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v3.20.4

Consolidated Statements of Cash Flows - USD ($) $ in Millions | 12 Months Ended
--- | ---
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018
Operating activities |  |  |
Net earnings | $ 15,769 | $ 14,239 | $ 12,382
Noncash items: |  |  |
Depreciation and amortization | 2,891 | 2,720 | 2,428
Deferred income taxes | (8) | 230 | 42
Share-based compensation | 679 | 697 | 638
Other, net | (52) | (106) | (71)
Net change in other operating items, net of effects from acquisitions and changes in AARP balances: |  |  |
Accounts receivable | (688) | 162 | (1,351)
Other assets | (2,195) | (1,563) | (750)
Medical costs payable | 152 | 1,221 | 1,831
Accounts payable and other liabilities | 5,348 | 733 | 526
Unearned revenues | 278 | 130 | 38
Cash flows from operating activities | 22,174 | 18,463 | 15,713
Investing activities |  |  |
Purchases of investments | (16,577) | (18,131) | (14,010)
Sales of investments | 6,489 | 8,536 | 3,641
Maturities of investments | 7,252 | 7,091 | 6,270
Cash paid for acquisitions, net of cash assumed | (7,139) | (8,343) | (5,997)
Purchases of property, equipment and capitalized software | (2,051) | (2,071) | (2,063)
Other, net | (506) | 219 | (226)
Cash flows used for investing activities | (12,532) | (12,699) | (12,385)
Financing activities |  |  |
Common share repurchases | (4,250) | (5,500) | (4,500)
Cash dividends paid | (4,584) | (3,932) | (3,320)
Proceeds from common stock issuances | 1,440 | 1,037 | 838
Repayments of long-term debt | (3,150) | (1,750) | (2,600)
Proceeds from (repayments of) short-term borrowings, net | 872 | 300 | (201)
Proceeds from issuance of long-term debt | 4,864 | 5,444 | 6,935
Customer funds administered | 1,677 | 13 | (131)
Other, net | (459) | (1,237) | (1,386)
Cash flows used for financing activities | (3,590) | (5,625) | (4,365)
Effect of exchange rate changes on cash and cash equivalents | (116) | (20) | (78)
Increase (decrease) in cash and cash equivalents | 5,936 | 119 | (1,115)
Cash and cash equivalents, beginning of period | 10,985 | 10,866 | 11,981
Cash and cash equivalents, end of period | 16,921 | 10,985 | 10,866
Supplemental cash flow disclosures |  |  |
Cash paid for interest | 1,704 | 1,627 | 1,410
Cash paid for income taxes | $ 4,935 | $ 3,542 | $ 3,257

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