HCA Healthcare announced financial and operating results for the fourth quarter ended December 31, 2025.

HCA Healthcare, Inc. (NYSE: HCA) today announced financial and operating results for the fourth quarter ended December 31, 2025.

Key fourth quarter metrics (all percentage changes compare 4Q 2025 to 4Q 2024 unless otherwise noted):

Revenues increased 6.7 percent to $19.513 billion

Net income attributable to HCA Healthcare, Inc. increased 30.6 percent to $1.878 billion

Diluted earnings per share increased 44.6 percent to $8.14 per share, and diluted earnings per share, as adjusted, increased 28.8 percent to $8.01 per share

Adjusted EBITDA increased 10.8 percent to $4.114 billion

Cash flows from operating activities totaled $2.359 billion, compared to $2.559 billion in the fourth quarter of 2024

Same facility admissions increased 2.4 percent and same facility equivalent admissions increased 2.5 percent

"We finished 2025 with strong performance consistent with previous quarters. Our investments in network expansion, workforce development, and advancing clinical capabilities further strengthened the HCA Healthcare system. I want to thank our colleagues for their outstanding work, their dedication to our patients, and their unyielding commitment to our mission," said Sam Hazen, Chief Executive Officer of HCA Healthcare.

Revenues in the fourth quarter of 2025 totaled $19.513 billion, compared to $18.285 billion in the fourth quarter of 2024. Net income attributable to HCA Healthcare, Inc. totaled $1.878 billion, or $8.14 per diluted share, compared to $1.438 billion, or $5.63 per diluted share, in the fourth quarter of 2024. Results for the fourth quarter of 2025 include gains on sales of facilities of $41 million, or $0.13 per diluted share, primarily related to the sale of a hospital facility in Indiana. Results for the fourth quarter of 2024 included losses on sales of facilities of $195 million, or $0.59 per diluted share, primarily related to the pending sale of a hospital facility in California, which was completed in the second quarter of 2025.

For the fourth quarter of 2025, Adjusted EBITDA totaled $4.114 billion, compared to $3.712 billion in the fourth quarter of 2024. Adjusted EBITDA is a non-GAAP financial measure. A table providing supplemental information on Adjusted EBITDA and reconciling net income attributable to HCA Healthcare, Inc. to Adjusted EBITDA is included in this release.

During the fourth quarter of 2024, the Company incurred additional expenses and experienced loss of revenues estimated at $200 million, or $0.60 per diluted share, associated with Hurricane Helene's impact on its North Carolina facilities, as well as from Hurricane Milton, which impacted certain facilities in Florida.

Same facility admissions increased 2.4 percent and same facility equivalent admissions increased 2.5 percent in the fourth quarter of 2025 compared to the prior year period. Same facility emergency room visits increased 0.5 percent in the fourth quarter of 2025 compared to the prior year period. Same facility inpatient surgeries were flat, and same facility outpatient surgeries declined 0.5 percent in the fourth quarter of 2025 compared to the same period of 2024. Same facility revenue per equivalent admission increased 2.9 percent in the fourth quarter of 2025 compared to the fourth quarter of 2024.

Year Ended December 31, 2025

Revenues for the year ended December 31, 2025 totaled $75.600 billion compared to $70.603 billion for the year ended December 31, 2024. Net income attributable to HCA Healthcare, Inc. was $6.784 billion, or $28.33 per diluted share, compared to $5.760 billion, or $22.00 per diluted share, for the year ended December 31, 2024. Results for the year ended December 31, 2025 include gains on sales of facilities of $37 million, or $0.12 per diluted share. Results for the year ended December 31, 2024 included gains on sales of facilities of $14 million, or $0.04 per diluted share.

For 2025, Adjusted EBITDA totaled $15.566 billion, compared to $13.882 billion in 2024. Adjusted EBITDA is a non-GAAP financial measure. A table providing supplemental information on Adjusted EBITDA and reconciling net income attributable to HCA Healthcare, Inc. to Adjusted EBITDA is included in this release.

Balance Sheet and Cash Flows from Operations

As of December 31, 2025, HCA Healthcare, Inc.’s balance sheet reflected cash and cash equivalents of $1.040 billion, total debt of $46.492 billion, and total assets of $60.720 billion. During the fourth quarter of 2025, capital expenditures totaled $1.489 billion, excluding acquisitions. Cash flows provided by operating activities in the fourth quarter of 2025 totaled $2.359 billion compared to $2.559 billion in the fourth quarter of 2024, and were impacted by approximately $1.3 billion of estimated tax payments that were deferred to the fourth quarter of 2025 due to IRS relief to taxpayers located in Tennessee as a result of severe weather in April 2025.

During the fourth quarter of 2025, the Company repurchased 5.432 million shares of its common stock at a cost of $2.558 billion. The Company had $750 million remaining under its repurchase authorization as of December 31, 2025. As of December 31, 2025, the Company had $5.779 billion of availability under its credit facilities (after giving effect to letters of credit and amounts reserved to backstop its commercial paper program).

Share Repurchase Program

The HCA Healthcare, Inc. Board of Directors has authorized an additional share repurchase program for up to $10 billion of the Company’s outstanding common stock. Repurchases will be made in accordance with applicable securities laws and may be made at management’s discretion from time to time in the open market, through privately negotiated transactions, or otherwise. The repurchase program has no time limit and may be suspended for periods or discontinued at any time.

Dividend

HCA today announced that its Board of Directors declared a quarterly cash dividend of $0.78 per share on the Company’s common stock. The dividend will be paid on March 31, 2026 to stockholders of record at the close of business on March 17, 2026.

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

2026 Guidance

Capital expenditures for 2026, excluding acquisitions, are estimated to range between $5.0 billion and $5.5 billion.

The Company’s guidance contains a number of assumptions, including, among others, the Company’s current expectations regarding volume growth coupled with an anticipated mostly stable operating environment, payer mix, the impact of current and future health care public policy developments, including the estimated impact on health insurance exchanges from administrative reforms and the expiration of the enhanced premium tax credits, anticipated results from resiliency initiatives, as well as general business or economic conditions, including inflation and the impact of trade policies, including tariffs, and excludes the impact of items such as, but not limited to, gains or losses on sales of facilities, losses on retirement of debt, legal claims costs and impairment of long-lived assets. In addition, the Company’s guidance excludes the impact of future approvals that could impact reimbursement under certain state Medicaid directed and supplemental payments.

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

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

Annual Stockholders' Meeting

The Company's 2026 annual stockholders' meeting will be held virtually on April 23, 2026 at 2:00 p.m. Central Time for stockholders of record as of February 23, 2026.

Earnings Conference Call

HCA Healthcare will host a conference call for investors at 9:00 a.m. Central Time today. All interested investors are invited to access a live audio broadcast of the call via webcast. The broadcast also will be available on a replay basis beginning this afternoon.

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