hca presents at bank of america 2008 credit conference 20-nov-2008

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Vic Campbell Senior Vice President David Anderson David Anderson Senior Vice President, Finance & Treasurer

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Page 1: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Vic CampbellSenior Vice President

David AndersonDavid AndersonSenior Vice President, Finance & Treasurer

Page 2: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

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 wordsmanagement initiatives and capital structure management, and can also be identified by the use of words 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 pK, 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-GAAPfinancial measures presented are reconciled on slides included in this presentation. These non GAAP financial measures should not be considered an alternative to the GAAP financial measures.

Page 3: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Introduction to HCA Today

InternationalAnchorage

Western GroupCentral GroupEastern Group

Central London

Leading investor-owned provider of acute care services, primarily focused in urban and suburban settings (~2.4x next largest

NortheastC

Terre Haute

Idaho FallsIdaho FallsWW

W

WesternIdaho

Ut h CNo. VA

WesternIdaho

Kansas City

investor-owned provider)

Accounted for approximately 5% of inpatient admissions in U.S. last

NW GAColumbus

Atlanta

Las VegasWWW

San JoseW Utah

SouthernCalifornia

Utah

W

Denver

WDallas/FW

Kansas City

Oklahoma City

WichitaW

Dallas/FtW

Wichita

El PasoCentralLouisiana

C

C

RichmondCSW VA

CFrankfort

C SW VAFrankfort

Nashville

Frankfort

EColumbus

TerreHaute

Middle GAPalmyra

Trident/CharlestonGrand StrandAugusta

ChattanoogaSW VASan Jose

NW GAAtlanta

Oklahoma City

year

Company operates 166 hospitals(1) and 107 freestanding surgery centers(1) in 20

Panhandle**

Orleans

Tallahassee

W

WSan AntonioAustin

HoustonW

W

Corpus ChristiMcAllenBrownsville

W

WW

San AntonioAustin

New

LafayetteTampa

North Central FloridaTreasure Coast

E

Palm Beach

DadeBroward

JacksonvilleColumbus

Panhandle

Palmyra

Houston

surgery centers in 20 states, and England

EBITDA in 2007 was $4.6B and September 2008 YTD is $3.3B

~ 186,000 employees

~ 35,000 affiliated physicians

More than 40,000 licensed beds

REVENUE BY GEOGRAPHY

REVENUE BY PATIENT MIX

Eastern 30%

Western 43%

International and Other

3% Outpatient37%

Inpatient

2

More than 40,000 licensed beds

(1) Includes 8 nonconsolidated hospitals and 8 nonconsolidated surgery centers and 2,367 beds managed under joint ventures

