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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
_________________________________________________________________________________
FORM 10-Q
_________________________________________________________________________________

☒ | QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2022

☐ | TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from to
Commission file number 1-4448
_________________________________________________________________________________
BAXTER INTERNATIONAL INC.
(Exact name of registrant as specified in its charter)
_________________________________________________________________________________

Delaware |  | 36-0781620
(State or other jurisdiction of incorporation or organization) |  | (I.R.S. Employer Identification No.)
One Baxter Parkway, | Deerfield, | Illinois |  | 60015
(Address of Principal Executive Offices) |  | (Zip Code)

|  | 224. | 948.2000 |  |
|  | (Registrant’s telephone number, including area code) |  |

_________________________________________________________________________________
Securities registered pursuant to Section 12(b) of the Act:

Title of each class |  | Trading Symbol(s) |  | Name of each exchange on which registered
Common Stock, $1.00 par value |  | BAX (NYSE) |  | New York Stock Exchange
|  |  |  | Chicago Stock Exchange
0.4% Global Notes due 2024 |  | BAX 24 |  | New York Stock Exchange
1.3% Global Notes due 2025 |  | BAX 25 |  | New York Stock Exchange
1.3% Global Notes due 2029 |  | BAX 29 |  | New York Stock Exchange

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes x No o
Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes x No o
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer | x |  | Accelerated filer | o
Non-accelerated filer | o |  | Smaller reporting company | ☐
Emerging growth company | ☐ |  |  |

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. o
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No x
The number of shares of the registrant’s Common Stock, par value $1.00 per share, outstanding as of October 20, 2022 was 504,120,759 shares.

BAXTER INTERNATIONAL INC.
FORM 10-Q
For the quarterly period ended September 30, 2022
TABLE OF CONTENTS

|  | Page Number
PART I. | FINANCIAL INFORMATION | 2
Item 1. | Financial Statements (unaudited) | 2
| Condensed Consolidated Balance Sheets | 2
| Condensed Consolidated Statements of Income (Loss) | 3
| Condensed Consolidated Statements of Comprehensive Income (Loss) | 4
| Condensed Consolidated Statements of Changes in Equity | 5
| Condensed Consolidated Statements of Cash Flows | 7
| Notes to Condensed Consolidated Financial Statements | 8
Item 2. | Management’s Discussion and Analysis of Financial Condition and Results of Operations | 32
Item 3. | Quantitative and Qualitative Disclosures about Market Risk | 49
Item 4. | Controls and Procedures | 50
PART II. | OTHER INFORMATION | 51
Item 1. | Legal Proceedings | 51
Item 1A. | Risk Factors | 51
Item 2. | Unregistered Sales of Equity Securities and Use of Proceeds | 51
Item 6. | Exhibits | 52
Signature |  | 53

PART I. FINANCIAL INFORMATION
Item 1. Financial Statements
Baxter International Inc.
Condensed Consolidated Balance Sheets (unaudited)
(in millions, except share information)

| September 30, 2022 | December 31, 2021
Current assets: |  |
Cash and cash equivalents | $ | 1,601 |  | $ | 2,951 |
Accounts receivable, net of allowances of $120 in 2022 and $122 in 2021 | 2,555 |  | 2,629 |
Inventories | 2,675 |  | 2,453 |
Prepaid expenses and other current assets | 979 |  | 839 |
Total current assets | 7,810 |  | 8,872 |
Property, plant and equipment, net | 4,799 |  | 5,178 |
Goodwill | 6,639 |  | 9,836 |
Other intangible assets, net | 6,927 |  | 7,792 |
Operating lease right-of-use assets | 546 |  | 630 |
Other non-current assets | 1,244 |  | 1,213 |
Total assets | $ | 27,965 |  | $ | 33,521 |
Current liabilities: |  |
Short-term debt | $ | 275 |  | $ | 301 |
Current maturities of long-term debt and finance lease obligations | 4 |  | 210 |
Accounts payable | 1,234 |  | 1,246 |
Accrued expenses and other current liabilities | 2,195 |  | 2,479 |
Total current liabilities | 3,708 |  | 4,236 |
Long-term debt and finance lease obligations, less current portion | 16,153 |  | 17,149 |
Operating lease liabilities | 454 |  | 522 |
Other non-current liabilities | 2,071 |  | 2,493 |
Total liabilities | 22,386 |  | 24,400 |
Commitments and contingencies |  |
Equity: |  |
Common stock, $1 par value, authorized 2,000,000,000 shares, issued 683,494,944 shares in 2022 and 2021 | 683 |  | 683 |
Common stock in treasury, at cost,179,451,293 shares in 2022 and 181,879,516 shares in 2021 | (11,406) |  | (11,488) |
Additional contributed capital | 6,297 |  | 6,197 |
Retained earnings | 14,015 |  | 17,065 |
Accumulated other comprehensive income (loss) | (4,054) |  | (3,380) |
Total Baxter stockholders’ equity | 5,535 |  | 9,077 |
Noncontrolling interests | 44 |  | 44 |
Total equity | 5,579 |  | 9,121 |
Total liabilities and equity | $ | 27,965 |  | $ | 33,521 |

The accompanying notes are an integral part of these condensed consolidated financial statements.
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Baxter International Inc.
Condensed Consolidated Statements of Income (Loss) (unaudited)
(in millions, except per share data)

| Three months ended September 30, |  | Nine months ended September 30,
| 2022 | 2021 |  | 2022 | 2021
Net sales | $ | 3,773 |  | $ | 3,226 |  |  | $ | 11,226 |  | $ | 9,270 |
Cost of sales | 2,640 |  | 1,905 |  |  | 7,292 |  | 5,571 |
Gross margin | 1,133 |  | 1,321 |  |  | 3,934 |  | 3,699 |
Selling, general and administrative expenses | 947 |  | 680 |  |  | 2,975 |  | 1,982 |
Research and development expenses | 152 |  | 129 |  |  | 450 |  | 396 |
Goodwill impairments | 2,785 |  | — |  |  | 2,785 |  | — |
Other operating expense (income), net | 48 |  | (1) |  |  | 20 |  | (6) |
Operating income (loss) | (2,799) |  | 513 |  |  | (2,296) |  | 1,327 |
Interest expense, net | 104 |  | 50 |  |  | 278 |  | 118 |
Other (income) expense, net | 63 |  | 12 |  |  | 3 |  | 15 |
Income (loss) before income taxes | (2,966) |  | 451 |  |  | (2,577) |  | 1,194 |
Income tax expense (benefit) | (32) |  | (1) |  |  | 29 |  | 141 |
Net income (loss) | (2,934) |  | 452 |  |  | (2,606) |  | 1,053 |
Net income attributable to noncontrolling interests | 3 |  | 2 |  |  | 8 |  | 7 |
Net income (loss) attributable to Baxter stockholders | $ | (2,937) |  | $ | 450 |  |  | $ | (2,614) |  | $ | 1,046 |
Earnings (loss) per share
Basic | $ | (5.83) |  | $ | 0.90 |  |  | $ | (5.20) |  | $ | 2.08 |
Diluted | $ | (5.83) |  | $ | 0.89 |  |  | $ | (5.20) |  | $ | 2.06 |
Weighted-average number of shares outstanding
Basic | 504 |  | 500 |  |  | 503 |  | 503 |
Diluted | 504 |  | 506 |  |  | 503 |  | 509 |

The accompanying notes are an integral part of these condensed consolidated financial statements.
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Baxter International Inc.
Condensed Consolidated Statements of Comprehensive Income (Loss) (unaudited)
(in millions)

| Three months ended September 30, |  | Nine months ended September 30,
| 2022 | 2021 |  | 2022 | 2021
Net income (loss) | $ | (2,934) |  | $ | 452 |  |  | $ | (2,606) |  | $ | 1,053 |
Other comprehensive income (loss), net of tax: |  |  |  |  |
Currency translation adjustments, net of tax expense (benefit) of ($16) and $3 for the three months ended September 30, 2022 and 2021, respectively, and ($25) and $16 for the nine months ended September 30, 2022 and 2021, respectively. | (319) |  | (137) |  |  | (751) |  | (257) |
Pension and other postretirement benefits, net of tax expense of $5 and $8 for the three months ended September 30, 2022 and 2021, respectively, and $13 and $19 for the nine months ended September 30, 2022 and 2021, respectively. | 16 |  | 22 |  |  | 48 |  | 63 |
Hedging activities, net of tax expense of $5 and $3 for the three months ended September 30, 2022 and 2021, respectively, and $8 and $8 for the nine months ended September 30, 2022 and 2021, respectively. | 16 |  | 9 |  |  | 27 |  | 26 |
Available-for-sale debt securities, net of tax expense of zero for the three months ended September 30, 2022 and 2021, respectively, and $1 and zero for the nine months ended September 30, 2022 and 2021, respectively. | — |  | — |  |  | 2 |  | — |
Total other comprehensive income (loss), net of tax | (287) |  | (106) |  |  | (674) |  | (168) |
Comprehensive income (loss) | (3,221) |  | 346 |  |  | (3,280) |  | 885 |
Less: Comprehensive income attributable to noncontrolling interests | 3 |  | 2 |  |  | 8 |  | 7 |
Comprehensive income (loss) attributable to Baxter stockholders | $ | (3,224) |  | $ | 344 |  |  | $ | (3,288) |  | $ | 878 |

The accompanying notes are an integral part of these condensed consolidated financial statements.
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Baxter International Inc.
Condensed Consolidated Statements of Changes in Equity (unaudited)
(in millions)

| For the three months ended September 30, 2022
| Baxter International Inc. stockholders' equity |  |
| Common stock shares | Common stock | Common stock shares in treasury | Common stock in treasury | Additional contributed capital | Retained earnings | Accumulated other comprehensive income (loss) | Total Baxter stockholders' equity | Noncontrolling interests | Total equity
Balance as of July 1, 2022 | 683 |  | $ | 683 |  | 180 |  | $ | (11,409) |  | $ | 6,253 |  | $ | 17,099 |  | $ | (3,767) |  | $ | 8,859 |  | $ | 44 |  | $ | 8,903 |
Net income (loss) | — |  | — |  | — |  | — |  | — |  | (2,937) |  | — |  | (2,937) |  | 3 |  | (2,934) |
Other comprehensive income (loss) | — |  | — |  | — |  | — |  | — |  | — |  | (287) |  | (287) |  | — |  | (287) |
Purchases of treasury stock | — |  | — |  | — |  | (24) |  | — |  | — |  | — |  | (24) |  | — |  | (24) |
Stock issued under employee benefit plans and other | — |  | — |  | (1) |  | 27 |  | 44 |  | — |  | — |  | 71 |  | — |  | 71 |
Dividends declared on common stock | — |  | — |  | — |  | — |  | — |  | (147) |  | — |  | (147) |  | — |  | (147) |
Change in noncontrolling interests | — |  | — |  | — |  | — |  | — |  | — |  | — |  | — |  | (3) |  | (3) |
Balance as of September 30, 2022 | 683 |  | $ | 683 |  | 179 |  | $ | (11,406) |  | $ | 6,297 |  | $ | 14,015 |  | $ | (4,054) |  | $ | 5,535 |  | $ | 44 |  | $ | 5,579 |

| For the nine months ended September 30, 2022
| Baxter International Inc. stockholders' equity |  |
| Common stock shares | Common stock | Common stock shares in treasury | Common stock in treasury | Additional contributed capital | Retained earnings | Accumulated other comprehensive income (loss) | Total Baxter stockholders' equity | Noncontrolling interests | Total equity
Balance as of January 1, 2022 | 683 |  | $ | 683 |  | 182 |  | $ | (11,488) |  | $ | 6,197 |  | $ | 17,065 |  | $ | (3,380) |  | $ | 9,077 |  | $ | 44 |  | $ | 9,121 |
Net income (loss) | — |  | — |  | — |  | — |  | — |  | (2,614) |  | — |  | (2,614) |  | 8 |  | (2,606) |
Other comprehensive income (loss) | — |  | — |  | — |  | — |  | — |  | — |  | (674) |  | (674) |  | — |  | (674) |
Purchases of treasury stock | — |  | — |  | — |  | (32) |  | — |  | — |  | — |  | (32) |  | — |  | (32) |
Stock issued under employee benefit plans and other | — |  | — |  | (3) |  | 114 |  | 100 |  | — |  | — |  | 214 |  | — |  | 214 |
Dividends declared on common stock | — |  | — |  | — |  | — |  | — |  | (436) |  | — |  | (436) |  | — |  | (436) |
Change in noncontrolling interests | — |  | — |  | — |  | — |  | — |  | — |  | — |  | — |  | (8) |  | (8) |
Balance as of September 30, 2022 | 683 |  | $ | 683 |  | 179 |  | $ | (11,406) |  | $ | 6,297 |  | $ | 14,015 |  | $ | (4,054) |  | $ | 5,535 |  | $ | 44 |  | $ | 5,579 |

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| For the three months ended September 30, 2021
| Baxter International Inc. stockholders' equity |  |
| Common stock shares | Common stock | Common stock shares in treasury | Common stock in treasury | Additional contributed capital | Retained earnings | Accumulated other comprehensive income (loss) | Total Baxter stockholders' equity | Noncontrolling interests | Total equity
Balance as of July 1, 2021 | 683 |  | $ | 683 |  | 184 |  | $ | (11,561) |  | $ | 6,090 |  | $ | 16,658 |  | $ | (3,376) |  | $ | 8,494 |  | $ | 41 |  | $ | 8,535 |
Net income (loss) | — |  | — |  | — |  | — |  | — | 450 |  | — |  | 450 |  | 2 |  | 452 |
Other comprehensive income (loss) | — |  | — |  | — |  | — |  | — |  | — |  | (106) |  | (106) |  | — |  | (106) |
Stock issued under employee benefit plans and other | — |  | — |  | (1) |  | 32 |  | 41 |  | — |  | — |  | 73 |  | — |  | 73 |
Dividends declared on common stock | — |  | — |  | — |  | — |  | — |  | (141) |  | — | (141) |  | — |  | (141) |
Change in noncontrolling interests | — |  | — |  | — |  | — |  | — |  | — |  | — |  | — |  | 2 |  | 2 |
Balance as of September 30, 2021 | 683 |  | $ | 683 |  | 183 |  | $ | (11,529) |  | $ | 6,131 |  | $ | 16,967 |  | $ | (3,482) |  | $ | 8,770 |  | $ | 45 |  | $ | 8,815 |

| For the nine months ended September 30, 2021
| Baxter International Inc. stockholders' equity |  |
| Common stock shares | Common stock | Common stock shares in treasury | Common stock in treasury | Additional contributed capital | Retained earnings | Accumulated other comprehensive income (loss) | Total Baxter stockholders' equity | Noncontrolling interests | Total equity
Balance as of January 1, 2021 | 683 |  | $ | 683 |  | 179 |  | $ | (11,051) |  | $ | 6,043 |  | $ | 16,328 |  | $ | (3,314) |  | $ | 8,689 |  | $ | 37 |  | $ | 8,726 |
Net income (loss) | — |  | — |  | — |  | — |  | — |  | 1,046 |  | — |  | 1,046 |  | 7 |  | 1,053 |
Other comprehensive income (loss) | — |  | — |  | — |  | — |  | — |  | — |  | (168) |  | (168) |  | — |  | (168) |
Purchases of treasury stock | — |  | — |  | 7 |  | (600) |  | — |  | — |  | — |  | (600) |  | — |  | (600) |
Stock issued under employee benefit plans and other | — |  | — |  | (3) |  | 122 |  | 88 |  | — |  | — |  | 210 |  | — |  | 210 |
Dividends declared on common stock | — |  | — |  | — |  | — |  | — |  | (407) |  | — |  | (407) |  | — |  | (407) |
Change in noncontrolling interests | — |  | — |  | — |  | — |  | — |  | — |  | — |  | — |  | 1 |  | 1 |
Balance as of September 30, 2021 | 683 |  | $ | 683 |  | 183 |  | $ | (11,529) |  | $ | 6,131 |  | $ | 16,967 |  | $ | (3,482) |  | $ | 8,770 |  | $ | 45 |  | $ | 8,815 |

The accompanying notes are an integral part of these condensed consolidated financial statements.
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Baxter International Inc.
Condensed Consolidated Statements of Cash Flows (unaudited)
(in millions)

| Nine months ended September 30,
| 2022 | 2021
Cash flows from operations |  |
Net income (loss) | $ | (2,606) |  | $ | 1,053 |
Adjustments to reconcile net income (loss) to cash flows from operations: |  |
Depreciation and amortization | 1,069 |  | 645 |
Deferred income taxes | (174) |  | (98) |
Stock compensation | 122 |  | 93 |
Net periodic pension and other postretirement costs | 42 |  | 77 |
Intangible asset impairments | 332 |  | — |
Goodwill impairments | 2,785 |  | — |
Loss on product divestiture arrangement | 54 |  | — |
Reclassification of cumulative translation loss to earnings | 65 |  | — |
Other | (35) |  | 46 |
Changes in balance sheet items: |  |
Accounts receivable, net | (116) |  | (128) |
Inventories | (410) |  | (149) |
Prepaid expenses and other current assets | (98) |  | (51) |
Accounts payable | 84 |  | 14 |
Accrued expenses and other current liabilities | (250) |  | 91 |
Other | (92) |  | (64) |
Cash flows from operations | 772 |  | 1,529 |
Cash flows from investing activities |  |
Capital expenditures | (479) |  | (508) |
Acquisitions, net of cash acquired, and investments | (206) |  | (463) |
Other investing activities, net | 10 |  | 38 |
Cash flows from investing activities | (675) |  | (933) |
Cash flows from financing activities |  |
Repayments of debt | (953) |  | (407) |
Issuances of debt | — |  | 50 |
Net increases (decreases) in debt with original maturities of three months or less | 30 |  | 251 |
Cash dividends on common stock | (427) |  | (390) |
Proceeds from stock issued under employee benefit plans | 114 |  | 135 |
Purchases of treasury stock | (32) |  | (600) |
Debt issuance costs | — |  | (37) |
Other financing activities, net | (51) |  | (33) |
Cash flows from financing activities | (1,319) |  | (1,031) |
Effect of foreign exchange rate changes on cash, cash equivalents and restricted cash | (130) |  | (40) |
Decrease in cash, cash equivalents and restricted cash | (1,352) |  | (475) |
Cash, cash equivalents and restricted cash at beginning of period (1) | 2,956 |  | 3,736 |
Cash, cash equivalents and restricted cash at end of period (1) | $ | 1,604 |  | $ | 3,261 |

(1) The following table provides a reconciliation of cash, cash equivalents and restricted cash shown above to the amounts reported within the condensed consolidated balance sheet as of September 30, 2022, December 31, 2021, and September 30, 2021 (in millions):

| September 30, 2022 | December 31, 2021 | September 30, 2021
Cash and cash equivalents | $ | 1,601 |  | $ | 2,951 |  | $ | 3,258 |
Restricted cash included in prepaid expenses and other current assets | 3 |  | 5 |  | 3 |
Cash, cash equivalents and restricted cash | $ | 1,604 |  | $ | 2,956 |  | $ | 3,261 |

