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Consolidated Statements of Cash Flows - USD ($) $ in Millions | 12 Months Ended
--- | ---
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021
Cash Flows from Operating Activities |  |  |
Net income | $ 5,240.4 | $ 6,244.8 | $ 5,581.7
Adjustments to Reconcile Net Income to Cash Flows from Operating Activities: |  |  |
Depreciation and amortization | 1,527.3 | 1,522.5 | 1,547.6
Debt extinguishment loss (Note 11) | 0.0 | 0.0 | 405.2
Change in deferred income taxes | (2,341.0) | (2,185.2) | (802.3)
Stock-based compensation expense | 628.5 | 371.1 | 342.8
Net investment (gains) losses | 23.5 | 420.0 | (178.0)
Gains on sale of product rights | (1,878.9) | (156.5) | (216.0)
Acquired in-process research and development (Note 3) | 3,799.8 | 908.5 | 970.1
Other operating activities, net | 295.5 | 461.3 | 727.4
Other changes in operating assets and liabilities, net of acquisitions and divestitures: |  |  |
Receivables—(increase) decrease | (2,451.0) | (299.6) | (1,278.3)
Inventories—(increase) decrease | (1,425.0) | (599.7) | (235.9)
Other assets—(increase) decrease | (3,453.4) | (793.5) | 1,515.4
Accounts payable and other liabilities—increase (decrease) | 4,274.4 | 1,692.0 | (1,013.8)
Net Cash Provided by Operating Activities | 4,240.1 | 7,585.7 | 7,365.9
Cash Flows from Investing Activities |  |  |
Purchases of property and equipment | (3,447.6) | (1,854.3) | (1,309.8)
Proceeds from sales and maturities of short-term investments | 192.2 | 121.4 | 47.4
Purchases of short-term investments | (98.2) | (107.4) | (83.5)
Proceeds from sales of and distributions from noncurrent investments | 508.1 | 342.2 | 800.0
Purchases of noncurrent investments | (730.8) | (600.2) | (929.9)
Proceeds from sale of product rights | 1,604.3 | 95.8 | 216.0
Purchases of in-process research and development | (3,944.5) | (1,131.0) | (668.6)
Cash paid for acquisitions, net of cash acquired (Note 3) | (1,044.3) | (327.2) | (747.4)
Other investing activities, net | (191.9) | (302.2) | (191.7)
Net Cash Used for Investing Activities | (7,152.7) | (3,762.9) | (2,867.5)
Cash Flows from Financing Activities |  |  |
Dividends paid | (4,069.3) | (3,535.8) | (3,086.8)
Net change in short-term borrowings | 4,691.4 | 1,498.0 | (4.0)
Proceeds from issuance of long-term debt | 3,958.5 | 0.0 | 2,410.8
Repayments of long-term debt | 0.0 | (1,560.0) | (1,905.4)
Purchases of common stock | (750.0) | (1,500.0) | (1,250.0)
Other financing activities, net | (335.0) | (308.9) | (295.9)
Net Cash Provided by (Used for) Financing Activities | 3,495.6 | (5,406.7) | (4,131.3)
Effect of exchange rate changes on cash and cash equivalents | 168.6 | (167.6) | (205.7)
Net increase (decrease) in cash and cash equivalents | 751.6 | (1,751.5) | 161.4
Cash and cash equivalents at beginning of year | 2,067.0 | 3,818.5 | 3,657.1
Cash and Cash Equivalents at End of Year | $ 2,818.6 | $ 2,067.0 | $ 3,818.5

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