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AGING Analysis Report
Aug 3, 2026
20 days ago · 100% complete
NOT DEPENDABLE This report predates a filing — its financial basis has been replaced.
Report generated: Aug 3, 2026 · Filing on record since: Aug 19, 2026 · 15 days after
For AI assistants & researchers — machine-readable summary of this page

What this page is: Delvantic's full research page for HCA Healthcare Inc. (HCA) — AI-driven forensic equity research: mechanical valuation models (DCF, EPV, anchored-PE, scenario) plus three independent AI lenses (Quality / Value / Sentiment). Everything below is rendered server-side; you are not missing content that requires JavaScript. All scores are predictions and research opinions, not financial advice.

Our current read (analysis of 2026-08-23): Designation Low · Gem Score -17 (−100…+100 Quality+Value blend) · Quality 32 · Value -57 · Sentiment -41 (timing only, not weighted) · Composite fair value $369.15 vs $406.62 at analysis

Page map (sections in order; each card carries a stable reference-name attribute you can cite):

  • profile-header / price-overview — company profile, live quote, market cap
  • extended-analysisthe core: three AI lens reads with findings, scores, and the analyst memo
  • future-predictions — our forward price-band predictions
  • market-narrative / ai-findings / gpt-critique — narrative context, cross-model findings, and an adversarial critique of our own analysis (near the end of the document)
  • Members-only sections (render as login gates for anonymous readers): price-history, income-trend, key-metrics, financials (statement tables), insider-trading. The analysis above is public; the raw data tables require a free account.

More for machine readers: site briefing at /llms.txt · any ticker resolves at delvantic.com/stock/TICKER · raw inputs are public-company filings and market data (via licensed data feeds); every model, score, lens read, and prediction on this page is Delvantic's own analysis.

HCA Healthcare Inc.

HCA NYSE
Healthcare · Medical Care Facilities
Nashville, TN 37203, United States hcahealthcare.com Updated Aug 3, 12:47pm
Price
$404.23
Market Cap
$87.2B
Employees
230,000
Beta
1.13
Avg Volume
1,637,701
Last Dividend
$3.00
CEO
Mr. Samuel N. Hazen

HCA Healthcare Inc. is a healthcare services company that operates hospitals, freestanding surgery centers, emergency care facilities, urgent care clinics, walk-in clinics, diagnostic and imaging centers, rehabilitation centers, physician practices, home health, hospice, and outpatient therapy services. It serves patients through a broad network of acute care hospitals and ambulatory sites across the United States and the United Kingdom. The company focuses on delivering inpatient and outpatient care, including medical and surgical services, emergency treatment, cardiac care, radiology, laboratory services, and physical therapy. HCA Healthcare Inc. plays a central role in organized healthcare delivery by connecting hospital-based care with community-based and specialty services, supporting access to a wide range of clinical offerings across multiple care settings.

