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To capitalize on this increasing demand, we approach each market with a generaloperating model, which we slightly nuance and tailor to meet local marketdynamics. Our objective with this model is to be the provider system of choicefor patients when they need healthcare services. Our general approach is:1To build broader and more clinicallycapable networks—networks that haveconveniently located facilities, are easyto access and navigate, have differentprice points, and are essentially “onestop shops” with comprehensive servicelines, so our patients can obtain all oftheir healthcare services within anHCA Healthcare network. In 2019, weadded to our facility offerings mainlythrough organic growth, but alsothrough strategic acquisitions. We nowhave more than 2,000 outpatient sitesof care that connect to our 184 hospitals.2To attract physicians to our networksby giving them the clinical resourcesthey need to deliver high-quality care, byproviding them a voice in our operations,by creating an efficient environment forthem, and by offering them opportunitiesto grow their practices. Over the pastfew years, the number of physicians whopractice at HCA Healthcare facilitieshas grown by approximately 2% peryear. Today, we have more than 45,000physicians on our medical staffs, and ourphysician engagement this past year wasat an all-time high.We want to thank our physicians fortheir commitment and service toHCA Healthcare. They are a tremendouspart of our success.3To support our local networks byleveraging the scale and capabilitieswe have across our enterprise. Thissupport enhances our efforts in achievingoperational excellence. Because mostof our competitors are local systems,we believe this part of our modelcreates a competitive advantage forus. For example, we have used ourscale to support expanding graduatemedical education (GME) programs in aconsistent manner across many of ourhospitals. Today, we have approximately4,000 medical residents, which makes usthe largest teaching provider of GME inthe country.We also own one of the largest cancerresearch organizations in the countrythrough Sarah Cannon ResearchInstitute, which currently has in excessof 3,000 patients enrolled in clinicaltrials, and since inception has led morethan 400 first-in-human clinical trials.Sarah Cannon supports our networkof oncology physicians in deliveringcancer care by giving them greateraccess to advanced therapies so ourpatients can stay closer to their homesand their families.We strongly believe the whole ofHCA Healthcare is much greater than thesum of its parts.We are confident that this operating model works. We believe our competitivepositioning across our markets is stronger than it ever has been as a resultof sustained improvements in quality outcomes, advancements in nursingperformance, and increases in capital spending. Inpatient market share for thecompany has consistently grown over the past few years, and currently it is at anall-time high of more than 26%. As necessary, we will refine our model to respondeffectively to market dynamics.5

We are in the people businessHCA Healthcare is fundamentally in the people business, and we are committed tosupporting our colleagues at all levels. We want our facilities to be the preferredplaces to work in the communities we serve, which means our facilities offeremployees a work environment where they are treated fairly, where they have theresources to succeed, and where they can grow individually.For us, it starts with our managementteams, which we believe are the best inthe industry. Truly, they are a “can-do”group. Our teams embrace our patientfirst culture and work well as a unit. Ourteams build enduring relationships withtheir employees, their physicians, andtheir communities. Our teams focusrelentlessly on executing our agenda todeliver excellent care to every patient,every time.The HCA Healthcare LeadershipInstitute, which is our leadershipdevelopment unit, has numerousprograms that we use to help ourmanagers grow and succeed. Wehad more than 39,000 participantsthroughout the various programs thispast year. We also utilize elements ofthis program to assist with our growingdiversity and inclusion programs.6Our management teams lead nearly280,000 employees—including98,000 registered nurses—acrossour organization. We support theirefforts with technology, systems,and a significant commitment toworkforce development initiatives.These initiatives include: increasedminimum wage policies; expandedfamily leave benefits; financialincentives and tuition reimbursementfor advanced levels of training andeducation; a student loan repaymentprogram; and a comprehensiveclinical education agenda thatimproves the skills of our nurses andother caregivers.We acquired what we believe to be abest in class, scalable nursing school—Galen School of Nursing—in January2020. We plan on expanding Galeninto many of our markets over thenext five years.

