sales of facilities (37) (14) 5
Income before income taxes 9,832 8,523 7,706
National Group [Member]      
Segment Reporting Information [Line Items]      
Goodwill and other intangible assets, Beginning Balance 1,237 1,241 1,244
Goodwill and other intangible assets, Acquisitions 21 0 0
Foreign Currency Translation Amortization And Other (24) (4) (3)
Goodwill and other intangible assets, Ending Balance 1,234 1,237 1,241
National Group [Member] | Operating Segments [Member]      
Segment Reporting Information [Line Items]      
Revenues 21,278 19,656 18,105
Salaries and benefits 7,812 7,542 7,196
Supplies 3,043 2,812 2,658
Other operating expenses 5,321 4,908 4,253
Equity in (earnings) losses of affiliates (1) 2 (2)
Operating expenses 16,175 15,264 14,105
Adjusted segment EBITDA 5,103 4,392 4,000
Depreciation and amortization 905 857 834
Assets 13,596 12,855 12,487
Atlantic Group [Member]      
Segment Reporting Information [Line Items]      
Goodwill and other intangible assets, Beginning Balance 2,124 2,064 2,057
Goodwill and other intangible assets, Acquisitions 90 61 8
Foreign Currency Translation Amortization And Other 0 (1) (1)
Goodwill and other intangible assets, Ending Balance 2,214 2,124 2,064
Atlantic Group [Member] | Operating Segments [Member]      
Segment Reporting Information [Line Items]      
Revenues 24,709 23,380 21,167
Salaries and benefits 9,023 8,686 8,058
Supplies 3,689 3,553 3,331
Other operating expenses 6,358 6,206 5,289
Equity in (earnings) losses of affiliates (3) (3) (3)
Operating expenses 19,067 18,442 16,675
Adjusted segment EBITDA 5,642 4,938 4,492
Depreciation and amortization 1,122 1,061 989
Assets 17,945 17,168 16,098
American Group [Member]      
Segment Reporting Information [Line Items]      
Goodwill and other intangible assets, Beginning Balance 5,586 5,478 5,152
Goodwill and other intangible assets, Acquisitions 101 105 326
Foreign Currency Translation Amortization And Other 1 3 0
Goodwill and other intangible assets, Ending Balance 5,688 5,586 5,478
American Group [Member] | Operating Segments [Member]      
Segment Reporting Information [Line Items]      
Revenues 26,445 24,668 22,318
Salaries and benefits 8,992 8,599 8,080
Supplies 4,263 4,035 3,616
Other operating expenses 6,962 6,367 5,473
Equity in (earnings) losses of affiliates (68) (62) (59)
Operating expenses 20,149 18,939 17,110
Adjusted segment EBITDA 6,296 5,729 5,208
Depreciation and amortization 1,131 1,083 971
Assets 21,217 20,714 19,786
Corporate and Other [Member]      
Segment Reporting Information [Line Items]      
Revenues 3,168 2,899 3,378
Depreciation and amortization 365 311 283
Assets 7,962 8,776 7,840
Goodwill and other intangible assets, Beginning Balance 1,146 1,162 1,200
Goodwill and other intangible assets, Acquisitions 6 4 28
Foreign Currency Translation Amortization And Other 5 (20) (66)
Goodwill and other intangible assets, Ending Balance $ 1,157 $ 1,146 $ 1,162
v3.25.4
Other Comprehensive (Loss) Income - Components of Accumulated Other Comprehensive Loss (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Equity [Abstract]      
Unrealized gains on available-for-sale securities, beginning balances $ (21) $ (22) $ (30)
Unrealized gains on available-for-sale securities, net of income taxes 10 1 9
Unrealized gains on available-for-sale securities, expense (benefit) reclassified into operations from other comprehensive income, net of income tax benefit     (1)
Unrealized gains on available-for-sale securities, ending balances (11) (21) (22)
Foreign currency translation adjustments, beginning balances (353) (339) (373)
Foreign currency translation adjustments, net of income tax benefit 54 (14) 34
Foreign currency translation adjustments, ending balances (299) (353) (339)
Defined benefit plans, beginning balances (13) (64) (87)
Defined benefit plans, net of income taxes 24 50 21
Defined benefit plans, expense (benefit) reclassified into operations from other comprehensive income (6) 1 2
Defined benefit plans, ending balances 5 (13) (64)
Accumulated other comprehensive loss, net of tax, beginning balances (387) (425) (490)
Unrealized gains on available-for-sale securities, net of income taxes 10 1 9
Foreign currency translation adjustments, net of income tax benefit 54 (14) 34
Defined benefit plans, net of income tax benefit 24 50 21
Expense (benefit) reclassified into operations from other comprehensive income, Total (6) 1 1
Accumulated other comprehensive loss, net of tax, ending balances $ (305) $ (387) $ (425)
v3.25.4
Other Comprehensive (Loss) Income - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Equity [Abstract]      
Foreign currency translation adjustments, income tax benefit   $ 2 $ 7
Foreign currency translation adjustments, income tax expense $ 10    
Unrealized gains on available-for-sale securities, tax expense 3   2
Defined benefit plans, income tax expense 7 $ 15 6
Defined benefit plans, benefit reclassified into operations from other comprehensive income     0
Interest expense on derivative instruments, benefit reclassified into operations from other comprehensive income     $ 1
Interest benefit on derivative instruments, expense reclassified into operations from other comprehensive income $ 2    
v3.25.4
Other Accrued Expenses - Summary of Other Accrued Expenses (Detail) - USD ($)
$ in Millions
Dec. 31, 2025
Dec. 31, 2024
Payables and Accruals [Abstract]    
Professional liability risks $ 578 $ 587
Defined contribution benefit plans 763 704
Right-of-use operating leases 352 343
Taxes other than income 504 419
Interest 499 502
Employee medical benefits 216 206
Other 1,365 1,138
Other accrued expenses $ 4,277 $ 3,899