The accompanying notes are an integral part of these condensed consolidated financial statements.
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Baxter International Inc.
Notes to Condensed Consolidated Financial Statements (unaudited)
1. BASIS OF PRESENTATION
The unaudited interim condensed consolidated financial statements of Baxter International Inc. and its subsidiaries (we or our) have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (SEC) for interim financial reporting. Accordingly, certain information and footnote disclosures normally included in financial statements prepared in accordance with U.S. generally accepted accounting principles (U.S. GAAP) in the United States have been condensed or omitted. These unaudited interim condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes included in our Annual Report on Form 10-K for the year ended December 31, 2021 (2021 Annual Report).
In the opinion of management, the unaudited interim condensed consolidated financial statements reflect all adjustments necessary for a fair presentation of the financial position, results of operations and cash flows for the periods presented. All such adjustments, unless otherwise noted herein, are of a normal, recurring nature. The results of operations for the current interim period are not necessarily indicative of the results of operations to be expected for the full year.
Risks and Uncertainties Related to COVID-19 and Global Economic and Other Conditions
Our global operations expose us to risks associated with public health crises and epidemics/pandemics, such as the novel strain of coronavirus (COVID-19). COVID-19 has had, and we expect will continue to have, an adverse impact on our operations, supply chains and distribution systems and has increased and we expect will continue to increase our expenses. Over the course of the pandemic, our business has been impacted by shifting healthcare priorities and significant volatility in the demand for our products. For further information about our revenues by product category, refer to Note 9. Significant uncertainty remains regarding the duration and overall impact of the COVID-19 pandemic. Concerns remain regarding the pace of economic recovery due to virus resurgence across the globe from the Omicron variants, subvariants and other virus mutations as well as vaccine distribution and hesitancy. The U.S. and other governments may continue existing measures or implement new restrictions and other requirements in light of the continuing spread of the pandemic (including with respect to moratoriums on elective procedures and mandatory quarantines and travel restrictions), resulting in higher levels of absenteeism, including at our manufacturing and distribution facilities. Due to the uncertainty caused by the pandemic, our operating performance and financial results, particularly in the short term, may be subject to volatility.
We have experienced significant challenges to our global supply chain in recent periods, including production delays and interruptions, increased costs and shortages of raw materials and component parts (including resins and electromechanical devices) and higher transportation costs, resulting from the pandemic and other exogenous factors including significant weather events, elevated inflation levels, disruptions to certain ports of call around the world, the war in Ukraine and other geopolitical events. We expect to experience some of these and other challenges related to our supply chain in future periods. These challenges, including the unavailability of certain raw materials and component parts, have also had a negative impact on our sales for certain product categories due to our inability to fully satisfy demand and may continue to have a negative impact on our sales in the future.
We expect that the challenges caused by the pandemic as well as global economic conditions, among other factors, may continue to have an adverse effect on our business.
New Accounting Standards
Recently adopted accounting pronouncements
As of January 1, 2022, we adopted Accounting Standards Update (ASU) 2021-05, Leases (Topic 842), which requires a lessor to classify a lease with variable lease payments (that do not depend on an index or rate) as an operating lease if (1) the lease would have been classified as a sales-type or direct financing lease, and (2) the lessor would have recognized a selling loss at lease commencement. These changes are intended to avoid recognizing a day-one loss for a lease with variable payments even though the lessor expects the arrangement will be profitable overall. The adoption of this ASU did not have a material impact on our condensed consolidated financial statements.
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2. ACQUISITIONS AND OTHER ARRANGEMENTS
Hillrom
On December 13, 2021, we completed our acquisition of all outstanding equity interests of Hill-Rom Holdings, Inc. (Hillrom) for a purchase price of $10.5 billion. Including the assumption of Hillrom's outstanding debt, the enterprise value of the transaction was approximately $12.8 billion. Under the terms of the transaction agreement, Hillrom shareholders received $156.00 in cash per outstanding Hillrom common share.
The following table summarizes the fair value of the total consideration paid:

(in millions) |
Cash consideration paid to Hillrom shareholders(a) | $ | 10,474 |
Fair value of equity awards issued to Hillrom equity award holders(b) | 2 |
Total Consideration | $ | 10,476 |

(a) Represents cash consideration transferred of $156.00 per outstanding Hillrom common share to existing shareholders and holders of equity awards that vested at closing pursuant to their original terms.
(b) Represents the pre-acquisition service portion of the fair value of 668 thousand replacement restricted stock units issued to Hillrom equity award holders at closing.
The valuation of assets acquired and liabilities assumed has not yet been finalized as of September 30, 2022. Finalization of the valuation during the measurement period could result in a change in the amounts recorded for acquired intangible assets, goodwill and income taxes among other items. The completion of the valuation will occur no later than one year from the acquisition date. The following table summarizes the preliminary fair values of the assets acquired and liabilities assumed as of the acquisition date:

(in millions) |
Assets acquired and liabilities assumed |
Cash and cash equivalents | $ | 399 |
Accounts receivable | 562 |
Inventories | 557 |
Prepaid expenses and other current assets | 49 |
Property, plant and equipment | 514 |
Goodwill | 6,810 |
Other intangible assets | 6,029 |
Operating lease right-of-use assets | 74 |
Other non-current assets | 132 |
Short-term debt | (250) |
Accounts payable | (140) |
Accrued expenses and other current liabilities | (558) |
Long-term debt and finance lease obligations | (2,118) |
Operating lease liabilities | (57) |
Other non-current liabilities | (1,527) |
Total assets acquired and liabilities assumed | $ | 10,476 |

In the first nine months of 2022 we recorded measurement period adjustments, primarily impacting accounts receivable, property, plant and equipment, other intangible assets, and deferred income tax liabilities. Individually the
9

measurement period adjustments were not material and in total increased goodwill by $25 million. The measurement period adjustments did not have a significant impact to our results of operations.
The goodwill from the Hillrom acquisition, which is not deductible for tax purposes, includes the value of an assembled workforce as well as the overall strategic benefits provided to our product portfolio and is included in the Hillrom segment. See Note 4 for additional information about impairments recognized in the third quarter of 2022 related to goodwill and certain intangible assets acquired in the Hillrom acquisition.
For the nine months ended September 30, 2022, we recognized $159 million of incremental costs of sales from the fair value step-ups on acquired Hillrom inventory that was sold in the first quarter.
Other Business Development Activities
Celerity Pharmaceuticals, LLC
In September 2013, we entered into an agreement with Celerity Pharmaceuticals, LLC (Celerity) to develop certain acute care generic injectable premix and oncolytic products through regulatory approval. We transferred our rights in these products to Celerity and Celerity assumed ownership and responsibility for development of the products. We are obligated to purchase the individual product rights from Celerity if the products obtain regulatory approval. In December 2020, we entered into an agreement with a third party to divest our rights to one of the products that was being developed by Celerity, a generic version of liposomal doxorubicin, for less than $1 million if that product were to receive regulatory approval in the U.S. and European Union in 2022. Liposomal doxorubicin is a chemotherapy medicine used to treat various types of cancer and we entered into this transaction to divest our rights to this generic version of that product after we had separately entered into a transaction to acquire the branded version.
The related regulatory approvals were subsequently obtained for the generic version of liposomal doxorubicin and we recognized a loss of approximately $54 million in the third quarter of 2022, representing the difference between the amount we owe Celerity following those regulatory approvals and the proceeds that we will receive from our divestiture of those product rights. That loss is reported within other operating expense (income), net in our condensed consolidated statements of operations for the three and nine months ended September 30, 2022.
Zosyn
In March 2022, we entered into an agreement with a subsidiary of Pfizer Inc. to acquire the rights to Zosyn, a premixed frozen piperacillin-tazobactam product, in the U.S. and Canada. Zosyn is used for the treatment of intra-abdominal infections, nosocomial pneumonia, skin and skin structure infections, female pelvic infections and community-acquired pneumonia. Under the terms of the acquisition, we paid the acquisition price of $122 million currently, received specified intellectual property, including patent rights, in the first quarter and will receive additional intellectual property, including the product rights to Zosyn, in the first quarter of 2023. Under the arrangement, we are entitled to receive profit sharing payments from sales of Zosyn until the product rights transfer to us in March 2023.
The transaction has been accounted for as an asset acquisition, as substantially all of the fair value of the assets being acquired under the arrangement was concentrated in the product rights that we will receive, which we classify as a developed technology intangible asset. Accordingly, the $122 million purchase price was primarily allocated to the developed technology intangible asset class and will be amortized over an estimated useful life of 9 years.
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3. SUPPLEMENTAL FINANCIAL INFORMATION
Allowance for Doubtful Accounts
The following table is a summary of the changes in our allowance for doubtful accounts for the three and nine months ended September 30, 2022 and 2021.

| Three months ended September 30, | Nine months ended September 30,
(in millions) | 2022 | 2021 | 2022 | 2021
Balance at beginning of period | $ | 125 |  | $ | 117 |  | $ | 122 |  | $ | 125 |
Charged to costs and expenses | 2 |  | 2 |  | 11 |  | (1) |
Write-offs | (2) |  | (2) |  | (4) |  | (3) |
Currency translation adjustments | (5) |  | (2) |  | (9) |  | (6) |
Balance at end of period | $ | 120 |  | $ | 115 |  | $ | 120 |  | $ | 115 |

Inventories

(in millions) | September 30, 2022 | December 31, 2021
Raw materials | $ | 690 |  | $ | 591 |
Work in process | 305 |  | 300 |
Finished goods | 1,680 |  | 1,562 |
Inventories | $ | 2,675 |  | $ | 2,453 |

Property, Plant and Equipment, Net

(in millions) | September 30, 2022 | December 31, 2021
Property, plant and equipment, at cost | $ | 11,084 |  | $ | 11,728 |
Accumulated depreciation | (6,285) |  | (6,550) |
Property, plant and equipment, net | $ | 4,799 |  | $ | 5,178 |

In September 2022, we signed a purchase agreement with a buyer to sell our corporate headquarters in Deerfield, Illinois for $52 million. The related assets are classified as held-for-sale and are presented within prepaid expenses and other current assets in the accompanying consolidated balance sheet as of September 30, 2022. While the closing remains subject to the satisfaction of various closing conditions (including satisfactory completion of municipal diligence by the buyer), we expect the transaction to close in 2023 and the net book value of the assets approximates the transaction price net of estimated selling costs.
Interest Expense, Net

| Three months ended September 30, |  | Nine months ended September 30,
(in millions) | 2022 | 2021 |  | 2022 | 2021
Interest expense, net of capitalized interest | $ | 109 |  | $ | 54 |  |  | $ | 290 |  | $ | 128 |
Interest income | (5) |  | (4) |  |  | (12) |  | (10) |
Interest expense, net | $ | 104 |  | $ | 50 |  |  | $ | 278 |  | $ | 118 |

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Other (Income) Expense, Net

| Three months ended September 30, |  | Nine months ended September 30,
(in millions) | 2022 | 2021 |  | 2022 | 2021
Foreign exchange (gains) losses, net | $ | — |  | $ | — |  |  | $ | (26) |  | $ | 5 |
Pension and other postretirement benefit plans | (5) |  | 4 |  |  | (17) |  | 11 |
Pension curtailment | — |  | — |  |  | (11) |  | — |
Change in fair value of marketable equity securities | 3 |  | 9 |  |  | (5) |  | 2 |
Reclassification of cumulative translation loss to earnings | 65 |  | — |  |  | 65 |  | — |
Other, net | — |  | (1) |  |  | (3) |  | (3) |
Other (income) expense, net | $ | 63 |  | $ | 12 |  |  | $ | 3 |  | $ | 15 |

We have been winding down our operations in Argentina since early 2021 and we determined that the net assets of the related entities were substantially liquidated during the third quarter of 2022. As a result of that determination, we reclassified their $65 million cumulative translation loss from accumulated other comprehensive income (loss) to other (income) expense, net.
Non-Cash Operating and Investing Activities
Right-of-use operating lease assets obtained in exchange for lease obligations for the nine months ended September 30, 2022 and 2021 were $59 million and $69 million, respectively.
Purchases of property, plant and equipment included in accounts payable as of September 30, 2022 and 2021 were $65 million and $49 million, respectively.
4. GOODWILL AND OTHER INTANGIBLE ASSETS, NET
Goodwill
The following is a reconciliation of goodwill by business segment.

(in millions) | Americas | EMEA | APAC | Hillrom | Total
Balance as of December 31, 2021 | $ | 2,517 |  | $ | 309 |  | $ | 224 |  | $ | 6,786 |  | $ | 9,836 |
Acquisition accounting adjustments | — |  | — |  | — |  | 25 |  | 25 |
Impairments | — |  | — |  | — |  | (2,785) |  | (2,785) |
Currency translation | (241) |  | (29) |  | (22) |  | (145) |  | (437) |
Balance as of September 30, 2022 | $ | 2,276 |  | $ | 280 |  | $ | 202 |  | $ | 3,881 |  | $ | 6,639 |

We assess goodwill and indefinite-lived intangible assets for impairment annually during the fourth quarter or whenever events or changes in circumstances indicate that the carrying amount of such assets may not be recoverable. We recognize a goodwill impairment charge for the amount by which a reporting unit's carrying amount exceeds its fair value.
Goodwill Impairments
As described in Note 2, we acquired Hillrom on December 13, 2021 and recognized $6.8 billion of goodwill and $6.0 billion of other intangible assets, including $1.9 billion of indefinite-lived intangible assets, in connection with that acquisition. Our Hillrom segment includes the following three reporting units: Patient Support Systems, Front Line Care and Surgical Solutions. During the third quarter of 2022, we performed trigger-based impairment tests of the goodwill of each of those three reporting units, as well as the indefinite-lived intangible assets, consisting primarily of trade names, that we acquired in connection with the Hillrom acquisition. We performed those tests as of September 30, 2022 due to (a) current macroeconomic conditions, including the rising interest rate environment and broad declines in equity valuations, and (b) reduced earnings forecasts for our three Hillrom reporting units, driven primarily by current shortages of certain component parts used in our products, raw materials inflation and increased supply chain costs. The impairment tests resulted in total pre-tax goodwill impairment charges of $2.8 billion in the third quarter of 2022, consisting of a $1.4 billion goodwill impairment for our Patient Support Systems reporting unit, a $1.0 billion goodwill impairment for our Front Line Care reporting unit and a $0.4 billion goodwill impairment for our Surgical
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Solutions reporting unit. See further discussion below for information regarding intangible asset impairment charges recognized during the third quarter of 2022.
The fair values of the reporting units tested for impairment during the third quarter of 2022 were determined based on a discounted cash flow model (an income approach) and earnings multiples (a market approach). Significant inputs to the reporting unit fair value measurements included forecasted cash flows, discount rates, terminal growth rates and earnings multiples. Our reporting unit fair value measurements are classified as Level 3 in the fair value hierarchy because they involve significant unobservable inputs.
Other intangible assets, net
The following is a summary of our other intangible assets.

|  |  |  | Indefinite-lived intangible assets |
(in millions) | Customer relationships | Developed technology, including patents | Other amortized intangible assets | Trade names | In process Research and Development | Total
September 30, 2022 |  |  |  |  |  |
Gross other intangible assets | $ | 3,447 |  | $ | 3,752 |  | $ | 310 |  | $ | 1,578 |  | $ | 213 |  | $ | 9,300 |
Accumulated amortization | (410) |  | (1,743) |  | (220) |  | — |  | — |  | (2,373) |
Other intangible assets, net | $ | 3,037 |  | $ | 2,009 |  | $ | 90 |  | $ | 1,578 |  | $ | 213 |  | $ | 6,927 |
December 31, 2021 |  |  |  |  |  |
Gross other intangible assets | $ | 3,437 |  | $ | 3,801 |  | $ | 344 |  | $ | 1,910 |  | $ | 230 |  | $ | 9,722 |
Accumulated amortization | (162) |  | (1,556) |  | (212) |  | — |  | — |  | (1,930) |
Other intangible assets, net | $ | 3,275 |  | $ | 2,245 |  | $ | 132 |  | $ | 1,910 |  | $ | 230 |  | $ | 7,792 |