30% 43%

Central24%

Inpatient63%

Page 4: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

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

InternationalInternational

Dallas/Ft. Worth

20.4%1,4

Dallas/Ft. Worth

20.4%1,4

El Paso32 0%2,5El Paso32.0%2,5

Dallas/Ft. Worth

20.4%1,4

Dallas/Ft. Worth

20.4%1,4

El Paso32 0%2,5El Paso32.0%2,5

Dallas/Ft. Worth

20.4%1,4

Dallas/Ft. Worth

20.4%1,4

El Paso32 0%2,5El Paso32.0%2,5

Dallas/Ft. Worth 18.0% 1,4

El Paso 34 2% 1 4

CIdaho FallsW

WWesternIdaho

Denver32 5%1,9Denver32.5%1,9 Kansas CityKansas City

24 7%1 6

CIdaho FallsW

WWesternIdaho

Denver32 5%1,9Denver32.5%1,9 Kansas CityKansas City

24 7%1 6

Austin47.2%2,5

Austin47.2%2,5

San Antonio34 6%1,5

San Antonio34.6%1,5

32.0%

Houston20.0%1,5Houston20.0%1,5

Austin47.2%2,5

Austin47.2%2,5

San Antonio34 6%1,5

San Antonio34.6%1,5

32.0%

Houston20.0%1,5Houston20.0%1,5

Austin47.2%2,5

Austin47.2%2,5

San Antonio34 6%1,5

San Antonio34.6%1,5

32.0%

Houston20.0%1,5Houston20.0%1,5

34.2% 1,4

Austin 39.8% 1,4

Houston 18.2% 1,4

San Antonio 29 1% 1 4

Kansas City Denver 32.2% 2,4

Ut hTerre HauteW

WW

W

San JoseW Utah

W

Kansas City

Oklahoma City

Wichita W

C

C

CSW VA

C

FrankfortC

SW VAFrankfort

E

Richmond44.0%3,6Richmond

44.0%3,6

Nashville30.1%1,6Nashville30.1%1,6Las Vegas

32.2%1,7Las Vegas

32.2%1,7

SouthernSouthern

32.5% y24.7%1,624.7%1,6

Utah20.1%2,6

Utah20.1%2,6

Oklahoma City19 7%2 6

Oklahoma City19 7%2,6

Terre HauteW

WW

W

San JoseW Utah

W

Kansas City

Oklahoma City

Wichita W

C

C

CSW VA

C

FrankfortC

SW VAFrankfort

E

Richmond44.0%3,6Richmond

44.0%3,6

Nashville30.1%1,6Nashville30.1%1,6Las Vegas

32.2%1,7Las Vegas

32.2%1,7

SouthernSouthern

32.5% y24.7%1,624.7%1,6

Utah20.1%2,6

Utah20.1%2,6

Oklahoma City19 7%2 6

Oklahoma City19 7%2,6

34.6% ,34.6% ,34.6% ,

Jacksonville23.0%2,3

Jacksonville23.0%2,3

Panhandle34.7%2,3

Panhandle34.7%2,3

Jacksonville23.0%2,3

Jacksonville23.0%2,3

Panhandle34.7%2,3

Panhandle34.7%2,3

29.1% 1,4

Jacksonville 20.7% 1,4

Ft Pi

Panhandle 30.2% 2,4

Nashville 32.5% 2,4

Richmond 39.4% 2,4

22.9% 3,4Utah 19.6% 3,4

Southern

Las Vegas 31.5% 1,4

Oklahoma City 15 3%

Notes: 1 2006 1st Q t d t 4 M d t t

Source:

ESouthernCalifornia19.1%2,5,8California19.1%2,5,8

Charleston28.0%2,10Charleston28.0%2,10

19.7%2,619.7%E

SouthernCalifornia19.1%2,5,8California19.1%2,5,8

Charleston28.0%2,10Charleston28.0%2,10

19.7%2,619.7%

Tampa Bay27.7%2,3

Tampa Bay27.7%2,3

D d

Broward23.1%2,3Broward23.1%2,3

Ft. Pierce54.1%2,3Ft. Pierce54.1%2,3NC Florida

34.9%2,3NC Florida

34.9%2,3

Tampa Bay27.7%2,3

Tampa Bay27.7%2,3

D d

Broward23.1%2,3Broward23.1%2,3

Ft. Pierce54.1%2,3Ft. Pierce54.1%2,3NC Florida

34.9%2,3NC Florida

34.9%2,3

Western Group

Central Group

Eastern Group

Western Group

Central Group

Eastern Group

Ft Pierce 49.5% 2,4

Broward 22.6% 2,4

Tampa Bay 26.4% 2,4

NC Florida 34.3% 2,4Charleston

29.1% 3,4

Southern California 13.6% 3,4

15.3% 3,4

3

1. 2006 1st Quarter data2. 2006 3rd Quarter data3. 2005

4. Medstat5. South Carolina Office of research & Statistics

Dade15.6%2,3

Dade15.6%2,3Dade

15.6%2,3Dade

15.6%2,3Dade

13.9% 2,4

Page 5: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Key Initiatives

Physician Engagement StrategiesAdvisory Committees

Quality Programs- CMS 90th percentile performance

- Advisory Committees- Physician Sales- Hospitalist- Physician Portal / EHR

- Centralized Credentialing- Electronic Health Record (EHR)

y

Access Points- Freestanding EDs

Service Line Strategies- Cardiology

- Rural Outreach- Primary Care Practice- EMS Relationship

- Orthopedic- Oncology- Women’s Services / NICU

4

Page 6: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Quality: CMS “Core Measure” ProgressPerformance by quarter compared with contemporaneous CMS data

100%

Performance by quarter compared with contemporaneous CMS data88% of HCA’s hospitals in top 25th

percentile

Total Measure Sets Scores (as of 10-10-2008)

