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CONDENSED CONSOLIDATED STATEMENT OF CASH FLOWS - USD ($) $ in Millions | 9 Months Ended
--- | ---
Sep. 30, 2023 | Sep. 30, 2022
Cash Flows from Operating Activities |  |
Net income | $ 1,603 | $ 11,508
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Amortization | 1,582 | 1,623
Depreciation | 1,326 | 1,394
Intangible asset impairment charges | 13 | 910
(Income) loss from investments in equity securities, net | (240) | 1,361
Charge for the acquisition of Prometheus Biosciences, Inc. | 10,217 | 0
Charge for the acquisition of Imago BioSciences, Inc. | 1,192 | 0
Deferred income taxes | (968) | (1,261)
Share-based compensation | 478 | 396
Other | (94) | 1,169
Net changes in assets and liabilities | (2,349) | (2,435)
Net Cash Provided by Operating Activities | 12,760 | 14,665
Cash Flows from Investing Activities |  |
Capital expenditures | (2,874) | (3,239)
Purchases of securities and other investments | (704) | (710)
Proceeds from sales of securities and other investments | 1,489 | 709
Acquisition of Prometheus Biosciences, Inc., net of cash acquired | (10,705) | 0
Acquisition of Imago BioSciences, Inc., net of cash acquired | (1,327) | 0
Other acquisitions, net of cash acquired | 0 | (121)
Other | (15) | 149
Net Cash Used in Investing Activities | (14,136) | (3,212)
Cash Flows from Financing Activities |  |
Proceeds from issuance of debt | 5,939 | 0
Payments on debt | (1,752) | (2,250)
Purchases of treasury stock | (953) | 0
Dividends paid to stockholders | (5,593) | (5,262)
Proceeds from exercise of stock options | 119 | 119
Other | (325) | (172)
Net Cash Used in Financing Activities | (2,565) | (7,565)
Effect of Exchange Rate Changes on Cash, Cash Equivalents and Restricted Cash | (163) | (776)
Net (Decrease) Increase in Cash, Cash Equivalents and Restricted Cash | (4,104) | 3,112
Cash, Cash Equivalents and Restricted Cash at Beginning of Year (includes restricted cash of $79 and $71 at January 1, 2023 and 2022, respectively, included in Other current assets) | 12,773 | 8,167
Cash, Cash Equivalents and Restricted Cash at End of Period (includes restricted cash of $64 and $134 at September 30, 2023 and 2022, respectively, included in Other current assets) | $ 8,669 | $ 11,279

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