Vic Campbell
Senior Vice President

David Anderson
Senior Vice President, Finance & Treasurer
HCA’s management will be providing certain forward-looking statements during today’s presentation.
These statements are in...
Introduction to HCA Today
                                                                                                ...
Local Market Leadership with Extensive Geographic Diversity

  HCA maintains the #1 or #2 inpatient market position with 2...
Key Initiatives

                                           Quality Programs
Physician Engagement Strategies
             ...
Quality: CMS “Core Measure” Progress
Performance by quarter compared with contemporaneous CMS data
                       ...
As Reported

    Adjusted EBITDA
($ in millions)

                                                     September          ...
Same Facility

   Volume Highlights
                                                                            Admissions...
Same Facility

Outpatient Services
                                                                                       ...
Same Facility

  Net Revenue
                                           1st Quarter           2nd Quarter     3rd Quarter ...
Same Facility

Expense Management
                                                                     Supply Cost by Cate...
As Reported
                                                                                       ($ in millions)

Other ...
HealthTrust Purchasing Group

  HPG functions as a traditional GPO offering contracts in the areas of
  supplies, pharmace...
Capex Discipline and Flexibility
 Portfolio of hospitals is well-capitalized
 Portions of both “routine capital” as well a...
Debt & Cash Flow
Debt Portfolio
($ in millions)



                                                                              Increase/
...
Free Cash Flow
($ in millions)


                                                                                         ...
LTM Cash Flow

             LTM Cash Flow From Operations and Cash Flow From Operations Before Interest & Taxes (“CFOBIT”)...
Scheduled Maturities
($ in millions)

     $12,000


     $10,000


      $8,000


      $6,000


      $4,000


      $2,...
Financial Considerations

   Focus is on cash conservation and improving liquidity

   Currently reviewing potential cost ...
Appendix
Supplemental Operating Results Summary
($ in millions)
                                                                   ...
Supplemental LTM Cash Flow Summary
($ in millions)

            LTM Cash Flow From Operations and Cash Flow From Operation...
Vic Campbell
Senior Vice President

David Anderson
Senior Vice President, Finance & Treasurer
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HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

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HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