23.3%

26.4%22.3% 21.3% 22.3%

16.3%21.4%

16.0%10.7%

48.7%43.2%

34.8%25.0%

12.2%

70%

80%

90%

62 7% 65 0% 63 5%70.8%

66 0%67.2%

67.3%28.6%

27.0%

50%

60%

70%

48.0%

64.6%

62.8%62.7% 65.0% 63.5% 66.0%

23.7%28.0%

20%

30%

40%

65% of HCA’s

10.8%15.0% 13.8% 14.3% 12.8% 12.7%

16.8%22.0%

27.6% 28.8%36.6%

0%

10%

20%

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

hospitals in top 10th

percentile

5

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

CMS Benchmarks = 1Q07 – 4Q07 Yellow = 75th Percentile in 3Q07 Qtr Incomplete

Page 7: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

($ in millions)

Adjusted EBITDAAs Reported

($ in millions)

September Prior2008 YTD Ratio Year Ratio

Revenues $21,109 $19,975

Provision for Doubtful Accounts 2,520 2,218

Cash Revenues 18,589 100.0% 17,757 100.0%

Salaries & Benefits 8,563 46.1% 8,002 45.1%

Supplies 3 463 18 6% 3 284 18 5%Supplies 3,463 18.6% 3,284 18.5%

Other Operating Expenses 3,396 18.2% 3,194 17.9%

Gains on Investments - - (6) -

Equity in Earnings of Affiliates (170) -0.9% (156) -0.9%

Total Operating Expenses 15,252 82.0% 14,318 80.6%

Adjusted EBITDA 3,337 18.0% 3,439 19.4%

Depreciation & Amortization 1,062 5.7% 1,072 6.2%

Interest 1 521 8 2% 1 674 9 4%Interest 1,521 8.2% 1,674 9.4%

Gains on Sales of Facilities (90) -0.5% (332) -1.9%

Impairment of Long-Lived Assets 53 0.3% 24 0.1%

Minority Interest 161 0.9% 160 0.9%

6

Income Before Taxes 630 3.4% 841 4.7%

Net Income $397 2.1% $596 3.4%

Page 8: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Same Facility

Volume HighlightsAdmissions by Payer

41 8%

Mix

+2.0%

% Change

Medicare

Admissions by Payer

ons

1st Quarter 2nd Quarter

41.8%

15.6% -1.8%

+0.7%

Managed/Discounted

Medicaid3rd Quarter

%1.3% Sept YTD

+0.9%

Adm

issi

o

34.0%

6.7%Source: QMIRS

+0.9%

3rd Quarter 2008

Uninsured0.8%

0.4%

0.9%

International +1.9%1.9%

Adj

uste

d dm

issi

ons Mix % Change

Sept YTD

+1.7%1.1%

2.0% 1.9%

43.3%+2.7%Medicare

AA

d

15.2% -2.0%

+1.0%

+2.3%

Managed/Discounted

Medicaid

7

33.3%

6.3%Source: QMIRS

2.3%

September 2008 YTD

Uninsured

International +4.9%1.9%

Page 9: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Outpatient ServicesSame Facility

ER Visits by Payer1st Quarter 2nd Quarter 3rd Quarter

tpat

ient

rg

erie

s

*Restating same store to include “new” ASCs which cannibalized existing hospital based outpatient surgeries

%

Mix % Change

20.3% 3.0%MedicareS t YTD0.8%-2.3%

-0.3%1.2%

d t s

Out Su

__._%

__._%33.6%

22.2%

-1.2%

13.9%

Managed/Discounted

Medicaid

0.8%Sept YTD

-0.3%

Sept YTD-0.7%-0.3%*-2.7%

-0.7%0.8%

ASC

Bas

eO

utpa

tient

Surg

erie

s

_._%Source: QMIRS

23.9% -0.2%

Discounted

Uninsured

3rd Quarter 2008

-0.7% -0.8%

spita

l Bas

edut

patie

nt

Surg

erie

s

__._%

Mix % Change

%

20.7% 4.9%Medicare

-4 0%

-0.7%0.8%

Sept YTD

Visi

tsH

os O S

__._%33.6%

22.2%

0.1%

12.7%

Managed/Discounted

Medicaid

4.0%-1.0%

6.8%4 4%

8

ER V

Source: QMIRS

23.5% 4.5%Uninsured

September 2008 YTD

4.4% 2.9%Sept YTD

+4.8%

Page 10: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Net RevenueSame Facility

