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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions | 9 Months Ended
--- | ---
Sep. 30, 2025 | Sep. 30, 2024
Statement of Cash Flows [Abstract] |  |
Net income | $ 1,723 | $ 3,492
Adjustments to reconcile net income to net cash provided by operating activities: |  |
Depreciation and amortization | 632 | 625
Deferred income tax expense (benefit) | 51 | (29)
Stock-based compensation expense | 79 | 52
Impairment and restructuring charges, and acquisition-related costs | 66 | 75
Litigation and investigation costs | 34 | 18
Net gains on sales, consolidation and deconsolidation of facilities | (4) | (2,906)
Loss from early extinguishment of debt | 0 | 8
Equity in earnings of unconsolidated affiliates, net of distributions received | (13) | (9)
Amortization of debt discount and debt issuance costs | 18 | 21
Net gains from the sale of investments and long-lived assets | (2) | (2)
Other items, net | (3) | (3)
Changes in cash from operating assets and liabilities: |  |
Accounts receivable | 68 | 183
Inventories and other current assets | (58) | 10
Income taxes | 15 | 821
Accounts payable, accrued expenses and other current liabilities | 237 | 123
Other long-term liabilities | 50 | 18
Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements | (84) | (119)
Net cash provided by operating activities | 2,809 | 2,378
Cash flows from investing activities: |  |
Purchases of property and equipment | (646) | (601)
Purchases of businesses or joint venture interests, net of cash acquired | (266) | (524)
Proceeds from sales of facilities and other assets | 18 | 4,965
Proceeds from sales of marketable securities and long-term investments | 74 | 25
Purchases of marketable securities and long-term investments | (69) | (46)
Other items, net | 3 | (18)
Net cash provided by (used in) investing activities | (886) | 3,801
Cash flows from financing activities: |  |
Repayments of borrowings | (90) | (2,212)
Proceeds from borrowings | 21 | 16
Repurchases of common stock | (1,188) | (672)
Distributions paid to noncontrolling interests | (585) | (496)
Proceeds from the sale of noncontrolling interests | 27 | 13
Purchases of noncontrolling interests | (88) | (127)
Advances from managed care payers | 0 | 342
Repayments of advances from managed care payers | (33) | (160)
Taxes paid related to net share settlement, net of proceeds from shares issued under stock-based compensation plans | (47) | (14)
Other items, net | 16 | (3)
Net cash used in financing activities | (1,967) | (3,313)
Net increase (decrease) in cash and cash equivalents | (44) | 2,866
Cash and cash equivalents at beginning of period | 3,019 | 1,228
Cash and cash equivalents at end of period | 2,975 | 4,094
Supplemental disclosures: |  |
Interest paid, net of capitalized interest | (499) | (555)
Income tax payments, net | $ (329) | $ (308)

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