T hank you everyone for joining us. I am really pleased to have HCA here for our next session. HCA is the largest health system in the country. With us from the company, we are really pleased to have Sam Hazen, CEO. Also on stage with us, Frank Morgan from Investor Relations. Maybe to kick things off, it has been a pretty dynamic year, both for the company and the space as a whole. Any kind of interest in maybe giving us a brief state of the union perspective on demand environment and how you are thinking about your demand in your markets over maybe a bit of a longer time period? Yeah, I think, clearly, Steve, thank you for having us. We are dealing with a unique year when it comes to policy implications. The enhanced premium tax credits, which we advocated strongly for in 2025, expired, and it had a more pronounced impact on our business and on people than, I think, a lot of estimates that were out there. For us, that has been the biggest dynamic, and I was trying to give some earlier groups some context around all of that. Through the first six months of this year, we have seen about 2.1 million adjusted admissions inside of HCA. The discussion has really revolved around 22,000. Those 22,000 adjusted admissions that were the adjusted admissions that migrated from a fairly profitable situation inside of the exchanges to a completely loss situation now and an uninsured status has had the impact that we shared on our call. But setting all that aside, 99% of our business has performed as we expected and actually better than it did in 2025. I n the context of what is going on from a macro standpoint, you have got the policy implications that have been negative with respect to the enhanced premium tax credits. A ctually for us this year, it has been positive when it comes to the One Big Beautiful Bill Act and the fact that the supplemental payment programs and the grandfathering provisions have allowed certain states to get their funding for Medicaid to a higher level, and that has benefited us in 2026 and somewhat offset some of the challenges with the enhanced premium tax credits. W hen you look more broadly at the business, our belief is that demand for healthcare, especially in our communities, because we are in the Southeast and the Southwest, and there is still this continued migration of people from the Northeast, Pacific Northwest, California, Midwest to the Southeast and the Southwest, gives us a confidence that demand for healthcare is going to continue to grow. We have scored that in the 2%-3%, and we think that is a reasonable scoring as we look to the future. That is a really positive backdrop. The second piece, I would say, with respect to our company, is that our ability to meet that demand with our strategy is getting better. We continue to add capabilities to our company with more outpatient facilities. We will approach roughly 3,000 outpatient facilities broadly across the organization that are part of what we call the hospital ecosystem within each of our communities. That extension of our reach to make it more convenient for our patients, and then creating the capacity downstream if they need acute care, is allowing us to meet that demand. We continue to see modest growth in our market share, and as the markets continue to grow and as we get better at executing our network strategy, we think we can meet that demand even more effectively. The third piece of what is going on in our company is this set of initiatives that we have undertaken to enhance what I call the enterprise capabilities to support our networks. What I mean by that is we have a one system opportunity inside of HCA, and that is connecting the local systems that we have in Dallas or Denver or Miami to the national system. We have a number of initiatives that are enterprise-oriented initiatives that we think are going to complement what our people do on the ground, what our facilities can provide, and enhance their overall capabilities, make them safer for our patients, a better place to work for our physicians and employees, and in a more efficient environment by leveraging our scale even more than we have done in the past. I think for HCA broadly, we are at the greatest inflection point with creating enterprise capabilities to support our individual networks in ways that we have never been able to do. Some of that is being enhanced by artificial intelligence and what the digital tools can do for our business. Some of it is advantaged by the Global Capability Center that we put forward, and we are finding ways, because of both of those, to leverage our shared services platform even more than we have done in the past. We think that is going to create value across a number of areas in the organization. Pretty exciting. All that results in, I think, a tremendous amount of capital production in our company. Our cash flow continues to grow and be very strong, and we have a lot of optionality to invest in the business, and then also allocate to our capital allocation plan. Okay. Well, fantastic. That is a great place to start. Lot to follow up on there. I guess before we get into a little bit more of the financial discussion, I wanted to ask about a couple of organizational items that have come up more recently. I guess first, recently announced the creation of the Ambulatory Operations Group. I'd love to just hear a little bit how that fits into what you're talking about. Also a recent key promotion, Dr. Michael Schlosser, to Chief Clinical Officer. Maybe you could touch on both of those points. Sure, I think both of those are really about some of the evolution that I just mentioned. As we've advanced our ambulatory network to the point, again, of roughly 3,000 physician clinics, urgent care centers, freestanding emergency rooms, ambulatory surgery centers, even affiliates that are outside the HCA network, we've seen an opportunity to coalesce them into a more coordinated function. They do a pretty good job of integrating into each of our markets. We see opportunities corporately to pull them together, create some synergy, create some consistency in how we think about growing them on the upside, if you will, and have forward-facing growth strategies for each of the individual units, and then tighter