ash

R/A

A

1st Quarter 2nd Quarter 3rd Quarter Sept YTD+4.2%+4.4%5.6%5.1%

3.7%

Ca

NR

Excluding UPL

4.7%

2.5%

4.5%

Mix per AA % Change

28 6% Medicare

Revenue Mix - QTD

4 4%

Mix per AA % Change

5 4%

Revenue Mix - YTD

__._%

%

9.3%

28.6% Medicare

Medicaid 3.6%

4.4%

*

__._%

%

8.4%

29.9%

6.0%

5.4%Medicare

Medicaid*

__._%

%6.2%9.3%

46.6% Managed/Discounted

UninsuredOther

1.4%

7.1%__._%

%9.3%

46.2%

7.3%

6.2%Managed/Discounted

UninsuredOth

9

_._%Source: QMIRS 3rd Quarter 2008

_._%6.2%Source: QMIRS

Other

* Medicaid per AA Change Excludes UPL

September 2008 YTD

Page 11: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Expense ManagementSame Facility

ash

xp./A

A

MedicalD i34 6%

% Total Per AA % change

+4.8%

1st Quarter 2nd Quarter 3rd Quarter Supply Cost by CategorySept YTD+5.7%+6.3%7.2% 6.0% 6.0%

Ca

Op.

Ex

Excluding UPL

Devices

Pharmacy19.4%

34.6% 4.8%

+0.3%Sept YTD

+4 9%

4.5%5.7%

7.0%

Wag

e R

ate Commodity

Blood

40.0%

6.0%East, West & Central Hospital Operations –

3rd Q t 2008

+5.1%

+14.2%

4.8% 4.9% 5.1%+4.9%

EEO

B

p pIncluding rebates 3rd Quarter 2008

MedicalDevices35.0% +5.6%

Sept YTD

1.8% 1.1% 1.8%+1.5%

plie

sA

E

As Reported Pharmacy

Commodity

19.6%

39 4%

+5.0%

+0.8%

6.4% 4 5% 4 9%

Sept YTD

+5.3%

10

Supp /A

A

Blood

39.4%

6.0%East, West & Central Hospital Operations –Including rebates

+17.6%

6.4% 4.5% 4.9%

September 2008 YTD

Page 12: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

As Reported($ in millions)

Other Operating Expenses

Professional Fees Contract Services

$500

$

$421.9 $900 $835.7

$863.8 19.6% 3.4%

$300

$400 $352.8

$700

$800

September YTD September YTD

$200 2007 2008

$600 2007 2008

UtilitiesRepairs & Maintenance

$400

$500 $406.8

$437.6

$400

$500

$342.5

9.3%7.6%

$300

$400

$200

$300

$$313.2

$342.5

11September YTDSeptember YTD

$200 2007 2008

$200 2007 2008

Page 13: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

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 performing GPO services; significantly lowered the Company's supply costspe o g G O se ces; s g ca t y o e ed t e Co pa y s supp y costs

Per-unit cost advantage over competitors

E t bli h d t di i i C T t i 2006 t id h lthEstablished separate division, CoreTrust, in 2006 to provide non-healthcare contracts (e.g. office supplies, pc’s, copiers) to non-healthcare Fortune 500 companies

12

Page 14: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Capex Discipline and FlexibilityPortfolio 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)

$2.0

2004

$1.522005

$1.62006

$1.852008E

$1.652007

$1.5

$1.6Facility Expansion /

$0.8

$1.2Renovation ProjectsNew & Replacement FacilitiesInfrastructure Development

$0.4

DevelopmentRoutine

13

$0.02004 2005 2006 2007 2008E

Page 15: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Debt & Cash FlowDebt & Cash Flow

Page 16: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Debt Portfolio($ in millions)

Increase/9/30/2008 12/31/2007 (Decrease)

Bank Revolver -$ -$ -$

($ in millions)

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 -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)$

D bt / EBITDA 6 0 5 9

15

Debt / EBITDA 6.0x 5.9x

Page 17: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Free Cash Flow($ in millions)($ in millions)

9 Months EndedSeptember 30,

2008 2007Free cash flow analysis:Free cash flow analysis:

