HCA Healthcare (HCA) Risk Factor Changes

The Company declares a regular quarterly cash dividend under our cash dividend program.

We are exposed to market risk related to market illiquidity.

We are exposed to market risk related to changes in market values of securities.

Other risks we face during periods of economic weakness and high unemployment include potential declines in the population covered under managed care agreements, increased patient decisions to postpone or cancel elect…

Our business is impacted by economic conditions in the United States, including periods of significant inflation, higher interest rates or economic weakness or recessions.

Our overall business results may suffer during periods of significant inflation, general economic weakness or recessions or as a result of changing governmental policies.

There are also several state-driven value-based care initiatives.

CMS has developed, and is continuing to modify and develop, alternative payment models that are intended to reduce costs and improve quality of care for Medicare beneficiaries.

Our hospitals and other facilities, including those in Florida, Texas and other coastal states, are located in regions that have been, and may in the future be, impacted by hurricanes, extreme weather events or other…

Our business and operations are subject to risks related to hurricanes, extreme weather events or other natural disasters.

December 31, 2025.

States are increasingly enacting laws modeled after the federal Hart-Scott-Rodino Act, requiring pre-notification of covered transactions.

compliance with Medicare coverage criteria for selected items and services under fee-for-service Medicare.

Volume, admission and case-mix trends may be impacted by factors beyond our control, such as changes in volume of certain high acuity services, variations in the prevalence and severity of outbreaks of influenza and o…

Reimbursement rates are set forth by contract when our facilities are in-network, and payers utilize plan structures to encourage or require the use of in-network providers.

Private third-party payers, including HMOs, PPOs and other managed care plans, typically reimburse health care providers at a higher rate than Medicare, Medicaid, other government health care programs or uninsured, se…

Our ability to maintain or increase patient volumes covered by private third-party payers and to maintain and obtain favorable contracts with private third-party payers significantly affects the revenues and operating…

We provide uninsured discounts and charity care for individuals, including for those residing in states that choose not to implement the Medicaid expansion or that modify the terms of the program, for undocumented imm…

Any increase in the volume of uninsured patients or deterioration in the collectability of uninsured, self-pay and other patient-responsibility accounts receivable could adversely affect our cash flows and results of…

The primary collection risks for our accounts receivable relate to the uninsured patient accounts and patient accounts for which the primary third-party payer has paid the amounts covered by the applicable agreement,…

serve provide services similar to those we offer.

provide a required notice could impair our ability to operate or expand operations.

Some states, particularly in the eastern part of the country, require health care providers to provide notice or obtain prior approval under a CON program for the purchase, construction or expansion of health care fac…

noncompliance.

We send short message service (“SMS”) text messages to patients.

A variety of state, national, foreign and international laws and regulations apply to the collection, use, retention, protection, security, disclosure, transfer and other processing of personal information.

In addition, several states in which we operate face budgetary challenges that have resulted, and likely will continue to result, in reduced Medicaid funding levels to hospitals and other providers.

From time to time, CMS revises the reimbursement systems used to reimburse health care providers, including changes to the inpatient hospital MS-DRG system and other payment systems, which may result in reduced Medica…

The health care industry has been and continues to be impacted by health care reform efforts and is subject to changing political, regulatory and other influences.

As a front-line provider of health care services, we are subject to the health and economic effects of public health conditions.

The development of AI technologies is complex, and there are technical challenges associated with achieving the desired level of accuracy, efficiency and reliability.

The federal government is promoting the adoption of health information technology and the nationwide health information exchange to improve health care.

we rely may experience system failures and disruptions.

Our operations could be impaired by a failure in or breach of our information systems or those of third parties on whose systems our business relies.

We have implemented multiple layers of security measures, including cybersecurity and information security systems, protocols and monitoring procedures, intended to protect the confidentiality, integrity and availabil…

The talents and efforts of our employees, particularly our key management, are vital to our success.

The success of our hospitals depends in part on the number and quality of the physicians on the medical staffs of our hospitals, the admission and utilization practices of those physicians, maintaining good relations…

Economic conditions, including macroeconomic uncertainties and inflationary pressure, workforce burnout, and public health conditions and other factors, have exacerbated workforce competition, personnel shortages and…

Under our senior unsecured credit facility, we are required to satisfy and maintain a specified financial ratio.

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Our senior unsecured credit facility and the indentures governing our outstanding notes contain various covenants that limit our ability to engage in specified types of transactions.