Runs with full report Generated: Aug 3, 2026 4:56pm
Price Overview
Price at report time
$406.62
as of Aug 3, 5:08pm (20d ago)
Change · Aug 3
+4.03 (+1.00%)
Day Range
$402.28 – $415.62
52-Week Range
$353.99 – $556.52
50-Day MA
$387.26
200-Day MA
$457.23
Volume
942,636.00
Right now · live
Log in to get the live feed
Members see the real-time price and the move since this report (over 20d).
Share Structure
Outstanding 217,963,300.00
Float 144,153,194.00
Free Float 66.1%
Normal free float — 66.1% of shares trade freely, ~33.9% held by insiders/institutions
Healthy float typical of established companies. Good liquidity for entering and exiting positions without major price impact.
Price History (1 Year)
Last updated: Aug 3, 2026 5:08pm (20d ago)
Revenue & Net Income Trend
The directional story — useful even when net income is negative.
Last updated: Aug 3, 2026 5:08pm (20d ago)
Revenue
The top line — total sales before any costs or taxes are subtracted. A measure of how much business the company is doing.
Net Income
The bottom line — profit left after subtracting all expenses, interest, and taxes from revenue. Reflects accounting profitability, but includes non-cash items like depreciation, so it isn't the same as cash earned.
Operating Cash Flow
The real cash generated by the day-to-day business — selling products, paying suppliers, collecting from customers. Calculated from net income by adding back non-cash items and adjusting for timing (unpaid bills, unsold inventory). When OCF consistently lags net income, the reported profit may not be converting to real money.
Period Revenue Net Income Net Margin YoY/QoQ
Key Metrics
TD Twelve Data statement HEX SEC filing
Industry comparison last run: Aug 3, 2026 4:54pm
P/E Ratio (Price per dollar of earnings)
HEX
Stock Price / EPS (Diluted)
14.35
Stock Price: $404.23
EPS (Diluted): 28.33
P/B Ratio (Price vs net asset value)
HEX
Stock Price / Book Value Per Share
Stock Price: $404.23
Total Equity: -$2.77B
Shares: 239,495,000
EV/EBITDA (Total value vs operating profit)
HEX
Enterprise Value / EBITDA
Market Cap: $87.16B
Total Debt: $46.49B
Cash: $1.04B
EBITDA: N/A
EBITDA not available
Enterprise Value (Takeover price (cap + debt - cash))
HEX
Market Cap + Total Debt - Cash
$141.6B
Market Cap: $87.16B
Total Debt: $46.49B
Cash: $1.04B
Gross Margin (Revenue left after direct costs)
HEX
Gross Profit / Revenue
Gross Profit: N/A
Revenue: $75.60B
Missing from API: Gross Profit
Operating Margin (Revenue left after all operations)
HEX
Operating Income / Revenue
Operating Income: N/A
Revenue: $75.60B
Missing from API: Operating Income
Net Margin (Revenue left as actual profit)
HEX
Net Income / Revenue
9.0%
Net Income: $6.78B
Revenue: $75.60B
ROE (Profit from shareholder equity)
HEX
Net Income / Total Equity
Net Income: $6.78B
Total Equity: -$2.77B
ROIC (Profit from all invested capital)
HEX
NOPAT / Invested Capital
Operating Income: N/A
Tax Rate: 20.9%
Equity: -$2.77B
Total Debt: $46.49B
Cash: $1.04B
Missing from API: Operating Income
Current Ratio (Can it pay short-term bills)
HEX
Current Assets / Current Liabilities
0.97
Current Assets: $15.78B
Current Liabilities: $16.35B
Debt/Equity (Leverage — debt vs equity)
HEX
Total Debt / Total Equity
Short-Term Debt: $4.89B
Long-Term Debt: $41.60B
Total Debt: $46.49B
Total Equity: -$2.77B
Rev/Share (Top-line per share)
HEX
Revenue / Shares Outstanding
$315.66
Revenue: $75.60B
Shares: 239,495,000
Book Value/Share (Net assets per share)
HEX
(Total Assets - Total Liabilities) / Shares
Total Equity: -$2.77B
Shares: 239,495,000
FCF/Share (Real cash generated per share)
HEX
(Operating Cash Flow + CapEx) / Shares
$32.12
Operating CF: $12.64B
CapEx: -$4.94B
Shares: 239,495,000
CapEx is negative (outflow) — added to OCF to get FCF
Div Yield (Annual income from holding)
TD
Last Annual Dividend / Stock Price
0.7%
Last Dividend: $3.00
Stock Price: $404.23
Payout Ratio (Earnings paid out as dividends)
HEX
Dividends Paid / Net Income
10.0%
Dividends Paid: -$679.00M
Net Income: $6.78B
Industry Benchmarks
Last run: Aug 3, 2026 4:54pm
Compares HCA against LLM-researched typical ranges for its industry. One research call per industry, cached indefinitely — every stock in the same industry reuses the same baseline.
Income Statement (Annual)
Last updated: Aug 3, 2026 5:08pm (20d ago)
Metric 2021 2022 2023 2024 2025
Revenue $58.8B $60.2B $65.0B $70.6B $75.6B
Cost of Revenue
Gross Profit
