Cash Flow Statement
Quarterly Data

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 (quarterly data)

US$ in millions

3 months ended:	Mar 31, 2022	Dec 31, 2021	Sep 30, 2021	Jun 30, 2021	Mar 31, 2021	Dec 31, 2020	Sep 30, 2020	Jun 30, 2020	Mar 31, 2020	Dec 31, 2019	Sep 30, 2019	Jun 30, 2019	Mar 31, 2019	Dec 31, 2018	Sep 30, 2018	Jun 30, 2018	Mar 31, 2018	Dec 31, 2017	Sep 30, 2017	Jun 30, 2017	Mar 31, 2017
Net income	1,465)	2,005)	2,472)	1,664)	1,580)	1,694)	779)	1,216)	698)	1,273)	764)	927)	1,181)	1,245)	896)	966)	1,282)	641)	530)	795)	777)
Accounts receivable	(427)	350)	(745)	(196)	(371)	(603)	(285)	751)	464)	(233)	81)	195)	(369)	(262)	72)	(229)	(4)	(531)	(151)	(87)	168)
Inventories and other assets	(121)	(207)	(120)	(128)	(85)	(268)	21)	139)	(196)	(63)	136)	(57)	(174)	(106)	64)	18)	(218)	(19)	128)	(181)	3)
Accounts payable and accrued expenses	(771)	268)	682)	420)	(371)	713)	878)	448)	(784)	514)	120)	413)	(651)	548)	119)	294)	(263)	543)	129)	293)	(591)
Contract liabilities, deferred revenues	—)	—)	—)	—)	—)	(6,123)	1,124)	4,999)	—)	—)	—)	—)	—)	—)	—)	—)	—)	—)	—)	—)	—)
Increase (decrease) in cash from operating assets and liabilities	(1,319)	411)	(183)	96)	(827)	(6,281)	1,738)	6,337)	(516)	218)	337)	551)	(1,194)	180)	255)	83)	(485)	(7)	106)	25)	(420)
Depreciation and amortization	732)	728)	716)	712)	697)	662)	694)	691)	674)	694)	647)	636)	619)	581)	582)	562)	553)	550)	539)	521)	521)
Income taxes	346)	(255)	183)	(404)	406)	155)	(586)	351)	121)	199)	24)	(242)	269)	74)	(118)	(128)	246)	442)	(276)	(25)	292)
(Gains) losses on sales of facilities	(10)	(563)	(1,047)	(8)	(2)	1)	(14)	27)	(7)	(1)	—)	(18)	1)	(8)	(6)	(9)	(405)	2)	(7)	(2)	(1)
Losses on retirement of debt	—)	—)	—)	12)	—)	—)	—)	—)	295)	—)	211)	—)	—)	—)	9)	—)	—)	—)	39)	—)	—)
Amortization of debt issuance costs and discounts	7)	6)	7)	6)	8)	8)	8)	7)	7)	7)	7)	8)	8)	8)	8)	7)	8)	8)	7)	8)	8)
Share-based compensation	86)	99)	115)	129)	97)	133)	81)	66)	82)	84)	105)	96)	62)	64)	70)	74)	60)	75)	55)	67)	73)
Other	38)	12)	14)	44)	29)	45)	17)	28)	21)	31)	31)	39)	28)	31)	25)	27)	24)	23)	15)	15)	30)
Adjustments to reconcile net income to net cash provided by operating activities	(120)	438)	(195)	587)	408)	(5,277)	1,938)	7,507)	677)	1,232)	1,362)	1,070)	(207)	930)	825)	616)	1)	1,093)	478)	609)	503)
Net cash provided by operating activities	1,345)	2,443)	2,277)	2,251)	1,988)	(3,583)	2,717)	8,723)	1,375)	2,505)	2,126)	1,997)	974)	2,175)	1,721)	1,582)	1,283)	1,734)	1,008)	1,404)	1,280)
Purchase of property and equipment	(861)	(1,192)	(889)	(842)	(654)	(748)	(489)	(745)	(853)	(1,274)	(1,139)	(964)	(781)	(1,153)	(846)	(880)	(694)	(982)	(729)	(733)	(571)
Acquisition of hospitals and health care entities	(2)	(617)	(390)	(76)	(22)	(188)	(34)	(18)	(328)	(90)	(88)	(30)	(1,474)	(197)	(518)	(159)	(379)	(70)	(847)	(205)	(90)
Sales of hospitals and health care entities	14)	180)	1,950)	10)	20)	—)	29)	4)	35)	12)	8)	11)	30)	6)	3)	32)	767)	1)	10)	10)	4)
Change in investments	10)	(79)	(26)	(10)	(2)	20)	(29)	(10)	(1)	(10)	(24)	23)	36)	(8)	42)	12)	11)	(58)	(4)	8)	(19)
Other	(6)	(6)	(5)	(2)	9)	6)	(7)	(39)	2)	17)	(19)	12)	24)	66)	19)	15)	(40)	2)	(11)	(2)	7)
Net cash used in investing activities	(845)	(1,714)	640)	(920)	(649)	(910)	(530)	(808)	(1,145)	(1,345)	(1,262)	(948)	(2,165)	(1,286)	(1,300)	(980)	(335)	(1,107)	(1,581)	(922)	(669)
Issuances of long-term debt	5,966)	7)	—)	4,337)	—)	—)	—)	—)	2,700)	—)	—)	4,951)	1,500)	—)	2,000)	—)	—)	—)	—)	1,502)	—)
Net change in revolving credit facilities	(2,780)	2,280)	(300)	720)	80)	—)	—)	(3,920)	1,440)	(530)	3,010)	(3,500)	460)	(310)	(540)	(60)	270)	110)	1,810)	(1,320)	160)
Repayment of long-term debt	(66)	(82)	(56)	(3,684)	(47)	(34)	(39)	(37)	(3,327)	(35)	(5,191)	(49)	(49)	(52)	(1,551)	(51)	(50)	(53)	(605)	(52)	(43)
Distributions to noncontrolling interests	(171)	(248)	(144)	(123)	(234)	(233)	(194)	(45)	(154)	(138)	(157)	(111)	(136)	(126)	(130)	(93)	(92)	(85)	(115)	(103)	(145)
Payment of debt issuance costs	(49)	—)	(6)	(32)	—)	—)	—)	(1)	(34)	(2)	(8)	(41)	(22)	(1)	(22)	—)	(2)	(1)	—)	(23)	(2)
Payment of dividends	(177)	(148)	(151)	(156)	(169)	—)	—)	(1)	(152)	(136)	(136)	(137)	(141)	(121)	(121)	(122)	(123)	—)	—)	—)	—)
Repurchase of common stock	(2,101)	(2,072)	(2,329)	(2,287)	(1,527)	—)	—)	—)	(441)	(272)	(239)	(242)	(278)	(335)	(302)	(470)	(423)	(576)	(509)	(542)	(424)
Other	(197)	(43)	(17)	(17)	(207)	(49)	(12)	(3)	(141)	3)	(10)	(17)	(118)	(16)	(40)	(1)	(191)	(8)	5)	8)	(50)
Net cash provided by (used in) financing activities	425)	(306)	(3,003)	(1,242)	(2,104)	(316)	(245)	(4,007)	(109)	(1,110)	(2,731)	854)	1,216)	(961)	(706)	(797)	(611)	(613)	586)	(530)	(504)
Effect of exchange rate changes on cash and cash equivalents	(5)	1)	(7)	1)	2)	14)	8)	(1)	(11)	12)	(4)	(4)	4)	(4)	(5)	(23)	17)	—)	—)	—)	—)
Change in cash and cash equivalents	920)	424)	(93)	90)	(763)	(4,795)	1,950)	3,907)	110)	62)	(1,871)	1,899)	29)	(76)	(290)	(218)	354)	14)	13)	(48)	107)