Intangible asset amortization expense was $168 million and $68 million for the three months ended September 30, 2022 and 2021, respectively, and $578 million and $199 million for the nine months ended September 30, 2022 and 2021.
Indefinite-lived Intangible Asset Impairments
In addition to the goodwill impairments discussed above, we recognized pre-tax impairment charges of $332 million in the third quarter of 2022 to reduce the carrying amounts of certain indefinite-lived intangible assets, which related to trade names acquired in the Hillrom acquisition, to their estimated fair values. Those intangible asset impairment charges are classified within cost of sales in the accompanying condensed consolidated statements of income (loss) for the three and nine months ended September 30, 2022.
The fair values of the indefinite-lived intangible assets tested for impairment were determined using a discounted cash flow model and significant inputs included forecasted cash flows, royalty rates and discount rates. Our indefinite-lived intangible asset fair value measurements are classified as Level 3 in the fair value hierarchy because they involve significant unobservable inputs.
5. FINANCING ARRANGEMENTS
Significant Debt Activity
In December 2021, we issued $800 million of 0.868% senior notes due in 2023, $1.4 billion of 1.322% senior notes due in 2024, $1.45 billion of 1.915% senior notes due in 2027, $1.25 billion of 2.272% senior notes due in 2028, $1.55 billion of 2.539% senior notes due in 2032, $750 million of 3.132% senior notes due in 2051, $300 million of floating rate senior notes due in 2023 and $300 million of floating rate senior notes due in 2024 (collectively, the Hillrom notes) to fund a portion of the consideration for the Hillrom acquisition, repay certain indebtedness of Hillrom and to pay fees and expenses related to the foregoing. In conjunction with the issuances of the Hillrom notes, we entered into a registration rights agreement in which we agreed to file a registration statement with the SEC with respect to an offer to exchange the Hillrom notes for new issues of notes with the same terms registered under the
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Securities Act of 1933, as amended. Those exchange offers with respect to the Hillrom notes were completed in the second quarter of 2022.
In the first half of 2022, we repaid $335 million of our $2.0 billion three-year term loan facility and $355 million of our $2.0 billion five-year term loan facility. The loss from the early extinguishment of this debt was not significant. In the third quarter of 2022, we amended the credit agreements governing our term loan facility and our U.S. dollar-denominated revolving credit facility and the guaranty agreement with respect to our Euro-denominated revolving credit facility, in each case to delay the commencement of our net leverage ratio covenant step-down schedule until June 30, 2024. We also amended the credit agreements governing our term loan facility and our U.S. dollar denominated revolving credit facility to transition the benchmark rate from LIBOR to the Secured Overnight Financing Rate (SOFR).
In the third quarter of 2022, we repaid $203 million of our 2.4% senior dues due in 2022.
Credit Facilities
Our U.S. dollar-denominated revolving credit facility has a capacity of $2.5 billion and our Euro-denominated revolving credit facility has a capacity of €200 million. Each of the facilities matures in 2026. There were no borrowings outstanding under these credit facilities as of September 30, 2022 or December 31, 2021. Our commercial paper borrowing arrangements require us to maintain undrawn borrowing capacity under our credit facilities for an amount at least equal to our outstanding commercial paper borrowings.
Commercial Paper
As of September 30, 2022, we had $275 million of commercial paper outstanding with a weighted-average interest rate of 3.02% and an original weighted-average term of 49 days. As of December 31, 2021, we had $300 million of commercial paper outstanding with a weighted-average interest rate of 0.27% and an original weighted-average term of 88 days.
6. COMMITMENTS AND CONTINGENCIES
We are involved in product liability, patent, commercial, and other legal matters that arise in the normal course of our business. We record a liability when a loss is considered probable and the amount can be reasonably estimated. If the reasonable estimate of a probable loss is a range, and no amount within the range is a better estimate, the minimum amount in the range is accrued. If a loss is not probable or a probable loss cannot be reasonably estimated, no liability is recorded. As of September 30, 2022 and December 31, 2021, our total recorded reserves with respect to legal and environmental matters were $31 million and $72 million, respectively.
We have established reserves for certain of the matters discussed below. We are not able to estimate the amount or range of any loss for certain contingencies for which there is no reserve or additional loss for matters already reserved. While our liability in connection with these claims cannot be estimated and the resolution thereof in any reporting period could have a significant impact on our results of operations and cash flows for that period, the outcome of these legal proceedings is not expected to have a material adverse effect on our consolidated financial position. While we believe that we have valid defenses in the matters set forth below, litigation is inherently uncertain, excessive verdicts do occur, and we may incur material judgments or enter into material settlements of claims.
In addition to the matters described below, we remain subject to the risk of future administrative and legal actions. With respect to governmental and regulatory matters, these actions may lead to product recalls, injunctions, and other restrictions on our operations and monetary sanctions, including significant civil or criminal penalties. With respect to intellectual property, we may be exposed to significant litigation concerning the scope of our and others’ rights. Such litigation could result in a loss of patent protection or the ability to market products, which could lead to a significant loss of sales, or otherwise materially affect future results of operations.
Environmental
We are involved as a potentially responsible party (PRP) for environmental clean-up costs at six Superfund sites. Under the U.S. Superfund statute and many state laws, generators of hazardous waste sent to a disposal or recycling site are liable for site cleanup if contaminants from that property later leak into the environment. The laws generally provide that a PRP may be held jointly and severally liable for the costs of investigating and remediating the site. Separate from these Superfund cases noted above, we are involved in an ongoing environmental remediations associated with historic operations at certain of our facilities. As of September 30, 2022 and December 31, 2021, our
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environmental reserves, which are measured on an undiscounted basis, were $17 million and $18 million, respectively. After considering these reserves, the outcome of these matters is not expected to have a material adverse effect on our financial position or results of operations.
General Litigation
In August 2019, we were named in an amended complaint filed by Fayette County, Georgia in the MDL In re: National Prescription Opiate Litigation pending in the U.S. District Court, Northern District of Ohio. The complaint alleges that multiple manufacturers and distributors of opiate products improperly marketed and diverted these products, which caused harm to Fayette County. The complaint is limited in its allegations as to Baxter and does not distinguish between injectable opiate products and orally administered opiates. We manufactured generic injectable opiate products in our facility in Cherry Hill, NJ, which we divested in 2011.
In November 2019, we and certain of our officers were named in a class action complaint captioned Ethan E. Silverman et al. v. Baxter International Inc. et al. that was filed in the United States District Court for the Northern District of Illinois. The plaintiff, who allegedly purchased shares of our common stock during the specified class period, filed this putative class action on behalf of himself and shareholders who acquired Baxter common stock between February 21, 2019 and October 23, 2019. The plaintiff alleged that we and certain officers violated Sections 10(b) and 20(a) of the Securities Exchange Act of 1934 and Rule 10b-5 promulgated thereunder by making allegedly false and misleading statements and failing to disclose material facts relating to certain intra-company transactions undertaken for the purpose of generating foreign exchange gains or avoiding foreign exchange losses, as well as our internal controls over financial reporting. On January 29, 2020, the Court appointed Varma Mutual Pension Insurance Company and Louisiana Municipal Police Employees Retirement System as lead plaintiffs in the case. Plaintiffs filed an amended complaint on June 25, 2020 containing substantially the same allegations. On August 24, 2020, we filed a motion to dismiss the amended complaint. On January 12, 2021, the Court granted our motion to dismiss the amended complaint but gave plaintiffs an opportunity to file a further-amended complaint. The parties reached an agreement to settle the case for $16 million, subject to the completion of confirmatory discovery and final approval by the Court. The Court granted final approval of the settlement on August 11, 2021 and the settlement became effective on September 13, 2021.
As initially disclosed in our Form 8-K on October 24, 2019, we voluntarily advised the staff of the SEC of an internal investigation into certain intra-company transactions that impacted our previously reported non-operating foreign exchanges gains and losses. We also received a stockholder request for inspection of our books and records in connection with the October 24, 2019 announcement. The Company has cooperated with the staff of the SEC in its investigation into related matters, and on February 18, 2022, we reached a settlement with the SEC. Without admitting or denying the findings in the administrative order issued by the SEC, we agreed to pay a civil penalty of $18 million and to cease and desist from violations of specified provisions of the federal securities laws and related rules. In the order, the SEC acknowledged the Company’s cooperation. We paid the penalty in the first quarter of 2022.
In March 2020, two lawsuits were filed against us in the Northern District of Illinois by plaintiffs alleging injuries as a result of exposure to ethylene oxide used in our manufacturing facility in Mountain Home, Arkansas to sterilize certain of our products. The plaintiffs sought damages, including compensatory and punitive damages in an unspecified amount, and unspecified injunctive and declaratory relief. The parties reached agreement to settle these lawsuits in the third quarter of 2021 for amounts that were not material to our financial results, which were paid in the fourth quarter of 2021. We have since resolved, without litigation, additional claims of injuries from exposure to ethylene oxide at Mountain Home for amounts within accruals previously established as of December 31, 2021. On October 20, 2022, a lawsuit was filed against us in the Western District of Arkansas alleging injury as a result of exposure to ethylene oxide at Mountain Home.
In July 2021, Hill-Rom, Inc. received a subpoena (from the United States Office of Inspector General for the Department of Health and Human Services (DHHS) requesting documents and information related to compliance with the False Claims Act and the Anti-Kickback Statute. Hillrom has been working with the DHHS and the Department of Justice (DOJ) to provide information responsive to the subpoena. Hillrom also voluntarily began a related internal review and Hillrom and now Baxter have been cooperating fully with the DHHS and the DOJ with respect to these matters. The DHHS often issues this type of subpoena when investigating alleged violations of the False Claims Act.
On December 28, 2021, Linet Americas, Inc. (Linet) filed a complaint against Hill-Rom Holdings, Inc., Hill-Rom Company, Inc., and Hill-Rom Services, Inc. in the United States District Court for the Northern District of Illinois, captioned Linet Americas, Inc. v. Hill-Rom Holdings, Inc.; Hill-Rom Company, Inc.; Hill-Rom Services, Inc. Linet alleges that Hillrom violated Sections 1, 2 and 3 of The Sherman Antitrust Act of 1890 and the Illinois Antitrust Act by
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allegedly engaging in anti-competitive conduct in alleged markets for standard, ICU and birthing beds. Hillrom filed an answer to the complaint on January 28, 2022 and filed on May 27, 2022, a motion challenging certain aspects of plaintiff's case.
7. STOCKHOLDERS’ EQUITY
Cash Dividends
Cash dividends declared per share for the three and nine months ended September 30, 2022 were $0.29 and $0.86. Cash dividends declared per share for the three and nine months ended September 30, 2021 were $0.280 and $0.805.
Stock Repurchase Programs
In July 2012, our Board of Directors authorized the repurchase of up to $2.0 billion of our common stock. Our Board of Directors increased this authority by an additional $1.5 billion in each of November 2016 and February 2018, by an additional $2.0 billion in November 2018 and by an additional $1.5 billion in October 2020. During the first nine months of 2022, we repurchased 0.5 million shares under this authority pursuant to a Rule 10b5-1 plan. During the first nine months of 2021, we repurchased 7.3 million shares under this authority pursuant to Rule 10b5-1 plans. We had $1.3 billion remaining available under the authorization as of September 30, 2022.
8. ACCUMULATED OTHER COMPREHENSIVE INCOME
Comprehensive income includes all changes in stockholders’ equity that do not arise from transactions with stockholders, and consists of net income (loss), cumulative translation adjustments (CTA), certain gains and losses from pension and other postretirement employee benefit (OPEB) plans and gains and losses on cash flow hedges.
The following table is a net-of-tax summary of the changes in accumulated other comprehensive income (loss) (AOCI) by component for the nine months ended September 30, 2022 and 2021.

(in millions) | CTA | Pension and OPEB plans | Hedging activities | Available-for-sale Debt securities | Total
Gains (losses) |  |  |  |  |
Balance as of December 31, 2021 | $ | (2,907) |  | $ | (347) |  | $ | (126) |  | $ | — |  | $ | (3,380) |
Other comprehensive income (loss) before reclassifications | (816) |  | 29 |  | 33 |  | 2 |  | (752) |
Amounts reclassified from AOCI (a) | 65 |  | 19 |  | (6) |  | — |  | 78 |
Net other comprehensive income (loss) | (751) |  | 48 |  | 27 |  | 2 |  | (674) |
Balance as of September 30, 2022 | $ | (3,658) |  | $ | (299) |  | $ | (99) |  | $ | 2 |  | $ | (4,054) |

(in millions) | CTA | Pension and OPEB plans | Hedging activities | Total
Gains (losses) |  |  |  |
Balance as of December 31, 2020 | $ | (2,587) |  | $ | (574) |  | $ | (153) |  | $ | (3,314) |
Other comprehensive income (loss) before reclassifications | (257) |  | 13 |  | 5 |  | (239) |
Amounts reclassified from AOCI (a) | — |  | 50 |  | 21 |  | 71 |
Net other comprehensive income (loss) | (257) |  | 63 |  | 26 |  | (168) |
Balance as of September 30, 2021 | $ | (2,844) |  | $ | (511) |  | $ | (127) |  | $ | (3,482) |

(a) See table below for details about these reclassifications.
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The following is a summary of the amounts reclassified from AOCI to net income during the three and nine months ended September 30, 2022 and 2021.

| Amounts reclassified from AOCI (a) |
(in millions) | Three months ended September 30, 2022 | Nine months ended September 30, 2022 | Location of impact in income statement
CTA |  |  |
Reclassification of cumulative translation loss to earnings | $ | (65) |  | $ | (65) |  | Other (income) expense, net
Less: Tax effect | — |  | — |  | Income tax expense
| $ | (65) |  | $ | (65) |  | Net of tax
Pension and OPEB items |  |  |
Amortization of net losses and prior service costs or credits | $ | (8) |  | $ | (25) |  | Other (income) expense, net
Less: Tax effect | 2 |  | 6 |  | Income tax expense
| $ | (6) |  | $ | (19) |  | Net of tax
Gains (losses) on hedging activities |  |  |
Foreign exchange contracts | $ | 6 |  | $ | 11 |  | Cost of sales
Interest rate contracts | (1) |  | (4) |  | Interest expense, net
| 5 |  | 7 |  | Total before tax
Less: Tax effect | (1) |  | (1) |  | Income tax expense
| $ | 4 |  | $ | 6 |  | Net of tax
Total reclassifications for the period | $ | (67) |  | $ | (78) |  | Total net of tax

(a) Amounts in parentheses indicate reductions to net income

| Amounts reclassified from AOCI (a) |
(in millions) | Three months ended September 30, 2021 | Nine months ended September 30, 2021 | Location of impact in income statement
Amortization of pension and OPEB items |  |  |
Amortization of net losses and prior service costs or credits | $ | (21) |  | $ | (62) |  | Other (income) expense, net
Less: Tax effect | 4 |  | 12 |  | Income tax expense
| $ | (17) |  | $ | (50) |  | Net of tax
Gains on hedging activities |  |  |
Foreign exchange contracts | $ | (5) |  | $ | (23) |  | Cost of sales
Interest rate contracts | (1) |  | (4) |  | Interest expense, net
| (6) |  | (27) |  | Total before tax
Less: Tax effect | 1 |  | 6 |  | Income tax expense
| $ | (5) |  | $ | (21) |  | Net of tax
Total reclassifications for the period | $ | (22) |  | $ | (71) |  | Total net of tax

Refer to Note 3 for additional information regarding the reclassification of a cumulative translation loss to earnings, Note 11 for additional information regarding the amortization of pension and OPEB items and Note 14 for additional information regarding hedging activity.
9. REVENUES
Revenue is measured as the amount of consideration we expect to receive in exchange for transferring goods or providing services. A performance obligation is a promise in a contract to transfer a distinct good or service to the customer and is the unit of account in the contract. A contract’s transaction price is allocated to each distinct performance obligation and recognized as revenue when, or as, the performance obligation is satisfied. Some of our contracts have multiple performance obligations. For contracts with multiple performance obligations, we allocate the
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contract’s transaction price to each performance obligation using our best estimate of the standalone selling price of each distinct good or service in the contract. Our global payment terms are typically between 30-90 days.
Most of our performance obligations are satisfied at a point in time. This includes sales of our broad portfolio of essential healthcare products across our business segments. Our three legacy Baxter geographic segments include acute and chronic dialysis therapies; sterile IV solutions; infusion systems and devices; parenteral nutrition therapies; inhaled anesthetics; generic injectable pharmaceuticals; and surgical hemostat and sealant products. Our legacy Hillrom segment includes smart bed systems; patient monitoring and diagnostic technologies; respiratory health devices; and advanced equipment for the surgical space. For most of those sales, our performance obligation is satisfied upon delivery to the customer. Shipping and handling activities are considered to be fulfillment activities and are not considered to be a separate performance obligation.
To a lesser extent, we enter into arrangements for which revenue may be recognized over time. For example, our Americas segment includes contract manufacturing arrangements, our Hillrom segment includes digital and connected care solutions and collaboration tools that are implemented over time and all of our segments include equipment leases and certain subscription software and licensing arrangements. We recognize revenue for these arrangements over time or at a point in time depending on our evaluation of when the customer obtains control of the promised goods or services. Revenue is recognized over time when we are creating or enhancing an asset that the customer controls as the asset is created or enhanced or our performance does not create an asset with an alternative use and we have an enforceable right to payment for performance completed.
As of September 30, 2022, we had $10.9 billion of transaction price allocated to remaining performance obligations related to executed contracts with an original duration of more than one year, which are primarily included in the Americas segment. Some contracts in the United States included in this amount contain index-dependent price increases, which are not known at this time. We expect to recognize approximately 10% of this amount as revenue over the remainder of 2022, 30% in each of 2023 and 2024, 15% in 2025 and 15% thereafter.
Significant Judgments
Revenues from product sales are recorded at the net sales price (transaction price), which includes estimates of variable consideration primarily related to rebates and wholesaler chargebacks. These reserves are based on estimates of the amounts earned or to be claimed on the related sales and are included in accrued expenses and other current liabilities and accounts receivable, net on the condensed consolidated balance sheets. Management's estimates take into consideration historical experience, current contractual and statutory requirements, specific known market events and trends, industry data, and forecasted customer buying and payment patterns. Overall, these reserves reflect our best estimates of the amount of consideration to which we are entitled based on the terms of the contract using the expected value method. The amount of variable consideration included in the net sales price is limited to the amount for which it is probable that a significant reversal in revenue will not occur when the related uncertainty is resolved. Revenue recognized during the three and nine months ended September 30, 2022 and 2021 related to performance obligations satisfied in prior periods was not material. Additionally, our contracts with customers often include promises to transfer multiple products and services to a customer. Determining whether products and services are considered distinct performance obligations that should be accounted for separately and determining the allocation of the transaction price may require significant judgement.
Contract Balances
The timing of revenue recognition, billings and cash collections results in the recognition of trade accounts receivable, unbilled receivables, contract assets and customer advances and deposits (contract liabilities) on our condensed consolidated balance sheets. Net trade accounts receivable was $2.3 billion and $2.4 billion as of September 30, 2022 and December 31, 2021, respectively.
For contract manufacturing arrangements, revenue is primarily recognized throughout the production cycle, which typically lasts up to 90 days, resulting in the recognition of contract assets until the related services are completed and the customers are billed. Additionally, for certain arrangements containing a performance obligation to deliver software that can be used with medical devices, we recognize revenue upon delivery of the software, which results in the recognition of contract assets when customers are billed over time, generally over one to five years. For bundled contracts involving equipment delivered up-front and consumable medical products to be delivered over time, total contract revenue is allocated between the equipment and consumable medical products. In certain of those arrangements, a contract asset is created for the difference between the amount of equipment revenue recognized upon delivery and the amount of consideration initially receivable from the customer. In those arrangements, the
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contract asset becomes a trade account receivable as consumable medical products are delivered and billed, generally over one to seven years.
The following table summarizes our contract assets:

(in millions) | September 30, 2022 | December 31, 2021
Contract manufacturing services | $ | 65 |  | $ | 50 |
Software sales | 44 |  | 45 |
Bundled equipment and consumable medical products contracts | 120 |  | 100 |
Contract assets | $ | 229 |  | $ | 195 |

The following table summarizes the classification of contract assets and contract liabilities as reported in the condensed consolidated balance sheets:

(in millions) | September 30, 2022 | December 31, 2021
Prepaid expenses and other current assets | $ | 106 |  | $ | 84 |
Other non-current assets | 123 |  | 111 |
Contract assets | $ | 229 |  | $ | 195 |
Accrued expenses and other current liabilities | $ | 158 |  | $ | 162 |
Other non-current liabilities | 82 |  | 84 |
Contract liabilities | $ | 240 |  | $ | 246 |

Contract liabilities represent deferred revenues that arise as a result of cash received from customers or where the timing of billing for services precedes satisfaction of our performance obligations. Such remaining performance obligations represent the portion of the contract price for which work has not been performed and are primarily related to our installation and service contracts. We expect to satisfy the majority of the remaining performance obligations and recognize revenue related to installation and service contracts within the next 12 months with most of the non-current performance obligations satisfied within 24 months.
The following table summarizes contract liability activity for the nine months ended September 30, 2022. The contract liability balance represents the transaction price allocated to the remaining performance obligations.

| Nine months ended September 30, 2022
Balance at beginning of period | $ | 246 |
New revenue deferrals | 460 |
Revenue recognized upon satisfaction of performance obligations | (463) |
Currency translation | (3) |
Balance at end of period | $ | 240 |

During the nine months ended September 30, 2021, the amount of revenue recognized that was included in contract liabilities as of December 31, 2020 was not significant.
Disaggregation of Net Sales
In connection with our acquisition of Hillrom in December 2021, we added three new product categories: Patient Support Systems, Front Line Care and Surgical Solutions.
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The following tables disaggregate our net sales from contracts with customers by product category between the U.S. and international:

| Three Months Ended September 30,
| 2022 | 2021
(in millions) | U.S. | International | Total | U.S. | International | Total
Renal Care 1 | $ | 240 |  | $ | 702 |  | $ | 942 |  | $ | 222 |  | $ | 759 |  | $ | 981 |
Medication Delivery 2 | 475 |  | 250 |  | 725 |  | 490 |  | 257 |  | 747 |
Pharmaceuticals 3 | 173 |  | 352 |  | 525 |  | 188 |  | 401 |  | 589 |
Clinical Nutrition 4 | 92 |  | 139 |  | 231 |  | 88 |  | 156 |  | 244 |
Advanced Surgery 5 | 141 |  | 106 |  | 247 |  | 135 |  | 114 |  | 249 |
Acute Therapies 6 | 53 |  | 105 |  | 158 |  | 69 |  | 116 |  | 185 |
BioPharma Solutions 7 | 99 |  | 73 |  | 172 |  | 109 |  | 97 |  | 206 |
Patient Support Systems 8 | 301 |  | 79 |  | 380 |  | — |  | — |  | — |
Front Line Care 9 | 209 |  | 70 |  | 279 |  | — |  | — |  | — |
Surgical Solutions 10 | 38 |  | 38 |  | 76 |  | — |  | — |  | — |
Other 11 | 28 |  | 10 |  | 38 |  | 18 |  | 7 |  | 25 |
Total Baxter | $ | 1,849 |  | $ | 1,924 |  | $ | 3,773 |  | $ | 1,319 |  | $ | 1,907 |  | $ | 3,226 |

| Nine Months Ended September 30,
| 2022 | 2021
(in millions) | U.S. | International | Total | U.S. | International | Total
Renal Care 1 | $ | 690 |  | $ | 2,077 |  | $ | 2,767 |  | $ | 655 |  | $ | 2,212 |  | $ | 2,867 |
Medication Delivery 2 | 1,406 |  | 735 |  | 2,141 |  | 1,345 |  | 751 |  | 2,096 |
Pharmaceuticals 3 | 494 |  | 1,080 |  | 1,574 |  | 550 |  | 1,137 |  | 1,687 |
Clinical Nutrition 4 | 266 |  | 422 |  | 688 |  | 255 |  | 460 |  | 715 |
Advanced Surgery 5 | 428 |  | 310 |  | 738 |  | 405 |  | 317 |  | 722 |
Acute Therapies 6 | 179 |  | 340 |  | 519 |  | 211 |  | 369 |  | 580 |
BioPharma Solutions 7 | 226 |  | 265 |  | 491 |  | 218 |  | 306 |  | 524 |
Patient Support Systems 8 | 880 |  | 247 |  | 1,127 |  | — |  | — |  | — |
Front Line Care 9 | 618 |  | 237 |  | 855 |  | — |  | — |  | — |
Surgical Solutions 10 | 111 |  | 112 |  | 223 |  | — |  | — |  | — |
Other 11 | 72 |  | 31 |  | 103 |  | 58 |  | 21 |  | 79 |
Total Baxter | $ | 5,370 |  | $ | 5,856 |  | $ | 11,226 |  | $ | 3,697 |  | $ | 5,573 |  | $ | 9,270 |