  1. 1. Vic Campbell Senior Vice President David Anderson Senior Vice President, Finance & Treasurer
  2. 2. HCA’s management will be providing certain forward-looking statements during today’s presentation. These statements are intended to be covered by the safe-harbor provisions of the Private Securities Litigation Reform Act of 1995. Forward-looking statements include all statements that do not relate solely to historical or current facts, including statements regarding future operations, cash flows, cost management initiatives and capital structure management and can also be identified by the use of words management, like “may,” “believe,” “will,” “expect,” “project,” “estimate,” “anticipate,” “plan,” “initiative,” “continue” or words or phrases of similar meaning. These forward-looking statements speak only as of the date hereof and are based on our current plans and expectations and are subject to a number of known and unknown uncertainties and risks, many of which are beyond our control. These risks and uncertainties are described in headings such as “Risk Factors” or “Forward Looking Statements” in our annual report on Form 10- g g p K, our quarterly reports on Form 10-Q and other filings with the SEC. As a consequence, current plans, anticipated actions and future financial position and results of operations may differ significantly from those expressed in any forward-looking statements in today’s presentation. You are cautioned not to unduly rely on such forward-looking statements when evaluating the information presented and we do not intend to update any of these forward-looking statements. The presentation also contains certain non-GAAP financial measures. The Company’s earnings releases, located on the company’s investor relations page at www.hcahealthcare.com, include a reconciliation of the difference between certain of the non-GAAP financial measures presented with the most directly comparable financial measure calculated in accordance with GAAP. Other non-GAAP financial measures presented are reconciled on slides included in this presentation These non-GAAP presentation. non GAAP financial measures should not be considered an alternative to the GAAP financial measures.
  3. 3. Introduction to HCA Today Leading investor-owned provider Western Group International Anchorage of acute care services, primarily Central Group Central London Eastern Group focused in urban and suburban settings (~2.4x next largest investor-owned provider) Western W Western C Northeast Idaho Idaho Accounted for approximately 5% W Idaho Falls Idaho Falls of inpatient admissions in U.S. last Kansas City No. VA W Terre Haute C year Utah Ut h Utah Terre W Denver Wichita C C Richmond Haute Kansas City San Jose San Jose C SWSW VA VA Frankfort Frankfort W Wichita W Company operates 166 Chattanooga Las Vegas C W W Nashville Augusta Grand Strand Oklahoma City hospitals(1) and 107 freestanding Southern Oklahoma City NW GANW GA California Central Atlanta Trident/Charleston Louisiana Atlanta E surgery centers(1) in 20 El Paso Dallas/FtW W Columbus Dallas/FW Middle GA Columbus Palmyra E Austin W Jacksonville Panhandle** Austin states, and England Antonio W Houston San San AntonioHouston North Central Florida Panhandle W W Treasure Coast Tallahassee Lafayette EBITDA in 2007 was $4.6B and Palm Beach W Corpus Christi Tampa McAllen W Broward New Orleans September 2008 YTD is $3.3B Brownsville Dade REVENUE BY REVENUE BY ~ 186,000 employees GEOGRAPHY PATIENT MIX International and Other ~ 35,000 affiliated physicians 3% Outpatient 37% Eastern Western More than 40,000 licensed beds 30% 43% Inpatient 63% Central 24% (1) Includes 8 nonconsolidated hospitals and 8 nonconsolidated surgery centers and 2,367 beds managed under joint ventures 2
