HCA Healthcare's origin traces to 1968, when Dr. Thomas Frist Sr., a Nashville physician who had organized Park View Hospital in 1956, joined with his son Dr. Thomas Frist Jr. and Nashville businessman Jack C. Massey to create the Hospital Corporation of America (HCA). The timing was pivotal: Medicare and Medicaid had been established in 1965, creating a federal funding stream that made hospital ownership financially attractive for the first time. HCA's initial business model was revolutionary for its era—applying corporate management principles, centralized purchasing, and standardized operations to a fragmented industry of independent community hospitals. The company went public in 1969, using the capital to fuel a rapid expansion through acquisitions and new construction. By 1979, HCA owned or managed 140 hospitals; by the mid-1980s, the chain included over 200 hospitals and held contracts to manage 200 more. In 1987, HCA sold 104 hospitals to the newly created HealthTrust corporation in a portfolio optimization move, but the company's defining transformation came in 1994 when HCA merged with Columbia Hospital Corporation. Columbia had been founded in 1987 by Richard Scott, a Dallas lawyer who purchased two troubled hospitals in El Paso, Texas, and built a chain through aggressive acquisitions including Galen Health Care (71 hospitals) in 1993. The HCA-Columbia merger, completed in February 1994 in a stock swap valued at $5.7 billion, created Columbia/HCA—the largest hospital company in the United States. Scott became CEO, while Thomas Frist Jr. became chairman. The company continued its acquisition spree, purchasing Medical Care America (96 ambulatory surgery centers) in 1994 and HealthTrust (117 hospitals) in 1995. By 1997, Columbia/HCA operated 343 hospitals, 136 outpatient surgery centers, 550 home health locations, and employed 285,000 people across 37 states and international markets. Revenues topped $19 billion, and Fortune magazine named Columbia/HCA the most admired healthcare company in 1997. The success came at a devastating price. In July 1997, federal agents raided Columbia/HCA hospitals and offices in seven states, launching an investigation into Medicare fraud, false billing, and illegal kickbacks to physicians. The allegations included upcoding patient diagnoses to secure higher reimbursement, improper cost report filings, and financial incentives to doctors in exchange for patient referrals. Richard Scott was forced to resign in July 1997, receiving approximately $10 million in cash and $300 million in stock. The company's new leadership, under Thomas Frist Jr., immediately changed course—ending physician partnerships, creating a compliance program, and cooperating with federal investigators. The financial and reputational damage was severe. Columbia/HCA pleaded guilty to 14 corporate felonies and paid a total of $1.7 billion in criminal fines and civil settlements, including $840 million in 2000 and $881 million in 2003. The Department of Justice characterized the settlement as 'by far the largest recovery ever reached by the government in a health care fraud investigation.' The company rebranded back to HCA, divested non-core assets, and focused on operational recovery. By 2006, HCA had stabilized and become the target of a record-breaking leveraged buyout. In July 2006, a consortium of Bain Capital, KKR, and Merrill Lynch Global Private Equity acquired HCA for approximately $33 billion—including $21 billion in equity and $11.7 billion in debt assumption—paying $51 per share, an 18% premium to the prior closing price. The Frist family retained a 4.4% stake. The LBO was the largest in history at the time and took HCA private for nearly five years. During private ownership, the company paid $4.25 billion in dividends to its backers in 2010 alone. HCA returned to public markets in March 2011 via an IPO that raised $3.8 billion, the largest private-equity-backed initial public offering in US history at the time. The IPO netted Bain Capital over $1 billion on an initial investment of just $64 million, generating a return exceeding 200%. In the public markets, HCA has pursued a strategy of organic growth, operational efficiency, and disciplined capital allocation. The 2019 acquisition of Mission Health added a leading hospital system in western North Carolina. The 2020 acquisition of a majority stake in Galen College of Nursing addressed workforce pipeline needs. The COVID-19 pandemic tested HCA's operational resilience, with surge capacity demands followed by a deferred-care recovery that drove volume growth in 2021–2024. Under CEO Sam Hazen, appointed in 2020, HCA has navigated post-pandemic normalization, labor market challenges, and natural disasters while delivering consistent financial performance.