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v3.21.1

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions | 3 Months Ended
--- | ---
Mar. 31, 2021 | Mar. 31, 2020
Cash flows from operating activities: |  |
Net income | $ 1,580 | $ 698
Increase (decrease) in cash from operating assets and liabilities: |  |
Accounts receivable | (371) | 464
Inventories and other assets | (85) | (196)
Accounts payable and accrued expenses | (371) | (784)
Depreciation and amortization | 697 | 674
Income taxes | 406 | 121
Gains on sales of facilities | (2) | (7)
Losses on retirement of debt | 0 | 295
Amortization of debt issuance costs and discounts | 8 | 7
Share-based compensation | 97 | 82
Other | 29 | 21
Net cash provided by operating activities | 1,988 | 1,375
Cash flows from investing activities: |  |
Purchase of property and equipment | (654) | (853)
Acquisition of hospitals and health care entities | (22) | (328)
Sales of hospitals and health care entities | 20 | 35
Change in investments | (2) | (1)
Other | 9 | 2
Net cash used in investing activities | (649) | (1,145)
Cash flows from financing activities: |  |
Issuances of long-term debt | 0 | 2,700
Net change in revolving credit facilities | 80 | 1,440
Repayment of long-term debt | (47) | (3,327)
Distributions to noncontrolling interests | (234) | (154)
Payment of debt issuance costs | 0 | (34)
Payment of dividends | (169) | (152)
Repurchase of common stock | (1,527) | (441)
Other | (207) | (141)
Net cash used in financing activities | (2,104) | (109)
Effect of exchange rate changes on cash and cash equivalents | 2 | (11)
Change in cash and cash equivalents | (763) | 110
Cash and cash equivalents at beginning of period | 1,793 | 621
Cash and cash equivalents at end of period | 1,030 | 731
Interest payments | 375 | 468
Income tax refunds, net | $ (13) | $ (9)

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