HCA · 10-K filed 10 Feb 2026 · year to 31 Dec 2025

HCA Healthcare

36 named things its latest annual report says its results depend on, each in the company's own words. 16 of them are also named by other companies we've read.

Read the filing on SEC.gov ↗

Customers

Managed care and other insurers

earns from · 48.9%named as a risk

Revenues derived from private third-party payers (domestic only) accounted for 48.9%, 49.5% and 49.0% of our revenues for 2025, 2024 and 2023, respectively.Risk factors (Item 1A)

Other companies

Labor unions

35 of our domestic hospitalsnamed as a risk

As of December 31, 2025, certain employees at 35 of our domestic hospitals are represented by various labor unions.Business (Item 1)

Also named by ECG, EME, JLL, LUV, MAR, NSC, NYT, SGI and 2 more

Frist-affiliated investors (Hercules Holding II, Frisco Holding II)

approximately 31%named as a risk

Through their investment in Hercules Holding II, Frisco Holding II and other holdings, certain of the Frist-affiliated investors continue to hold a significant interest in our outstanding common stock (approximately 31% as of January 31, 2026).Risk factors (Item 1A)

Places

Florida

concentrated in · 51% of our consolidated revenuesnamed as a risk

We operated 190 hospitals at December 31, 2025, and 102 of those hospitals are located in Florida and Texas.Risk factors (Item 1A)

Also named by ABR, ALLY, AN, AXP, AZO, BBY, BJ, BRO and 54 more

Texas

concentrated in · 51% of our consolidated revenuesnamed as a risk

This geographic concentration makes us particularly sensitive to regulatory, economic, public health, environmental and competitive conditions in those states.Risk factors (Item 1A)

Also named by ABR, AFRM, ALLY, AN, ASO, ASTS, ATO, AXP and 70 more

United Kingdom

operates in · 2.5named as a risk

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 significant fines in the event of violations.Risk factors (Item 1A)

Also named by AGX, AJG, AMP, BAC, BF/B, BGC, BRO, C and 59 more

Hazards

Hurricanes

operates in · $110 million per occurrencenamed as a risk

Our business assets and activities and the communities we serve have been and could in the future be harmed by a particularly active hurricane season or even a single storm.Risk factors (Item 1A)

Also named by AIG, AN, ASO, BAC, BBY, BJ, BPOP, BRO and 89 more

Commodities and inputs

Medical supplies

exposed to its pricenamed as a risk

We have also experienced, and may continue to experience, supply disruptions, shortages, and other incremental costs.Risk factors (Item 1A)

Nurses

depends onnamed as a risk

Nurse and medical support personnel availability and retention can present significant operational issues for our hospitals and other facilities, including capacity and growth constraints, reduced patient satisfaction, reduced physician satisfaction, impacts on services offered and increased costs.Business (Item 1)

Regulators

Centers for Medicare & Medicaid Services (CMS)

subject to · approximately 2.6%named as a risk

For federal fiscal year 2026, CMS increased the MS-DRG payment rates by approximately 2.6%.Business (Item 1)

Also named by A, ABT, AMGN, AXGN, BAX, BWIN, CNC, COO and 23 more

Food and Drug Administration (FDA)

subject tonamed as a risk

For example, if the FDA determines that any of our software programs are medical devices under the FDCA, the use of those software programs may require premarket approval or clearance, and we may be required to cease use of such programs until we obtain any required premarket approval or clearance.Business (Item 1)

Also named by A, ABBV, ABT, AMGN, ARE, ARWR, ATR, AXGN and 112 more

Laws and programs

Medicare

earns from · 14.9%named as a risk

Specifically, we derived 45.4% of our revenues from the Medicare and Medicaid programs in 2025.Risk factors (Item 1A)

Also named by ABT, ARWR, AXGN, BAX, BDX, BMY, BSX, CAH and 48 more

Medicaid

earns from · 45.4% of our revenues from the Medicare and Medicaid programsnamed as a risk

Specifically, we derived 45.4% of our revenues from the Medicare and Medicaid programs in 2025.Risk factors (Item 1A)

Also named by ABBV, ABT, ARE, ARWR, BAX, BMY, BSX, CHE and 39 more

340B Drug Pricing Program

subject to · 0.5% annuallynamed as a risk

In order to comply with budget neutrality requirements, the U.S. Department of Health and Human Services (“HHS”) finalized a corresponding offset in future non-drug item and service payments for all outpatient PPS providers (except new providers) that will reduce the outpatient PPS conversion factor by 0.5% annually until the past invalidated payments are offset.Business (Item 1)

Also named by ABBV, BAX, BIIB, BMY, CAH, COR, CVS, EXEL and 13 more

Medicare Advantage

earns from · 17.8named as a risk

Under the Managed Medicare program (also known as Medicare Part C, or Medicare Advantage), the federal government contracts with private health insurers to provide members with Medicare Part A, Part B and Part D benefits.Business (Item 1)

Also named by BWIN, CDNA, CHE, CNC, CVS, DGX, DOC, DVA and 3 more

No Surprises Act

subject to · $400named as a risk

If the uninsured or self-pay patient receives a bill that exceeds the good faith estimate by an amount deemed to be substantial by regulation (which is currently $400), they may initiate a patient-provider dispute resolution process established by regulation.Risk factors (Item 1A)

