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1 Vic CampbellSenior Vice President Mark KimbroughVice President, Investor Relations Bryan RogersPresident, Midwest Division Clifton MillsCFO, Midwest Division
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2 Cautionary Note Regarding Forward-looking Statements HCA’s management will be making some forward-looking statements during today’s presentation. Those forward-looking statements are based on management’s current expectations and are subject to risks and uncertainties that may cause those forward looking statements to be materially incorrect. Certain of those risks and uncertainties are discussed in HCA’s filings with the Securities and Exchange Commission, including the company’s report on Form 10-K and its quarterly reports on form 10-Q, to which you are referred. Management cautions you not to rely on, and makes no promises to update any of the forward looking statements.
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3 HCA Hospitals Located in Growth Markets Switzerland U.K. Percent Growth in Market Population 2000-2005 Compared to the National Average of 4.5% Percent Growth in Market Population 2000-2005 Compared to the National Average of 4.5% Las Vegas +22% Las Vegas +22% Southern California +9% Southern California +9% Denver +9% Denver +9% Dade +8% Dade +8% Nashville +8% Nashville +8% Panhandle +10% Panhandle +10% Tampa Bay +8% Tampa Bay +8% Dallas/Ft. Worth +12% Dallas/Ft. Worth +12% Austin +18% Austin +18% Richmond +8% Richmond +8% Palm Beach +11% Palm Beach +11% Houston +10% Houston +10% Kansas City +5% Kansas City +5% 187 Hospitals 94 Surgery Centers Generally 25%-40% Market Share 40% of facilities in Texas & Florida
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4 What Will Drive HCA’s Future Success Aging Population Located in Large, Growth Markets Aging Population Located in Large, Growth Markets Capital Investments Enhanced Outpatient Strategy Capital Investments Enhanced Outpatient Strategy Quality and Patient Safety Initiatives Prudent use of Company’s Strong Cash Flows
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5 Inpatient Admissions and Outpatient Visits 1980 - 2003
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6 Socio-Demographics—Age Wave Driving Healthcare Utilization 2000200120022003200420052006200720082009201020112012201320142015 95 100 105 110 115 120 125 Acute Care Utilization Index (2003=100) Baby Boomer Impact Accelerates 1.58% CAGR 2003-2012 121 119 117 115 113 112 110 108 106 105 103 102 100 98 97 96 1.7% 1.6% 1.5% 1.6% 1.5% 1.6% 1.5% 1.4% 1.56% 3-Year CAGR 1.59% 3-Year CAGR 1.58% 3-Year CAGR 1.62% 3-Year CAGR
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7 Midwest Division Facility Expansion Projects New & Replacement Facilities Infrastructure Develop., IT&S, & Pat. Safety Shared Services Routine Capital Note: Does not include potential new and replacement facilities. $0.0 $0.5 $1.0 $1.5 $2.0` 200020012002200320042005E Billions 2000 $1.2 2001 $1.4 2002 $1.7 2003 $1.8 2004 $1.5 2005E $1.5 HCA Capital Expenditures Distribution of Capital Dollars 2005 and Beyond 1,611 New Beds Three New Facilities 310 Beds Open Heart, Cardiology Oncology, etc. 33 ER Expansi ons Three Facilities 511 Beds Land & Improvements 12%/$505M Surgery/Special Units 21%/$875M Beds 14%/$590M New Facilities 8%/$340M ER Services 8%/$325 Outpatient Services/MOBs 11%/$480M Replacement Facilities 10%/$420M New and Expanded Services 16%/$690M Capital Commitments: Houston, TX $517 million Pearland, TX new hospital (2007) Denver, CO $250 million new children’s hospital/ expansion of 3 hospitals San Antonio, TX $165 million new hospital with JV partner (2007) Atlanta, GA $130 million Emory John’s Creek, new hospital (2007) Salt Lake City, UT $85 million new hospital (2007/ 08)