  4. 4. Local Market Leadership with Extensive Geographic Diversity HCA maintains the #1 or #2 inpatient market position with 20% to 40% market share in most geographies, which provides additional negotiating leverage Geographically diverse portfolio of markets help insulate the company from market-level fluctuations Dallas/Ft. Dallas/Ft. Dallas/Ft. Worth Worth Worth 18.0% 1,4 20.4%1,4 20.4%1,4 International El Paso El Paso El Paso 32.0%2,5 32 0%2,54 32.0% 1 34.2% 34 2% 1,4 Austin Austin Austin 39.8% 1,4 47.2%2,5 47.2%2,5 Western W C Idaho San Houston San Houston San Houston W Idaho Falls Denver 20.0%1,5 Antonio Denver 20.0%1,5 Antonio 18.2% 1,4 Antonio Denver 32.2% 2,4 Kansas City Kansas City Kansas Cityy 32.5%1,9 34.6%1,5 32 5%1,9 32.5% 34 6%1,54 29.1% , 29 1% 1,4 34.6% 1 24.7%1,6 24 7%1 6 Utah Ut h 22.9% 24.7%1,6 3,4 Utah Utah W Terre Haute 19.6% 2,6 20.1% 3,4 20.1%2,6 C Utah W Richmond Richmond Richmond C C Kansas City San Jose 39.4% 2,4 44.0%3,6 C 44.0%3,6 SW VA Frankfort W Wichita W Jacksonville Jacksonville Nashville Jacksonville Nashville Las Vegas Nashville Las Vegas C Las Vegas 20.7% 1,4 23.0%2,3 W W 23.0%2,3 32.5% 30.1%1,6 W Panhandle 30.1%1,6 2,4 32.2%1,7 31.5% 32.2%1,71,4 Panhandle Panhandle Oklahoma City 30.2% 2,4 34.7%2,3 34.7%2,3 OklahomaCity City Oklahoma2,6City Southern E Southern Southern 19.7% 19 7% 15.3% 2,6 15 3% 2 6 19.7% 19 7% 3,4 Ft. Pierce Ft Pi California Ft.Pierce Pierce California NC Florida California NC Florida E NC Florida 19.1%2,5,8 54.1%2,3 49.5% 2,3 19.1%2,5,8 54.1% 2,4 Charleston 34.9%2,3 13.6% 3,4 34.3% 2,4 Charleston 34.9%2,3 Charleston 29.1% 2,10 28.0% 3,4 28.0%2,10 Tampa Bay Tampa Western Group Tampa Bay 27.7%2,3 27.7%2,3 26.4% 2,4 Central Group Broward Broward Broward 22.6% 2,3 23.1% 2,4 23.1%2,3 Eastern Group Source: Notes: 2006 1st Q t data Quarter d t 4. 4 Mdtt Medstat 1. 1 Dade Dd Dade Dade 15.6%2,3 2006 3rd Quarter data 5. South Carolina Office of research & Statistics 13.9% 2,3 2. 15.6% 2,4 2005 3. 3
  5. 5. Key Initiatives Quality Programs Physician Engagement Strategies - CMS 90th percentile performance - Advisory Committees - Centralized Credentialing - Physician Sales - Electronic Health Record (EHR) - Hospitalist y - Physician Portal / EHR Service Line Strategies Access Points - Cardiology - Freestanding EDs - Orthopedic - Rural Outreach - Oncology - Primary Care Practice - Women’s Services / NICU - EMS Relationship 4
  6. 6. Quality: CMS “Core Measure” Progress Performance by quarter compared with contemporaneous CMS data 88% of HCA’s hospitals in Total Measure Sets Scores (as of 10-10-2008) top 25th 100% percentile 10.7% 12.2% 16.0% 16.3% 90% 21.3% 21.4% 22.3% 22.3% 25.0% 26.4% 34.8% 80% 43.2% 23.3% 48.7% 70% 27.0% 60% 67.3% 28.6% 67.2% 50% 70.8% 62 7% 62.7% 65 0% 65.0% 63 5% 63.5% 66 0% 66.0% 28.0% 62.8% 40% 23.7% 64.6% 30% 48.0% 65% of HCA’s 20% 36.6% hospitals in 28.8% 27.6% top 10th 22.0% 10% 16.8% 15.0% 14.3% percentile 13.8% 12.8% 12.7% 10.8% 0% 3Q 05 4Q 05 1Q 06 2Q 06 3Q 06 4Q 06 1Q 07 2Q 07 3Q 07 4Q 07 1Q 08 2Q 08 3Q 08 Yellow = 75th Percentile in 3Q07 CMS Benchmarks = 1Q07 – 4Q07 Qtr Incomplete 5
  7. 7. As Reported Adjusted EBITDA ($ in millions) September Prior Ratio Ratio 2008 YTD Year Revenues $21,109 $19,975 Provision for Doubtful Accounts 2,520 2,218 100.0% 100.0% Cash Revenues 18,589 17,757 Salaries & Benefits 8,563 8,002 46.1% 45.1% 18.6% 18 6% 18.5% 18 5% Supplies 3,463 3 463 3,284 3 284 18.2% 17.9% Other Operating Expenses 3,396 3,194 Gains on Investments - (6) - - -0.9% -0.9% Equity in Earnings of Affiliates (170) (156) 82.0% 80.6% Total Operating Expenses 15,252 14,318 Adjusted EBITDA 3,337 3,439 18.0% 19.4% 5.7% 6.2% Depreciation & Amortization 1,062 1,072 8.2% 8 2% 9.4% 9 4% Interest 1,521 1 521 1,674 1 674 Gains on Sales of Facilities (90) (332) -0.5% -1.9% 0.3% 0.1% Impairment of Long-Lived Assets 53 24 0.9% 0.9% Minority Interest 161 160 Income Before Taxes 630 841 3.4% 4.7% 2.1% 3.4% Net Income $397 $596 6