1 Renal Care includes sales of our peritoneal dialysis (PD), hemodialysis (HD) and additional dialysis therapies and services.
2 Medication Delivery includes sales of our intravenous (IV) therapies, infusion pumps, administration sets and drug reconstitution devices.
3 Pharmaceuticals includes sales of our premixed and oncology drug platforms, inhaled anesthesia and critical care products and pharmacy compounding services.
4 Clinical Nutrition includes sales of our parenteral nutrition (PN) therapies and related products.
5 Advanced Surgery includes sales of our biological products and medical devices used in surgical procedures for hemostasis, tissue sealing and adhesion prevention.
6 Acute Therapies includes sales of our continuous renal replacement therapies (CRRT) and other organ support therapies focused in the intensive care unit (ICU).
7 BioPharma Solutions includes sales of contracted services we provide to various pharmaceutical and biopharmaceutical companies.
8 Patient Support Systems includes sales of our connected care solutions: devices, software, communications and integration technologies and smart beds.
9 Front Line Care includes sales of our integrated patient monitoring and diagnostic technologies to help diagnose, treat and manage a wide variety of illness and diseases, including respiratory therapy, cardiology, vision screening and physical assessment.
10 Surgical Solutions includes sales of our surgical video technologies, tables, lights, pendants, precision positioning devices and other accessories.
11 Other includes sales of miscellaneous product and service offerings.
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Lease Revenue
We lease smart beds, such as bariatric, critical care, maternal, and home care beds, as well as other surfaces, to customers during periods of peak demand or for specialty purposes. We also lease medical equipment, such as renal dialysis equipment and infusion pumps, to customers, primarily in conjunction with arrangements to provide consumable medical products such as dialysis therapies, IV fluids and inhaled anesthetics. Certain of our equipment leases are classified as sales-type leases and the remainder are operating leases. The terms of the related contracts, including the proportion of fixed versus variable payments and any options to shorten or extend the lease term, vary by customer. We allocate revenue between equipment leases and medical products based on their standalone selling prices.
The components of lease revenue for the three and nine months ended September 30, 2022 and 2021 were:

(in millions) | Three months ended September 30, 2022 | Nine months ended September 30, 2022
Sales-type lease revenue | $ | 3 |  | $ | 11 |
Operating lease revenue | 145 |  | 380 |
Variable lease revenue | 9 |  | 41 |
Total lease revenue | $ | 157 |  | $ | 432 |

(in millions) | Three months ended September 30, 2021 | Nine months ended September 30, 2021
Sales-type lease revenue | $ | 3 |  | $ | 19 |
Operating lease revenue | 21 |  | 90 |
Variable lease revenue | 27 |  | 59 |
Total lease revenue | $ | 51 |  | $ | 168 |

Our net investment in sales-type leases was $95 million as of September 30, 2022, of which $18 million originated in 2018 and prior, $19 million in 2019, $26 million in 2020, $24 million in 2021, and $8 million in 2022.
10. BUSINESS OPTIMIZATION CHARGES
In recent years, we have undertaken actions to transform our cost structure and enhance operational efficiency. These efforts include restructuring the organization, optimizing the manufacturing footprint, R&D operations and supply chain network, employing disciplined cost management, and centralizing and streamlining certain support functions. In the current period, restructuring charges include actions taken in connection with our integration of Hillrom. From the commencement of our business optimization activities in the second half of 2015 through September 30, 2022, we have incurred cumulative pre-tax costs of $1.4 billion related to these actions. The costs consisted primarily of employee termination costs, implementation costs, contract termination costs, asset impairments and accelerated depreciation. We currently expect to incur additional pre-tax costs, primarily related to implementation of business optimization programs, of approximately $14 million through the completion of initiatives that are currently underway. We continue to pursue cost savings initiatives, including those related to our integration of Hillrom, and, to the extent further cost savings opportunities are identified, we would incur additional restructuring charges and costs to implement business optimization programs in future periods.
During the three and nine months ended September 30, 2022 and 2021, we recorded the following charges related to business optimization programs.

| Three Months Ended September 30, |  | Nine Months Ended September 30,
(in millions) | 2022 | 2021 |  | 2022 | 2021
Restructuring charges | $ | 57 |  | $ | 32 |  |  | $ | 150 |  | $ | 67 |
Costs to implement business optimization programs | 16 |  | 4 |  |  | 46 |  | 14 |
Total business optimization charges | $ | 73 |  | $ | 36 |  |  | $ | 196 |  | $ | 81 |

For segment reporting purposes, business optimization charges are unallocated expenses.
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Costs to implement business optimization programs for the three and nine months ended September 30, 2022 and 2021, respectively, consisted primarily of external consulting and transition costs, including employee compensation and related costs. These costs were primarily included within cost of sales and SG&A expense.
During the three and nine months ended September 30, 2022 and 2021, we recorded the following restructuring charges.

| Three months ended September 30, 2022
(in millions) | COGS | SG&A | R&D | Total
Employee termination costs | $ | 13 |  | $ | 36 |  | $ | 4 |  | $ | 53 |
Contract termination and other costs | — |  | 2 |  | — |  | 2 |
Asset impairments | 1 |  | 1 |  | — |  | 2 |
Total restructuring charges | $ | 14 |  | $ | 39 |  | $ | 4 |  | $ | 57 |

| Three months ended September 30, 2021
(in millions) | COGS | SG&A |  | Total
Employee termination costs | $ | 11 |  | $ | 8 |  |  | $ | 19 |
Contract termination and other costs | — |  | 2 |  |  | 2 |
Asset impairments | 11 |  | — |  |  | 11 |
Total restructuring charges | $ | 22 |  | $ | 10 |  |  | $ | 32 |

| Nine months ended September 30, 2022
(in millions) | COGS | SG&A | R&D | Total
Employee termination costs | $ | 19 |  | $ | 99 |  | $ | 4 |  | $ | 122 |
Contract termination and other costs | — |  | 19 |  | — |  | 19 |
Asset impairments | 1 |  | 8 |  | — |  | 9 |
Total restructuring charges | $ | 20 |  | $ | 126 |  | $ | 4 |  | $ | 150 |

| Nine months ended September 30, 2021
(in millions) | COGS | SG&A |  | Total
Employee termination costs | $ | 35 |  | $ | 14 |  |  | $ | 49 |
Contract termination and other costs | — |  | 2 |  |  | 2 |
Asset impairments | 16 |  | — |  |  | 16 |
Total restructuring charges | $ | 51 |  | $ | 16 |  |  | $ | 67 |

The following table summarizes activity in the liability related to our restructuring initiatives.

(in millions) |
Liability balance as of December 31, 2021 | $ | 109 |
Charges | 147 |
Payments | (108) |
Reserve adjustments | (6) |
Currency translation | (14) |
Liability balance as of September 30, 2022 | $ | 128 |

Substantially all of our restructuring liabilities as of September 30, 2022 relate to employee termination costs, with the remaining liabilities attributable to contract termination costs. Substantially all of the cash payments for those liabilities are expected to be disbursed by the end of 2023.
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11. PENSION AND OTHER POSTRETIREMENT BENEFIT PROGRAMS
The following is a summary of net periodic benefit cost relating to our pension and OPEB plans.

| Three months ended September 30, |  | Nine months ended September 30,
(in millions) | 2022 | 2021 |  | 2022 | 2021
Pension benefits |  |  |  |  |
Service cost | $ | 19 |  | $ | 22 |  |  | $ | 59 |  | $ | 66 |
Interest cost | 25 |  | 18 |  |  | 73 |  | 54 |
Expected return on plan assets | (39) |  | (36) |  |  | (118) |  | (108) |
Amortization of net losses and prior service costs | 11 |  | 23 |  |  | 34 |  | 69 |
Net periodic pension cost | $ | 16 |  | $ | 27 |  |  | $ | 48 |  | $ | 81 |
OPEB |  |  |  |  |
Interest cost | $ | 1 |  | $ | 1 |  |  | $ | 3 |  | $ | 3 |
Amortization of net loss and prior service credit | (3) |  | (2) |  |  | (9) |  | (7) |
Net periodic OPEB cost (income) | $ | (2) |  | $ | (1) |  |  | $ | (6) |  | $ | (4) |

U.S. Hillrom Pension Plan Amendment
In May 2022, we announced that the pay and service amounts used to calculate pension benefits for active non-bargaining participants in our U.S. Hillrom pension plan will freeze as of December 31, 2022. Years of additional service earned and eligible compensation received after December 31, 2022 will not be included in the determination of the benefits payable to those participants. This change resulted in an $11 million decline in the projected benefit obligation (PBO) with an offsetting curtailment gain included within other (income) expense, net on the condensed consolidated statements of income (loss) for the nine months ended September 30, 2022.
12. INCOME TAXES
Our effective income tax rate was 1.1% and (0.2)% for the three months ended September 30, 2022 and 2021, respectively, and (1.1)% and 11.8% for the nine months ended September 30, 2022 and 2021, respectively. Our effective income tax rate can differ from the 21% U.S. federal statutory rate due to a number of factors, including foreign rate differences, tax incentives, non-deductible expenses, non-taxable income, increases or decreases in valuation allowances and liabilities for uncertain tax positions and excess tax benefits or shortfalls on stock compensation awards.
For the three and nine months ended September 30, 2022, the difference between our effective income tax rate and the U.S. federal statutory rate was primarily attributable to non-deductible goodwill impairments.
For the three months ended September 30, 2021, the difference between our effective income tax rate and the U.S. federal statutory rate was primarily attributable to a $58 million tax benefit related to a tax-deductible foreign statutory loss on an investment in a foreign subsidiary, as well as changes related to our ability to realize tax credit carryforwards based on a favorable tax ruling in a foreign jurisdiction.
For the nine months ended September 30, 2021, the difference between our effective income tax rate and the U.S. federal statutory rate was primarily attributable to a $58 million tax benefit related to a tax-deductible foreign statutory loss on an investment in a foreign subsidiary, as well as a favorable geographic earnings mix and changes related to our ability to realize tax credit carryforwards based on a favorable tax ruling in a foreign jurisdiction.
13. EARNINGS PER SHARE
The numerator for both basic and diluted earnings per share (EPS) is net income (loss) attributable to Baxter stockholders. The denominator for basic EPS is the weighted-average number of shares outstanding during the period. The dilutive effect of outstanding stock options, RSUs and PSUs is reflected in the denominator for diluted EPS using the treasury stock method.
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The following table is a reconciliation of basic shares to diluted shares.

| Three months ended September 30, |  | Nine months ended September 30,
(in millions) | 2022 | 2021 |  | 2022 | 2021
Basic shares | 504 |  | 500 |  |  | 503 |  | 503 |
Effect of dilutive securities | — |  | 6 |  |  | — |  | 6 |
Diluted shares | 504 |  | 506 |  |  | 503 |  | 509 |

Basic and diluted shares are the same for the three and nine months ended September 30, 2022 due to our net losses for those periods. The effect of dilutive securities for the three and nine months ended September 30, 2021 includes unexercised stock options, unvested RSUs and contingently issuable shares related to granted PSUs.
Diluted EPS excludes 23 million shares issuable under equity awards for the three and nine months ended September 30, 2022, respectively, and 7 million shares issuable under equity awards for the three and nine months ended September 30, 2021, respectively, because their inclusion would have had an anti-dilutive effect on diluted EPS. Refer to Note 7 for additional information regarding items impacting basic and diluted shares.
14. DERIVATIVE INSTRUMENTS AND HEDGING ACTIVITIES
We operate on a global basis and are exposed to the risk that our earnings, cash flows and equity could be adversely impacted by fluctuations in foreign exchange and interest rates. Our hedging policy attempts to manage these risks to an acceptable level based on our judgment of the appropriate trade-off between risk, opportunity and costs.
We are primarily exposed to foreign exchange risk with respect to recognized assets and liabilities, forecasted transactions and net assets denominated in the Euro, British Pound, Chinese Renminbi, Korean Won, Australian Dollar, Canadian Dollar, Japanese Yen, Colombian Peso, Brazilian Real, Mexican Peso, Turkish Lira, Indian Rupee and Swedish Krona. We manage our foreign currency exposures on a consolidated basis, which allows us to net exposures and take advantage of any natural offsets. In addition, we use derivative and nonderivative instruments to further reduce the net exposure to foreign exchange risk. Gains and losses on the hedging instruments offset losses and gains on the hedged transactions and reduce the earnings and equity volatility resulting from changes in foreign exchange rates. Financial market and currency volatility may limit our ability to cost-effectively hedge these exposures.
We are also exposed to the risk that our earnings and cash flows could be adversely impacted by fluctuations in interest rates. Our policy is to manage interest costs using the mix of fixed- and floating-rate debt that we believe is appropriate at that time. To manage this mix in a cost-efficient manner, we periodically enter into interest rate swaps in which we agree to exchange, at specified intervals, the difference between fixed and floating interest amounts calculated by reference to an agreed-upon notional amount.
We do not hold any instruments for trading purposes and none of our outstanding derivative instruments contain credit-risk-related contingent features.
All derivative instruments are generally recognized as either assets or liabilities at fair value in the condensed consolidated balance sheets and are classified as short-term or long-term based on the scheduled maturity of the instrument. We designate certain of our derivatives and foreign-currency denominated debt as hedging instruments in cash flow, fair value or net investment hedges.
Cash Flow Hed g es
We may use options, including collars and purchased options, forwards and cross-currency swaps to hedge the foreign exchange risk to earnings relating to forecasted transactions and recognized assets and liabilities. We periodically use treasury rate locks to hedge the risk to earnings associated with movements in interest rates relating to anticipated issuances of debt.
For each derivative instrument that is designated and effective as a cash flow hedge, the gain or loss on the derivative is recorded in AOCI and then recognized in earnings consistent with the underlying hedged item. Option premiums or net premiums paid are initially recorded as assets and reclassified to other comprehensive income (OCI) over the life of the option, and then recognized in earnings consistent with the underlying hedged item. Cash flow hedges are
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classified in cost of sales and interest expense, net, and are primarily related to forecasted intra-company sales denominated in foreign currencies and forecasted interest payments on anticipated issuances of debt, respectively.
The notional amounts of foreign exchange contracts designated as cash flow hedges were $407 million and $377 million as of September 30, 2022 and December 31, 2021, respectively. The maximum term over which we have cash flow hedge contracts in place related to forecasted transactions at September 30, 2022 is 12 months for foreign exchange contracts. There were no outstanding interest rate contracts designated as cash flow hedges as of September 30, 2022 and December 31, 2021.
Fair Value Hed g es
We periodically use interest rate swaps to convert a portion of our fixed-rate debt into variable-rate debt. These instruments hedge our earnings from changes in the fair value of debt due to fluctuations in the designated benchmark interest rate. For each derivative instrument that is designated and effective as a fair value hedge, the gain or loss on the derivative is recognized immediately to earnings, and offsets changes in fair value attributable to a particular risk, such as changes in interest rates, of the hedged item, which are also recognized in earnings. Changes in the fair value of hedge instruments designated as fair value hedges are classified in interest expense, net, as they hedge the interest rate risk associated with certain of our fixed-rate debt.
There were no outstanding interest rate contracts designated as fair value hedges as of September 30, 2022 and December 31, 2021.
Net Investment Hed g es
In May 2017, we issued €600 million of senior notes due May 2025. In May 2019, we issued €750 million of senior notes due May 2024 and €750 million of senior notes due May 2029. We have designated these debt obligations as hedges of our net investment in our European operations and, as a result, mark to spot rate adjustments on the outstanding debt balances are recorded as a component of AOCI. As of September 30, 2022, we had an accumulated pre-tax unrealized translation gain in AOCI of $265 million related to the Euro-denominated senior notes.
Dedesignations
If it is determined that a derivative or nonderivative hedging instrument is no longer highly effective as a hedge, we discontinue hedge accounting prospectively. Gains or losses relating to terminations of effective cash flow hedges generally continue to be deferred and are recognized consistent with the loss or income recognition of the underlying hedged items. However, if it is probable that the hedged forecasted transactions will not occur, any gains or losses would be immediately reclassified from AOCI to earnings.
There were no hedge dedesignations in the first nine months of 2022 or 2021 resulting from changes in our assessment of the probability that the hedged forecasted transactions would occur.
If we terminate a fair value hedge, an amount equal to the cumulative fair value adjustment to the hedged item at the date of termination is amortized to earnings over the remaining term of the hedged item. There were no fair value hedges terminated during the first nine months of 2022 or 2021.
If we remove a net investment hedge designation, any gains or losses recognized in AOCI are not reclassified to earnings until we sell, liquidate, or deconsolidate the foreign investments that were being hedged. There were no net investment hedges terminated during the first nine months of 2022 or 2021.
Undesignated Derivative Instruments
We use forward contracts to hedge earnings from the effects of foreign exchange relating to certain of our intra-company and third-party receivables and payables denominated in a foreign currency. These derivative instruments are generally not formally designated as hedges and the terms of these instruments generally do not exceed one month.
The total notional amount of undesignated derivative instruments was $548 million as of September 30, 2022 and $851 million as of December 31, 2021.
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Gains and Losses on Hedging Instruments and Undesignated Derivative Instruments
The following tables summarize the gains and losses on our hedging instruments and the classification of those gains and losses within our condensed consolidated financial statements for the three months ended September 30, 2022 and 2021.

| Gain (loss) recognized in OCI |  | Location of gain (loss) in income statement | Gain (loss) reclassified from AOCI into income
(in millions) | 2022 |  | 2021 |  | 2022 |  | 2021
Cash flow hedges |  |  |  |  |  |  |  |
Interest rate contracts | $ | — |  |  | $ | — |  |  | Interest expense, net | $ | (1) |  |  | $ | (1) |
Foreign exchange contracts | 26 |  |  | 6 |  |  | Cost of sales | 6 |  |  | (5) |
Net investment hedges | 126 |  |  | 60 |  |  | Other (income) expense, net | — |  |  | — |
Total | $ | 152 |  |  | $ | 66 |  |  |  | $ | 5 |  |  | $ | (6) |

| Location of gain (loss) in income statement | Gain (loss) recognized in income
(in millions) | 2022 |  | 2021
Undesignated derivative instruments |  |  |  |
Foreign exchange contracts | Other (income) expense, net | $ | (11) |  |  | $ | (7) |

The following tables summarize the gains and losses on our hedging instruments and the classification of those gains and losses within our condensed consolidated financial statements for the nine months ended September 30, 2022 and 2021.

