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CONSOLIDATED STATEMENTS OF CASH FLOW - USD ($) $ in Millions | 12 Months Ended
--- | ---
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021
Cash flows from operating activities |  |  |
Net income | $ 2,484 | $ 2,802 | $ 2,934
Adjustments to reconcile net income to net cash provided by operating activities: |  |  |
Gain on sale of Gentiva Hospice | 0 | (237) | 0
Loss on investment securities, net | 54 | 205 | 130
Gain on Kindred at Home equity method investment | 0 | 0 | (1,129)
Equity in net losses (earnings) | 63 | 4 | (65)
Stock-based compensation | 175 | 216 | 180
Depreciation | 850 | 749 | 640
Amortization | 67 | 96 | 73
Impairment of property and equipment | 206 | 248 | 0
Impairment of indefinite-lived intangible assets | 55 | 0 | 0
Deferred income taxes | (167) | (100) | 15
Changes in operating assets and liabilities, net of effect of businesses acquired and dispositions: |  |  |
Receivables | (337) | (54) | (280)
Other assets | (1,318) | (463) | (491)
Benefits payable | 915 | 975 | 104
Other liabilities | 841 | 44 | 176
Unearned revenues | (20) | 32 | (65)
Other, net | 113 | 70 | 40
Net cash provided by operating activities | 3,981 | 4,587 | 2,262
Cash flows from investing activities |  |  |
Proceeds from sale of Gentiva Hospice, net | 0 | 2,701 | 0
Acquisitions, net of cash and cash equivalents acquired | (233) | (337) | (4,187)
Purchases of property and equipment | (1,004) | (1,137) | (1,342)
Proceeds from sale of property and equipment | 210 | 17 | 26
Purchases of investment securities | (7,552) | (6,049) | (7,197)
Maturities of investment securities | 1,292 | 1,365 | 2,597
Proceeds from sales of investment securities | 3,795 | 2,434 | 3,547
Net cash used in investing activities | (3,492) | (1,006) | (6,556)
Cash flows from financing activities |  |  |
Receipts (withdrawals) from contract deposits, net | 828 | 1,993 | (306)
Proceeds from issuance of senior notes, net | 2,544 | 1,982 | 2,984
Repayment of senior notes | (1,832) | (1,000) | 0
Proceeds (repayments) from issuance of commercial paper, net | 211 | (376) | 352
Proceeds from short-term borrowings | 100 | 0 | 0
Repayment of short-term borrowings | (100) | 0 | 0
Proceeds from term loan | 0 | 0 | 2,500
Repayment of term loan | (500) | (2,000) | (2,078)
Debt issue costs | (7) | (6) | (31)
Common stock repurchases | (1,573) | (2,096) | (79)
Dividends paid | (431) | (392) | (354)
Change in book overdraft | 55 | (28) | 6
Other, net | (151) | 9 | 21
Net cash (used in) provided by financing activities | (856) | (1,914) | 3,015
(Decrease) increase in cash and cash equivalents | (367) | 1,667 | (1,279)
Cash and cash equivalents at beginning of period | 5,061 | 3,394 | 4,673
Cash and cash equivalents at end of period | 4,694 | 5,061 | 3,394
Supplemental cash flow disclosures: |  |  |
Interest payments | 394 | 354 | 285
Income tax payments, net | 997 | 758 | 227
Details of businesses acquired in purchase transactions: |  |  |
Fair value of assets acquired, net of cash acquired | 462 | 460 | 9,804
Less: Fair value of liabilities assumed | (234) | (70) | (3,235)
Less: Noncontrolling interests acquired | 5 | (53) | (22)
Less: Remeasured existing Kindred at Home equity method investment | 0 | 0 | (2,360)
Cash paid for acquired businesses, net of cash acquired | $ 233 | $ 337 | $ 4,187

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- Definition The charge against earnings resulting from the aggregate write down of tangible assets from their carrying value to their fair value. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Topic 360 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 2 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482099/360-10-50-2 Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef -Topic 205 -SubTopic 20 -Name Accounting Standards Codification -Section 50 -Paragraph 1 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org//1943274/2147483499/205-20-50-1 + Details
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Namespace Prefix: | us-gaap_
Data Type: | xbrli:monetaryItemType
Balance Type: | debit
Period Type: | duration