integration into the system downstream. Charles Gressle, who is moving from our East Florida division in Miami, is going to lead the Ambulatory Operations Group and bring that together and then integrate, again, organizationally into some of the other corporate functions in ways that I think are going to create value for this large platform that we've built over the past few years. We've added to that platform significantly this year. Just recently announced an urgent care center acquisition in Texas. We've done some other outpatient facility acquisitions across our networks this year. We continue to add significantly to the ambulatory network. On the digital side, Mike Schlosser led our digital transformation and innovation agenda. His background, he's a neurosurgeon by trade and went to MIT, and he started our digital agenda. Previously, he was one of our chief medical officers for the national group, one of our hospitals in Nashville. Neurosurgeon by training, as I mentioned. The last two or three years, he's been separated and building up digital capabilities. The holy grail for our AI agenda is inside, I'll call it, the clinical world. If we can make the work environment better for our employees and for our physicians, then we can extend that broadly into patient safety, quality, more consistency, eliminating unnecessary work. I felt it important that we integrate now that we've matured our digital thinking and capabilities into the clinical teams, where when our clinical teams are talking, the digital people are in the room with them. When the digital team is talking, the clinical people are in the room with them. That's going to create organizational alignment, some synergies. We still have an opportunity administratively to do some digital things, and they'll own that as well. Those two realignments are really about just sort of the natural evolution of some key initiatives for the company. Okay. Got it. Just to come back to, I guess then, the performance financially this year. When we look at, obviously, the exchanges, was always going to be a difficult item to estimate accurately in real time. So, understanding and kind of setting aside the revision that you made on the exchanges, and we'll talk a little about that in a minute, and setting aside some of the changes on the Medicaid front. It looks like the "core guidance" has come down by about 3% with the revision you made with the second quarter. I guess, how should we think about the key drivers of that and what's played out perhaps differently on that core component of the business relative to the initial expectations? Your definition of core may be different than my definition of core. I don't know how you're necessarily defining that. Sure. Let me speak to it this way. 2024 and 2025 were incredible years for our company. I think we grew almost double digits on sort of the business. Volumes were strong, payer mix was strong. A number of things went our way, and our business performed really well. When we look at the business today, and back to the 99%, it is performing pretty darn close to the high side of our long-term guidance of 4%-6% EBITDA growth. I think from that standpoint, there is a lot of puts and takes. The service mix maybe has not been as great as we had hoped. There is some elective dynamics with consumer sentiment that maybe is playing into some of this, but our core business continues to perform really well. As we think about the last half of the year, we have a pretty positive outlook on volume and demand growth. That is really coming from how the last four months of the first half of the year performed. We are also encouraged by our financial resiliency agenda and how it is maturing. The growth that we see in sort of the core is pretty solid. Okay. Got it. I appreciate that perspective. Obviously, there has been a lot of discussion around surgical trends, and that was a big item for the company in the second quarter, in particular. I guess, walk us through the major factors that are impacting surgical trends. You spoke a little bit about electives. As you have continued to study that issue, I guess, what have you kind of seen around elective trends, and I guess, how are you thinking about the surgical schedule as we look maybe into the coming quarters? Well, I think the HIX discussion that we talked about is connected heavily to the surgical discussion. We call this out on our call, where most of our elective surgical declines were attributable to the HIX classification. The HIX has been a bit cross-cutting, and that's the lion's share of the decline. The second piece is a little bit of what we get anecdotally from our physicians, and that is that, "Hey, there's a hesitancy for some of our patients to want to go and get their surgery done." That may change as we push through the balance of the year. We don't know. The hesitancy is generated mostly by this sentiment that maybe I should pause. It doesn't hurt that bad, can't afford it to the same degree I could in the past. So that's been a piece of it, a smaller piece, a much smaller piece. The smallest piece has been the inpatient rule change, where we've had a little bit of the Medicare Inpatient-Only List affect surgery, and then when it moves from inpatient to outpatient, it gets a little bit more diluted because there's more outpatient suppliers, so you lose a little market share with that. T hose are the three pieces that make up the surgery. Our guidance for the balance of the year does not consider a rebound in surgery. It sort of continues throughout the balance of the year. The main driver is the HIX and these other two factors. It's possible that the consumer sentiment thing could ease a little bit as people get to their deductibles and find that in the fourth quarter they can actually, now's a good time to do it. We'll have to see. Okay. Yeah, there's been some coverage recently of efforts to try to collect more upfront and establish payment for cost sharing upfront before procedures are actually done. Has the company made any changes to how it approaches doing that? I wonder if that could be something that might be exacerbating what we're seeing. We haven't really changed how we approach our patients with co-pays and