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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: |  |  |
Cash receipts from customers | $ 345,464 | $ 313,662 | $ 284,219
Cash paid for inventory, prescriptions dispensed and health services rendered | (208,848) | (189,766) | (165,783)
Insurance benefits paid | (84,097) | (69,728) | (63,598)
Cash paid to other suppliers and employees | (34,735) | (32,662) | (31,652)
Interest and investment income received | 1,584 | 1,026 | 743
Interest paid | (2,418) | (2,239) | (2,469)
Income taxes paid | (3,524) | (4,116) | (3,195)
Net cash provided by operating activities | 13,426 | 16,177 | 18,265
Cash flows from investing activities: |  |  |
Proceeds from sales and maturities of investments | 7,729 | 6,729 | 7,246
Purchases of investments | (9,043) | (7,746) | (9,963)
Purchases of property and equipment | (3,031) | (2,727) | (2,520)
Acquisitions (net of cash and restricted cash acquired) | (16,612) | (139) | (146)
Proceeds from sale of subsidiaries (net of cash and restricted cash sold of $2,854 in 2022) | 0 | (1,249) | 0
Other | 68 | 85 | 122
Net cash used in investing activities | (20,889) | (5,047) | (5,261)
Cash flows from financing activities: |  |  |
Commercial paper borrowings (repayments), net | 200 | 0 | 0
Proceeds from issuance of short-term loan | 5,000 | 0 | 0
Repayment of short-term loan | (5,000) | 0 | 0
Proceeds from issuance of long-term debt | 10,898 | 0 | 987
Repayments of long-term debt | (3,166) | (4,211) | (10,254)
Repurchase of common stock | (2,012) | (3,500) | 0
Dividends paid | (3,132) | (2,907) | (2,625)
Proceeds from exercise of stock options | 277 | 551 | 549
Payments for taxes related to net share settlement of equity awards | (181) | (370) | (168)
Other | (201) | (79) | 155
Net cash provided by (used in) financing activities | 2,683 | (10,516) | (11,356)
Net increase (decrease) in cash, cash equivalents and restricted cash | (4,780) | 614 | 1,648
Cash, cash equivalents and restricted cash at the beginning of the period | 13,305 | 12,691 | 11,043
Cash, cash equivalents and restricted cash at the end of the period | 8,525 | 13,305 | 12,691
Reconciliation of net income to net cash provided by operating activities: |  |  |
Net income | 8,368 | 4,327 | 7,989
Adjustments required to reconcile net income to net cash provided by operating activities: |  |  |
Depreciation and amortization | 4,366 | 4,224 | 4,486
Loss on assets held for sale | 349 | 2,533 | 0
Store impairments | 0 | 0 | 1,358
Goodwill impairment | 0 | 0 | 431
Stock-based compensation | 588 | 447 | 484
Gain on sale of subsidiaries | 0 | (475) | 0
Loss on early extinguishment of debt | 0 | 0 | 452
Deferred income taxes | (676) | (2,029) | (402)
Other noncash items | 416 | 332 | (390)
Change in operating assets and liabilities, net of effects from acquisitions: |  |  |
Accounts receivable, net | (6,260) | (2,971) | (2,703)
Inventories | 1,233 | (1,435) | 735
Other assets | (510) | (491) | (30)
Accounts payable and pharmacy claims and discounts payable | 3,618 | 4,260 | 2,898
Health care costs payable and other insurance liabilities | 394 | 992 | 101
Other liabilities | 1,540 | 6,463 | 2,856
Net cash provided by operating activities | $ 13,426 | $ 16,177 | $ 18,265

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