  8. 8. Same Facility Volume Highlights Admissions by Payer Mix % Change Medicare +2.0% 41.8% 41 8% +0.7% Medicaid 2nd Quarter 3rd Quarter 1st Quarter Managed/ 15.6% -1.8% Sept YTD ons 1.3% Discounted +0.9% 0.9% Admissio 0.8% % +0.9% 34.0% Uninsured 0.4% +1.9% 6.7% International 1.9% 3rd Quarter 2008 Source: QMIRS Sept YTD dmissions Mix % Change 2.0% 1.9% +1.7% Adjusted 1.1% Medicare +2.7% 43.3% A Ad Medicaid +1.0% 15.2% -2.0% Managed/ Discounted +2.3% 2.3% 33.3% Uninsured +4.9% 6.3% International 1.9% 7 September 2008 YTD Source: QMIRS
  9. 9. Same Facility Outpatient Services ER Visits by Payer 2nd Quarter 3rd Quarter 1st Quarter *Restating same store to include “new” ASCs which cannibalized existing hospital Mix % Change based outpatient surgeries 1.2% tpatient Surgeries -0.3% 20.3% Medicare 3.0% -2.3% 0.8%S t YTD __._% % Sept Out -0.7% -0.7% 22.2% -2.7% -0.3%* Medicaid 13.9% Sept YTD __._% 0.8% -0.3% Managed/ 33.6% -1.2% ASC Based Discounted t Outpatient Surgeries s -0.7% -0.8% 23.9% Uninsured -0.2% _._% Source: QMIRS 3rd Quarter 2008 Mix % Change spital Based -0.7% Outpatient Surgeries 0.8% 20.7% 4.9% Medicare __._% Sept YTD -4 0% 4.0% S Hos 22.2% % -1.0% 12.7% Medicaid __._% ER Visits 33.6% 0.1% Managed/ 6.8% Discounted V 4.4% 4 4% 2.9%Sept YTD 23.5% 4.5% +4.8% Uninsured Source: QMIRS September 2008 YTD 8
  10. 10. Same Facility Net Revenue 1st Quarter 2nd Quarter 3rd Quarter Sept YTD +4.2% R/AA 5.1% 5.6% +4.4% ash 3.7% Ca NR 4.5% 4.7% 2.5% Excluding UPL Revenue Mix - YTD Revenue Mix - QTD Mix per AA % Change per AA % Change Mix 5.4% 5 4% Medicare 4.4% 4 4% 28.6% 28 6% Medicare 29.9% __._% __._% 9.3% 6.0% 3.6% Medicaid * 8.4% * Medicaid __._% % __._% % Managed/ 46.6% 6.2% 7.1% Managed/ 46.2% Discounted Discounted Uninsured 9.3% 7.3% 1.4% Uninsured 9.3% 6.2% Other _._% % Other Oth _._% % 6.2% 3rd Quarter 2008 Source: QMIRS September 2008 YTD Source: QMIRS 9 * Medicaid per AA Change Excludes UPL
  11. 11. Same Facility Expense Management Supply Cost by Category 2nd Quarter 3rd Quarter 1st Quarter xp./AA Sept YTD % Total Per AA % change +5.7% +6.3% 7.2% ash Medical 6.0% 6.0% +4.8% 4.8% Op.Ex 34.6% 34 6% Devices Di Ca 7.0% 5.7% 4.5% Pharmacy Excluding UPL +0.3% 19.4% Sept YTD +4.9% +4 9% Commodity Wage +5.1% Rate 4.9% 4.8% 5.1% 40.0% +14.2% Blood 6.0% East, West & Central Hospital Operations – p p 3rd Q Quarter 2008 t Including rebates Sept YTD +1.5% EEOB Medical 1.8% 1.1% 1.8% +5.6% 35.0% Devices E Pharmacy +0.8% As Reported 19.6% Sept YTD plies Commodity +5.3% +5.0% /AA A 6.4% 39.4% 39 4% Supp 4.5% 4 5% 4.9% 4 9% Blood +17.6% 6.0% East, West & Central Hospital Operations – September 2008 YTD 10 Including rebates
  12. 12. As Reported ($ in millions) Other Operating Expenses Contract Services Professional Fees $863.8 3.4% $500 $900 19.6% $835.7 $421.9 $352.8 $ $400 $800 $300 $700 $200 $600 2007 2008 2007 2008 September YTD September YTD Utilities Repairs & Maintenance $500 $500 $437.6 7.6% 9.3% $406.8 $ $400 $342.5 $400 $313.2 $300 $300 $200 $200 2007 2008 2007 2008 September YTD September YTD 11
  13. 13. HealthTrust Purchasing Group HPG functions as a traditional GPO offering contracts in the areas of supplies, pharmaceuticals, medical devices, and capital equipment Currently serves over 4,000 members, including more than 1,400 acute care hospitals and 400+ surgery centers Over 1,200 contracts with $15 billion annualized compliant purchasing volume Generates significant annual profits from administrative fees from suppliers for pe o performing GPO services; s g ca t y lowered t e Co pa y s supp y costs g G O se ces; significantly o e ed the Company's supply Per-unit cost advantage over competitors Established E t bli h d separate di i i t division, C T t i 2006 t provide non-healthcare CoreTrust, in to id h lth contracts (e.g. office supplies, pc’s, copiers) to non-healthcare Fortune 500 companies 12
  14. 14. Capex Discipline and Flexibility Portfolio of hospitals is well-capitalized Portions of both “routine capital” as well as “new” and “expansion / renovation” capital could be delayed to increase cash flow if needed CAPITAL EXPENDITURES ($ in billions) 2008E 2007 2005 2006 2004 $1.65 $1.5 $1.6 $1.85 $1.52 $2.0 $1.6 Facility Expansion / Renovation Projects $1.2 New & Replacement Facilities Infrastructure $0.8 Development Routine $0.4 $0.0 2004 2005 2006 2007 2008E 13