deductibles. We have a pretty consistent method that we've used over the years. That can get nuanced a little bit, but it's not at a quarter, and it's not having an influence on the business trends. Okay. Got it. If we were to look at the commercial business and set aside the exchanges, I think one of the highlights was that commercial x exchange volume rebounded a good deal in the second quarter. Kind of a big improvement. I know obviously this is going to bounce around from quarter-to-quarter, but I guess how do you think about where employers are in your markets at this point in time from just a hiring and demand perspective? Well, I think this goes back to the backdrop on demand, Steve. When you look at this growth in the southeastern parts and southwestern parts of the country, I think they're very vibrant economies. You have a lot of movement to these communities from the Northeast, Pacific Northwest, and the Midwest continue to move, actually more than we anticipated. We thought it would slow down a little bit post-COVID, but it hasn't. When I think about the commercial component of what's going on in that macro, we're optimistic that we're going to continue to see good job opportunities for people, continued coverage through employers, and solid demand as a result of that for healthcare services. Okay. When we think about some of the other market dynamics, obviously gaining market share has been a big part of the company's long-term volume algorithm. I guess, how would you describe competitive dynamics over the past couple of years? Has there been any impact from the upswing of Medicaid supplemental payment programs or potentially 340B Drug Pricing Program to some of your competitors? No, I think we've gone through different cycles in our company with, I'll call them competitive cycles. We go through political cycles, recessionary cycles, and so forth, expansion cycles. I think the competitive dynamic is there. There's some formidable competitors. They do have some resources that have come to them through these programs you mentioned. The market's performed well, stock market, and a lot of them have large investments. T here's investments, capital spending by our competitors. I don't think we're getting outspent, nor do I think we're losing position, but we have to be better, and that's what we've challenged our teams around is how do we get sharper at what we do. As a company, how do we support our networks with analytics, with some of this reorganization that we've talked about, with market intelligence? W e've got new tools to get even sharper, and I think we have a pathway to continue to grow market share. We don't have to grow it that much to accomplish what we need to accomplish when we have demand naturally growing in our communities. I think from that standpoint, we're trying to sharpen our tools so that we can compete even more effectively, and our overall positioning continues to be strong. Okay. When we think about the guidance, I won't ask this in terms of a core EBITDA framing, but when we think about what the company has assumed in the back half guidance post the revision, I guess maybe you could help us understand how you're thinking about maybe the impact of resiliency in the balance of the year, and maybe that's a greater contributor than it was in the first half of the year. Broadly, how you're thinking about the level of demand and cost performance that needs to occur to deliver. You want to take that? Yeah, I'd say for the second half of the year, basically, the guidance assumes that, as Sam mentioned earlier, surgical volumes remain about the same. Overall demand in the second half of the year is about the same. I think one thing you will see is the benefits of resiliency, certainly more so in the fourth quarter than the third. We talked about when we were updating our guidance that the growth rate in the fourth quarter year-over-year would be better than the growth rate year-over-year than the third quarter, and I think that's a reflection of the ultimate implementation and effect of some of these resiliency programs that really take traction. Okay. Got it. Maybe as part of that discussion, obviously we've seen, again, the big issue with exchanges has been just kind of the lack of conversion to other forms of coverage. I guess when you now have a pretty good line of sight to where exchange volumes are in the second quarter, I guess how are you thinking about exchanges and where that goes in the back half of the year? I think we assume attrition levels, that's going to level out, and that's informed by years of history looking at attrition patterns amongst the HIX population. We have several years of data there. We've looked at real time data through the months of the second quarter. We feel like the adjustments we've made here will accommodate that in our guidance range that we've laid out. I would say that by the fourth quarter, when we talk about this third versus fourth quarter dynamic, one of the benefits we'll see is we just mechanically have an easier comp in the fourth quarter of this year. If you look at the effects, we think you started to see some of these negative effects actually starting occurring in the fourth quarter of last year. B asically, the comp should be a lot easier in the fourth quarter of this year versus prior. Okay, to focus a little bit more on the exchange volume that still remains in the system. One of the watch areas seems like there's been a material shift, especially in some markets, the products that have higher deductibles and cost sharing. Could you just elaborate a little bit on how the company has planned for this aspect of it? In terms of collection timelines on these dollars, are you at the point now where you feel like you have good visibility into how that's going to play out, or is that still going to be something that takes some time to really, to know for sure? I think we are comfortable with our visibility into co-pays and deductibles. It's been a bit of a pressure point to your comment there, where people have more co-pays and deductible responsibilities this year than they did last year, but they had more in 2025 than they did in 2024 also. We don't know exactly how that's playing into an overall economic