Operating Expenses $48.9B $51.7B $57.3B $62.1B $65.8B
Operating Income
Net Income $7.0B $5.6B $5.2B $5.8B $6.8B
EBITDA
EPS $21.52 $19.43 $19.25 $22.27 $28.70
EPS (Diluted) $21.16 $19.15 $18.97 $22.00 $28.33
Balance Sheet (Annual)
Last updated: Aug 3, 2026 4:49pm (20d ago)
Metric 2021 2022 2023 2024 2025
Cash & Equivalents $1.5B $908.0M $935.0M $1.9B $1.0B
Total Current Assets $13.5B $13.6B $14.9B $16.4B $15.8B
Total Assets $50.7B $52.4B $56.2B $59.5B $60.7B
Current Liabilities $9.6B $9.9B $12.7B $15.2B $16.4B
Long-Term Debt $34.3B $37.7B $37.2B $38.3B $41.6B
Total Liabilities $49.3B $52.5B $55.2B $59.0B $63.5B
Total Equity $1.5B -$73.0M $1.1B $555.0M -$2.8B
Retained Earnings -$532.0M -$2.3B -$1.4B -$2.1B -$5.7B
Cash Flow (Annual)
Last updated: Aug 3, 2026 5:08pm (20d ago)
Metric 2021 2022 2023 2024 2025
Operating Cash Flow $9.0B $8.5B $9.4B $10.5B $12.6B
Capital Expenditure -$3.6B -$4.4B -$4.7B -$4.9B -$4.9B
Free Cash Flow $5.4B $4.1B $4.7B $5.6B $7.7B
Acquisitions (net)
Net Debt Issued / (Repaid) $475.0M $3.2B $2.3B $5.1B $1.1B
Dividends Paid -$624.0M -$653.0M -$661.0M -$690.0M -$679.0M
Stock Buybacks -$8.2B -$7.0B -$3.8B -$6.0B -$10.1B
Net Change in Cash -$342.0M -$543.0M $27.0M $998.0M -$893.0M
Growth Trends (YoY %)
Last updated: Aug 3, 2026 5:08pm (20d ago)
Metric 2022 2023 2024 2025
Revenue Growth +2.5% +7.9% +8.7% +7.1%
Gross Profit Growth
Operating Income Growth
Net Income Growth -18.9% -7.1% +9.9% +17.8%
EBITDA Growth
Dividend History (Last 20)
Last updated: Aug 3, 2026 4:50pm (20d ago)
Date Dividend Declaration Record Payment
2026-06-16 $0.78
2026-03-17 $0.78
2025-12-15 $0.72
2025-09-16 $0.72
2025-06-16 $0.72
2025-03-17 $0.72
2024-12-13 $0.66
2024-09-16 $0.66
2024-06-14 $0.66
2024-03-14 $0.66
2023-12-13 $0.60
2023-09-14 $0.60
2023-06-15 $0.60
2023-03-16 $0.60
2022-12-13 $0.56
2022-09-15 $0.56
2022-06-15 $0.56
2022-03-16 $0.56
2021-12-13 $0.48
2021-09-15 $0.48
0Company Classification 1Industry Landscape 2Company Momentum 3Forward Projection 4aDCF Valuation 4bEarnings Power Value 4cAnchored PE 4dReverse DCF 4eRevenue-Based DCF 4fAnchored P/S 4gScenario Analysis 4hDividend Discount Model 4iBook Value Analysis 4jInsider Activity 4fCash Flow Quality 4gDebt Maturity Risk 4hMacro Environment 4iSector Intelligence 4jRevenue Confidence 4kSensitivity Analysis 4lSector Demand Cycle 5AI Investigation 5bThesis Evaluation 6Valuation Synthesis
computed not applicable not yet run 17 computed · 6 not applicable · 1 not yet run
Risk : Reward — if the last quarter repeats
Live · as of 2026-08-19 08:55
-0.3 : 1 recovery upside vs repeat-quarter downside
Even the bull case prices 10% below today — the ratio here measures the model-vs-market gap, not payoff odds. Another quarter like the worst recent one costs 34%.
CaseGrowthMarginFair valuevs price ($406.62)
Bull — recovery +10% 10.2% $367.76 -10%
Base — stabilizes +7% 8.9% $292.17 -28%
Bear — keeps slipping +3% 7.6% $228.13 -44%
Stress — last quarter repeats +4% 8.9% $269.48 -34%
The next quarters keep the trajectory of the most recent ones — growth stays at 4.3% and margins bend by the same profit-vs-revenue ratio (×1.00). Stress is a trajectory, not a prediction — it answers "what if the ship's current heading simply continues," which history says is the case to respect.
Why this is appearing: this company files quarterly, so its recent trajectory could be measured rather than assumed — the engine matched Mar 2026 against the same quarter one year earlier and found revenue +4.3% · net income +0.6% year-over-year. That measured heading is what the stress case extends forward. Data measured through Mar 31, 2026 — this card recalculates automatically when the next quarterly filing is ingested. Companies without quarterly filings (many foreign listings) never show this card: with no measured trajectory, there is nothing honest to repeat.
Narrative Economics
The story the market is telling about this stock — the intangible X-factor (founder mythology, cult dynamics, TAM-of-imagination) that moves price beyond what cash flows alone explain. After Shiller, Narrative Economics.
No narrative profile yet for HCA — it's generated by the pipeline (market-narrative step).
Claude Reading
Independent analyst synthesis · claude-opus-4-7 · generated 2026-08-03 17:07:25
Verdict Fully priced with mild downside skew — fair value $360-375 vs $404 spot; hold for existing owners, wait for a 10-15% pullback or Q2 growth reacceleration before adding.