We may find it necessary or prudent to refinance our outstanding indebtedness, the terms of which refinancing may not be favorable to us.

In addition, we conduct our operations through our subsidiaries.

We and our subsidiaries have the ability to incur additional indebtedness in the future, subject to the restrictions contained in our senior unsecured credit facility and the indentures governing our outstanding notes.

investments in future periods should issuers default on interest payments or should the fair market valuations of the securities deteriorate due to ratings downgrades or other issue specific factors.

In a strategic report issued in 2021 and updated in 2022, the CMS Innovation Center highlighted the need to accelerate the movement to value-based care and drive broader system transformation.

In the post-acute care space, home health agencies participate in the nationwide HHVBP Model.

In addition, changes in consumer preferences and legislation and regulatory requirements regarding sustainability matters, including those associated with the transition to a low-carbon economy, may increase costs ass…

increase in climate-related events that result in material losses we may be unable to obtain similar levels of property insurance coverage in the future.

responsibility for care to individuals.

The health care business is highly competitive, and competition among hospitals and other health care providers for patients has intensified in recent years.

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care programs, and/or impose additional taxes on hospitals to help finance or expand the states’ Medicaid systems.

require other changes if federal funding is reduced.

In addition, the Medicare and Medicaid programs are subject to change, including as a result of changes from the 2024 federal election.

The health care industry is subject to changing political, regulatory and other influences.

If a pandemic, epidemic, outbreak of an infectious disease or other public health crisis were to occur in an area in which we operate, our operations could be adversely affected.

As a front-line provider of health care services, we are subject to the health and economic effects of public health conditions.

As health care technology continues to advance, the price of purchasing new technology has significantly increased for providers.

We may not be adequately reimbursed by third-party payers for services involving new technology.

systems, we could be subject to penalties that may have an adverse effect on our financial condition and results of operations.

not offer employment terms that are competitive with the rest of the labor market.

Under our asset-based revolving credit facility, borrowing availability is subject to a borrowing base of 85% of eligible accounts receivable less customary reserves, with any reduction in the borrowing base that resu…

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to enable us to make payments in respect of our indebtedness.

As of December 31, 2024, our total indebtedness was $43.031 billion.

availability, terms or timing on which we may obtain any additional funding and our ability to access our cash.

indicating that features of models may include requirements that all alternative payment models involve downside risk or that some financial risk shift from conveners to providers.

The new strategic direction announced by the CMS Innovation Center in 2025 continues to support the transition from Medicare fee-for-service models to value-based payment and care delivery models.

We operated 190 hospitals at December 31, 2025, and 102 of those hospitals are located in Florida and Texas.

Controls imposed by Medicare, managed Medicare, Medicaid, managed Medicaid and private third-party payers designed to reduce admissions, intensity of services, surgical procedure volumes and lengths of stay, in some i…

in plans purchased through the Exchanges, or expanding short-term insurance options.

The health care business is highly competitive, and competition among hospitals and other health care providers for patients has intensified in recent years.

As a result of our operations in the United Kingdom, we are subject to the UK Data Protection Act, which contains stricter privacy restrictions than laws and regulations in the United States and provides for significa…

flexibilities in the administration of state Medicaid programs.

Legislation and administrative actions at the federal and state levels may also impact the funding for, or structure or administration of, the Medicaid program, including through changes to Medicaid supplemental payme…

rate-setting measures, including limits on hospital rates.

In addition, the Medicare and Medicaid programs are subject to change as a result of legislation and administrative actions.

that impact or may impact the health care industry, including measures aimed at restructuring government agencies and eliminating government expenditures and resulting in holds on or cancellations of congressionally a…

The health care industry is heavily regulated.

Further, we are executing financial resiliency initiatives designed to generate efficiencies and cost reductions that we expect will offset in part the adverse effects on our business from recent health care policy re…

We are implementing a new EHR platform across our facilities, which is complex and time-intensive.

We utilize multiple integrated software and hardware operating systems across our operations, including in our hospitals.

Failure to effectively manage change associated with our technology, resiliency and other initiatives, including with respect to the implementation of a new EHR platform, may adversely affect our business, services an…

comply with applicable AI laws and regulations could result in investigations or legal proceedings, which could result in significant legal costs and potential liability.

We have taken precautionary measures designed to prevent problems that could affect our information systems.

intentionally implemented or used in a manner that could compromise cybersecurity or information security.

indebtedness.

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As of December 31, 2025, our total indebtedness was $46.492 billion.