Net Income Trend: Net income displays clear periodic fluctuations with notable growth in certain quarters, particularly accelerating from early 2020 through 2021. The peak was reached in Q3 2021 at 2,472 million US dollars. Conversely, earlier periods, such as 2017, saw more moderate levels, generally under 1,300 million US dollars.
Accounts Receivable and Current Assets: Accounts receivable fluctuates significantly, displaying both positive and negative values, showing volatile changes in receivables management or collection practices. Inventories and other assets remain relatively low and erratic without a clear upward or downward trend, reflecting stable operational asset levels.
Accounts Payable and Operating Liabilities: Accounts payable and accrued expenses exhibit wide fluctuations, alternating between sizable negative and positive values, indicating variable timing in payables settlements and accruals. Contract liabilities and deferred revenues appear notably only in the last few quarters of 2020 and 2021, with a dramatic swing from a positive 4,999 million to negative 6,123 million, suggesting adjustments in revenue recognition.
Cash Flow from Operating Activities: Net cash provided by operating activities consistently remains positive, though rates vary. There is a sharp increase in mid-2020 corresponding with significant positive changes in operating assets and liabilities, followed by periods of decline and recovery. Operating cash flow demonstrates resilience despite the volatility in working capital accounts.
Investing Cash Flow: Cash flows used in investing activities are consistently negative, reflecting ongoing capital expenditures, acquisitions, and investments. Purchases of property and equipment form the core outflow, peaking near Q4 2019 and Q1 2022. Sales of hospitals and healthcare entities show spikes in Q1 2018 and Q4 2021, indicating occasional divestitures impacting cash inflow. Overall, investing activities signal continued investment in business infrastructure.
Financing Cash Flow: Financing cash flows exhibit substantial volatility, with large negative outflows predominating due to consistent repurchases of common stock and dividend payments. Issuances of long-term debt fluctuate heavily, notably with large issuances in 2019 and 2022 counterbalanced by substantial repayments. Revolving credit facility usage varies widely, indicating active short-term debt management.
Debt and Equity Management: The data reflects active management of debt through issuance and repayment cycles, alongside ongoing share repurchases and dividend payments. The outstanding repurchase commitments peak in 2021, suggesting aggressive capital return strategies. These activities imply a focus on optimizing the capital structure and shareholder returns.
Nonoperating Adjustments: Nonoperating items such as gains or losses on sales of facilities and losses on debt retirement show sporadic but sometimes sizable impacts, particularly large losses in late 2021 and early 2022. Depreciation and amortization steadily increase over time, indicating ongoing asset base growth and aging.
Overall Summary: The financial data depicts a company experiencing growth in profitability alongside dynamic working capital management and significant investing in physical and operational assets. Financing activities are characterized by strategic use of debt and active shareholder returns through dividends and stock repurchases. The volatility in some balance sheet elements and cash flows reflects both external market conditions and internal strategic shifts, especially around 2020 and 2021. The patterns suggest a focus on expansion and shareholder value with responsive financial tactics amid fluctuating operational needs.

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HCA Healthcare Inc. (NYSE:HCA)

Cash Flow Statement Quarterly Data

Cash Flow Statement
Quarterly Data