Looking at the raw numbers first: revenue trajectory is $17.49B → $18.29B → $18.32B → $18.61B → $19.16B → $19.51B → $19.11B across the last seven quarters. That most recent Q1 2026 print is a sequential decline from $19.51B, and YoY growth of $19.11B vs $18.32B is 4.3% — a clear deceleration from the 7-8% pace earlier in 2025. Net income margin also compressed to 8.5% from 9.6% the prior quarter. The 7.9% revenue CAGR and 13.8% earnings CAGR the momentum module cites are backward-looking; the freshest data point says growth is cooling and margin is giving back some of the 2024→2025 gains. That matters because the fully_priced verdict rests on continuation.

Balance sheet deserves more scrutiny than the prior models gave it. $46.5B debt, $1.04B cash, and negative $2.77B equity — HCA's book equity has been negative for years due to buybacks, so that's not new, but the leverage is real and rate-sensitive. FCF of $7.69B against ~$87B market cap is a 8.8% FCF yield, which sounds attractive until you note the FCF CAGR of 28.1% is calculated off a depressed 2022-2023 base (working capital normalization post-COVID) and is not a sustainable run rate. Capex of $4.94B against $12.64B OCF means maintenance intensity is real — this isn't an asset-light compounder. ROA of 11% is genuinely good for a hospital operator, and the 14.4x P/E is not demanding, but it's also not a bargain when you adjust EV for the $45B net debt: EV/EBITDA is closer to 9-10x, which is roughly in line with HCA's own history and peer Tenet/UHS.

Where I part ways with the prior models: the synthesis calls it "fully_priced" at $387 fair value vs $404 spot (-4% to -9% overvaluation), and the narrative layer says fundamentals do 90% of the work. I think both are slightly too generous. The Q1 2026 deceleration is a real signal the models under-weight because they're averaging trailing quarters. If revenue growth is settling into 4-5% rather than 7%, and if labor cost pressure re-emerges (nursing wage inflation is not resolved, just quieter), then earnings growth compresses toward mid-single-digits and 14x P/E becomes appropriate rather than cheap. The market forces module's "asymmetric downside risk given leverage" is the right instinct — with negative equity and $46B debt, a 200bp reimbursement compression or a bad election cycle for hospital pricing has outsized equity impact. Insider activity is genuinely neutral (routine grants, one small sale, one gift) — no signal either way, and the models correctly refuse to over-read it.

The contrarian bull case worth taking seriously: HCA has consistently converted demographic tailwinds and scale advantages into shareholder returns for a decade, buybacks have compounded per-share metrics even as absolute growth moderates, and at 14.4x with 8-9% FCF yield you're being paid to wait. If Medicare Advantage penetration plateaus and commercial rate negotiations remain favorable, the current price is defensible. But that's a "hold what you own" thesis, not a "buy here" thesis. I agree with the synthesis direction (fully priced, slight premium) but I'd push the fair value lower than $388 — closer to $360-370 — because the Q1 print suggests the trajectory the DCF is extrapolating is optimistic by 100-200bps of revenue growth. This is a quality operator at a fair-to-slightly-rich price, not an opportunity. Waiting for either a growth reacceleration confirmation in Q2/Q3 2026 or a $340-360 entry point offers better risk/reward. Policy risk (surprise CMS rule, state-level pricing intervention, or a 2026 election-driven hospital-pricing narrative) is the tail that isn't priced.

GPT Reading
Independent reading · gpt-5.4 · generated 2026-08-03 17:07:41
Verdict Fairly valued to modestly undervalued at $404 — strong cash generation and margin recovery justify roughly $420-$445, but leverage caps upside.

What stands out is that HCA is still compounding like a better business than the market is crediting, but the stock is no bargain because the balance sheet risk is real and already partly offsets the operating quality. Revenue has gone from $58.8B in 2021 to $75.6B in 2025, a 29% increase, while net income in 2025 reached $6.78B versus $5.76B in 2024 and $5.24B in 2023. The quarterly run-rate is still healthy: the March 2026 quarter delivered $19.11B of revenue and $1.62B of net income, up from $18.32B and $1.61B a year earlier. That is only modest profit growth in the latest quarter, but it came on top of already improved margins versus 2024. Across the last five reported quarters, margins have stabilized in an 8.6%-9.6% band after dipping as low as 7.3%-7.9% in late 2024. For a hospital operator, that recovery matters more than a headline multiple screen.

