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CONSOLIDATED STATEMENTS OF CASH FLOW - USD ($) | 12 Months Ended
--- | ---
Dec. 31, 2024 | Dec. 31, 2023 | Dec. 31, 2022
Cash flows from operating activities |  |  |
Net income | $ 1,214,000,000 | $ 2,484,000,000 | $ 2,802,000,000
Adjustments to reconcile net income to net cash provided by operating activities: |  |  |
Gain on sale of Gentiva Hospice | 0 | 0 | (237,000,000)
(Gain) loss on investment securities, net | (24,000,000) | 54,000,000 | 205,000,000
Equity in net losses | 94,000,000 | 63,000,000 | 4,000,000
Stock-based compensation | 207,000,000 | 175,000,000 | 216,000,000
Depreciation | 908,000,000 | 850,000,000 | 749,000,000
Amortization | 60,000,000 | 67,000,000 | 96,000,000
Impairment of property and equipment | 237,000,000 | 206,000,000 | 248,000,000
Impairment of indefinite-lived intangible assets | 200,000,000 | 55,000,000 | 0
Deferred income taxes | (192,000,000) | (167,000,000) | (100,000,000)
Changes in operating assets and liabilities, net of effect of businesses acquired and dispositions: |  |  |
Receivables | (669,000,000) | (337,000,000) | (54,000,000)
Other assets | 1,003,000,000 | (1,318,000,000) | (463,000,000)
Benefits payable | 199,000,000 | 915,000,000 | 975,000,000
Other liabilities | (373,000,000) | 841,000,000 | 44,000,000
Unearned revenues | (6,000,000) | (20,000,000) | 32,000,000
Other, net | 108,000,000 | 113,000,000 | 70,000,000
Net cash provided by operating activities | 2,966,000,000 | 3,981,000,000 | 4,587,000,000
Cash flows from investing activities |  |  |
Proceeds from sale of Gentiva Hospice, net | 0 | 0 | 2,701,000,000
Acquisitions, net of cash and cash equivalents acquired | (89,000,000) | (233,000,000) | (337,000,000)
Purchases of property and equipment | (575,000,000) | (1,004,000,000) | (1,137,000,000)
Proceeds from sale of property and equipment | 7,000,000 | 210,000,000 | 17,000,000
Changes in securities lending collateral receivable | (418,000,000) | 0 | 0
Purchases of investment securities | (8,185,000,000) | (7,552,000,000) | (6,049,000,000)
Proceeds from maturities of investment securities | 2,982,000,000 | 1,292,000,000 | 1,365,000,000
Proceeds from sales of investment securities | 3,376,000,000 | 3,795,000,000 | 2,434,000,000
Other | (50,000,000) | 0 | 0
Net cash used in investing activities | (2,952,000,000) | (3,492,000,000) | (1,006,000,000)
Cash flows from financing activities |  |  |
(Payments) receipts from contract deposits, net | (1,933,000,000) | 828,000,000 | 1,993,000,000
Proceeds from issuance of senior notes, net | 2,232,000,000 | 2,544,000,000 | 1,982,000,000
Repayment of senior notes | (1,107,000,000) | (1,832,000,000) | (1,000,000,000)
(Repayments) proceeds from issuance of commercial paper, net | (907,000,000) | 211,000,000 | (376,000,000)
Proceeds from short-term borrowings | 0 | 100,000,000 | 0
Repayment of short-term borrowings | 0 | (100,000,000) | 0
Repayment of term loan | 0 | (500,000,000) | (2,000,000,000)
Debt issue costs | (7,000,000) | (7,000,000) | (6,000,000)
Common stock repurchases | (817,000,000) | (1,573,000,000) | (2,096,000,000)
Dividends paid | (431,000,000) | (431,000,000) | (392,000,000)
Changes in securities lending payable | 418,000,000 | 0 | 0
Changes in rebate factor payable | 123,000,000 | 0 | 0
Change in book overdraft | 50,000,000 | 55,000,000 | (28,000,000)
Other, net | (108,000,000) | (151,000,000) | 9,000,000
Net cash used in financing activities | (2,487,000,000) | (856,000,000) | (1,914,000,000)
(Decrease) increase in cash and cash equivalents | (2,473,000,000) | (367,000,000) | 1,667,000,000
Cash and cash equivalents at beginning of period | 4,694,000,000 | 5,061,000,000 | 3,394,000,000
Cash and cash equivalents at end of period | 2,221,000,000 | 4,694,000,000 | 5,061,000,000
Supplemental cash flow disclosures: |  |  |
Interest payments | 584,000,000 | 394,000,000 | 354,000,000
Income tax payments, net | 570,000,000 | 997,000,000 | 758,000,000
Details of businesses acquired in purchase transactions: |  |  |
Fair value of assets acquired, net of cash acquired | 124,000,000 | 462,000,000 | 460,000,000
Less: Fair value of liabilities assumed | (35,000,000) | (234,000,000) | (70,000,000)
Less: Noncontrolling interests acquired | 0 | 5,000,000 | (53,000,000)
Cash paid for acquired businesses, net of cash acquired | $ 89,000,000 | $ 233,000,000 | $ 337,000,000

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- Definition The cash outflow for a long-term debt where the holder has highest claim on the entity's asset in case of bankruptcy or liquidation during the period. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Topic 230 -SubTopic 10 -Name Accounting Standards Codification -Section 45 -Paragraph 15 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org/1943274/2147482740/230-10-45-15 + Details
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- Definition The cash outflow for a borrowing having initial term of repayment within one year or the normal operating cycle, if longer. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Topic 230 -SubTopic 10 -Name Accounting Standards Codification -Section 45 -Paragraph 15 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org/1943274/2147482740/230-10-45-15 + Details
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- Definition The cash outflow to repay long-term debt that is not secured by collateral. Excludes repayments of tax exempt unsecured debt. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Topic 230 -SubTopic 10 -Name Accounting Standards Codification -Section 45 -Paragraph 15 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org/1943274/2147482740/230-10-45-15 + Details
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- Definition Amount of noncash expense for share-based payment arrangement. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Name Accounting Standards Codification -Section 45 -Paragraph 28 -Subparagraph (a) -SubTopic 10 -Topic 230 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482740/230-10-45-28 + Details
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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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