Additionally, in times of need, we careand support one another through theHCA Healthcare Hope Fund, whichis a charitable organization, where100% of our colleagues’ donations godirectly to helping employees and theirimmediate families who are affectedby financial hardship. This includesdisasters, extended illnesses/injuries,domestic violence, death of a lovedone, and other special situations. In2019, the fund granted nearly 8 million to HCA Healthcareemployees in need.These programs and others haveallowed us to attract bettertalent, reduce turnover withbetter employee engagement, andbuild a more capable workforce.These improved employee metricsdrove better patient satisfactionacross most of our services.As we write this letter, we wantto thank our colleagues for theircommitment, work and dedicationto the communities we serve. Asour country faces the challengesposed by the coronavirus (COVID-19),we are leveraging our resourcesto protect our nurses, physicians,and employees so they can carefor our patients. Our focus, now asever, is to diligently respond to theevolving needs of those we serve.7

Clinical excellence—raising the barAs an organization, we are continuously moving forward, driven by theconstant pursuit of our mission to care for and improve human life.A patient-first culture requires that we make decisions and allocateresources to advance the best interests of our patients. Clinicalexcellence means we deliver high-quality care that is both transparentand efficient for our patients. Our clinical excellence agenda emphasizesleadership, training, technology, innovation, partnerships, andmeasurement systems. All of these elements strengthen the serviceswe provide to our patients.8

Last year, we highlighted a numberof areas where our clinical excellenceprogram produced great outcomes,which in many instances led theindustry. These areas are stillimportant elements of our program,and we continue to push forward onthem to improve outcomes further.Also, 81% of HCA Healthcare’shospitals received a HospitalSafety Grade of “A” or “B” from TheLeapfrog Group in the fall of 2019.This compares favorably to the restof the industry, which only had 57%of participating hospitals achievingthese grades.Again this year, we have more areasof progress to share. Through ourEnhanced Surgical Recovery program,which uses a multimodal approachto pain management combined withevidence-based interventions, wehave reduced complications for oursurgical patients by 36%. We arecontinuing to implement this programmore broadly and expect even moreimprovement in the coming years.This program, coupled with ourAlternatives to Opioids program inthe emergency room, is part of ourcomprehensive opioids reduction plan,which was developed using insightsfrom our clinical data warehouse andpartnerships with our physicians.We must always “raise the bar” forour patients. They deserve this fromus; therefore, we will continue toinvest significantly in finding waysto deliver better care through ourclinical excellence program.81% ofHCA Healthcare’shospitals received aHospital Safety Gradeof “A” or “B” from TheLeapfrog Group in thefall of 2019.9

Significant community benefit—creating healthier tomorrowsIn many ways, our networks are fundamental to the community infrastructure,and we take that responsibility seriously. Our communities depend on us toprovide important services, advance health and wellness, offer education andoutreach, and contribute to economic growth.As we have shared with our colleagues, the significantly positive impactHCA Healthcare has on our communities is especially noteworthyand multifaceted:Our scaled, time-tested emergencyoperations teams are prepared to actwhen crisis strikes our communities,providing lifesaving supplies, logistics,and care support in times of adversity.Unfortunately, over the past few years,we have had to use these capabilitiesfor natural disasters and other masscasualty events far too often. Wecontinue to learn from them andimprove our preparedness.10Our clinicians and facility leaders aretaking a lead role in combating theopioid crisis facing our country bypartnering with law enforcement tosponsor “take back” days in our localcommunities. We helped collect morethan 2.5 tons of unused or expiredmedications as part of the Crush theCrisis effort in 2019.Our graduate medical educationprograms for physicians, as well as ourinvestments in nursing education, arehelping to increase the future supply ofcaregivers in our communities.