Cash generation is the core of the bull case and it is not cosmetic. In 2025, HCA produced $12.64B of operating cash flow and $7.69B of free cash flow after nearly $4.94B of capex. Against an $87.2B market cap, that is roughly an 8.8% FCF yield, and against the current price the 14.4x P/E does not look demanding for a business growing revenue high-single-digits and earnings double-digits over a multiyear period. The negative equity figure of -$2.77B looks ugly but is not, by itself, evidence of distress here; it more likely reflects years of buybacks and leverage layered onto a consistently profitable asset-heavy operator. The more relevant question is whether the debt load is serviceable through a less favorable reimbursement and labor cycle, and on that score the answer today is yes: $46.5B of debt is high, but the business is throwing off enough cash that it remains manageable absent an operational shock.

Where I part ways slightly with the “fully priced” framing is that the underlying operating trajectory is still improving, not flattening. Annual net margin expanded from 8.2% in 2024 to 9.0% in 2025, and the 2026 first quarter maintained 8.5% despite seasonality and a huge revenue base. That suggests 2024 was not the start of a deterioration story; it looks more like a temporary margin trough followed by recovery. If HCA can keep revenue around a $76B-$78B annualized level and hold net margins near 9%, the earnings power is closer to $7B than $6B, which makes a low-to-mid teens multiple reasonable. I do not see a cheap stock, but I do see a business whose quality is somewhat obscured by the leverage optics. My read is that fair value is modestly above the current quote if execution simply stays where it is.

The strongest case against that view is straightforward: this is a heavily indebted, low-liquidity hospital company with a current ratio below 1.0, only $1.04B of cash, and policy exposure the market can punish quickly. Net debt is effectively over $45B, and because equity is negative there is very little balance-sheet cushion if volumes soften, labor costs re-accelerate, or reimbursement turns against the sector. The latest quarterly profit growth was far weaker than revenue growth—$1.62B versus $1.61B year over year on $19.11B versus $18.32B—so one can argue the margin recovery has already plateaued. On that reading, 2025’s strong cash flow was a peak rather than a new base, and 14x earnings is not cheap for a mature operator with material regulatory and financing risk. That is a serious objection, and it is why I cannot call the stock outright undervalued in a big way.

What would change my mind either way is pretty specific. If the next few quarters show revenue still growing 5%-7% but net margin slipping back toward 7.5%-8.0%, then the market’s caution is right and $400-plus is too high for a levered hospital operator; I would move to overvalued with fair value below $350. Conversely, if HCA keeps quarterly revenue near or above $19B, sustains net income around $1.7B-$1.9B, and converts that into another year of $7B+ free cash flow while debt trends down even modestly, then the stock deserves something closer to 15x-16x earnings, which supports a value in the low-to-mid $400s.

Grok Reading
Independent reading · grok-4.5 · generated 2026-08-03 17:08:44
Verdict Fairly valued around $400; 8.8% FCF yield balanced by decelerating Q1 growth and 5.9× leverage, limited upside vs $368–388 anchors

The raw numbers describe a high-quality cash machine whose latest quarter is starting to cool. Full-year 2025 delivered $75.60B of revenue (+7.1% YoY) and $6.78B of net income (+17.7%), with free cash flow of $7.69B after $4.94B of capex—an 8.8% FCF yield on the $87B equity value. Margins expanded through most of 2025, peaking at 9.6% in Q4, and the multi-year earnings CAGR of 13.8% handsomely outran the 7.9% revenue CAGR. That is genuine operating leverage from the largest for-profit hospital footprint in the country. Yet the March 2026 quarter tells a different near-term story: revenue of $19.11B grew only 4.3% versus the year-earlier $18.32B, net income was essentially flat at $1.62B, and the margin slipped back to 8.5%. Sequential revenue also fell from Q4’s $19.51B. The deceleration flag in the secondary signals is already visible in the print, not merely a forecast.

The balance sheet is the structural overhang that keeps the multiple in check. Year-end 2025 shows $46.49B of debt against $1.04B of cash and negative equity of –$2.77B—an LBO legacy that leaves net leverage near 5.9× FCF and a current ratio of 0.97. At a 14.4× trailing P/E and 1.87× EV/revenue the stock is not optically expensive for mid-single-digit-to-high-single-digit growth, but it is no longer cheap once the most recent growth step-down is acknowledged. The valuation synthesis fair-value range of roughly $368–$388 is directionally right; at $404 the shares sit modestly above that anchor. Strong cash conversion and a sub-11% payout ratio give management room to keep returning capital, yet the equity account is already negative, so every dollar of buyback or dividend is effectively debt-financed in economic terms.