  15. 15. Debt & Cash Flow
  16. 16. Debt Portfolio ($ in millions) Increase/ 9/30/2008 12/31/2007 (Decrease) Bank Revolver $ - $ - $ - Asset-Based Revolver 1,880 1,350 530 Term Loan A 2,553 2,638 (85) Term Loan B 8,646 8,712 (66) European Term Loan 887 967 (80) Total Bank Debt 13,966 13,667 299 Second Lien Cash Pay Notes 4,200 4,200 - Second Lien Toggle Notes 1,500 1,500 - Other Secured Debt 406 427 (21) Total Senior Secured Debt 20,072 19,794 278 Unsecured Notes, net 6,969 7,514 (545) Total Debt $ 27,041 $ 27,308 $ (267) Debt D bt / EBITDA 6.0x 60 5.9x 59 15
  17. 17. Free Cash Flow ($ in millions) 9 Months Ended September 30, 2008 2007 Free cash flow analysis: Free cash flow analysis: Net cash provided by operating activities: Net income……………………………………………………………………………… $             397 $             596 Provision for doubtful accounts………………………………………………             2,520            2,218 Depreciation and amortization…………………………………………………             1,062            1,072 Income taxes……………………………………………………………………………            ( (379) )            ( ) (103) Gains on sales of facilities…………………………………………………………                 (90)               (332) Impairment of long‐lived assets………………………………………………                   53                   24 Changes in operating assets and liabilities…………………………………          (2,420)            (2,598) Share‐based compensation………………………………………………………                  25                   17 Change in minority interest………………………………………………………                  10                   33 Other………………………………………………………………………………………                   86                   58 Net cash provided by operating activities……………………… $          1,264 $             985 Less: Capital expenditures………………………………………………………………… Capital expenditures…………………………………………………………………          1,115             997 Free cash flow…………………………………………………………………………………… $             149 $              (12) 16
  18. 18. LTM Cash Flow LTM Cash Flow From Operations and Cash Flow From Operations Before Interest & Taxes (“CFOBIT”) $4,500 $4,000 $3,500 $millions $3,000 $2,500 $2,000 $1,500 $1,000 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08 2Q08 3Q08 Quarter Ended Cash Flow From Operations CFOBIT 17
  19. 19. Scheduled Maturities ($ in millions) $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $0 '08 '09 '10 '11 '12 '13 '14 '15 '16 '23 '24 '25 '27 '33 '36 '95 Public Debt - Unsecured Public Debt - 2nd Lien Bonds Bank Term D bt B kT Debt Bank Revolvers - C B kR l Commitment it t 2008 2009 2010 2011 2012 2013 2014 2015 2016 Public Debt - Unsecured $12 $46 $923 $314 $902 $1,000 $621 $900 $1,000 Public Debt - 2nd Lien Bonds - - - - - - 1,000 - 4,700 Bank Term Debt 54 328 328 553 1,728 9,097 - - - Bank R B k Revolvers - C l Commitment it t - - - - 4,000 4 000 - - - - Total $66 $373 $1,251 $867 $6,630 $10,097 $1,621 $900 $5,700 18 Note: Excludes $406 million of other secured debt (primarily capitalized leases)
  20. 20. Financial Considerations Focus is on cash conservation and improving liquidity Currently reviewing potential cost cutting strategies, size of cost-cutting strategies the capital expenditure program and utilizing alternative financing sources to improve liquidity PIK Toggle Notes – election to PIK improves liquidity; PIK option exercised on the Toggle Notes for the next interest period (ending 5/15/09) Operations and ability to generate cash remain strong despite industry and general economic challenges Liquidity position is strong with Revolver capacity of ~$2 billion at 9/30/08 and no meaningful debt maturities until 2nd half of 2010 19
  21. 21. Appendix