Net cash provided by operating activities:397$               596$              

2,520              2,218             1,062              1,072             ( ) ( )

Net income………………………………………………………………………………Provision for doubtful accounts………………………………………………Depreciation and amortization…………………………………………………

(379)              (103)             (90)                  (332)               53                     24                    

(2,420)             (2,598)            Share‐based compensation……………………………………………………… 25                     17                    

Impairment of long‐lived assets………………………………………………Changes in operating assets and  liabilities…………………………………

Income taxes……………………………………………………………………………Gains on sales of facilities…………………………………………………………

Change in minority  interest……………………………………………………… 10                     33                    86                     58                    

1,264$            985$              Less:

1,115 997

Other………………………………………………………………………………………Net cash provided by operating activities………………………

Capital expenditures………………………………………………………………… 1,115            997              149$               (12)$               

Capital expenditures…………………………………………………………………Free cash flow……………………………………………………………………………………

16

Page 18: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

LTM Cash Flow

LTM Cash Flow From Operations and Cash Flow From Operations Before Interest & Taxes (“CFOBIT”)

$4,500

$3,500

$4,000

$2,500

$3,000

$mill

ions

$1,500

$2,000

$1,000 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08 2Q08 3Q08

Quarter Ended

17

Cash Flow From Operations CFOBIT

Page 19: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Scheduled Maturities($ in millions)($ in millions)

$10,000

$12,000

$6,000

$8,000

$2,000

$4,000

$0'08 '09 '10 '11 '12 '13 '14 '15 '16 '23 '24 '25 '27 '33 '36 '95

Public Debt - Unsecured Public Debt - 2nd Lien BondsB k T D bt B k R l C it tBank Term Debt Bank Revolvers - Commitment

2008 2009 2010 2011 2012 2013 2014 2015 2016Public Debt - Unsecured $12 $46 $923 $314 $902 $1,000 $621 $900 $1,000Public Debt - 2nd Lien Bonds - - - - - - 1,000 - 4,700 Bank Term Debt 54 328 328 553 1,728 9,097 - - - B k R l C it t 4 000

18

Bank Revolvers - Commitment - - - - 4,000 - - - - Total $66 $373 $1,251 $867 $6,630 $10,097 $1,621 $900 $5,700

Note: Excludes $406 million of other secured debt (primarily capitalized leases)

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

Financial Considerations

Focus is on cash conservation and improving liquidity

Currently reviewing potential cost cutting strategies size ofCurrently reviewing potential cost-cutting strategies, size of 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)period (ending 5/15/09)

Operations and ability to generate cash remain strong despite industry and general economic challengesindustry 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

19

billion at 9/30/08 and no meaningful debt maturities until 2half of 2010

Page 21: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

AppendixAppendix

Page 22: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

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

($ in millions)

Net income $ 86 $ 300 $ 397 $ 596Gains on sales of facilities (net of tax) (29) (193) (53) (203)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 350 356 1,062 1,072 Interest expense 497 560 1,521 1,674p , ,Minority interests in earnings of consolidated entities 49 44 161 160 Provision for income taxes 72 (84) 215 125

Adjusted EBITDA (a) $ 1,053 $ 983 $ 3,337 $ 3,439

(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 

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, g g p g jperformance 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 comparable to other similarly titled measures presented by other companies. 

Page 23: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Supplemental LTM Cash Flow Summary($ in millions)

4Q2006 1Q2007 2Q2007 3Q2007 4Q2007 1Q2008 2Q2008 3Q2008

C h Fl F O ti $1 845 $1 850 $1 519 $1 477 $1 396 $1 271 $1 414 $1 675

($ in millions)

LTM Cash Flow From Operations and Cash Flow From Operations Before Interest & Taxes (“CFOBIT”)

Cash Flow From Operations $1,845 $1,850 $1,519 $1,477 $1,396 $1,271 $1,414 $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 $3 688 $3 657 $3 838 $3 980 $4 099 $4 218 $4 381CFOBIT $3,825 $3,688 $3,657 $3,838 $3,980 $4,099 $4,218 $4,381

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Page 24: HCA Presents at Bank of America 2008 Credit Conference 20-Nov-2008

Vic CampbellSenior Vice President

David AndersonDavid AndersonSenior Vice President, Finance & Treasurer