effect when it comes to consumers in general. I think our collection rates have been about the same as they've been in the past. We work with our patients to get them coverage. We work with them to have payment terms that work. I think we feel like we're doing the appropriate things there. But it has been a little bit of a pressure point through the first six months. That is factored into, as Frank alluded to, our guidance as we push through the balance of the year. Okay. Maybe to talk a little bit about the labor side. I guess first you have a recent acquisition of The College of Health Care Professions. Maybe just update us on the fit there and how the interplay is with the overall Galen strategy. Well, I think it goes back to what I mentioned at the beginning, and that is what are the enterprise capabilities that we need to build as a system nationally in order to support our local networks. One of the areas that we were struggling with was allied health in techs, radiology techs, MRI techs, OR techs, all these different components outside of nursing. The College of Health Care Professions, which is based in Texas, actually, we have some relationships with them already, is sort of a complement to Galen, and we figured out how to scale up a college of nursing. We'll have almost 30 college campuses by the end of next year, pushing 30,000 students in nursing. We're going to replicate that model, and we're going to be able to do it in communities where we know we have insufficient supply of allied health and techs. We think that's going to help us with capacity constraints in some cases, contract labor in other cases, and just being an overall better employer because we're in a position to give people a career opportunity for life inside of our company. We're extremely excited about what The College of Health Care Professions provides for our organization overall, Steve, and I think, again, it's part of that larger discussion point about what are the areas that we need to invest in corporately to support the networks more broadly. Okay. Then, obviously, labor and SWBs are the strong point in the second quarter. I think SWB per adjusted admission was down 1% year-over-year. I guess big picture, what are the key operational levers the company's pulling to be able to deliver that kind of performance when you're still seeing a decent amount of labor inflation on base out there? Yeah. Obviously, we do have wage inflation. We have to compete on wages, and we do. We compete very effectively there. But as we grow our business, you get natural operating leverage that comes with that. We've been able to find ways to eliminate overhead, and get more efficient with our overhead platform, and we still have opportunities there. T hat's helped our productivity also. Then we've been able to use benchmarking more effectively, where we've been able to highlight variances. It just didn't make sense. Through those systems and that approach, we've been able to get more efficient and generate productivity. Okay. To some of your points earlier, obviously, your markets are a lot different than the national average. But when we look at some of the broader wage data that is out there, it does seem like you are seeing a pretty decent slowdown in base wage inflation. You are seeing declines in openings and turnover rates and things like that that have been negatively impactful to your business in the past. Do you think we are potentially entering a different phase of the labor market? I think we have already entered it. Obviously, 2021, 2022, 2023 were very difficult periods. We have upped our game as a company. Our human resources functioning operationally with their tools, with recruiting capabilities, with how we integrate into our facilities is much better. Our employee engagement continues to be strong, so I think we are in it. I do not see it changing in the short run or intermediate run in any material way, either positive or negative. I think it is pretty neutral right now. Okay. To expand a little bit on some of the resiliency efforts, this would probably be a good opportunity to maybe talk a little bit more about what the company is really excited about on the AI front. I guess maybe some incremental color would be great on how much you are investing. It would be great if you could maybe touch on some of the highest impact use cases and how to think about the returns on that investment that you see in the business already today versus what is possible really over the next couple of years. Yeah. We have a number of initiatives that are underway. I want to speak to those because we are having to absorb most of those right now into the income statement. We had to absorb them last year into the income statement. It starts with, I am going to focus on our Global Capability Center where we have been able to tap into talent, create 24/7 capabilities to support our business, which never closes. We think that particular component of our set of initiatives will start to create value for the company in 2027 and 2028. The digital agenda has really two components. The first component is implementing a new clinical system, and we are partnered with MEDITECH in implementing their new MEDITECH Expanse platform. We are about halfway through the company's installation there. That clinical system is giving us standardized data sets broadly across the company. Heretofore, we were not as standard as we needed to be. This is also upgrading sort of the infrastructure when it comes to the workflow and so forth. That investment, again, has yield beyond 2028. We are having to absorb the cost today. The third piece of our agenda is our AI agenda, and that is where we see a lot of opportunity. As I mentioned a minute ago, focusing the AI with the realignment that we have done in the clinical space, which is the holy grail in many ways for us is centered on making our work environment better for our employees. If we can do that and for our physicians, then we get a much better patient outcome, and we will get more efficient and open up growth lanes for us. That is where most of our energy is going to go. We do have opportunities in revenue cycle. We have opportunities in HR. We have opportunities in IT. Those are all