Cash Flow Statement

The cash flow statement provides information about a company cash receipts and cash payments during an accounting period, showing how these cash flows link the ending cash balance to the beginning balance shown on the company balance sheet.

The cash flow statement consists of three parts: cash flows provided by (used in) operating activities, cash flows provided by (used in) investing activities, and cash flows provided by (used in) financing activities.

HCA Healthcare Inc., consolidated cash flow statement

US$ in millions

12 months ended:	Dec 31, 2021	Dec 31, 2020	Dec 31, 2019	Dec 31, 2018	Dec 31, 2017
Net income	7,721)	4,387)	4,145)	4,389)	2,743)
Accounts receivable	(962)	327)	(326)	(423)	(601)
Inventories and other assets	(540)	(304)	(158)	(242)	(69)
Accounts payable and accrued expenses	999)	1,255)	396)	698)	374)
Increase (decrease) in cash from operating assets and liabilities	(503)	1,278)	(88)	33)	(296)
Depreciation and amortization	2,853)	2,721)	2,596)	2,278)	2,131)
Income taxes	(70)	41)	250)	74)	433)
(Gains) losses on sales of facilities	(1,620)	7)	(18)	(428)	(8)
Losses on retirement of debt	12)	295)	211)	9)	39)
Amortization of debt issuance costs	27)	30)	30)	31)	31)
Share-based compensation	440)	362)	347)	268)	270)
Other	99)	111)	129)	107)	83)
Adjustments to reconcile net income to net cash provided by operating activities	1,238)	4,845)	3,457)	2,372)	2,683)
Net cash provided by operating activities	8,959)	9,232)	7,602)	6,761)	5,426)
Purchase of property and equipment	(3,577)	(2,835)	(4,158)	(3,573)	(3,015)
Acquisition of hospitals and health care entities	(1,105)	(568)	(1,682)	(1,253)	(1,212)
Sales of hospitals and health care entities	2,160)	68)	61)	808)	25)
Change in investments	(117)	(20)	25)	57)	(73)
Other	(4)	(38)	34)	60)	(4)
Net cash used in investing activities	(2,643)	(3,393)	(5,720)	(3,901)	(4,279)
Issuances of long-term debt	4,344)	2,700)	6,451)	2,000)	1,502)
Net change in revolving credit facilities	2,780)	(2,480)	(560)	(640)	760)
Repayment of long-term debt	(3,869)	(3,437)	(5,324)	(1,704)	(753)
Distributions to noncontrolling interests	(749)	(626)	(542)	(441)	(448)
Payment of debt issuance costs	(38)	(35)	(73)	(25)	(26)
Payment of dividends	(624)	(153)	(550)	(487)	—)
Repurchase of common stock	(8,215)	(441)	(1,031)	(1,530)	(2,051)
Other	(284)	(205)	(142)	(248)	(45)
Net cash used in financing activities	(6,655)	(4,677)	(1,771)	(3,075)	(1,061)
Effect of exchange rate changes on cash and cash equivalents	(3)	10)	8)	(15)	—)
Change in cash and cash equivalents	(342)	1,172)	119)	(230)	86)
Cash and cash equivalents at beginning of period	1,793)	621)	502)	732)	646)
Cash and cash equivalents at end of period	1,451)	1,793)	621)	502)	732)

Based on: 10-K (reporting date: 2021-12-31), 10-K (reporting date: 2020-12-31), 10-K (reporting date: 2019-12-31), 10-K (reporting date: 2018-12-31), 10-K (reporting date: 2017-12-31).

Net Income: Net income shows a generally increasing trend over the five-year period, rising from $2,743 million in 2017 to $7,721 million in 2021. There was a slight dip in 2019, but overall profitability improved significantly by 2021.
Accounts Receivable: Accounts receivable values fluctuate significantly, with negative values from 2017 to 2019, a positive value in 2020, and a large negative number again in 2021. This inconsistency suggests variability in collection or reporting methods for receivables.
Inventories and Other Assets: These items have remained negative and trended downward, reaching -$540 million by 2021, indicating an increasing use or depletion of these assets over time.
Accounts Payable and Accrued Expenses: There is notable volatility in payables and accrued expenses, with a general increase peaking at $1,255 million in 2020 before a slight decrease in 2021, implying fluctuating obligations to suppliers or expense accruals.
Cash Flow from Operating Assets and Liabilities: This item varies considerably, showing a negative figure in 2017, small positive fluctuations in some years, a strong positive cash impact in 2020, but a pronounced negative impact again in 2021. These swings may reflect changes in working capital management.
Depreciation and Amortization: Depreciation and amortization expenses steadily increased each year, from $2,131 million in 2017 to $2,853 million in 2021, indicating growing asset bases or changes in asset depreciation policies.
Income Taxes: Income tax expenses decreased sharply over time, turning negative in 2021 at -$70 million, which could signify tax benefits or credits that offset taxable income.
(Gains) Losses on Sales of Facilities: Large fluctuations occurred in gains and losses from facility sales, especially marked by a significant gain of -$1,620 million in 2021, indicating major asset disposals during that year.
Losses on Retirement of Debt: Losses peaked in 2020 at $295 million but were relatively low in other years. This suggests occasional debt restructuring or refinancing costs.
Share-Based Compensation: Share-based compensation consistently increased from $270 million in 2017 to $440 million in 2021, reflecting higher employee compensation costs through equity.
Adjustments to Reconcile Net Income to Net Cash from Operating Activities: These adjustments fluctuated, peaking in 2020 at $4,845 million and decreasing sharply in 2021 to $1,238 million, which influenced the net cash generated from operations.
Net Cash Provided by Operating Activities: The operating cash flow increased steadily from $5,426 million in 2017 to a peak of $9,232 million in 2020, slightly decreasing to $8,959 million in 2021, reflecting strong and relatively stable operational cash generation.
Capital Expenditures and Acquisitions: Capital expenditures fluctuated, with the highest spend in 2019 at -$4,158 million, followed by a decrease in 2020 and a rise again in 2021. Acquisitions of hospitals were irregular, with a notable drop in 2020 but increased again in 2021, while sales of hospitals spiked substantially in 2021, suggesting strategic portfolio adjustments.
Investing Activities: Net cash used in investing activities declined broadly over the period from -$4,279 million in 2017 to -$2,643 million in 2021, indicating reduced cash outflows on investments over time.
Financing Activities: Issuances of long-term debt increased significantly, peaking at $6,451 million in 2019 and then fluctuating downward before rising again in 2021. Repayment of long-term debt showed a strong upward trend until 2019, then stabilized at a high level through 2021. Notably, repurchase of common stock rose sharply to -$8,215 million in 2021 following decreases in prior years, suggesting a focused effort on returning capital to shareholders.
Dividends and Distributions: Dividend payments were inconsistent, with a noticeable absence in 2017, moderate amounts in subsequent years, and a spike in 2021. Distributions to noncontrolling interests increased gradually, reflecting growth in related entity obligations.
Net Cash Used in Financing Activities: Cash outflows from financing activities increased over the period, from -$1,061 million in 2017 to -$6,655 million in 2021, driven largely by increased stock repurchases and sustained debt repayments.
Cash and Cash Equivalents: Cash balances fluctuated notably, with a drop in 2018, then a substantial increase through 2020, reaching $1,793 million, followed by a decline to $1,451 million in 2021, indicating active cash management amidst operational and investing cash movements.

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HCA Healthcare Inc. (NYSE:HCA)

Cash Flow Statement