Nashville, TN-based hospital operator HCA Inc.'s net income decreased 21.7% in the fourth quarter of 2009 compared to the same period a year ago, as the amount of charity care rose. Net income totaled $216 million for the quarter, down from $276 million in the fourth quarter of 2008. In the quarter that ended Dec. 31, revenue for HCA totaled $7.6 billion, up 4.7% compared with $7.26 billion in the same quarter a year ago.