| Gain (loss) recognized in OCI | Location of gain (loss) in income statement | Gain (loss) reclassified from AOCI into income
(in millions) | 2022 | 2021 | 2022 | 2021
Cash flow hedges |  |  |  |  |
Interest rate contracts | $ | — |  | $ | — |  | Interest expense, net | $ | (4) |  | $ | (4) |
Foreign exchange contracts | 42 |  | 7 |  | Cost of sales | 11 |  | (23) |
Net investment hedges | 311 |  | 143 |  | Other (income) expense, net | — |  | — |
Total | $ | 353 |  | $ | 150 |  |  | $ | 7 |  | $ | (27) |

| Location of gain (loss) in income statement | Gain (loss) recognized in income
(in millions) | 2022 | 2021
Undesignated derivative instruments |  |  |
Foreign exchange contracts | Other (income) expense, net | $ | (34) |  | $ | (26) |

As of September 30, 2022, $22 million of deferred, net after-tax gains on derivative instruments included in AOCI are expected to be recognized in earnings during the next 12 months, coinciding with when the hedged items are expected to impact earnings.
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Derivative Assets and Liabilities
The following table summarizes the classification and fair values of derivative instruments reported in the condensed consolidated balance sheet as of September 30, 2022.

| Derivatives in asset positions |  | Derivatives in liability positions
(in millions) | Balance sheet location | Fair value |  | Balance sheet location | Fair value
Derivative instruments designated as hedges |  |  |  |  |
Foreign exchange contracts | Prepaid expenses and other current assets | $ | 31 |  |  | Accrued expenses and other current liabilities | $ | — |
Total derivative instruments designated as hedges |  | 31 |  |  |  | — |
Undesignated derivative instruments |  |  |  |  |
Foreign exchange contracts | Prepaid expenses and other current assets | 4 |  |  | Accrued expenses and other current liabilities | 9 |
Total derivative instruments |  | $ | 35 |  |  |  | $ | 9 |

The following table summarizes the classification and fair values of derivative instruments reported in the condensed consolidated balance sheet as of December 31, 2021.

| Derivatives in asset positions |  | Derivatives in liability positions
(in millions) | Balance sheet location | Fair value |  | Balance sheet location | Fair value
Derivative instruments designated as hedges |  |  |  |  |
Foreign exchange contracts | Prepaid expenses and other current assets | $ | 6 |  |  | Accrued expenses and other current liabilities | $ | 3 |
Total derivative instruments designated as hedges |  | 6 |  |  |  | 3 |
Undesignated derivative instruments |  |  |  |  |
Foreign exchange contracts | Prepaid expenses and other current assets | 2 |  |  | Accrued expenses and other current liabilities | 2 |
Total derivative instruments |  | $ | 8 |  |  |  | $ | 5 |

While some of our derivatives are subject to master netting arrangements, we present our assets and liabilities related to derivative instruments on a gross basis within the condensed consolidated balance sheets. Additionally, we are not required to post collateral for any of our outstanding derivatives.
The following table provides information on our derivative positions as if they were presented on a net basis, allowing for the right of offset by counterparty.

| September 30, 2022 |  | December 31, 2021
(in millions) | Asset | Liability |  | Asset | Liability
Gross amounts recognized in the condensed consolidated balance sheets | $ | 35 |  | $ | 9 |  |  | $ | 8 |  | $ | 5 |
Gross amount subject to offset in master netting arrangements not offset in the condensed consolidated balance sheet | (7) |  | (7) |  |  | (2) |  | (2) |
Total | $ | 28 |  | $ | 2 |  |  | $ | 6 |  | $ | 3 |

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The following table presents the amounts recorded on the condensed consolidated balance sheet related to fair value hedges:

| Carrying amount of hedged item |  | Cumulative amount of fair value hedging adjustment included in the carrying amount of the hedged item (a)
(in millions) | Balance as of September 30, 2022 | Balance as of December 31, 2021 |  | Balance as of September 30, 2022 | Balance as of December 31, 2021
Long-term debt | $ | 101 |  | $ | 101 |  |  | $ | 4 |  | $ | 4 |

(a) These fair value hedges were terminated in 2018 and earlier periods.
15. FAIR VALUE MEASUREMENTS
The following tables summarize our assets and liabilities that are measured at fair value on a recurring basis.

|  | Basis of fair value measurement
(in millions) | Balance as of September 30, 2022 | Quoted prices in active markets for identical assets (Level 1) | Significant other observable inputs (Level 2) | Significant unobservable inputs (Level 3)
Assets |  |  |  |
Foreign exchange contracts | $ | 35 |  | $ | — |  | $ | 35 |  | $ | — |
Available-for-sale debt securities | 44 |  | — |  | — |  | 44 |
Marketable equity securities | 25 |  | 25 |  | — |  | — |
Total | $ | 104 |  | $ | 25 |  | $ | 35 |  | $ | 44 |
Liabilities |  |  |  |
Foreign exchange contracts | $ | 9 |  | $ | — |  | $ | 9 |  | $ | — |
Contingent payments related to acquisitions | 90 |  | — |  | — |  | 90 |
Total | $ | 99 |  | $ | — |  | $ | 9 |  | $ | 90 |

|  | Basis of fair value measurement
(in millions) | Balance as of December 31, 2021 | Quoted prices in active markets for identical assets (Level 1) | Significant other observable inputs (Level 2) | Significant unobservable inputs (Level 3)
Assets |  |  |  |
Foreign exchange contracts | $ | 8 |  | $ | — |  | $ | 8 |  | $ | — |
Available-for-sale debt securities | 30 |  | — |  | — |  | 30 |
Marketable equity securities | 10 |  | 10 |  | — |  | — |
Total | $ | 48 |  | $ | 10 |  | $ | 8 |  | $ | 30 |
Liabilities |  |  |  |
Foreign exchange contracts | $ | 5 |  | $ | — |  | $ | 5 |  | $ | — |
Contingent payments related to acquisitions | 143 |  | — |  | — |  | 143 |
Total | $ | 148 |  | $ | — |  | $ | 5 |  | $ | 143 |

As of September 30, 2022 and December 31, 2021, cash and cash equivalents of $1.6 billion and $3.0 billion, respectively, included money market and other short-term funds of approximately $161 million and $816 million, respectively, which are considered Level 2 in the fair value hierarchy.
For assets that are measured using quoted prices in active markets, the fair value is the published market price per unit multiplied by the number of units held, without consideration of transaction costs. The majority of the derivatives entered into by us are valued using internal valuation techniques as no quoted market prices exist for such instruments. The principal techniques used to value these instruments are discounted cash flow and Black-Scholes models. The key inputs, which are considered observable and vary depending on the type of derivative, include contractual terms, interest rate yield curves, foreign exchange rates and volatility.
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Available-for-sale debt securities, which consist of convertible debt and convertible redeemable preferred shares issued by nonpublic entities, are measured using discounted cash flow and option pricing models. Those available-for-sale debt securities are classified as Level 3 fair value measurements when there are no observable transactions near the balance sheet date due to the lack of observable data over certain fair value inputs such as equity volatility. The fair values of available-for-sale debt securities increase when interest rates decrease, equity volatility increases, or the fair values of the equity shares underlying the conversion options increase.
Contingent payments related to acquisitions, which consist of milestone payments and sales-based payments, are valued using discounted cash flow techniques. The fair value of milestone payments reflects management’s expectations of probability of payment, and increases as the probability of payment increases or the expected timing of payments is accelerated. The fair value of sales-based payments is based upon probability-weighted future revenue estimates, and increases as revenue estimates increase, probability weighting of higher revenue scenarios increases or the expected timing of payment is accelerated.
The following table is a reconciliation of recurring fair value measurements that use significant unobservable inputs (Level 3), which consist of contingent payments related to acquisitions and available-for-sale debt securities.

| Three months ended September 30,
| 2022 |  | 2021
(in millions) | Contingent payments related to acquisitions | Available-for-sale debt securities |  | Contingent payments related to acquisitions
Fair value at beginning of period | $ | 113 |  | $ | 44 |  |  | $ | 34 |
Additions | — |  | — |  |  | 28 |
Change in fair value recognized in earnings | (6) |  | — |  |  | (1) |
Payments | (17) |  | — |  |  | — |
Fair value at end of period | $ | 90 |  | $ | 44 |  |  | $ | 61 |

| Nine months ended September 30,
| 2022 |  | 2021
(in millions) | Contingent payments related to acquisitions | Available-for-sale debt securities |  | Contingent payments related to acquisitions
Fair value at beginning of period | $ | 143 |  | $ | 30 |  |  | $ | 30 |
Additions | — |  | 21 |  |  | 52 |
Change in fair value recognized in earnings | (34) |  | — |  |  | (6) |
Change in fair value recognized in AOCI | — |  | 3 |  |  | — |
Payments | (19) |  | — |  |  | (16) |
Transfers out of Level 3 | — |  | (10) |  |  | — |
Currency translation | — |  | — |  |  | 1 |
Fair value at end of period | $ | 90 |  | $ | 44 |  |  | $ | 61 |

During the nine months ended September 30, 2022, $8 million of available-for-sale debt securities that were previously classified as Level 3 converted to marketable equity securities, which are classified as Level 1 in the fair value hierarchy, upon the initial public offering of the investee.
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Financial Instruments Not Measured at Fair Value
In addition to the financial instruments that we are required to recognize at fair value in the condensed consolidated balance sheets, we have certain financial instruments that are recognized at amortized cost or some basis other than fair value. For these financial instruments, the following table provides the values recognized in the condensed consolidated balance sheets and the estimated fair values as of September 30, 2022 and December 31, 2021.

| Book values |  | Fair values(a)
(in millions) | 2022 | 2021 |  | 2022 | 2021
Liabilities |  |  |  |  |
Short-term debt | $ | 275 |  | $ | 301 |  |  | $ | 275 |  | $ | 301 |
Current maturities of long-term debt and finance lease obligations | 4 |  | 210 |  |  | 4 |  | 212 |
Long-term debt and finance lease obligations | 16,153 |  | 17,149 |  |  | 14,402 |  | 17,568 |

(a) These fair value amounts are classified as Level 2 within the fair value hierarchy as they are estimated based on observable inputs.
The carrying value of short-term debt approximates its fair value due to the short-term maturities of the obligations. The estimated fair values of current and long-term debt were computed by multiplying price by the notional amount of the respective debt instruments. Price is calculated using the stated terms of the respective debt instrument and yield curves commensurate with our credit risk. The carrying values of other financial instruments, such as accounts receivable and accounts payable, approximate their fair values due to the short-term maturities of most of those assets and liabilities.
Equity investments not measured at fair value are comprised of other equity investments without readily determinable fair values and were $102 million as of September 30, 2022 and $114 million as of December 31, 2021. Those investments are included in Other non-current assets on our condensed consolidated balance sheets.
16. SEGMENT INFORMATION
We manage our business based on four segments, consisting of the following geographic segments related to our legacy Baxter business: Americas (North and South America), EMEA (Europe, Middle East and Africa) and APAC (Asia Pacific), and a new global segment for the acquired Hillrom business. The Americas, EMEA and APAC segments provide a broad portfolio of essential healthcare products, including acute and chronic dialysis therapies; sterile IV solutions; infusion systems and devices; parenteral nutrition therapies; inhaled anesthetics; generic injectable pharmaceuticals; and surgical hemostat and sealant products. The Hillrom segment provides digital and connected care solutions and collaboration tools, including smart bed systems, patient monitoring and diagnostic technologies, respiratory health devices, and advanced equipment for the surgical space.
We use operating income on a segment basis to make resource allocation decisions and assess the ongoing performance of our business segments. Intersegment sales are eliminated in consolidation.
Certain items are maintained at Corporate and are not allocated to a segment. They primarily include corporate headquarters costs, certain R&D costs, manufacturing variances and centrally managed supply chain costs, product category support costs, stock compensation expense, certain employee benefit plan costs, and certain gains, losses, and other charges (such as business optimization, acquisition and integration costs, intangible asset amortization and asset impairments). For the period from our acquisition of Hillrom on December 13, 2021 through December 31, 2021, we previously included all costs incurred by the Hillrom business within that segment, including the types of costs described in the preceding sentence that are maintained at Corporate for our legacy Baxter segments. In connection with our ongoing integration activities, beginning in the first quarter 2022, we have updated the measure of profitability for our Hillrom segment by excluding such unallocated costs, consistent with our legacy Baxter segments. Those unallocated costs related to Hillrom, which totaled $3.0 billion and $3.3 billion for the three and nine months ended September 30, 2022, respectively, and primarily related to goodwill and intangible asset impairments are now presented within Corporate as well.
Our chief operating decision maker does not receive any asset information by operating segment and, accordingly, we do not report asset information by operating segment.
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Financial information for our segments is as follows.

| Three months ended September 30, |  | Nine months ended September 30,
(in millions) | 2022 | 2021 |  | 2022 | 2021
Net sales: |  |  |  |  |
Americas | $ | 1,703 |  | $ | 1,727 |  |  | $ | 4,975 |  | $ | 4,911 |
EMEA | 692 |  | 779 |  |  | 2,129 |  | 2,300 |
APAC | 643 |  | 720 |  |  | 1,917 |  | 2,059 |
Hillrom | 735 |  | — |  |  | 2,205 |  | — |
Total net sales | $ | 3,773 |  | $ | 3,226 |  |  | $ | 11,226 |  | $ | 9,270 |
Operating income: |  |  |  |  |
Americas | $ | 588 |  | $ | 676 |  |  | $ | 1,765 |  | $ | 1,907 |
EMEA | 145 |  | 167 |  |  | 433 |  | 461 |
APAC | 152 |  | 166 |  |  | 459 |  | 456 |
Hillrom | 215 |  | — |  |  | 564 |  | — |
Total segment operating income | $ | 1,100 |  | $ | 1,009 |  |  | $ | 3,221 |  | $ | 2,824 |

The following is a reconciliation of segment operating income to income before income taxes per the condensed consolidated statements of income.

| Three months ended September 30, |  | Nine months ended September 30,
(in millions) | 2022 | 2021 |  | 2022 | 2021
Total segment operating income | $ | 1,100 |  | $ | 1,009 |  |  | $ | 3,221 |  | $ | 2,824 |
Corporate and other | (3,899) |  | (496) |  |  | (5,517) |  | (1,497) |
Total operating income (loss) | (2,799) |  | 513 |  |  | (2,296) |  | 1,327 |
Interest expense, net | 104 |  | 50 |  |  | 278 |  | 118 |
Other (income) expense, net | 63 |  | 12 |  |  | 3 |  | 15 |
Income (loss) before income taxes | $ | (2,966) |  | $ | 451 |  |  | $ | (2,577) |  | $ | 1,194 |

Refer to Note 9 for additional information on Net Sales by product category.
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Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
Refer to our Annual Report on Form 10-K for the year ended December 31, 2021 for management’s discussion and analysis of our financial condition and results of operations. The following is management’s discussion and analysis of our financial condition and results of operations for the three and nine months ended September 30, 2022 and 2021.
RESULTS OF OPERATIONS
On December 13, 2021, we completed our acquisition of all outstanding equity interests of Hill-Rom Holdings, Inc. (Hillrom) for a purchase price of $10.5 billion. Including the assumption of Hillrom’s outstanding debt, the enterprise value of the transaction was approximately $12.8 billion. While the current year periods include the results of operations and cash flows of Hillrom, the prior year periods do not as they preceded the acquisition date. In the third quarter of 2022, we recognized impairments of goodwill and certain indefinite-lived intangible assets that arose from the Hillrom acquisition. See Note 4, Goodwill and Other Intangible Assets, Net, of the accompanying condensed consolidated financial statements for additional information about those impairments.
Net income (loss) attributable to Baxter stockholders for the three and nine months ended September 30, 2022 totaled $(2,937) million, or $(5.83) per diluted share, and $(2,614) million, or $(5.20) per diluted share, compared to $450 million, or $0.89 per diluted share, and $1,046 million, or $2.06 per diluted share, for the three and nine months ended September 30, 2021. Net income (loss) for the three and nine months ended September 30, 2022 included special items which decreased net income by $3.4 billion and $3.9 billion, respectively, or $6.65 and $7.81 per diluted share, respectively, as further discussed below. Net income (loss) for the three and nine months ended September 30, 2021 included special items which decreased net income by $66 million and $265 million, respectively, or $0.13 and $0.52 per diluted share, respectively, as further discussed below.
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Special Items
The following table provides a summary of our special items and the related impact by line item on our results for the three and nine months ended September 30, 2022 and 2021.

| Three months ended September 30, |  | Nine months ended September 30,
(in millions) | 2022 | 2021 |  | 2022 | 2021
Gross Margin |  |  |  |  |
Intangible asset amortization expense | $ | (110) |  | $ | (68) |  |  | $ | (344) |  | $ | (199) |
Business optimization items 1 | (13) |  | (20) |  |  | (21) |  | (51) |
Acquisition and integration expenses 2 | 2 |  | (1) |  |  | (171) |  | (1) |
European medical devices regulation 3 | (12) |  | (11) |  |  | (35) |  | (30) |
Product-related items 5 | (20) |  | — |  |  | (43) |  | — |
Intangible asset impairments 6 | (332) |  | — |  |  | (332) |  | — |
Total Special Items | $ | (485) |  | $ | (100) |  |  | $ | (946) |  | $ | (281) |
Impact on Gross Margin Ratio | (12.9 pts) | (3.1 pts) |  | (8.5 pts) | (3.0 pts)
Selling, General and Administrative (SG&A) Expenses |  |  |  |  |
Intangible asset amortization expense | $ | 58 |  | $ | — |  |  | $ | 234 |  | $ | — |
Business optimization items 1 | 57 |  | 16 |  |  | 171 |  | 30 |
Acquisition and integration expenses 2 | 11 |  | 21 |  |  | 55 |  | 23 |
Investigation and related costs 4 | — |  | 3 |  |  | — |  | 31 |
Total Special Items | $ | 126 |  | $ | 40 |  |  | $ | 460 |  | $ | 84 |
Impact on SG&A Ratio | 3.3 pts | 1.3 pts |  | 4.1 pts | 0.9 pts
Research and Development (R&D) Expenses |  |  |  |  |
Business optimization items 1 | $ | 3 |  | $ | — |  |  | $ | 4 |  | $ | — |
Acquisition and integration expenses 2 | 1 |  | — |  |  | 1 |  | — |
Total Special Items | $ | 4 |  | $ | — |  |  | $ | 5 |  | $ | — |
Impact on R&D Ratio | 0.1 pts | 0.0 pts |  | 0.0 pts | 0.0 pts
Goodwill Impairments |  |  |  |  |
Goodwill impairments 6 | $ | 2,785 |  | $ | — |  |  | $ | 2,785 |  | $ | — |
Total Special Items | $ | 2,785 |  | $ | — |  |  | $ | 2,785 |  | $ | — |
Other Operating Expense (Income), net |  |  |  |  |
Loss on product divestiture arrangement 7 | $ | 54 |  | $ | — |  |  | $ | 54 |  | $ | — |
Acquisition and integration expenses 2 | (6) |  | (1) |  |  | (34) |  | (6) |
Total Special Items | $ | 48 |  | $ | (1) |  |  | $ | 20 |  | $ | (6) |
Interest Expense, net |  |  |  |  |
Acquisition and integration expenses 2 | $ | — |  | $ | 18 |  |  | $ | — |  | $ | 18 |
Total Special Items | $ | — |  | $ | 18 |  |  | $ | — |  | $ | 18 |
Other Income (Expense), net |  |  |  |  |
Pension curtailment 8 | $ | — |  | $ | — |  |  | $ | (11) |  | $ | — |
Reclassification of cumulative translation loss to earnings 9 | 65 |  | — |  |  | 65 |  | — |
Total Special Items | $ | 65 |  | $ | — |  |  | $ | 54 |  | $ | — |
Income Tax Expense |  |  |  |  |
Tax matters 10 | $ | — |  | $ | (58) |  |  | $ | — |  | $ | (36) |
Tax effects of special items 11 | (162) |  | (33) |  |  | (328) |  | (76) |
Total Special Items | $ | (162) |  | $ | (91) |  |  | $ | (328) |  | $ | (112) |
Impact on Effective Tax Rate | (22.7 pts) | (15.0 pts) |  | (22.2 pts) | (4.3 pts)

