Annual report pursuant to Section 13 and 15(d)

CONSOLIDATED STATEMENTS OF CASH FLOWS

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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2019
Dec. 31, 2018
Dec. 31, 2017
Cash flows from operating activities:      
Net earnings $ 1,309 $ 894 $ 808
Adjustments to reconcile net earnings to net cash provided by operating activities      
Depreciation and amortization 643 495 361
Stock compensation expense 177 145 135
Goodwill and intangible impairment 271 0 0
Loss on debt extinguishment (30) 0 0
Deferred income taxes 55 (129) (108)
Changes in assets and liabilities      
Premium and trade receivables (1,076) (1,173) (50)
Other assets (234) (38) (146)
Medical claims liabilities 578 1,325 359
Unearned revenue (9) (52) 19
Accounts payable and accrued expenses (421) (533) 53
Other long-term liabilities 185 258 68
Other operating activities, net (25) 42 (10)
Net cash provided by operating activities 1,483 1,234 1,489
Cash flows from investing activities:      
Capital expenditures (730) (675) (422)
Purchases of investments (2,575) (3,846) (2,656)
Sales and maturities of investments 1,809 1,991 1,862
Acquisitions, net of cash acquired (36) (2,055) (50)
Other investing activities, net 0 0 12
Net cash used in investing activities (1,532) (4,585) (1,254)
Cash flows from financing activities:      
Proceeds from the issuance of common stock 0 2,779 0
Proceeds from borrowings 24,721 6,077 1,400
Payments of long-term debt (17,803) (4,083) (1,353)
Common stock repurchases (75) (71) (65)
Purchase of noncontrolling interest 0 (74) (66)
Contribution from noncontrolling interest 21 0 0
Payments for debt extinguishment (23) 0 0
Debt issue costs (25) (25) (3)
Other financing activities, net 16 9 5
Net cash provided by (used in) financing activities 6,832 4,612 (82)
Effect of exchange rate changes on cash, cash equivalents, and restricted cash (2) 0 0
Net increase in cash, cash equivalents, and restricted cash and equivalents 6,781 1,261 153
Cash, cash equivalents, and restricted cash and cash equivalents, beginning of period 5,350 4,089 3,936
Cash, cash equivalents, and restricted cash and cash equivalents, end of period 12,131 5,350 4,089
Supplemental disclosures of cash flow information:      
Interest paid 374 323 237
Income taxes paid 612 448 496
Equity issued in connection with acquisitions $ 0 $ 507 $ 0