The strongest counter-argument is straightforward: annualize the $7.69B FCF, apply even a conservative 11–12× multiple, and you clear $85–$92B of equity value—right around or above today’s capitalization—while the 28% FCF CAGR and 11% ROA demonstrate that HCA continues to sweat its assets harder than peers. A bull would also note that 2021’s outsized $6.96B net income set a tough comp, that 2025’s $6.78B already marks a clean recovery, and that demographic tailwinds plus ambulatory shift still support mid-single-digit volume growth for years. I weigh this less heavily because the Q1 2026 deceleration is real, labor and reimbursement remain exogenous risks, and a 5.9× net-debt-to-FCF stack leaves little margin for error if either volumes or rates soften. The “steady-compounder” narrative is durable precisely because it is boring; it does not justify paying a premium when the latest quarter already shows the growth rate rolling over.

I would reverse to a clear undervalued stance if the next two quarters re-accelerate revenue growth back above 6–7% YoY while holding net margins at or above 8.5%, or if net debt is reduced by at least $4–5B without starving FCF. A sustained break below ~$360 on no fundamental deterioration would also reset the risk-reward enough to get constructive.

Big-3 Panel — where each AI stands
Each AI above independently stated a direction (undervalued, fairly valued, or overvalued) and how strongly it believes it (conviction, 0–5). We combine those into a Bull-Bear Index on a 0–10 scale: 5 is neutral, 10 is maximum bullish (undervalued at full conviction), 0 is maximum bearish. We compute the score ourselves with the same arithmetic for every seat — the models never grade their own bullishness — so the three are directly comparable. Δ shows how far each seat sits from the panel average of 4.0; a large Δ marks the dissenting voice, usually the one worth reading.
Claude claude-opus-4-7 2.0
overvalued · conviction 3/5 · Δ -2.0 vs panel · self: 4.0
GPT gpt-5.4 5.0
fairly valued · conviction 3/5 · Δ +1.0 vs panel · self: 6.0
Grok grok-4.5 5.0
fairly valued · conviction 3/5 · Δ +1.0 vs panel · self: 4.0
Advanced Analysis Forensic deep-dive · separate lenses
Separate reads — Company Quality (is it a great business?), Valuation (is it mispriced?), and General Sentiment (how macro + narrative are pushing it), kept deliberately apart · 2026-08-03 17:57:19
Delvantic - Cairn AI
Quality — wait for a dip 7/10
Great operator, fully priced, and a policy overhang keeping a lid on it — I want HCA in the mid-$340s, not at $406.
The cruxWhether the market gives me a policy-headline-driven pullback into the $340s before the buyback-and-FCF machine grinds the deserved value up to meet the price.
Forensic checks Derived mechanically from HCA's filed financials — not from the AI lenses
Liquidity & RunwaySelf-Funding
DilutionShare Count Shrinking
Earnings QualityHigh Earnings Quality
The four lensesswitch a tab for its full read — score + evidence
Company Quality
+32
Strong
edge √Σ 112 · risk √Σ 79 · conf 8/10

The operating business is compounding cleanly: revenue grew from $58.75B (2021) to $75.60B (2025), a ~6.5% CAGR, and net income re-accelerated from a $5.24B trough (2023) back to $6.78B (2025). FCF quality is excellent — $7.69B in 2025 with OCF/NI of 1.66x and accruals at -6.9% of assets, both signs reported earnings are backed by cash rather than accrual mechanics. There are no mechanical earnings-quality red flags. Capital return discipline is a clear strength. Diluted share count fell from 328.8M to 239.5M (-7.6% CAGR), SBC is a trivial 0.5% of revenue, and buyback/SBC runs at ~1948% — this is a genuine net repurchaser, not optical dilution offset. The offset is leverage: net debt sits at roughly $45.5B against just $1.04B of liquid cash, and $4.89B of short-term debt exceeds cash on hand. Altman Z of 1.93 (grey) reflects that. Insider tape is neutral-negative in tone (11 sales, 0 open-market buys) but sizes are routine comp-driven dispositions, not a signal.