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Intangible asset amortization expense, which increased significantly from the prior year due to the Hillrom acquisition, is identified as a special item to facilitate an evaluation of current and past operating performance and is consistent with how management and our Board of Directors assess performance. Additional special items are identified above because they are highly variable, difficult to predict and of a size that may substantially impact our reported results of operations for the period. Management believes that providing the separate impact of those items may provide a more complete understanding and facilitate a fuller analysis of our results of operations, particularly in evaluating performance from one period to another.
1 In 2022 and 2021, our results were impacted by costs associated with our execution of programs to optimize our organization and cost structure. These actions included streamlining our international operations, rationalizing our manufacturing and distribution facilities, reducing our general and administrative infrastructure, re-aligning certain R&D activities and cancelling certain R&D programs. In the current period, restructuring charges include actions taken in connection with our integration of Hillrom, which we acquired in December 2021. Our results in 2022 included business optimization charges of $73 million in the third quarter and $196 million in the first nine months. Our results in 2021 included business optimization charges of $36 million in the third quarter and $81 million in the first nine months. Refer to Note 10 in Item 1 of this Quarterly Report on Form 10-Q for further information regarding these charges and related liabilities.
2 Our results in 2022 included $4 million in the third quarter and $193 million in the first nine months of acquisition and integration-related expenses. Those costs included $10 million in the third quarter and $227 million in the first nine months related to our acquisition of Hillrom, primarily reflecting $159 million of incremental costs of sales in the first nine months from the fair value step-ups on acquired Hillrom inventory that was sold in the first quarter. We have not incurred and we do not expect to incur significant incremental cost of sales from those inventory fair value step-ups beyond what was recognized in the first quarter 2022. Other integration expenses in the current period included third party consulting costs related to our integration and related cost savings activities. Those acquisition and integration-related expenses related to Hillrom were partially offset by a $6 million benefit in the third quarter and a $34 million benefit in the first nine months from changes in the estimated fair value of contingent consideration liabilities. Our results in 2021 included acquisition, integration and related financing expenses of $39 million in the third quarter and $36 million in the first nine months. This included acquisition, integration and related financing expenses for our acquisition of Hillrom and the acquisition to the rights to Caelyx and Doxil for specified territories outside of the U.S. These expenses were partially offset by benefits in the third quarter and first nine months from changes in the estimated fair value of contingent consideration liabilities. Refer to Note 2 in Item 1 of this Quarterly Report on Form 10-Q for further information regarding business development activities.
3 Our results in 2022 included $12 million in the third quarter and $35 million in the first nine months of costs related to updating our quality systems and product labeling to comply with the new medical device reporting regulation and other requirements of the European Union’s regulations for medical devices that became effective in stages beginning in 2021. Our results in 2021 included $11 million in the third quarter and $30 million in the first nine months of costs related to these requirements.
4 Our results in 2021 included charges of $3 million in the third quarter and $31 million in the first nine months for investigation and related cost for matters associated with our previously announced investigation of foreign exchange gains and losses. Refer to Note 6 in Item 1 of this Quarterly Report on Form 10-Q for further information regarding the investigation.
5 Our results in 2022 included charges of $20 million in the third quarter and $43 million in the first nine months related to warranty and remediation activities arising from two field corrective actions on certain of our infusion pumps.
6 Our results in 2022 included charges of $3.1 billion in the third quarter and first nine months for goodwill and indefinite-lived intangible asset impairments. Refer to Note 4 in Item 1 of this Quarterly Report on Form 10-Q for further information regarding the impairments.
7 Our results in 2022 included a loss of $54 million in the third quarter and first nine months under an arrangement to divest certain product rights for an amount that is less than our cost of those product rights, which was triggered by U.S. and European Union regulatory approvals of the related products. Refer to Note 2 in Item 1 of this Quarterly Report on Form 10-Q for further information about the related transactions.
8 Our results in 2022 included a curtailment gain of $11 million in the first nine months related to an announced change for active non-bargaining participants in our U.S. Hillrom pension plan.
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9 Our results in 2022 included a charge of $65 million in the third quarter and first nine months for cumulative translation adjustments (CTA) reclassified from accumulated other comprehensive income (loss) as a result of the substantial liquidation of our operations in Argentina.
10 Our results in the third quarter and first nine months of 2021 included a $58 million tax benefit related to a tax-deductible foreign statutory loss on an investment in a foreign subsidiary. Our results in the first nine months of 2021 also included a charge of $22 million related to an unfavorable court ruling for an uncertain tax position.
11 Reflected in this item is the income tax impact of the special items identified in this table. The tax effect of each special item is based on the jurisdiction in which the item was incurred and the tax laws in effect for each such jurisdiction.
FACTORS AFFECTING OUR RESULTS OF OPERATIONS
Risks and Uncertainties Related to COVID-19
Our global operations expose us to risks associated with public health crises and epidemics/pandemics, such as the novel strain of coronavirus (COVID-19). COVID-19 has had, and we expect will continue to have, an adverse impact on our operations, supply chains and distribution systems and has increased and we expect will continue to increase our expenses. Over the course of the pandemic, our business has been impacted by shifting healthcare priorities and significant volatility in the demand for our products. For further information about our revenues by product category, refer to Note 9 in Item 1 of this Quarterly Report on Form 10-Q. Significant uncertainty remains regarding the duration and overall impact of the COVID-19 pandemic. Concerns remain regarding the pace of economic recovery due to virus resurgence across the globe from the Omicron variants, subvariants and other virus mutations as well as vaccine distribution and hesitancy. The U.S. and other governments may continue existing measures or implement new restrictions and other requirements in light of the continuing spread of the pandemic (including with respect to moratoriums on elective procedures and mandatory quarantines and travel restrictions), resulting in higher levels of absenteeism, including at our manufacturing and distribution facilities. Due to the uncertainty caused by the pandemic, our operating performance and financial results, particularly in the short term, may be subject to volatility.
Supply Constraints, Global Economic Conditions
We have experienced significant challenges to our global supply chain in recent periods, including production delays and interruptions, increased costs and shortages of raw materials and component parts (including resins and electromechanical devices) and higher transportation costs, resulting from the pandemic and other exogenous factors including significant weather events, elevated inflation levels, disruptions to certain ports of call around the world, the war in Ukraine and other geopolitical events. We expect to experience some of these and other challenges related to our supply chain in future periods. These challenges, including the unavailability of certain raw materials and component parts, have also had a negative impact on our sales for certain product categories due to our inability to fully satisfy demand and may continue to have a negative impact on our sales in the future.
Our results of operations are also affected by macroeconomic conditions and levels of business confidence. The war in Ukraine and the sanctions and other measures being imposed in response to this conflict have increased the levels of economic and political uncertainty. In response, we continue to monitor the developing situation with respect to ongoing business in Russia and are working on appropriate contingency plans that will support our desire to serving existing, chronically ill patient populations while remaining compliant with all applicable U.S. and European Union sanctions and regulations. While Russia and Ukraine do not constitute a material portion of our business, a significant escalation or expansion of economic disruption or the conflict’s current scope could have an adverse effect on our business.
In addition, the existence of inflation in the United States and in many of the countries where we conduct business has resulted in, and may continue to result in, higher interest rates and capital costs, shipping costs, increased costs of labor, weakening exchange rates and other similar effects. We have experienced and may continue to experience inflationary increases in manufacturing costs and operating expenses as well as negative impacts from weakening exchange rates, caused by the COVID-19 pandemic or as a result of general macroeconomic factors, and may not be able to pass these cost increases on to our customers in a timely manner or at all, which could have a material adverse impact on our profitability and results of operations. Inflation may also cause our customers to reduce or delay orders for our products and services, which could have a material adverse impact on our sales and results of operations.
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In addition to acquisitions and organic reinvestment, we consistently look for opportunities to optimize our portfolio. As such, we may divest businesses, discontinue products or exit markets (in a manner consistent with our commitments to patient safety and quality) to create value and drive enhanced future performance in line with our strategic objectives.
Regulatory Environment
Our operations and products, and those of our customers, are subject to regulation globally by numerous government agencies. We, like other businesses in our industry, face challenges inherent in product development, including the potential inability to obtain and maintain regulatory approvals and registrations in the United States and abroad, which could preclude or delay commercialization of a product and increase development costs. New or changing laws and regulations, or changes in enforcement practices in response to requests from various regulatory authorities, could also affect our domestic and foreign operations. In particular, the U.S. and other countries may impose new requirements regarding registration, labeling or prohibited materials (including DEHP and polyvinyl chloride) that may require us to re-register products already on the market or change product formulations or otherwise impact our ability to market our products. Environmental laws, particularly with respect to the emission of greenhouse gases, are also becoming more stringent throughout the world. Product efficacy or safety concerns regarding products could result in regulatory action on the part of the FDA or foreign counterparts, declining sales and product liability claims, and damage to our reputation. For example, manufacturers across the pharmaceutical industry, including us, are evaluating their product portfolios for the potential presence or formation of nitrosamines.
We expect that these challenges and conditions, among other factors, may continue to have an adverse effect on our business.
For further discussion, please refer to Item 1A, "Risk Factors" in our Annual Report on Form 10-K for the fiscal year ended December 31, 2021.
NET SALES

| Three Months Ended September 30, |  | Percent change
(in millions) | 2022 | 2021 |  | At actual currency rates | At constant currency rates
United States | $ | 1,849 |  | $ | 1,319 |  |  | 40 | % | 40 | %
International | $ | 1,924 |  | 1,907 |  |  | 1 | % | 12 | %
Total net sales | $ | 3,773 |  | $ | 3,226 |  |  | 17 | % | 23 | %

| Nine Months Ended September 30, |  | Percent change
(in millions) | 2022 | 2021 |  | At actual currency rates | At constant currency rates
United States | $ | 5,370 |  | $ | 3,697 |  |  | 45 | % | 45 | %
International | $ | 5,856 |  | 5,573 |  |  | 5 | % | 13 | %
Total net sales | $ | 11,226 |  | $ | 9,270 |  |  | 21 | % | 26 | %

Our acquisition of Hillrom favorably impacted net sales by 23 and 24 percentage points during the third quarter and first nine months of 2022, respectively, compared to the prior year periods. Foreign currency unfavorably impacted net sales by 6 and 5 percentage points during the third quarter and first nine months of 2022, respectively, compared to the prior-year periods, principally due to the strengthening of the U.S. Dollar relative to the Euro, British Pound, Turkish Lira, Australian Dollar and Japanese Yen.
The comparisons presented at constant currency rates reflect local currency sales at the prior period’s foreign exchange rates. This measure provides information on the change in net sales assuming that foreign currency exchange rates had remained constant between the prior and the current period. We believe that the non-GAAP measure of change in net sales at constant currency rates, when used in conjunction with the U.S. GAAP measure of change in net sales at actual currency rates, may provide a more complete understanding and facilitate a fuller analysis of our results of operations, particularly in evaluating performance from one period to another.
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Product Category Net Sales Reporting
Upon our acquisition of Hillrom, we added three new product categories: Patient Support Systems, Front Line Care and Surgical Solutions. Our product categories include the following:
• Renal Care includes sales of our peritoneal dialysis (PD), hemodialysis (HD) and additional dialysis therapies and services.
• Medication Delivery includes sales of our intravenous (IV) therapies, infusion pumps, administration sets and drug reconstitution devices.
• Pharmaceuticals includes sales of our premixed and oncology drug platforms, inhaled anesthesia and critical care products and pharmacy compounding services.
• Clinical Nutrition includes sales of our parenteral nutrition (PN) therapies and related products.
• Advanced Surgery includes sales of our biological products and medical devices used in surgical procedures for hemostasis, tissue sealing and adhesion prevention.
• Acute Therapies includes sales of our continuous renal replacement therapies (CRRT) and other organ support therapies focused in the intensive care unit (ICU).
• BioPharma Solutions includes sales of contracted services we provide to various pharmaceutical and biopharmaceutical companies.
• Patient Support Systems includes sales of our connected care solutions: devices, software, communications and integration technologies and smart beds.
• Front Line Care includes sales of our integrated patient monitoring and diagnostic technologies to help diagnose, treat and manage a wide variety of illness and diseases, including respiratory therapy, cardiology, vision screening and physical assessment.
• Surgical Solutions includes sales of our surgical video technologies, tables, lights, pendants, precision positioning devices and other accessories.
• Other includes sales of other miscellaneous product and service offerings.
The following is a summary of net sales by product category:

| Three Months Ended September 30, |  | Percent change
(in millions) | 2022 | 2021 |  | At actual currency rates | At constant currency rates
Renal Care | $ | 942 |  | $ | 981 |  |  | (4) | % | 4 | %
Medication Delivery | 725 |  | 747 |  |  | (3) | % | (0) | %
Pharmaceuticals | 525 |  | 589 |  |  | (11) | % | (3) | %
Clinical Nutrition | 231 |  | 244 |  |  | (5) | % | 4 | %
Advanced Surgery | 247 |  | 249 |  |  | (1) | % | 6 | %
Acute Therapies | 158 |  | 185 |  |  | (15) | % | (9) | %
BioPharma Solutions | 172 |  | 206 |  |  | (17) | % | (10) | %
Patient Support Systems | 380 |  | — |  |  | N/A | N/A
Front Line Care | 279 |  | — |  |  | N/A | N/A
Surgical Solutions | 76 |  | — |  |  | N/A | N/A
Other | 38 |  | 25 |  |  | 52 | % | 56 | %
Total Baxter | $ | 3,773 |  | $ | 3,226 |  |  | 17 | % | 23 | %

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| Nine months ended September 30, |  | Percent change
(in millions) | 2022 | 2021 |  | At actual currency rates | At constant currency rates
Renal Care | $ | 2,767 |  | $ | 2,867 |  |  | (3) | % | 2 | %
Medication Delivery | 2,141 |  | 2,096 |  |  | 2 | % | 4 | %
Pharmaceuticals | 1,574 |  | 1,687 |  |  | (7) | % | (1) | %
Clinical Nutrition | 688 |  | 715 |  |  | (4) | % | 3 | %
Advanced Surgery | 738 |  | 722 |  |  | 2 | % | 7 | %
Acute Therapies | 519 |  | 580 |  |  | (11) | % | (7) | %
BioPharma Solutions | 491 |  | 524 |  |  | (6) | % | (0) | %
Patient Support Systems | 1,127 |  | — |  |  | N/A | N/A
Front Line Care | 855 |  | — |  |  | N/A | N/A
Surgical Solutions | 223 |  | — |  |  | N/A | N/A
Other | 103 |  | 79 |  |  | 30 | % | 33 | %
Total Baxter | $ | 11,226 |  | $ | 9,270 |  |  | 21 | % | 26 | %

Renal Care net sales decreased 4% in the third quarter and 3% in the first nine months of 2022, as compared to the prior-year periods. The decrease in the third quarter and first nine months was driven by an 8% and 5%, respectively, negative impact from foreign exchange rate changes, as compared to the prior-year periods, and lower in-center HD sales, partially offset by global patient growth in PD.
Medication Delivery net sales decreased 3% in the third quarter and increased 2% in the first nine months of 2022, as compared to the prior-year periods. The decrease in the third quarter was driven by a 3% negative impact from foreign exchange rates as compared to the prior-year period. The increase in the first nine months was driven by increased demand for IV administration sets and solutions, reflecting a recovery in hospital admission rates and surgical procedures. The first nine months of 2022 was also favorably impacted by lower U.S. customer rebates in the current year period. Those items were partially offset by lower sales of infusion pumps, a 2% negative impact in the first nine months of 2022 from foreign exchange rates as compared to the prior-year period and sales headwinds in China driven by COVID-related lockdowns. Supply chain constraints, including constraints related to the availability of semiconductor components and other components used in the production of our infusion pumps, and the fact that our new infusion pump platform has not yet received FDA clearance in the U.S. have contributed to lower sales of infusion pumps in the current year periods.
Pharmaceuticals net sales decreased 11% in the third quarter and 7% in the first nine months of 2022, as compared to the prior-year periods. The decrease in the third quarter and first nine months was primarily driven by a 8% and 6%, respectively, negative impact from foreign exchange rates, as compared to the prior-year periods. Additionally, pharmaceuticals net sales were adversely impacted by new market entrants increasing competition and supply constraints for certain molecules. Those items were partially offset by increased sales internationally for inhaled anesthesia products.
Clinical Nutrition net sales decreased 5% in the third quarter and 4% in the first nine months of 2022, as compared to the prior-year periods. The decrease in the third quarter and first nine months was driven by a 9% and 7%, respectively, negative impact from foreign exchange rate changes, as compared to the prior-year periods, and lower sales of vitamins resulting from ongoing supply constraints. Those decreases were partially offset by growth in the U.S. for our PN therapies and related products, including our PN multi-chamber bags.
Advanced Surgery net sales decreased 1% in the third quarter and increased 2% in the first nine months of 2022, as compared to the prior-year periods. The decrease in the third quarter was driven by a 7% negative impact from foreign exchange rate changes, as compared to the prior-year period, partially offset by continued recovery in surgical procedures. The increase in the first nine months was driven by the continued recovery in surgical procedures, particularly in EMEA, and benefits from competitor supply constraints, partially offset by a 5% negative impact from foreign exchange rates, as compared to the prior-year period.
Acute Therapies net sales decreased 15% in the third quarter and 11% in the first nine months of 2022, as compared to the prior-year periods. The decrease in the third quarter and first nine months was driven by lower COVID-related
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demand for our CRRT systems and a 6% and 4%, respectively, negative impact from foreign exchange rate changes, as compared to the prior-year periods.
BioPharma Solutions net sales decreased 17% in the third quarter and 6% in the first nine months of 2022, as compared to the prior-year periods. The decrease in the third quarter and first nine months includes a 7% and 6%, respectively, negative impact from foreign exchange rates, as compared to the prior-year periods. The decrease in the third quarter was also driven by lower sales from manufacturing services and supply packaging related to the production of COVID-19 vaccines on behalf of multiple pharmaceutical companies, reflecting a challenging comparison against a strong prior-year period.
The Patient Support Systems, Front Line Care and Surgical Solutions product categories were added in connection with our acquisition of Hillrom in December of 2021. Net sales of those product categories have been adversely impacted in the current year periods by ongoing supply chain constraints, particularly related to components used in our Front Line Care product offerings, and by delays in product installations for Patient Support Systems and Surgical Solutions resulting from limitations on hospital access due, in part, to staffing challenges being experienced by those customers.
Gross Margin and Expense Ratios

| Three months ended September 30,
| 2022 | % of net sales | 2021 | % of net sales | $ change | % change
Gross margin | $ | 1,133 |  | 30.0 | % | $ | 1,321 |  | 40.9 | % | $ | (188) |  | (14.2) | %
SG&A | $ | 947 |  | 25.1 | % | $ | 680 |  | 21.1 | % | $ | 267 |  | 39.3 | %
R&D | $ | 152 |  | 4.0 | % | $ | 129 |  | 4.0 | % | $ | 23 |  | 17.8 | %

| Nine months ended September 30,
| 2022 | % of net sales | 2021 | % of net sales | $ change | % change
Gross margin | $ | 3,934 |  | 35.0 | % | $ | 3,699 |  | 39.9 | % | $ | 235 |  | 6.4 | %
SG&A | $ | 2,975 |  | 26.5 | % | $ | 1,982 |  | 21.4 | % | $ | 993 |  | 50.1 | %
R&D | $ | 450 |  | 4.0 | % | $ | 396 |  | 4.3 | % | $ | 54 |  | 13.6 | %

