Name: HCA Healthcare Inc. (NYSE:HCA) | Cash Flow Statement
Creator: Stock Analysis on Net

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.

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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).

The financial trajectory from 2017 to 2021 is characterized by a substantial expansion in operational cash generation and a strategic pivot toward aggressive shareholder returns in the final year of the period.

Operating Cash Flow Analysis: Net income demonstrated a strong growth trend, increasing from 2,743 million in 2017 to 7,721 million in 2021. This upward movement is reflected in the net cash provided by operating activities, which grew from 5,426 million to 8,959 million, reaching a peak of 9,232 million in 2020. Depreciation and amortization expenses rose steadily from 2,131 million to 2,853 million over the five-year span, indicating a consistent increase in the company's depreciable asset base.
Investing Activity and Capital Expenditure: A consistent pattern of heavy reinvestment is observed, with annual expenditures for property and equipment ranging between 2,835 million and 4,158 million. The acquisition of hospitals and healthcare entities remained a recurring theme, although the scale of these acquisitions fluctuated, with a low of 568 million in 2020. This investment strategy was partially offset by the sale of facilities, which spiked significantly in 2021 to 2,160 million. Net cash used in investing activities remained negative throughout the period, underscoring a sustained commitment to capacity expansion.
Financing Activity and Liquidity Management: Financing activities show a dynamic approach to debt and equity management. The company engaged in significant debt cycling, notably in 2019, which saw 6,451 million in long-term debt issuances countered by 5,324 million in repayments. Shareholder returns shifted dramatically in 2021, as the repurchase of common stock surged to 8,215 million, compared to much lower levels in previous years. Dividend payments were maintained throughout most of the period, though they saw a temporary decline in 2020.

In summary, the cash flow profile reveals a strong operational engine capable of self-funding significant capital expenditures and acquisitions. The transition in 2021 toward massive share repurchases suggests a shift in capital allocation strategy, utilizing high operating cash flows and facility divestitures to return value to shareholders.

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