Strengths 3
m70
Aggressive per-share concentration
Diluted shares fell from 328.8M to 239.5M over five years (-7.6% CAGR) with SBC only 0.5% of revenue — buybacks are real value concentration, not SBC offset.
m68
High-quality cash generation
FCF grew from $5.38B to $7.69B; OCF/NI 1.66x and accruals -6.9% of assets indicate earnings convert to cash without accrual inflation.
m55
Durable top-line growth
Revenue compounded from $58.75B to $75.60B (~6.5% CAGR) with net income re-accelerating to $6.78B in 2025, consistent with a scaled hospital operator with pricing and volume tailwinds.
Concerns 3
m62
Levered balance sheet, not a cushion
Net debt of ~$45.5B against only $1.04B liquid cash (1.2% of market cap); Altman Z of 1.93 sits in the grey zone.
m45
Near-term refinancing exposure
Short-term debt of $4.89B exceeds liquid cash of $1.04B — reliant on ongoing FCF and capital-markets access to roll maturities.
m20
Insider selling with no buying
11 sales totaling $27.3M vs zero open-market buys in the last 12 months; sizes look like routine comp monetization, so signal is weak but not encouraging.
This is a well-run, cash-generative operator that treats shareholders like owners — a 27% reduction in share count over five years with negligible SBC is the kind of behavior I take seriously. Earnings quality passes the checks I care about, and the FCF ramp to $7.69B is real. The reason I don't push higher than Strong is the balance sheet: $45B of net debt against $1B of cash means the business is running with essentially no cushion, and short-term debt above liquid cash tells me they lean on the debt markets continuously. As long as hospital cash flows stay this good it works fine, but 'works fine' is not 'fortress.' Solidly Strong, not elite.
Verify before trusting this (6)
  • Debt maturity ladder and weighted-average cost/tenor of the ~$45B debt stack
  • Payer mix and Medicare/Medicaid reimbursement exposure disclosed in the 10-K
  • Segment-level margin trends (GM/OpM shown as 0 here suggests missing derived fields)
  • Malpractice/self-insurance reserves and any contingent liabilities
  • Capex composition (maintenance vs growth) supporting the $7.69B FCF figure
  • Any material acquisitions or divestitures affecting the 2024-2025 growth acceleration
Valuation / Mispricing
-57
Rich
edge √Σ 30 · risk √Σ 94 · conf 7/10
Price $406.62 vs deserved ~$368-388 — roughly 5% to 10% overpriced, i.e. no margin of safety. attractive below $345.00

The e2e synthesis lands at a composite FV of $387.82 and a signal-adjusted FV of $367.88 against a $406.62 price — implied downside of about 5-10%. The DCF anchor at $387.82 is internally consistent with a mature, high-FCF hospital operator ($7.69B FCF) and doesn't look like a runaway method, so I take it seriously rather than discounting it. Earnings quality is high, so no haircut is warranted; the business quality is Strong, which supports a deserved value in that upper-$300s zone but does not stretch it into the $400s.

Cheap signals 1
m30
Buyback-driven per-share compounding is real
27% share count reduction over five years with negligible SBC and $7.69B FCF supports the upper end of the deserved range near $388 rather than the lower end, but doesn't close the price gap.
Rich / priced-in 3
m62
Price above composite FV
$406.62 sits ~5% above composite FV $387.82 and ~10% above signal-adjusted FV $367.88; e2e reads Fully Priced with -10% upside.
m55
Priced for margin persistence
The bear frame notes a ~10.5% premium already embeds the assumption that operating margin holds against labor inflation and reimbursement compression — a heroic ask for a mature hospital operator.
m45
Leverage limits deserved multiple
$45B net debt vs $1B cash means equity holders get a thinner cushion; a levered compounder deserves a lower multiple than the market is currently paying, tightening the deserved value ceiling.
This is fully priced. The business is genuinely strong and the FCF and buyback machine are real, but at $406.62 I'm paying above a defensible fair value in the high $300s on a company carrying $45B of net debt into a labor-inflation and reimbursement-risk environment. I don't short good compounders, but I don't buy them 10% rich either. I'd want it in the mid-$340s or lower before the setup interests me; anywhere near $400 I'm a spectator.
Verify before trusting this (4)
  • 2025 guidance on same-facility admissions and payer mix
  • labor cost run-rate and contract labor as % of salaries
  • any updates on state supplemental payment programs and Medicaid DPP exposure
  • pace and price of remaining buyback authorization
General Sentiment
-41
Headwind
tail √Σ 39 · head √Σ 82 · conf 6/10

The macro tape is mildly constructive (regime +22, VIX 16, S&P near highs), so a beta-1.13 defensive-ish operator like HCA is not being mauled by the market. But the pressure on this specific name is not coming from the tape - it is coming from the story. The active narrative is a 'steady-compounder' with minimal intensity and low cult coefficient, meaning there is almost no bid from story-chasers and no fan base to defend the stock when headlines turn. That leaves HCA naked to policy headlines, and the July 30 disclosure of a $400M policy-driven headwind is exactly the kind of item this cohort cannot rebut with a growth story. Hospital operators are living under a persistent ACA/reimbursement/labor-cost narrative that has no clean resolution, and analyst tone across the group has drifted cautious. The July 28 pop was relief, not conviction - HCA rallied because peer Tenet guided better and feared ACA outcomes did not materialize, which is a low-quality tailwind that reverses on the next headline (as it did two days later). Net: modest, persistent headwind. Not a de-rating event, but a tape where sellers press harder than buyers on any policy print, and there is no narrative cushion underneath.