Gross Margin
The gross margin ratio was 30.0% and 35.0% in the third quarter and first nine months of 2022, respectively. The special items identified above had an unfavorable impact of approximately 12.9 and 8.5 percentage points on the gross margin ratio in the third quarter and first nine months of 2022, respectively. The gross margin ratio was 40.9% and 39.9% in the third quarter and first nine months of 2021, respectively. The special items identified above had an unfavorable impact of approximately 3.1 and 3.0 percentage points on the gross margin ratio in the third quarter and first nine months of 2021, respectively. Refer to the Special Items caption above for additional detail.
Excluding the impact of the special items, the gross margin ratio decreased in the third quarter and increased in the first nine months of 2022 compared to the prior-year periods. The decrease in the third quarter was primarily driven by raw materials inflation and increased supply chain costs, partially offset by a favorable product mix that was primarily driven by our acquisition of Hillrom and lower bonus accruals under our annual employee incentive compensation plans. The increase in the first nine months resulted from a favorable product mix that was that was primarily driven by our acquisition of Hillrom and lower bonus accruals under our annual employee incentive compensation plans, which exceeded the adverse impacts of raw materials inflation and increased supply chain costs for the year-to-date period.
SG&A
The SG&A expenses ratio was 25.1% and 26.5% in the third quarter and first nine months of 2022, respectively. The special items identified above had an unfavorable impact of approximately 3.3 and 4.1 percentage points on the SG&A expenses ratio in the third quarter and first nine months of 2022, respectively. The SG&A expenses ratio was 21.1% and 21.4% in the third quarter and first nine months of 2021, respectively. The special items identified above had an unfavorable impact of approximately 1.3 and 0.9 percentage points on the SG&A expenses ratio in the third quarter and first nine months of 2021, respectively. Refer to the Special Items caption above for additional detail.
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Excluding the impact of the special items, the SG&A expenses ratio increased in the third quarter and first nine months of 2022 compared to the prior-year periods primarily due to the acquisition of Hillrom and increased outbound freight costs, partially offset by lower bonus accruals under our annual employee incentive compensation plans.
R&D
The R&D expenses ratio was 4.0% in the third quarter and first nine months of 2022. The R&D expenses ratio was 4.0% and 4.3% in the third quarter and first nine months of 2021, respectively.
The R&D expenses ratio remained relatively flat in the third quarter and first nine months of 2022 compared to the prior-year periods, with the increase in total spend primarily driven by the Hillrom acquisition, partially offset by lower bonus accruals under our annual employee incentive compensation plans.
Business Optimization Items
In recent years, we have undertaken actions to transform our cost structure and enhance operational efficiency. These efforts include restructuring the organization, optimizing our manufacturing footprint, R&D operations and supply chain network, employing disciplined cost management, and centralizing and streamlining certain support functions. In the current year periods, restructuring charges include actions taken in connection with our integration of Hillrom. From the commencement of our business optimization actions in the second half of 2015 through September 30, 2022, we have incurred cumulative pre-tax costs of $1.4 billion related to these actions. The costs consisted primarily of employee termination costs, implementation costs, contract termination costs, asset impairments, and accelerated depreciation.
We currently expect to incur additional pre-tax costs, primarily related to the implementation of business optimization programs, of approximately $14 million through the completion of initiatives that are currently underway. We continue to pursue cost savings initiatives, including those related to our integration of Hillrom, and, to the extent further cost savings opportunities are identified, we would incur additional restructuring charges and costs to implement business optimization programs in future periods.
Goodwill Impairments
We assess goodwill and indefinite-lived intangible assets for impairment annually during the fourth quarter or whenever events or changes in circumstances indicate that the carrying amount of such assets may not be recoverable. We recognize a goodwill impairment charge for the amount by which a reporting unit's carrying amount exceeds its fair value.
As described above, we acquired Hillrom on December 13, 2021 and recognized $6.8 billion of goodwill and $6.0 billion of other intangible assets, including $1.9 billion of indefinite-lived intangible assets, in connection with that acquisition. Our Hillrom segment includes the following three reporting units: Patient Support Systems, Front Line Care and Surgical Solutions. During the third quarter of 2022, we performed trigger-based impairment tests of the goodwill of each of those three reporting units, as well as the indefinite-lived intangible assets, consisting primarily of trade names, that we acquired in connection with the Hillrom acquisition. We performed those tests as of September 30, 2022 due to (a) current macroeconomic conditions, including the rising interest rate environment and broad declines in equity valuations, and (b) reduced earnings forecasts for our three Hillrom reporting units, driven primarily by current shortages of certain component parts used in our products, raw materials inflation and increased supply chain costs. The impairment tests resulted in total pre-tax goodwill impairment charges of $2.8 billion in the third quarter of 2022, consisting of a $1.4 billion goodwill impairment for our Patient Support Systems reporting unit, a $1.0 billion goodwill impairment for our Front Line Care reporting unit and a $0.4 billion goodwill impairment for our Surgical Solutions reporting unit.
Further adverse changes to macroeconomic conditions or our earnings forecasts could lead to additional goodwill or intangible asset impairment charges in future periods and such charges could be material to our results of operations.
Other Operating Expense (Income), Net
Other operating expense (income), net was $48 million and $20 million in the third quarter and first nine months of 2022, respectively. The current year periods include a loss of $54 million under an arrangement to divest certain product rights for an amount that is less than our cost of those product rights, which was triggered by U.S. and European Union regulatory approvals of the related products. Refer to Note 2 in Item 1 of this Quarterly Report on
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Form 10-Q for further information about the related transactions. That loss was partially offset by gains from net decreases in the estimated fair values of contingent consideration liabilities of $6 million and $34 million in the third quarter and first nine months of 2022, respectively.
Other operating expense (income), net was $1 million and $6 million in the third quarter and first nine months of 2021, respectively, which consisted of gains from net decreases in the estimated fair values of contingent consideration liabilities.
Interest Expense, Net
Interest expense, net was $104 million and $278 million in the third quarter and first nine months of 2022, respectively, and $50 million and $118 million in the third quarter and first nine months of 2021, respectively. The increases in the third quarter and first nine months of 2022 were primarily driven by higher average debt outstanding in connection with the Hillrom acquisition.
Other (Income) Expense, Net
Other (income) expense, net was an expense of $63 million and $3 million in the third quarter and first nine months of 2022, respectively, and an expense of $12 million and $15 million in the third quarter and first nine months of 2021, respectively. The increases in the third quarter of 2022 compared to the prior year period was primarily due to the reclassification of a cumulative translation loss from accumulated other comprehensive income (loss) to earnings due to the substantial liquidation of our operations in Argentina, partially offset by pension benefits in the current-year period. The decrease in the first nine months of 2022 compared to the prior year was primarily due to foreign exchange gains in the current-year period versus losses in the prior-year period, pension benefits in the current-year period versus expenses in the prior-year period and a pension curtailment gain in the current-year period, partially offset by the reclassification of the Argentina cumulative translation loss to earnings.
Income Taxes
Our effective income tax rate was 1.1% and (0.2)% in the third quarter, and (1.1)% and 11.8% in the first nine months of 2022 and 2021, respectively. Our effective income tax rate can differ from the 21% U.S. federal statutory rate due to a number of factors, including foreign rate differences, tax incentives, non-deductible expenses, non-taxable income, increases or decreases in valuation allowances and liabilities for uncertain tax positions and excess tax benefits or shortfalls on stock compensation awards.
For the three and nine months ended September 30, 2022, the difference between our effective income tax rate and the U.S. federal statutory rate was primarily attributable to non-deductible goodwill impairments.
For the three months ended September 30, 2021, the difference between our effective income tax rate and the U.S. federal statutory rate was primarily attributable to a $58 million tax benefit related to a tax-deductible foreign statutory loss on an investment in a foreign subsidiary, as well as changes related to our ability to realize tax credit carryforwards based on a favorable tax ruling in a foreign jurisdiction.
For the nine months ended September 30, 2021, the difference between our effective income tax rate and the U.S. federal statutory rate was primarily attributable to a $58 million tax benefit related to a tax-deductible foreign statutory loss on an investment in a foreign subsidiary, as well as a favorable geographic earnings mix and changes related to our ability to realize tax credit carryforwards based on a favorable tax ruling in a foreign jurisdiction.
Segment Results
We manage our global operations based on four segments, consisting of the following geographic segments related to legacy Baxter business: Americas, EMEA and APAC, and a new global segment for our recently acquired Hillrom business. We use net sales and operating income on a segment basis to make resource allocation decisions and
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assess the ongoing performance of our segments. The following is a summary of financial information for our reportable segments:

| Net sales |  | Operating income (loss)
| Three months ended September 30, |  | Nine months ended September 30, |  | Three months ended September 30, |  | Nine months ended September 30,
(in millions) | 2022 | 2021 |  | 2022 | 2021 |  | 2022 | 2021 |  | 2022 | 2021
Americas | $ | 1,703 |  | $ | 1,727 |  |  | $ | 4,975 |  | $ | 4,911 |  |  | $ | 588 |  | $ | 676 |  |  | $ | 1,765 |  | $ | 1,907 |
EMEA | 692 |  | 779 |  |  | 2,129 |  | 2,300 |  |  | 145 |  | 167 |  |  | 433 |  | 461 |
APAC | 643 |  | 720 |  |  | 1,917 |  | 2,059 |  |  | 152 |  | 166 |  |  | 459 |  | 456 |
Hillrom | 735 |  | — |  |  | 2,205 |  | — |  |  | 215 |  | — |  |  | 564 |  | — |
Total segments | 3,773 |  | 3,226 |  |  | 11,226 |  | 9,270 |  |  | 1,100 |  | 1,009 |  |  | 3,221 |  | 2,824 |
Corporate and other | — |  | — |  |  | — |  | — |  |  | (3,899) |  | (496) |  |  | (5,517) |  | (1,497) |
Total | $ | 3,773 |  | $ | 3,226 |  |  | $ | 11,226 |  | $ | 9,270 |  |  | $ | (2,799) |  | $ | 513 |  |  | $ | (2,296) |  | $ | 1,327 |

Americas
Segment net sales and operating income were $1.7 billion and $588 million, respectively, in the third quarter and $5.0 billion and $1.8 billion, respectively, in the first nine months of 2022. Segment net sales and operating income were $1.7 billion and $676 million, respectively, in the third quarter and $4.9 billion and $1.9 billion, respectively, in the first nine months of 2021. The decrease in operating income in the third quarter of 2022 was due to higher supply chain costs and lower sales in our BioPharma Solutions, Pharmaceuticals and Acute Therapies product categories, partially offset by higher sales in our Renal Care and Advanced Surgery product categories. The decrease in operating income in the first nine months of 2022 was due to raw materials inflation, higher supply chain costs and lower sales in our Pharmaceuticals, Acute Therapies and BioPharma Solutions product categories, partially offset by higher sales in our Medication Delivery, Renal Care and Advanced Surgery product categories.
EMEA
Segment net sales and operating income were $692 million and $145 million, respectively, in the third quarter and $2.1 billion and $433 million, respectively, in the first nine months of 2022. Segment net sales and operating income were $779 million and $167 million, respectively, in the third quarter and $2.3 billion and $461 million, respectively, in the first nine months of 2021. The decrease in operating income in the third quarter and first nine months of 2022 was primarily due to an unfavorable impact of foreign exchange rates on results as compared to the prior-year period, lower sales in our Acute Therapies and BioPharma Solutions product categories and higher supply chain costs, partially offset by lower operating expenses and improved gross margin, driven by a favorable product mix. For the first nine months of 2022, the decrease in operating income was partially offset by having a full nine months of sales from our February 2021 acquisition of the rights to Caelyx and Doxil for specified territories outside the U.S.
APAC
Segment net sales and operating income were $643 million and $152 million, respectively, in the third quarter and $1.9 billion and $459 million, respectively, in the first nine months of 2022. Segment net sales and operating income were $720 million and $166 million, respectively, in the third quarter and $2.1 billion and $456 million, respectively, in the first nine months of 2021. The decrease in operating income in the third quarter of 2022 was driven by the unfavorable impact of foreign exchange rates on results as compared to the prior-year period. The increase in operating income in the first nine months of 2022 was due to lower operating expenses and an improved gross margin, driven by a favorable product mix, partially offset by the unfavorable impact of foreign exchange rates on results as compared to the prior-year period, higher supply chain costs and sales headwinds in China driven by COVID-related lockdowns.
Hillrom
Segment net sales and operating income were $735 million and $215 million, respectively, in the third quarter and $2.2 billion and $564 million, respectively, in the first nine months of 2022. The increases in net sales and operating income in the third quarter and first nine months of 2022, from zero in the prior year periods, were due to our acquisition of Hillrom in December 2021.
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Corporate and Other
Certain items are maintained at Corporate and are not allocated to a segment. They primarily include corporate headquarters costs, certain R&D costs, manufacturing variances and centrally managed supply chain costs, product category support costs, stock compensation expense, certain employee benefit plan costs, and certain gains, losses, and other charges (such as business optimization, acquisition and integration costs, intangible asset amortization and asset impairments). For the period from our acquisition of Hillrom on December 13, 2021 through December 31, 2021, we previously included all costs incurred by the Hillrom business within that segment, including the types of costs described in the preceding sentence that are maintained at Corporate for our legacy Baxter segments. In connection with our ongoing integration activities, beginning in the first quarter 2022, we have updated the measure of profitability for our Hillrom segment by excluding such unallocated costs, consistent with our legacy Baxter segments. Those unallocated costs related to Hillrom, which totaled $3.0 billion and $3.3 billion for the three and nine months ended September 30, 2022, respectively, are now presented within Corporate as well.
The Corporate operating loss in the third quarter was significantly higher than the prior-year period primarily due to goodwill and intangible asset impairments, higher intangible asset amortization expense, acquisition and integration-related expenses and business optimization charges and increased manufacturing variances and centrally managed supply chain costs, partially offset by lower bonus accruals under our annual employee incentive compensation plans.
LIQUIDITY AND CAPITAL RESOURCES
The following table is a summary of the statement of cash flows for the nine-month periods ended September 30, 2022 and 2021.

| Nine months ended September 30,
(in millions) | 2022 |  | 2021
Cash flows from operations | $ | 772 |  |  | $ | 1,529 |
Cash flows from investing activities | (675) |  |  | (933) |
Cash flows from financing activities | (1,319) |  |  | (1,031) |

