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v3.19.3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions | 9 Months Ended
--- | ---
Sep. 30, 2019 | Sep. 30, 2018
Cash flows from operating activities: |  |
Net income | $ 2,872 | $ 3,144
Increase (decrease) in cash from operating assets and liabilities: |  |
Accounts receivable | (93) | (161)
Inventories and other assets | (95) | (136)
Accounts payable and accrued expenses | (118) | 150
Depreciation and amortization | 1,902 | 1,697
Income taxes | 51 |
Gains on sales of facilities | (17) | (420)
Losses on retirement of debt | 211 | 9
Amortization of debt issuance costs and discounts | 23 | 23
Share-based compensation | 263 | 204
Other | 98 | 76
Net cash provided by (used in) operating activities | 5,097 | 4,586
Cash flows from investing activities: |  |
Purchase of property and equipment | (2,884) | (2,420)
Acquisition of hospitals and health care entities | (1,592) | (1,056)
Disposal of hospitals and health care entities | 49 | 802
Change in investments | 35 | 65
Other | 17 | (6)
Net cash used in investing activities | (4,375) | (2,615)
Cash flows from financing activities: |  |
Issuances of long-term debt | 6,451 | 2,000
Net change in revolving bank credit facilities | (30) | (330)
Repayment of long-term debt | (5,289) | (1,652)
Distributions to noncontrolling interests | (404) | (315)
Payment of debt issuance costs | (71) | (24)
Payment of cash dividends | (414) | (366)
Repurchases of common stock | (759) | (1,195)
Other | (145) | (232)
Net cash (used in) provided by financing activities | (661) | (2,114)
Effect of exchange rate changes on cash and cash equivalents | (4) | (11)
Change in cash and cash equivalents | 57 | (154)
Cash and cash equivalents at beginning of period | 502 | 732
Cash and cash equivalents at end of period | 559 | 578
Interest payments | 1,492 | 1,422
Income tax payments, net | $ 714 | $ 702

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