  22. 22. Supplemental Operating Results Summary ($ in millions) For the Nine Months Third Quarter Ended September 30, 2008 2007 2008 2007 Revenues $ 7,002 $ 6,569 $ 21,109 $ 19,975 Net income $ 86 $ 300 $ 397 $ 596 Gains on sales of facilities (net of tax) (29) (193) (203) (53) Impairment of long-lived assets (net of tax) 28 — 34 15 Net income, excluding gains on sales of facilities and impairment of long-lived assets 85 107 378 408 Depreciation and amortization 356 1,072 350 1,062 Interest expense p 497 560 1,521 , 1,674 , Minority interests in earnings of consolidated entities 49 44 161 160 Provision for income taxes 72 (84) 215 125 Adjusted EBITDA (a) $ 983 $ 3,439 $ 1,053 $ 3,337 (a) Net income, excluding gains on sales of facilities and impairment of long‐lived assets and adjusted EBITDA are non‐GAAP financial  measures. We believe that net income, excluding gains on sales of facilities and impairment of long‐lived assets and adjusted EBITDA are  important measures that supplement discussions and analysis of our results of operations. We believe that it is useful to investors to  provide disclosures of our results of operations on the same basis as that used by management. Management relies upon net income,  excluding gains on sales of facilities and impairment of long‐lived assets and adjusted EBITDA as the primary measures to review and  assess operating performance of its hospital facilities and their management teams.   Management and investors review both the overall performance (including; net income, excluding gains on sales of facilities and  impairment of long‐lived assets and GAAP net income) and operating performance (adjusted EBITDA) of our health care facilities.  Adjusted EBITDA and the adjusted EBITDA margin (adjusted EBITDA divided by revenues) are utilized by management and investors to  compare our current operating results with the corresponding periods during the previous year and to compare our operating results  with other companies in the health care industry. It is reasonable to expect that gains on sales of facilities and impairments of long‐lived  assets will occur in future periods, but the amounts recognized can vary significantly from quarter to quarter, do not directly relate to  the ongoing operations of our health care facilities and complicate quarterly comparisons of our results of operations and operations  comparisons with other health care companies.   Net income, excluding gains on sales of facilities and impairment of long‐lived assets and adjusted EBITDA are not measures of financial  , gg p g j performance under accounting principles generally accepted in the United States, and should not be considered as alternatives to net  income as a measure of operating performance or cash flows from operating, investing and financing activities as a measure of liquidity.  Because net income, excluding gains on sales of facilities and impairment of long‐lived assets and adjusted EBITDA are not  measurements determined in accordance with generally accepted accounting principles and are susceptible to varying calculations, net  income, excluding gains on sales of facilities and impairment of long‐lived assets and adjusted EBITDA, as presented, may not be  21 comparable to other similarly titled measures presented by other companies. 
  23. 23. Supplemental LTM Cash Flow Summary ($ in millions) LTM Cash Flow From Operations and Cash Flow From Operations Before Interest & Taxes (“CFOBIT”) 4Q2006 1Q2007 2Q2007 3Q2007 4Q2007 1Q2008 2Q2008 3Q2008 Cash Flow F C h Fl From O Operations ti $1,845 $1 845 $1,850 $1 850 $1,519 $1 519 $1,477 $1 477 $1,396 $1 396 $1,271 $1 271 $1,414 $1 414 $1,675 $1 675 Taxes Paid 1,087 663 504 500 421 697 726 685 Interest Paid 893 1,175 1,634 1,861 2,163 2,131 2,078 2,021 CFOBIT $3,825 $3 825 $3,688 $3 688 $3,657 $3 657 $3,838 $3 838 $3,980 $3 980 $4,099 $4 099 $4,218 $4 218 $4,381 $4 381 22
  24. 24. Vic Campbell Senior Vice President David Anderson Senior Vice President, Finance & Treasurer
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