Cash Flows from Operations
In the first nine months of 2022, cash provided by operating activities was $772 million, as compared to cash provided by operating activities of $1.5 billion in the first nine months of 2021, a decrease of $757 million. The decrease was primarily due to a decrease in our net income in 2022, increases in inventory levels and higher annual payouts under our employee incentive compensation plans in the current year period compared to the prior year period.
Cash Flows from Investing Activities
In the first nine months of 2022, cash used for investing activities included payments for acquisitions and investments of $206 million, primarily related to our payment to acquire the rights to Zosyn, and capital expenditures of $479 million. In the first nine months of 2021, cash used for investing activities included payments for acquisitions and investments of $463 million, primarily related to Caelyx and Doxil, Transderm Scop and PerClot Polysaccharide Hemostatic System (PerClot), and capital expenditures of $508 million. See Note 2 in Item 1 of this Quarterly Report on Form 10-Q for further information regarding business development activities.
Cash Flows from Financing Activities
In the first nine months of 2022, cash used in financing activities included debt repayments of $953 million and dividend payments of $427 million, partially offset by a net increase in commercial paper borrowings of $30 million and proceeds from stock issued under employee benefit plans of $114 million. In the first nine months of 2021, cash used for financing activities included payments for treasury stock repurchases of $600 million, debt repayments of $407 million and dividend payments of $390 million, partially offset by proceeds from stock issued under employee benefit plans of $135 million and the net proceeds from commercial paper borrowings of $300 million.
As authorized by our Board of Directors, we repurchase our stock depending upon our cash flows, net debt levels and market conditions. In July 2012, our Board of Directors authorized the repurchase of up to $2.0 billion of our common stock. Our Board of Directors increased this authority by an additional $1.5 billion in each of November 2016 and February 2018, by an additional $2.0 billion in November 2018 and by an additional $1.5 billion in October 2020.
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During the first nine months of 2022, we repurchased 0.5 million shares under this authority pursuant to a Rule 10b5-1 plan. We had $1.3 billion remaining available under this authorization as of September 30, 2022.
Credit Facilities and Access to Capital and Credit Ratings
Credit Facilities
As of September 30, 2022, our U.S. dollar-denominated revolving credit facility and Euro-denominated revolving credit facility had a maximum capacity of $2.5 billion and €200 million, respectively. There were no borrowings outstanding under these credit facilities as of September 30, 2022 or December 31, 2021. Our commercial paper borrowing arrangements require us to maintain undrawn borrowing capacity under our credit facilities for an amount at least equal to our outstanding commercial paper borrowings.
As of September 30, 2022, we were in compliance with the financial covenants in these agreements. In the third quarter of 2022, we amended the credit agreement governing our U.S. dollar-denominated revolving credit facility and the guaranty agreement with respect to our Euro-denominated revolving credit facility, in each case to delay the commencement of our net leverage ratio covenant step-down schedule until June 30, 2024. The non-performance of any financial institution supporting either of the credit facilities would reduce the maximum capacity of these facilities by the institution’s respective commitment.
Access to Capital and Credit Ratings
We intend to fund short-term and long-term obligations as they mature through cash on hand, future cash flows from operations or by issuing additional debt. We had $1.6 billion of cash and cash equivalents as of September 30, 2022, with adequate cash available to meet operating requirements in each jurisdiction in which we operate. We invest our excess cash in money market and other funds and diversify the concentration of cash among different financial institutions. As of September 30, 2022, we had approximately $16.4 billion of long-term debt and finance lease obligations, including current maturities, and short-term debt. Subject to market conditions, we regularly evaluate opportunities with respect to our capital structure.
Our ability to generate cash flows from operations, issue debt or enter into other financing arrangements on acceptable terms could be adversely affected if there is a material decline in the demand for our products or in the solvency of our customers or suppliers, deterioration in our key financial ratios or credit ratings or other significantly unfavorable changes in conditions, including global economic conditions. However, we believe we have sufficient financial flexibility to issue debt, enter into other financing arrangements and attract long-term capital on acceptable terms to support our growth objectives. Although our outlook was downgraded from stable to negative by two of the rating agencies during the third quarter of 2022, there have been no changes to our investment grade credit ratings that we disclosed in our 2021 Annual Report.
LIBOR Reform
In 2017, the United Kingdom’s Financial Conduct Authority announced that after 2021 it would no longer compel banks to submit the rates required to calculate the London Interbank Offered Rate (LIBOR) and other interbank offered rates, which have been widely used as reference rates for various securities and financial contracts, including loans, debt and derivatives. This announcement indicated that the continuation of LIBOR on the current basis was not guaranteed after 2021. Regulators in the U.S. and other jurisdictions have been working to replace these rates with alternative reference interest rates that are supported by transactions in liquid and observable markets, such as the Secured Overnight Financing Rate (SOFR). In 2020, it was announced that certain U.S. dollar LIBOR tenors would not cease until 2023. In September 2022, our $2.5 billion U.S. dollar-denominated revolving credit facility and our $4.0 billion Term Loan Credit Agreement were amended to reference SOFR-based rates. Currently, our €200 million Euro-denominated revolving credit facility references LIBOR-based rates. The discontinuation of LIBOR will require this arrangement to be modified in order to replace LIBOR with an alternative reference interest rate, which could impact our cost of funds. That credit facility agreement includes provisions related to the determination of a successor LIBOR rate.
CRITICAL ACCOUNTING POLICIES
The preparation of financial statements in accordance with U.S. GAAP requires management to make estimates and judgments that affect the reported amounts of assets, liabilities, revenues and expenses. A summary of our significant accounting policies is included in Note 1 to our consolidated financial statements in our 2021 Annual Report. Certain
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of our accounting policies are considered critical, as these policies are the most important to the depiction of our financial statements and require significant, difficult or complex judgments by us, often employing the use of estimates about the effects of matters that are inherently uncertain. Such policies are summarized in the Management’s Discussion and Analysis of Financial Condition and Results of Operations section in our 2021 Annual Report. We identified the Valuation of Intangible Assets, Including IPR&D, as one of our critical accounting policies in our 2021 Annual Report. We currently consider the valuation of goodwill to be a part of that critical accounting policy.
Goodwill is initially measured as the excess of the purchase price over the fair value (or other measurement attribute required by U.S. GAAP) of acquired assets and liabilities in a business combination. Goodwill is not amortized but is subject to an impairment review annually and whenever indicators of impairment exist. We have the option to assess goodwill for impairment by initially performing a qualitative assessment to determine whether it is more-likely-than-not that the fair value of a reporting unit is less than its carrying amount. If we determine that it is not more-likely-than-not that the fair value of a reporting unit is less than its carrying amount, then the quantitative goodwill impairment test is not required to be performed. If we determine that it is more-likely-than-not that the fair value of a reporting unit is less than its carrying amount, or if we do not elect the option to perform an initial qualitative assessment, we perform a quantitative goodwill impairment test. In the quantitative impairment test, we calculate the estimated fair value of the reporting unit. If the carrying amount of the reporting unit exceeds the estimated fair value, an impairment charge is recorded for the amount that the reporting unit’s carrying amount, including goodwill, exceeds its fair value, limited to the total amount of goodwill allocated to that reporting unit. In a quantitative goodwill impairment test, the fair values of our reporting units are generally determined based on a discounted cash flow model (an income approach) and earnings multiples (a market approach). Significant inputs to reporting unit fair value measurements generally include forecasted cash flows, discount rates, terminal growth rates and earnings multiples. Each of those inputs can significantly affect the fair values of our reporting units. During the third quarter of 2022, we recognized $2.8 billion of goodwill impairment charges and $332 million of indefinite-lived intangible asset impairment charges. See Note 4, Goodwill and Other Intangible Assets, Net in Item 1 of this Quarterly Report on Form 10-Q for further information about those impairments.
There have been no other updates to our critical accounting policies and no significant changes in the application of our critical accounting policies during the first nine months of 2022.
RECENT ACCOUNTING PRONOUNCEMENTS
In June 2022, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update (ASU) 2022-03, Fair Value Measurement (Topic 820): Fair Value Measurement of Equity Securities Subject to Contractual Sales Restrictions, which (1) clarifies the guidance in Topic 820 on the fair value measurement of an equity security that is subject to contractual restrictions that prohibit the sale of an equity security and (2) requires specific disclosures related to such an equity security. The standard is effective for our financial statements beginning in 2024. The impact of the adoption of this ASU is not expected to have a material effect on our condensed consolidated financial statements.
LEGAL CONTINGENCIES
Refer to Note 6 within Item 1 for a discussion of our legal contingencies. Upon resolution of any of these uncertainties, we may incur charges in excess of presently established liabilities. While our liability in connection with certain claims cannot be estimated with any certainty, and although the resolution in any reporting period of one or more of these matters could have a significant impact on our results of operations and cash flows for that period, the outcome of these legal proceedings is not expected to have a material adverse effect on our consolidated financial position. While we believe that we have valid defenses in these matters, litigation is inherently uncertain, excessive verdicts do occur, and we may in the future incur material judgments or enter into material settlements of claims.
CERTAIN REGULATORY MATTERS
The U.S. Food and Drug Administration (FDA) commenced an inspection of Claris’ facilities in Ahmedabad, India in July 2017, immediately prior to the closing of our acquisition of Claris Injectables Limited (Claris). FDA completed the inspection and subsequently issued a Warning Letter based on observations identified in the 2017 inspection (Claris Warning Letter).1 FDA re-inspected the facilities and issued a Form 483 on May 17, 2022. On September 1, 2022, FDA notified the company that the inspection had been classified as voluntary action indicated (VAI). Since the issuance of the Claris Warning Letter, we have implemented corrective and preventive actions to address FDA’s prior
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observations and other items we identified and management has begun working with other manufacturing locations, including contract manufacturing organizations, to support the production of new products for distribution in the U.S.
1 Available online at https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm613538.htm
FORWARD-LOOKING INFORMATION
This quarterly report on Form 10-Q includes forward-looking statements. Use of the words “may,” “will,” “would,” “could,” “should,” “believes,” “estimates,” “projects,” “potential,” “expects,” “plans,” “seeks,” “intends,” “evaluates,” “pursues,” “anticipates,” “continues,” “designs,” “impacts,” “affects,” “forecasts,” “target,” “outlook,” “initiative,” “objective,” “designed,” “priorities,” “goal,” or the negative of those words or other similar expressions is intended to identify forward-looking statements that represent our current judgment about possible future events. These forward-looking statements may include statements with respect to accounting estimates and assumptions, impacts of the COVID-19 pandemic and global economic conditions, litigation-related matters including outcomes, impacts of the internal investigation related to foreign exchange gains and losses, future regulatory filings and our R&D pipeline, strategic objectives, sales from new product offerings, credit exposure to foreign governments, potential developments with respect to credit ratings, investment of foreign earnings, estimates of liabilities including those related to uncertain tax positions, contingent payments, future pension plan contributions, costs, discount rates and rates of return, our exposure to financial market volatility and foreign currency and interest rate risks, the impact of competition, future sales growth, business development activities (including the acquisitions of Cheetah, Seprafilm, certain outside of the U.S. (OUS) rights to Caelyx and Doxil, full U.S. and specific OUS rights to Transderm Scop, PerClot, Hillrom and certain rights to Zosyn in the U.S. and Canada), business optimization and portfolio rationalization initiatives, cost saving initiatives, future capital and R&D expenditures, future debt issuances, manufacturing expansion, the adequacy of credit facilities, tax provisions and reserves, the effective tax rate and all other statements that do not relate to historical facts.
These forward-looking statements are based on certain assumptions and analyses made in light of our experience and perception of historical trends, current conditions, and expected future developments as well as other factors that we believe are appropriate in the circumstances. While these statements represent our judgment on what the future may hold, and we believe these judgments are reasonable, these statements are not guarantees of any events or financial results. Whether actual future results and developments will conform to expectations and predictions is subject to a number of risks and uncertainties, including the following factors, many of which are beyond our control:

| • | demand for and market acceptance risks for and competitive pressures related to new and existing products (including challenges with our ability to accurately predict changing customer preferences, which has led to and may continue to lead to increased inventory levels, and needs and advances in technology and the resulting impact on customer inventory levels and the impact of reduced hospital admission rates and elective surgery volumes), and the impact of those products on quality and patient safety concerns;

| • | the continuity, availability and pricing of acceptable raw materials and component parts (and our ability to pass some or all of these costs on to our customers), and the related continuity of our manufacturing and distribution (including impacts from COVID-19) and those of our suppliers;
| • | inability to create additional production capacity in a timely manner or the occurrence of other manufacturing, sterilization or supply difficulties (including as a result of natural disaster, public health crises and epidemics/pandemics, regulatory actions or otherwise);
| • | product development risks, including satisfactory clinical performance and obtaining required regulatory approvals (including as a result of evolving regulatory requirements), the ability to manufacture at appropriate scale, and the general unpredictability associated with the product development cycle;

| • | our ability to finance and develop new products or enhancements on commercially acceptable terms or at all;

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| • | the impact of global economic conditions (including, among other things, the ongoing war in Ukraine, the related economic sanctions being imposed globally in response to the conflict and potential trade wars and global inflationary pressures) and continuing public health crises, pandemics and epidemics, such as the ongoing COVID-19 pandemic, on us and our employees, customers and suppliers, including foreign governments in countries in which we operate;

| • | our ability to identify business development, portfolio rationalization and growth opportunities and to successfully execute on these strategies (including the Hillrom acquisition and related integration and restructuring activities);

| • | product quality or patient safety issues, leading to product recalls, withdrawals, launch delays, warning letters, import bans, sanctions, seizures, litigation, or declining sales, including the focus on evaluating product portfolios for the potential presence or formation of nitrosamines;

| • | breaches or failures of our information technology systems or products, including by cyber-attack, data leakage, unauthorized access or theft (as a result of increased remote working arrangements or otherwise);

| • | future actions of (or failures to act or delays in acting by) FDA, the European Medicines Agency or any other regulatory body or government authority (including the SEC, DOJ or the Attorney General of any State) that could delay, limit or suspend product development, manufacturing or sale or result in seizures, recalls, injunctions, monetary sanctions or criminal or civil liabilities, including the continued delay in lifting the warning letter at our Ahmedabad facility;

| • | failures with respect to our quality, compliance or ethics programs;

| • | future actions of third parties, including third-party payers and our customers and distributors (including group purchasing organizations and formed integrated delivery networks), the impact of healthcare reform and its implementation, suspension, repeal, replacement, amendment, modification and other similar actions undertaken by the United States or foreign governments, including with respect to pricing, reimbursement, taxation and rebate policies; legislation, regulation and other governmental pressures in the United States or globally, including the cost of compliance and potential penalties for purported noncompliance thereof, all of which may affect pricing, reimbursement, taxation and rebate policies of government agencies and private payers or other elements of our business, including new or amended laws, rules and regulations (such as the California Consumer Privacy Act of 2018, the European Union’s General Data Protection Regulation and proposed regulatory changes of the U.S. Department of Health and Human Services in kidney health policy and reimbursement, which may substantially change the U.S. end stage renal disease market and demand for our peritoneal dialysis products, necessitating significant multi-year capital expenditures, which are difficult to estimate in advance);

| • | the outcome of pending or future litigation, including the opioid litigation and ethylene oxide litigation or other claims;
| • | failure to achieve our short- and long-term financial goals;

| • | the impact of competitive products and pricing, including generic competition, drug reimportation and disruptive technologies;

| • | global regulatory, trade and tax policies (including with respect to climate change and other sustainability matters);

| • | the ability to protect or enforce our owned or in-licensed patent or other proprietary rights (including trademarks, copyrights, trade secrets and know-how) or patents of third parties preventing or restricting our manufacture, sale or use of affected products or technology;

| • | the impact of any goodwill or other intangible asset impairments on our operating results;

| • | fluctuations in foreign exchange and interest rates;

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| • | any changes in law concerning the taxation of income (whether with respect to current or future tax reform), including income earned outside the United States and potential taxes associated with the Base Erosion and Anti-Abuse Tax or the Build Back Better framework;

| • | actions by tax authorities in connection with ongoing tax audits;

| • | loss of key employees, the occurrence of labor disruptions or the inability to identify and recruit new employees;

| • | other factors identified elsewhere in this report and other filings with the SEC, including those factors described in Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2021, all of which are available on our website.

Actual results may differ materially from those projected in the forward-looking statements. We do not undertake to update our forward-looking statements.
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Item 3. Quantitative and Qualitative Disclosures About Market Risk
Currency Risk
We are primarily exposed to foreign exchange risk with respect to revenues generated outside of the United States denominated in the Euro, British Pound, Chinese Renminbi, Korean Won, Australian Dollar, Canadian Dollar, Japanese Yen, Colombian Peso, Brazilian Real, Mexican Peso, Indian Rupee and Swedish Krona. We manage our foreign currency exposures on a consolidated basis, which allows us to net exposures and take advantage of any natural offsets. In addition, we use derivative and nonderivative financial instruments to further reduce the net exposure to foreign exchange. Gains and losses on the hedging instruments offset losses and gains on the hedged transactions and reduce the earnings and stockholders’ equity volatility relating to foreign exchange. However, we don't hedge our entire foreign exchange exposure and are still subject to earnings and stockholders' equity volatility relating to foreign exchange risk. Financial market and currency volatility may limit our ability to cost-effectively hedge these exposures.
We use options and forwards to hedge the foreign exchange risk to earnings relating to forecasted transactions and recognized assets and liabilities denominated in foreign currencies. The maximum term over which we have cash flow hedge contracts in place related to foreign exchange risk on forecasted transactions as of September 30, 2022 is 12 months. We also enter into derivative instruments to hedge foreign exchange risk on certain intra-company and third-party receivables and payables and debt denominated in foreign currencies.
As part of our risk-management program, we perform sensitivity analyses to assess potential changes in the fair value of our foreign exchange instruments relating to hypothetical and reasonably possible near-term movements in foreign exchange rates.
A sensitivity analysis of changes in the fair value of foreign exchange contracts outstanding as of September 30, 2022, while not predictive in nature, indicated that if the U.S. Dollar uniformly weakened by 10% against all currencies, the net pre-tax asset balance of $26 million with respect to those contracts would change by $70 million.
The sensitivity analysis model recalculates the fair value of the foreign exchange contracts outstanding as of September 30, 2022 by replacing the actual exchange rates as of September 30, 2022 with exchange rates that are 10% weaker compared to the actual exchange rates for each applicable currency. All other factors are held constant. These sensitivity analyses disregard the possibility that currency exchange rates can move in opposite directions and that gains from one currency may or may not be offset by losses from another currency. The analyses also disregard the offsetting change in value of the underlying hedged transactions and balances.
In February 2022, the three-year cumulative inflation rate in Turkey exceeded 100 percent. As a result, on April 1, 2022, we began reporting the results of our subsidiary in that jurisdiction using highly inflationary accounting, which requires that the functional currency of the entity be changed to the reporting currency of its parent. As of September 30, 2022, our subsidiary in Turkey had net monetary assets of $40 million.
Interest Rate and Other Risks
Refer to the caption “Interest Rate and Other Risks” in the “Financial Instrument Market Risk” section of the 2021 Annual Report. There were no significant changes during the quarter ended September 30, 2022.
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Item 4. Controls and Procedures
Evaluation of Disclosure Controls and Procedures
Our management, with the participation of our Chief Executive Officer and our Chief Financial Officer, has evaluated the effectiveness of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934, as amended (the Exchange Act)) as of September 30, 2022. Based on that evaluation, our Chief Executive Officer and our Chief Financial Officer concluded that our disclosure controls and procedures were effective as of September 30, 2022.
Chan g es in Internal Control over Financial Reporting
In connection with our finance transformation and process optimization initiatives, during the quarter ended September 30, 2022 we transferred certain accounting and finance activities to new Baxter global business service centers located in Kuala Lumpur, Malaysia, and Warsaw, Poland. These transitions followed several months of knowledge transfer and training programs and included modifications to the design and operation of our internal controls over financial reporting in some cases. Additional transitions of accounting and finance activities to our global business service centers are planned over the coming year.
Except as described in the preceding paragraph, there have been no changes in our internal control over financial reporting (as such term is defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act) during the quarter ended September 30, 2022 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
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PART II. OTHER INFORMATION
Item 1. Legal Proceedings
The information in Part I, Item 1, Note 6 is incorporated herein by reference.
Item 1A. Risk Factors
We do not believe that there have been any material changes to the risk factors previously disclosed in our 2021 Annual Report.
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds

Period | Total number of shares purchased (1) | Average price paid per share | Total number of shares purchased as part of publicly announced program(1) | Approximate dollar value of shares that may yet be purchased under the program(1)
July 1, 2022 through July 31, 2022 | 375,000 |  | $ | 64.80 |  | 375,000 |  |
August 1, 2022 through August 31, 2022 | — |  | $ | — |  | — |  |
September 1, 2022 through September 30, 2022 | — |  | $ | — |  | — |  |
Total | 375,000 |  | $ | 64.80 |  | 375,000 |  | $ | 1,264,718,521 |

(1) In July 2012, we announced that our Board of Directors authorized us to repurchase up to $2.0 billion of our common stock on the open market or in private transactions. The Board of Directors increased this authority by an additional $1.5 billion in each of November 2016 and February 2018, by an additional $2.0 billion in November 2018 and by an additional $1.5 billion in October 2020. During the third quarter of 2022, we repurchased approximately 0.4 million shares for $24 million pursuant to this authority through a Rule 10b5-1 purchase plan. We had $1.3 billion remaining under this program as of September 30, 2022. This program does not have an expiration date.
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Item 6. Exhibits
Exhibit Index:

Exhibit Number |  | Description |
10.1 |  | First Amendment, dated as of September 28, 2022, to the Credit Agreement, dated as of September 30, 2021, among Baxter International Inc., as Borrower, JPMorgan Chase Bank, National Association, as Administrative Agent and certain other financial institutions named therein (incorporated by reference to Exhibit 10.1 to the Company's Current Report on Form 8-K, filed on September 30, 2022). |
10.2 |  | Second Amendment, dated as of September 28, 2022, to the Credit Agreement, dated as of September 30, 2021, as amended by the First Amendment, dated as of September 28, 2022, amount Baxter International Inc., as Borrower, JPMorgan Chase Bank, National Association, as Administrative Agent and certain other financial institutions named therein (incorporated by reference to Exhibit 10.2 to the Company's Current Report on Form 8-K, filed on September 30, 2022). |
10.3 |  | First Amendment, dated as of September 28, 2022, to the Five-Year Credit Agreement, dated as of September 30, 2021, among Baxter International Inc., as Borrower, JPMorgan Chase Bank, National Association, as Administrative Agent and certain other financial institutions named therein (incorporated by reference to Exhibit 10.3 to the Company's Current Report on Form 8-K, filed on September 30, 2022). |
10.4 |  | Second Amendment, dated as of September 28, 2022, to the Five-Year Credit Agreement, dated as of September 30, 2021, among Baxter International Inc., as Borrower, JPMorgan Chase Bank, National Association, as Administrative Agent and certain other financial institutions named therein (incorporated by reference to Exhibit 10.4 to the Company's Current Report on Form 8-K, filed on September 30, 2022). |
10.5 |  | Second Amendment, dated as of September 28, 2022, to the Credit Agreement, dated as of December 20, 2019, as amended by the First Amendment, dated as of October 1, 2021, among Baxter Healthcare SA and Baxter World Trade SRL, as Borrowers, JPMorgan SE, as Administrative Agent and certain other financial institutions named therein (incorporated by reference to Exhibit 10.5 to the Company's Current Report on Form 8-K, filed on September 30, 2022). |
31.1* |  | Certification of Chief Executive Officer Pursuant to Rules 13a-14 (a) and 15d-14(a) of the Securities Exchange Act of 1934, as amended. |
31.2* |  | Certification of Chief Financial Officer Pursuant to Rules 13a-14(a) and 15d-14(a) of the Securities Exchange Act of 1934, as amended. |
32.1* |  | Certification of Chief Executive Officer Pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. |
32.2* |  | Certification of Chief Financial Officer Pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. |
101.INS* |  | XBRL Instance Document |
101.SCH* |  | XBRL Taxonomy Extension Schema Document |
101.CAL* |  | XBRL Taxonomy Extension Calculation Linkbase Document |
101.LAB* |  | XBRL Taxonomy Extension Label Linkbase Document |
101.PRE* |  | XBRL Taxonomy Extension Presentation Linkbase Document |
101.DEF* |  | XBRL Taxonomy Extension Definition Linkbase Document |
104* |  | Cover Page Interactive Data File (formatted as Inline XBRL and contained within the Inline XBRL Instance Document in Exhibit 101) |

_____________________________________
* Filed herewith.
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Signature
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.

|  | BAXTER INTERNATIONAL INC.
|  | (Registrant)
Date: October 27, 2022 |  |
| By: | /s/ James K. Saccaro
|  | James K. Saccaro Executive Vice President and Chief Financial Officer (duly authorized officer and principal financial officer)

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