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8 Transactions totaling $130 million completed 20–30 imaging center and 8-10 surgery center transactions expected to be completed over the next 12 months Sarah Cannon Research Institute (Nashville) Austin Radiology Assoc. 2 imaging centers Austin Radiology Assoc. 2 imaging centers Diversified Radiology (Denver) 4 imaging centers/fifth under construction Diversified Radiology (Denver) 4 imaging centers/fifth under construction Thousand Oaks Diagnostic Imaging Thousand Oaks Diagnostic Imaging Millcreek Imaging Center Salt Lake City, UT Millcreek Imaging Center Salt Lake City, UT HCA Surgery Centers LAD Imaging Centers (Orange City, Deltona) LAD Imaging Centers (Orange City, Deltona) Total I Management, LLC (Tampa Bay Area) 5 imaging centers Total I Management, LLC (Tampa Bay Area) 5 imaging centers Outpatient Strategy Progressing First Health (Jacksonville) MDI 7 Centers MDI 7 Centers Ultra Open MRI (Tampa) 6 centers Ultra Open MRI (Tampa) 6 centers Hope Cancer Centers (Tallahassee) 3 centers Hope Cancer Centers (Tallahassee) 3 centers
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9 199920002001200220032004 +2.7%+2.8%+2.7% +2.5%+0.6% +0.7% Volume +2.5%+2.6% +0.0% +1.3% Equivalent Admissions Same Facility % Change from PY Equivalent Admissions Same Facility % Change from PY Admissions Same Facility % Change from PY Admissions Same Facility % Change from PY 2005
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10 7.6% 7.5% 7.7% 8.0% 10.1% 11.4% 1999200020012002200320042005 39.3%39.0%39.4% 39.2%38.5% 38.4% 16.0%15.9%16.0% 16.1%16.2% 16.7% Operating Expenses Bad Debt As Reported % of Net Revenue Bad Debt As Reported % of Net Revenue Supplies Same Facility % of Net Revenue Supplies Same Facility % of Net Revenue SW&B 1 Same Facility % of Net Revenue SW&B 1 Same Facility % of Net Revenue 39.2% Sep YTD 9.6% Sep YTD 17.0% Sep YTD 12.2% Adjusted for uninsured discounts
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11 Uninsured Uninsured Admissions Same Facility % of Total Admissions 20002001200220032004 Uninsured ER Visits Same Facility % of Total ER Visits N/A HCA Financial History – 2005.ppt 7.2% vs. PY 2.4% vs. PY 7.5% vs. PY 11.5% vs. PY 13.7% vs. PY 15.2% vs. PY 7.1% vs. PY 3.7% vs. PY Uninsured Admissions Same Facility % Chg from Prior Year 2004: +9.7% 2005 +5.0% Sep YTD Sep YTD +7.7% +20.2% 3.3% vs. PY 5.1% vs. PY 15.0% vs. PY
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12 Cash flow in 2005 Remains Positive Net Cash Provided by Operating Activities 1 Dollars in Millions Excluding settlements with government agencies and investigation related costs. 1: 1999-2003 are non-GAAP numbers 2: YTD 2005- 9/30/05 2 Uses of Cash (1) Capital Reinvestment $1.5B in 2005 in existing markets and $1.8B in 2006 (2) Share Repurchase Program $11.5B in 8 years $1.44B “Dutch Auction” complete 28.8 million shares $1B open-market authorization (3) Dividend Policy Approx. $250mm annually (4) Acquisitions – opportunistic $1B Health Midwest - April 2003 Austin, TX- pending acquisition (5) Debt Repayment
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13 Prudent Financial Strategy Focused on Shareholder Value Strong Cash Flows Great Assets In Summary We Have….