Also named by ELV, GMED, MOH, OSCR

Medicaid supplemental payments and state directed payments

earns from · approximately $6.2 billionnamed as a risk

Revenues from these programs totaled approximately $6.2 billion, $5.5 billion and $4.4 billion in 2025, 2024 and 2023, respectively.Business (Item 1)

Budget Control Act of 2011 sequestration

subject to · 2%named as a risk

For example, Congress established automatic spending reductions, referred to as sequestration, under the BCA, resulting in a 2% reduction in Medicare payments that extends through the first five months of federal fiscal year 2033.Risk factors (Item 1A)

Medicaid Disproportionate Share Hospital payments

earns from · $8 billionnamed as a risk

Under current law, Medicaid DSH payments will be reduced by $8 billion in federal fiscal year 2028.Business (Item 1)

Hospital Value-Based Purchasing Program

subject to · 2%named as a risk

CMS has implemented a value-based purchasing program for inpatient hospital services that reduces inpatient hospital payments for all discharges by 2% in each federal fiscal year.Risk factors (Item 1A)

Hospital Readmission Reduction Program

subject to · up to 3%named as a risk

The reduction in payments to hospitals with excess readmissions can be up to 3% of a hospital’s base payments.Risk factors (Item 1A)

Medicare Promoting Interoperability Program

subject to · 75%named as a risk

Under a rule finalized by HHS in July 2024, a hospital found to have engaged in information blocking will not qualify as a “meaningful electronic health record user” under the Medicare Promoting Interoperability Program and as a result will lose 75% of the annual market basket increase it would otherwise receive, and MIPS-eligible clinicians, ACOs and ACO participants face similar disincentives.Risk factors (Item 1A)

EMTALA

subject to · approximately 88%

For the year ended December 31, 2025, approximately 88% of our admissions of uninsured patients occurred through our emergency rooms.Business (Item 1)

False Claims Act

subject tonamed as a risk

Additionally, if we violate the Anti-kickback Statute or Stark Law, or if we improperly bill for our services, we may be found to violate the FCA, either under a suit brought by the government or by a private person under a qui tam, or “whistleblower,” suit.Risk factors (Item 1A)

Also named by ACN, ASTS, CDW, CHE, CI, CVS, DGX, FLR and 13 more

Telephone Consumer Protection Act

subject tonamed as a risk

Determination by a court or regulatory agency that our SMS texting practices violate the TCPA or similar state laws could subject us to civil penalties and could require us to change some portions of our business.Risk factors (Item 1A)

Also named by ADP, AFL, BBW, CART, COMP, CRM, CSGP, FCFS and 9 more

Anti-kickback Statute

subject tonamed as a risk

While we endeavor to comply with the applicable safe harbors, certain of our current arrangements, including joint ventures and financial relationships with physicians and other referral sources and persons and entities to which we refer patients, do not qualify for safe harbor protection.Risk factors (Item 1A)

Also named by BSX, CAH, LH, ORCL, PROF, ZBH

Stark Law

subject tonamed as a risk

Thus, we cannot provide assurance that every relationship complies fully with the Stark Law.Risk factors (Item 1A)

Also named by CHE, DVA, GMED, LH, RMD

2025 Federal Budget Act (FBA)

subject tonamed as a risk

The FBA is expected to decrease federal Medicaid spending, including as a result of changes to Medicaid eligibility policies and changes to Medicaid financing mechanisms, such as limitations on provider tax arrangements.Business (Item 1)

Affordable Care Act enhanced premium tax credits (Exchanges)

earns fromnamed as a risk

We believe the expiration of the enhanced premium tax credits will adversely impact Exchange enrollment and significantly increase the uninsured rate.Risk factors (Item 1A)

Texas Healthcare Transformation and Quality Improvement Program

earns fromnamed as a risk

For example, the Texas Healthcare Transformation and Quality Improvement Program, which is operated under a Medicaid waiver, enables the expansion of Medicaid managed care programs in the state and provides funding for uncompensated care.Business (Item 1)

Medicare inpatient-only list phase-out

subject tonamed as a risk

Efforts to shift treatment to lower-acuity settings, such as the elimination of Medicare’s inpatient-only list over a three year period beginning in 2026, may reduce our inpatient volumes as various inpatient hospital procedures become eligible for reimbursement by Medicare when performed in outpatient settings and may result in patients seeking care from other providers.Risk factors (Item 1A)

WISeR model

subject tonamed as a risk

CMS is implementing a new payment and service delivery model, the Wasteful and Inappropriate Service Reduction (“WISeR”) model, in six states in 2026, including Texas.Business (Item 1)

Transforming Episode Accountability Model (TEAM)

subject tonamed as a risk

For example, beginning January 2026, CMS requires hospitals in selected markets to participate in TEAM, a new model focused on five specified surgical episodes.Risk factors (Item 1A)

Recovery Audit Contractor program

subject tonamed as a risk

However, the RAC audit and appeals processes can impose a significant administrative burden on providers, and we may experience delays in appealing RAC payment denials.Risk factors (Item 1A)

U.S. tariffs on imported medical supplies

exposed to its pricenamed as a risk

Additionally, imposed or threatened tariffs have raised, and may continue to raise, the cost of certain medical supplies and products we source from outside the United States.Risk factors (Item 1A)

Technology

New EHR platform

depends onnamed as a risk

We are implementing a new EHR platform across our facilities, which is complex and time-intensive.Risk factors (Item 1A)