HCA Holdings Inc was incorporated in Nevada in January 1990 and reincorporated in Delaware in September 1993. It is a health care services company in the United States. It operates 168 hospitals, comprised of 164 general, acute care hospitals; three psychiatric hospitals; and one rehabilitation hospital. In addition, it operates 116 freestanding surgery centers. Its facilities are located in 20 states and England. Its general, acute care hospitals typically provide services to accommodate such medical specialties as internal medicine, general surgery, cardiology, oncology, neurosurgery, orthopedics and obstetrics, as well as diagnostic and emergency services. Outpatient and ancillary health care services are provided by its general, acute care hospitals, freestanding surgery centers, diagnostic centers and rehabilitation facilities. Its psychiatric hospitals provide mental health care services through inpatient, partial hospitalization and outpatient settings. The Company is subject to various federal, state and local statutes and ordinances regulating the discharge of materials into the environment. Some competing facilities are physician-owned or are owned by tax-supported government agencies and many others are owned by not-for-profit entities that may be supported by endowments, charitable contributions and/or tax revenues and are exempt from sales, property and income taxes. It also faces competition from specialty hospitals and from both its own and unaffiliated freestanding ASCs for market share in certain high margin services.