Healthcare · Profile from Healthcare Research Companion
HCA Healthcare, Inc.
The Nashville hospital company that invented the investor-owned hospital chain in 1968 and became the largest for-profit hospital operator in the world. Its history covers the full arc of US hospital capitalism: founding roll-up, a management LBO, the Columbia/HCA merger and the largest healthcare fraud case of its era, a record private-equity buyout in 2006, a record PE-backed IPO in 2011, and a decade of share-price outperformance built on dense urban markets in high-growth Sun Belt states. Its 2019 purchase of Mission Health in North Carolina made it the leading test case of what happens when a for-profit chain buys a regional nonprofit.
At a glance
- Founded
- 1968, Nashville, Tennessee, as Hospital Corporation of America (first hospital: Park View Hospital, Nashville)
- Founders
- Dr. Thomas F. Frist Sr. (physician), Dr. Thomas F. Frist Jr. (physician) and Jack C. Massey (businessman, earlier the owner who built up Kentucky Fried Chicken)
- Headquarters
- Nashville, Tennessee
- Ownership / structure
- Public company, NYSE: HCA (re-listed March 2011 after the 2006 buyout); the Frist family remains a significant holder
- Leadership (2026)
- Samuel N. Hazen, CEO since January 2019; Thomas F. Frist III, chairman (verify current titles); Michael Schlosser, MD, chief clinical officer from September 2026 (reported)
- Segment
- Provider: acute-care hospitals, freestanding emergency rooms, ambulatory surgery centers, urgent care (CareNow), physician clinics, a UK private hospital business (HCA Healthcare UK) and nursing education (Galen College of Nursing)
- Scale
- ~190 hospitals and ~2,400+ sites of care in 20 US states and England (reported, 2025); roughly 300,000+ colleagues (verify)
- Revenue
- 2025 revenue ~$75.6bn, net income attributable to HCA ~$6.8bn, adjusted EBITDA ~$15.6bn, operating cash flow ~$12.6bn (reported); 2026 guidance ~$76.5–80bn revenue
- Capital / valuation
- 2006 LBO ~$33bn including debt (then the largest LBO on record); 2011 IPO raised ~$3.8bn; market capitalisation roughly $100bn+ in 2025–26 (verify)
- Signature moves (incl. failures)
- Founding roll-up and 1969 IPO; HealthTrust ESOP spin-off (1987) and management LBO (1989); Columbia/HCA merger (1994); federal fraud investigation, CEO ouster and ~$1.7bn settlements (1997–2003); KKR/Bain/Merrill LBO (2006); IPO (2011); Mission Health acquisition and North Carolina AG lawsuit (2019–); return of ~$6bn of CARES Act funds (2020); 2023 data breach affecting ~11m patients
9 strategic moves analysed
Each one gets a full strategy file in the companion: context, the decision, the financing, what happened, and the lesson.
1968
Founding and Hospital Roll Up
Founding / roll-up
1987
HealthTrust Spinoff and Management LBO
Spin-off (to an employee stock ownership plan) followed by a management-led leveraged buyout
1994
Columbia HCA Merger
Merger
1997
Columbia HCA Fraud and Settlements
Regulatory settlement / restructuring / leadership change
2006
Leveraged Buyout
Leveraged buyout (take-private)
2011
IPO
IPO (return to public markets)
2019
Mission Health Acquisition
Acquisition (for-profit purchase of a nonprofit regional system)
2020
COVID and CARES Act Repayment
Capital / policy decision (voluntary repayment of federal relief)
2023
Data Breach
Failure / privacy incident and response