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14 Bryan Rogers, President Midwest Division
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15 Midwest Division Hospitals Midwest Division Hospitals The “Big Six” Hospitals: Research Medical Center Baptist-Lutheran Medical Center Overland Park Regional Medical Center Menorah Medical Center Independence Regional Health Center Medical Center of Independence Suburban /Rural/Specialty Hospitals: Allen County Hospital Lafayette Regional Health Center Lee’s Summit Hospital Research Belton Hospital Research Psychiatric Center The “Big Six” Hospitals: Research Medical Center Baptist-Lutheran Medical Center Overland Park Regional Medical Center Menorah Medical Center Independence Regional Health Center Medical Center of Independence Suburban /Rural/Specialty Hospitals: Allen County Hospital Lafayette Regional Health Center Lee’s Summit Hospital Research Belton Hospital Research Psychiatric Center
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16 Kansas City Marketplace Kansas City Profile –26+ Full Service Acute Hospitals –6,507 Licensed / 5,254 Staffed Beds –3,343 ADC –64% Occupancy (staffed) –1.87M Residents in MSA - 2004 –5.9% Population Growth 2004-09 PRO –No dominant system –High “use rate” for service utilization –Lack of inpatient “niche” traction –Missouri: Certificate of Need state –Low % of uninsured population CON –Provider owned MCOs / dueling systems –Available bed capacity –Irrational capital spending by stand alone single hospital franchises –Low commodity pricing
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17 2004 Kansas City Market Share 11 County Service Area
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18 Characteristics of Health Midwest System Developed through Acquisition (13) Poor Management Control Systems Centralized Decision Making Declining Market Share Lack of Leadership Attempted Vertical Integration Low Employee Morale Lack of Capital Spending System Developed through Acquisition (13) Poor Management Control Systems Centralized Decision Making Declining Market Share Lack of Leadership Attempted Vertical Integration Low Employee Morale Lack of Capital Spending
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19 Recruited 54 New Physicians to Market Managed Care Pricing: 9% 2004; 9% 2005 ASC Development Projects Approved (Independence, MMC, OPRMC) New Service Development Pancreas / Transplant Services (RMC) Gyn Oncology (OPRMC / RMC) Trauma (OPRMC/Independence) Open Heart Services (OPRMC / BLMC) Cyberknife JV (MMC) Chest Pain Accreditation The Cancer Institute Unwind (Health Midwest/St. Luke’s Oncology JV) CON Approval: Independence & Lee’s Summit Imaging Growth 2003-2005 62%- MRI 38% - CT Key Accomplishments - Growth Key Accomplishments - Growth
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20 Key Accomplishments – Cost /Efficiency Key Accomplishments – Cost /Efficiency Labor Reductions Closed Unprofitable Services (Skilled Nursing, Rehabilitation Units) “Shed” Non-core Businesses (EHS, Trinity Manor, Fitness Center) Built Flexible Workforce (implemented “All About Staffing”) Case Management: Avoidable Day Reduction Supply Chain Warehouse PAS Implementation
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21 Capital Investment Major Capital Initiatives: $281 Million – New Independence Hospital ($196M) & New Lee’s Summit Hospital ($85M) $92 Million – Research Medical Center (ER, Patient Rooms, Cancer, Imaging) $25 Million – Overland Park Regional Health Center (Women’s Services & ICU) $15 Million – Outpatient Strategy Development (ASC, JVs, etc.) $32 Million – Financial & Clinical Information System $16 Million – Imaging Investment
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22 New Replacement Hospitals Site Summary: 39 acres purchased for $8M Bed Profile Proposed: –Medical / Surgical 48 –Intensive Care Unit 10 –Women’s Services 6 TOTAL 64 ER Bays 14 treatment bays Surgical OR 4 PACU 8 positions Prep & Recovery 12 positions Site Summary: 89 acres purchased for $15M Bed Profile Proposed: –Medical / Surgical156 –Intensive Care Unit 28 –NICU (Level II & III) 12 –GYN/Antepartum 9 –Post Partum 16 TOTAL221 ER Bays 32 treatment bays Surgical OR 10 PACU 15 positions Prep & Recovery 30 positions Lee’s Summit Independence
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23 Stabilized Run Rate Admissions
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24 Long Run Strategy #1: Growth: Increase Market Share in High Margin Services #2: Execute Capital Investment Strategy #3: Upgrade Quality / Satisfaction #4: HCA Goodwill / Communication Efforts #5: Execute Revenue Plan to Address Provider Reimbursement #6: Bed Consolidation #7: Shared Service Initiatives / Continued Reduction in Fixed Costs #8: Geographical Expansion into New Markets #1: Growth: Increase Market Share in High Margin Services #2: Execute Capital Investment Strategy #3: Upgrade Quality / Satisfaction #4: HCA Goodwill / Communication Efforts #5: Execute Revenue Plan to Address Provider Reimbursement #6: Bed Consolidation #7: Shared Service Initiatives / Continued Reduction in Fixed Costs #8: Geographical Expansion into New Markets
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