Our national nonprofit partnershipswith leading community organizations,like the March of Dimes, the AmericanRed Cross, and The Jason Foundation,are working to build stronger, healthiercommunities through research, funding,and other collaborative work.Our partnership with the U.S. Chamberof Commerce Foundation in the “Hiring100,000 Military Spouses” campaignled to the hiring of nearly 1,000 militaryspouses in the past year with a pledgeto hire 1,100 more in 2020.Our robust patient financial supportprogram is among the most generousin the industry and supports patients inmaking informed healthcare decisions,enables patients to access programs anddiscounts for which they may be eligible,and helps patients in need of financialassistance. Approximately 25% of alladmissions and 50% of all emergencyroom visits in HCA Healthcare facilitiesare either patients who have Medicaid orare uninsured, and the unfunded costs ofdelivering these services are in excess of 3 billion annually.Our environmental sustainabilityefforts continued to broaden intowater, electrical, greenhouse gases,and medical waste, exceeding all legaland regulatory standards. And, for 10consecutive years, HCA Healthcare wasnamed one of the World’s Most EthicalCompanies by Ethisphere.In 2019, HCA Healthcare committed 1 million in scholarship funding overfour years to Fisk University, one of thenation’s historically black colleges andthe oldest institution of higher learningin Nashville, TN. The HCA HealthcareScholars at Fisk University programwill create scholarships and internshipopportunities for high-achieving FiskUniversity students.HCA Healthcare pays property, sales,and income taxes, unlike most healthsystems in the country. As one ofthe largest taxpayers in most ofour communities, HCA Healthcarecontributes significantly to local schooldistricts, city and county basic services,and infrastructure investments. In 2019,we incurred 1.6 billion in property,sales, and income taxes.In 2020, our giving and volunteering incentives program will expand enterprisewide. Our employees live and work in the communities we serve and, as such,they are aware of local issues and needs. Our program provides incentives forour employees to volunteer, to donate, and/or to serve on boards of nonprofitagencies that help solve community problems.11

Our bright futureIn closing, we see this as a great time to be a part of HCA Healthcare. Webelieve we are well positioned for growth, and we also believe we are wellpositioned to respond effectively to market dynamics. By connecting ourlocal networks with our unique enterprise capabilities, we can improvemore lives in more ways and advance healthcare together.We are very proud of theaccomplishments of the organization,and we remain focused on deliveringvalue to you, our shareholders, aswell as to the other stakeholders whodepend on us. Thank you for yourcommitment to HCA Healthcare.Sincerely,Thomas Frist IIIChairmanSam HazenChief Executive OfficerThis document contains forward-looking statements within the meaning of the federal securities laws. These forwardlooking statements are based on our current plans and expectations and are subject to a number of known and unknownuncertainties and risks, including those set forth in our earnings releases and reports filed with the Securities andExchange Commission.All references to “Company,” “HCA,” “HCA Healthcare,” “we,” and “us” as used herein refer toHCA Healthcare, Inc. and its affiliates.12

