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Consolidated Statements of Cash Flows - USD ($) $ in Millions | 12 Months Ended
--- | ---
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020
Cash flows from operating activities: |  |  |
Cash receipts from customers | $ 313,662 | $ 284,219 | $ 264,327
Cash paid for inventory and prescriptions dispensed by retail network pharmacies | (189,766) | (165,783) | (158,636)
Insurance benefits paid | (69,728) | (63,598) | (55,124)
Cash paid to other suppliers and employees | (32,662) | (31,652) | (29,763)
Interest and investment income received | 1,026 | 743 | 894
Interest paid | (2,239) | (2,469) | (2,904)
Income taxes paid | (4,116) | (3,195) | (2,929)
Net cash provided by operating activities | 16,177 | 18,265 | 15,865
Cash flows from investing activities: |  |  |
Proceeds from sales and maturities of investments | 6,729 | 7,246 | 6,467
Purchases of investments | (7,746) | (9,963) | (9,639)
Purchases of property and equipment | (2,727) | (2,520) | (2,437)
Proceeds from sale-leaseback transactions | 0 | 0 | 101
Acquisitions (net of cash acquired) | (139) | (146) | (866)
Proceeds from sale of subsidiaries (net of cash and restricted cash sold of $2,854, $0 and $9) | (1,249) | 0 | 840
Other | 85 | 122 | 0
Net cash used in investing activities | (5,047) | (5,261) | (5,534)
Cash flows from financing activities: |  |  |
Proceeds from issuance of long-term debt | 0 | 987 | 9,958
Repayments of long-term debt | (4,211) | (10,254) | (15,631)
Derivative settlements | 0 | 0 | (7)
Repurchase of common stock | (3,500) | 0 | 0
Dividends paid | (2,907) | (2,625) | (2,624)
Proceeds from exercise of stock options | 551 | 549 | 264
Payments for taxes related to net share settlement of equity awards | (370) | (168) | (88)
Other | (79) | 155 | 432
Net cash used in financing activities | (10,516) | (11,356) | (7,696)
Net increase in cash, cash equivalents and restricted cash | 614 | 1,648 | 2,635
Cash, cash equivalents and restricted cash at the beginning of the period | 12,691 | 11,043 | 8,408
Cash, cash equivalents and restricted cash at the end of the period | 13,305 | 12,691 | 11,043
Reconciliation of net income to net cash provided by operating activities: |  |  |
Net income | 4,165 | 7,898 | 7,192
Adjustments required to reconcile net income to net cash provided by operating activities: |  |  |
Depreciation and amortization | 4,247 | 4,512 | 4,441
Loss on assets held for sale | 2,533 | 0 | 0
Store impairments | 0 | 1,358 | 0
Goodwill impairment | 0 | 431 | 0
Stock-based compensation | 447 | 484 | 400
Gain on sale of subsidiaries | (475) | 0 | (269)
Loss on early extinguishment of debt | 0 | 452 | 1,440
Deferred income taxes | (2,075) | (428) | (570)
Other noncash items | 332 | (390) | 72
Change in operating assets and liabilities, net of effects from acquisitions: |  |  |
Accounts receivable, net | (2,971) | (2,703) | (1,510)
Inventories | (1,435) | 735 | (973)
Other assets | (566) | (3) | 364
Accounts payable and pharmacy claims and discounts payable | 4,260 | 2,898 | 2,769
Health care costs payable and other insurance liabilities | 1,247 | 169 | (231)
Other liabilities | 6,468 | 2,852 | 2,740
Net cash provided by operating activities | $ 16,177 | $ 18,265 | $ 15,865

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