DeathbyPE

The Mixed Ledger

HCA Healthcare, Inc.

Owner during assessed period: Hercules Holding II · Former · Control · Nov. 17, 2006 – ongoing or unrecorded

Hercules Holding II take-private of HCA Inc. (2006)
Sponsors: Bain Capital · KKR (Kohlberg Kravis Roberts) · Merrill Lynch Global Private Equity

Hercules Holding II's ownership of HCA began on 17 November 2006, when HCA Inc. completed its merger with Hercules Acquisition Corporation. What the verified record documents about the private period is financial: three distributions declared in 2010 to stockholders and holders of stock options — $1.751 billion, $500 million and approximately $2.1 billion, each in the aggregate. What it does not document is what those years meant for patients or for the people who staffed the hospitals; no verified assertion in this ledger speaks to either, so both pillars are recorded UNKNOWN rather than inferred. Verified enforcement facts from 2023 and 2025 describe the company's condition long after this period and are read here only as evidence of that later condition, never as findings about the ownership period itself.

What happened after the deal

Four pillars, scored from currently verified evidence. Not enough evidence is a real, honest result on this rubric, not an error.

Customer Outcome

Did the product or service measurably improve for the people who use it, during this ownership period?

Not enough evidence

Nothing in the verified ledger establishes what happened to HCA's patients during this ownership period — access, outcomes, bedside staffing or billing. The later regulatory matters in the record concern events years afterward, including a hospital system HCA did not acquire until 2019, and are deliberately not back-projected onto this period. UNKNOWN.

Worker Outcome

Were workers materially better off, or at least not worse off, during this ownership period?

Not enough evidence

The ledger holds no verified evidence about pay, staffing levels or working conditions for HCA's workforce during this ownership period. The labor-adjacent facts that do exist — the 2023 Mission Health litigation and the 2025 California Attorney General action — post-date it by more than a decade and are not treated as evidence about it. UNKNOWN, never an assumed positive.

Operational Integrity

Was the company run, or was it drained, during this ownership period?

Mixed

Three distributions to owners are documented during the private period, all declared in 2010: $1.751 billion in the aggregate to stockholders and holders of vested stock options (27 January), $500 million on the same basis (5 May), and approximately $2.1 billion to stockholders and holders of stock options (23 November). The distributions are established by the filings. Their consequences are not: the verified record does not establish that any of them was debt-funded, that it impaired patient care, or that it displaced investment the hospitals needed. MIXED records the documented scale of cash returned to owners together with the absence of verified evidence about what it cost the business.

  • During this ownership period

    Distribution To Owners: $1.751 billion in the aggregate to stockholders and holders of vested stock options (USD)

    Reviewed Aug. 21, 2026

    SupportsHCA Holdings, Inc., Form 424B4 (IPO prospectus)SEC / financial filing · March 11, 2011 · Dividend Policy / Capitalization discussion

  • During this ownership period

    Distribution To Owners: $500 million in the aggregate to stockholders and holders of vested stock options (USD)

    Reviewed Aug. 21, 2026

    SupportsHCA Holdings, Inc., Form 424B4 (IPO prospectus)SEC / financial filing · March 11, 2011 · Dividend Policy / Capitalization discussion

  • During this ownership period

    Distribution To Owners: approximately $2.1 billion in the aggregate to stockholders and holders of stock options (USD)

    Reviewed Aug. 21, 2026

    SupportsHCA Holdings, Inc., Form 424B4 (IPO prospectus)SEC / financial filing · March 11, 2011 · Dividend Policy / Capitalization discussion

Durable Health

Years after the ownership period ended, is the company still healthy across all four dimensions?

Mixed

The company's later record carries documented regulatory exposure. The North Carolina Attorney General filed suit against HCA on 14 December 2023 concerning Mission Health, which HCA acquired in 2019, and a California Attorney General enforcement action followed on 24 July 2025. Both assertions establish that an action occurred — not the truth of what was alleged — and neither is a finding about this ownership period; this assessment does not attribute them to it. On that evidence the long-run record is MIXED rather than clear in either direction: there is documented later exposure, and no verified evidence establishing either sustained harm or sustained health.

Editorial context

Notes from the editors who scored this assessment. Context, not evidence.

  • 1.Two of the four pillars are UNKNOWN because the evidence to score them does not exist in this ledger, not because the record was found to be neutral. The post-ownership enforcement facts cited below establish that an action occurred; they do not establish the truth of the underlying allegations, and nothing here attributes them to the ownership period.

Assessment v1 · methodology four-pillar-v1 · published Aug. 25, 2026

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