UNITED STATESSECURITIES AND EXCHANGE COMMISSIONWashington, D.C. 20549Form 10-K(Mark One)È ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIESEXCHANGE ACT OF 1934For the fiscal year ended December 31, 2019Or‘ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIESEXCHANGE ACT OF 1934For the transition period fromtoCommission File Number 1-11239HCA Healthcare, Inc.(Exact Name of Registrant as Specified in its Charter)Delaware27-3865930(State or Other Jurisdiction ofIncorporation or Organization)(I.R.S. EmployerIdentification No.)One Park PlazaNashville, Tennessee37203(Address of Principal Executive Offices)(Zip Code)Registrant’s telephone number, including area code: (615) 344-9551Securities Registered Pursuant to Section 12(b) of the Act:Title of Each ClassTradingSymbol(s)Name of Each Exchangeon Which RegisteredCommon Stock, 0.01 Par ValueHCANew York Stock ExchangeSecurities Registered Pursuant to Section 12(g) of the Act: NoneIndicate by check mark if the Registrant is a well-known seasoned issuer, as defined in Rule 405 of the SecuritiesYes È No ‘Indicate by check mark if the Registrant is not required to file reports pursuant to Section 13 or Section 15(d) of theAct. Yes ‘ No ÈIndicate by check mark whether the Registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of theSecurities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the Registrant was requiredto file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes È No ‘Indicate by check mark whether the Registrant has submitted electronically every Interactive Data File required to besubmitted pursuant to Rule 405 of Regulation S-T (§ 232.405 of this chapter) during the preceding 12 months (or for suchshorter period that the Registrant was required to submit such files). Yes È No ‘Indicate by check mark whether the Registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, asmaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “acceleratedfiler,” “smaller reporting company” and “emerging growth company” in Rule 12b-2 of the Exchange Act.Large accelerated filer ÈAccelerated filer‘Non-accelerated filer ‘Smaller reporting company ‘Emerging growth company ‘If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transitionperiod for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of theExchange Act. ‘Indicate by check mark whether the Registrant is a shell company (as defined in Rule 12b-2 of the Act). Yes ‘ No ÈAs of January 31, 2020, there were 338,427,300 outstanding shares of the Registrant’s common stock. As of June 30,2019, the aggregate market value of the common stock held by nonaffiliates was approximately 36.403 billion. For purposesof the foregoing calculation only, Hercules Holding II and the Registrant’s directors and executive officers have been deemedto be affiliates.DOCUMENTS INCORPORATED BY REFERENCEPortions of the Registrant’s definitive proxy materials for its 2020 Annual Meeting of Stockholders are incorporated byreference into Part III hereof.Act.

INDEXPageReferencePart IItem 1.Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Item 1A.Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30Item 1B.Unresolved Staff Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47Item 2.Properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47Item 3.Legal Proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48Item 4.Mine Safety Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48Market for Registrant’s Common Equity, Related Stockholder Matters and IssuerPurchases of Equity Securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49Item 6.Selected Financial Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51Item 7.Management’s Discussion and Analysis of Financial Condition and Results ofOperations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53Item 7A.Quantitative and Qualitative Disclosures about Market Risk . . . . . . . . . . . . . . . . . . . . . . . .73Item 8.Financial Statements and Supplementary Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73Item 9.Changes in and Disagreements with Accountants on Accounting and FinancialDisclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73Item 9A.Controls and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73Item 9B.Other Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75Item 10.Directors, Executive Officers and Corporate Governance . . . . . . . . . . . . . . . . . . . . . . . . . . .75Item 11.Executive Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75Item 12.Security Ownership of Certain Beneficial Owners and Management and RelatedStockholder Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76Item 13.Certain Relationships and Related Transactions, and Director Independence . . . . . . . . . . .76Item 14.Principal Accountant Fees and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76Item 15.Exhibits and Financial Statement Schedules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77Item 16.Form 10-K Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90Signatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91Part IIItem 5.Part IIIPart IV2

PART IItem 1.BusinessGeneralHCA Healthcare, Inc. is one of the leading health care services companies in the United States. AtDecember 31, 2019, we operated 184 hospitals, comprised of 179 general, acute care hospitals; three psychiatrichospitals; and two rehabilitation hospitals. In addition, we operated 123 freestanding surgery centers. Ourfacilities are located in 21 states and England.The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicatedby context, refer to HCA Healthcare, Inc. and its affiliates. The term “affiliates” means direct and indirectsubsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners.The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA, and the term“employees” refers to employees of affiliates of HCA.Our primary objective is to provide a comprehensive array of quality

Annual Meeting of Shareholders The annual meeting of shareholders will be held on May 1, 2020, at 2:00 pm local time at the HCA corporate offices located at One Park Plaza, Nashville, Tennessee 37203. Shareholders of record as of March 9, 2020 are invited to attend. One Park Plaza Nashville, Tennessee 37203 www.hcahealthcare.com Annual Report