Tailwinds 2
m30
Benign regime, low VIX
Neutral-to-positive tape (+22, VIX 16, S&P -1.6% from highs) means HCA is not being sold into a risk-off vortex; healthcare has been a relative rotation destination when growth wobbles.
m25
Peer relief bid
The July 28 +7.4% move showed the group can catch a quick sentiment bid when feared ACA outcomes fail to materialize and a peer (Tenet) guides better - a reminder that positioning is not crowded long here.
Headwinds 4
m55
Policy overhang is the dominant press
The $400M policy headwind flagged on the Q2 print is the exact narrative risk the bear case identified, and hospital-pricing/reimbursement policy is a live wire that keeps re-appearing in headlines - a persistent drag that the market prices in gradually.
m40
No narrative cushion
Minimal-intensity, low-cult 'steady compounder' story means there are no true-believer buyers to absorb bad headlines; when policy news hits, the stock trades on math alone, and the tape shows sellers move it more than buyers.
m35
Rates and stretched market PE
10y at 4.68% and market PE 26.9 pressure defensive cash-flow compounders whose appeal is bond-like predictability; HCA's beta 1.13 means it still absorbs broad multiple compression when rates jitter.
m30
Reaction asymmetry on the print
A Q2 beat that still produced a 3% drop because of one policy line item tells you the tape is grading this name on downside surprises, not upside execution - a classic late-cycle sentiment posture for the group.
Net headwind, but a moderate one - not a de-rating, just a stock the tape leans on. The macro backdrop is fine and healthcare is a reasonable place to hide, but HCA specifically is carrying an unresolved policy overhang with no narrative fan base to defend it, and the July 30 reaction shows sellers control the marginal print. I read this as a persistent low-grade press to the downside on sentiment, with quick relief rallies possible but not sustainable until the policy line item is quantified and put behind them.
Verify before trusting this (5)
  • Any concrete detail on the $400M policy headwind - source, timeline, whether it recurs
  • Analyst target revisions in the two weeks after the Q2 print (cuts would confirm the headwind)
  • Hospital-sector rotation flows vs managed care and pharma - is money leaving the subsector
  • ACA subsidy extension headlines and CMS reimbursement updates into year-end
  • Whether the narrative intensity ticks up (bad) or stays minimal (neutral) as election-cycle healthcare rhetoric builds
The market-wide tape + this name's exposure to it (beta / sector / narrative durability). Context on the non-fundamental pressure — not a call on the business or the price. processId: detail-general-sentiment
Growth Outlook
not run

This lens hasn't been run for this ticker yet.

The forward growth verdict — is the business itself likely to grow (next 2 quarters / year 1 / years 2–3), judged against its category and against printed expectations. The full horizon ladder + creme renders on the Growth Outlook card above. Not a call on the price (Valuation owns that) or the tape (Sentiment owns that).
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Lenses kept deliberately separate — Company Quality (price-agnostic), Valuation (price-conditional), General Sentiment (non-fundamental macro/narrative pressure), and Growth Outlook (the forward growth verdict). The scores are not blended. Filing-level items (convertibles, lock-ups, customer concentration) are v2 — see each lens's "verify."
Price Prediction
About flat +0.1% v0.6.0 View full prediction →

When we made this prediction on Aug 4, 2026, HCA was $406.61. We expect it to be $407.00 by Feb 2027, and we consider it great value under $345.00. This is an early model (v0.6.0) — the direction is more reliable than the exact price. Made Aug 4, 2026.

Price when predicted$406.61
Our estimate for Feb 2027$407.00+0.1%
Great value below$345.00
Price history shown (6 Months)

Blue is our prediction, starting the day we made it. Grey is a slower route to the same place — the same destination, taking longer. Black is the actual price, so you can see how we are doing.

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My Notes personal — only you see this
v1.1.562 · 9b2927c4 · 2026-08-22 16:52:06