moving as well, but they do not have sort of the scaled effects potentially that we see in our facilities. It is a very exciting agenda. We are rolling out ambient listening technology to our physicians. We will soon migrate that to nursing. We are doing a nurse handoff tool, which is very efficient and a greater patient safety alignment. That is happening as well. We have got other sort of infrastructure investments that we are making on staffing and scheduling to enhance sort of the process for our leaders. A lot of things are going toward, again, making the work environment better so that it is safer and more efficient in the process. We are already seeing yield in some cases, b ut net-net, we are still investing in that initiative. Okay. No, that is great. Obviously, one of the big themes at the moment is just everything that is going on from a policy perspective that is in front of the industry. I guess at this stage, you are probably starting to plan more for Medicaid expansion and kind of work requirements on that part of the population. I know that your footprint is not necessarily incredibly oriented towards Medicaid expansion states. But at this early stage, I guess, how are you thinking about what you might see across the enterprise from Medicaid expansion and Medicaid-related policies over the next couple of years? Roughly 60%, almost 2/3 of our Medicaid business is in non-expansion states. The rules for expansion states versus non-expansion states are not as austere. Yeah. I think from that standpoint, we do have some exposure to the non-expansion states having earlier implementation requirements to some of the changes in Medicaid. We see those as imminently manageable to the company as we push forward and not having an onerous effect on our growth assumptions and so forth. And that's where, again, some of these other capabilities that we're building are creating, if you will, our own tailwinds to compensate for some of those headwinds that will come from those kind of policies. Okay. And kind of to come back to maybe the capital deployment side of things, and when you think about the profile of sort of what you might be interested in from a capital deployment point of view or how you might spend capital, I guess, what would you characterize as kind of being the same as what the traditional HCA playbook that we've come to know is, and I guess, what do you think might look different over the next, I don't know, three to five years? I don't think we're going to have significant differences in anything unless the not-for-profit world changes and there's a lot of acquisition opportunities. That would be the only thing that's materially different. We don't anticipate that. This year, we will spend $5.5 billion of capital inside of our networks to add capacity, add technology, add outpatient facilities, invest in some of our digital agenda, and so forth. That's up over roughly $5 billion last year, so a pretty significant increase. Additionally, we will have acquired roughly $1 billion worth of new facilities, mainly outpatient facilities where we have added to our networks. W e're investing roughly $6.5 billion back into the existing networks that HCA has to strengthen their position, meet the demand expectations that we see in the market, and help us become even more relevant in the communities that we serve. That leaves us with a lot of optionality because our cash flow from operations is significantly greater than that. Today, we're using less of our overall cash flow than we did five or six years ago. Historically, it was about 50% of our cash flow went to the network development. We're running about 40%-45% now. We think over time, that's maybe going to create even more flexibility for us to allocate capital to whatever opportunities exist, whether it's to our share buyback program or to an acquisition, or to even more network investments if we see that as a need. We're prepared to do that, and we think that's one of the value drivers. It's clear to us as we think the next three to five years for HCA is this tremendous flexibility to invest capital where it makes the most sense. Okay. To come back to the Ambulatory Operations Group, is that sort of explicitly something that you think will be seeing more capital or maybe using more of your capital over the next few years? It is really capital efficient, because i t is small dollar investments. It is not like hospital investments, which are long-lived assets, very heavy from a capital intensity standpoint. We will continue to invest, but I do not think it is going to move the needle. Okay. Obviously, doing health system and hospital is very challenging in the current environment. As you think about things that could be attractive to the company, in the past you have looked at things like urgent care assets, for example. What do you think external to the company's own internal development could be a strategic fit for you? We're built to be bigger, so we can easily add new markets if they're available and they make sense economically. I don't see a lot of that, because t he construct of the industry is not set up that way, and so unless a hospital system is in dire straits, they're typically unlikely to want to sell their organization to an entity like HCA. Most of our acquisition opportunities have been in the outpatient space where people are motivated by systems and value and so forth, and we'll continue to invest in those. Again, that's just a piece, though. The bigger piece will be in our core capital spending inside of our facilities. Okay. When you talk about what you're doing to better support the individual markets through the national platform, ultimately, do you think that's more of a play for an ability to grow more? Do you think it's an ability to become more cost-efficient? Do you think about it as a mix of both? I would put to deliver higher quality and greater patient safety, so it is all three. Of course. Yeah, which kind of dovetails into everything that we have been talking about. Well, fantastic. I think that is about all the time that we are going to have today. Thank you very much for the discussion. It's been great. Yeah, very nice to be here. Thanks for being here. Thank you. Thanks, Steve.