Cash Flow Statement
Quarterly Data
The cash flow statement provides information about a company cash receipts and cash payments during an accounting period, showing how these cash flows link the ending cash balance to the beginning balance shown on the company balance sheet.
The cash flow statement consists of three parts: cash flows provided by (used in) operating activities, cash flows provided by (used in) investing activities, and cash flows provided by (used in) financing activities.
Based on: 10-K (reporting date: 2025-12-31), 10-Q (reporting date: 2025-09-30), 10-Q (reporting date: 2025-06-30), 10-Q (reporting date: 2025-03-31), 10-K (reporting date: 2024-12-31), 10-Q (reporting date: 2024-09-30), 10-Q (reporting date: 2024-06-30), 10-Q (reporting date: 2024-03-31), 10-K (reporting date: 2023-12-31), 10-Q (reporting date: 2023-09-30), 10-Q (reporting date: 2023-06-30), 10-Q (reporting date: 2023-03-31), 10-K (reporting date: 2022-12-31), 10-Q (reporting date: 2022-09-30), 10-Q (reporting date: 2022-06-30), 10-Q (reporting date: 2022-03-31), 10-K (reporting date: 2021-12-31), 10-Q (reporting date: 2021-09-30), 10-Q (reporting date: 2021-06-30), 10-Q (reporting date: 2021-03-31).
The cash flow statement reveals significant fluctuations across the observed period, spanning from March 2021 to December 2025. Overall cash flow from operating activities demonstrates considerable variability, with notable peaks and troughs. A period of strong positive operating cash flow is evident through September 2023, followed by a substantial decline and negative cash flow in the subsequent quarters.
- Net Earnings and Noncash Adjustments
- Net earnings exhibit a generally increasing trend from 2021 to September 2023, peaking at $6,038 million, before experiencing a dramatic decrease to a loss of $1,221 million in March 2024. Noncash items, including depreciation, amortization, share-based compensation, and deferred income taxes, consistently contribute positively to cash flow from operations, with a general upward trend in these adjustments over time. However, the impact of deferred income taxes is highly variable, swinging between positive and negative values.
- Working Capital Dynamics
- Changes in working capital components demonstrate substantial volatility. Accounts receivable show significant fluctuations, often negatively impacting cash flow, particularly in the earlier periods and again in March 2024. Medical costs payable and accounts payable generally contribute positively to cash flow, though with considerable quarterly variation. Unearned revenues exhibit particularly large swings, with a massive inflow in September 2022 ($10,641 million) followed by a substantial outflow in December 2022 (-$10,075 million), indicating potentially significant timing differences in revenue recognition. Other operating items also display large and inconsistent changes.
- Investing Activities
- Cash flows used for investing activities are consistently negative, primarily driven by purchases of investments and property, equipment, and capitalized software. Purchases of investments represent a substantial outflow throughout the period. Significant activity related to acquisitions, including substantial cash outlays in March 2024 ($7,086 million) and June 2024 ($1,225 million), and related dispositions are observed. The company also engages in lending activities to care providers, with associated repayments.
- Financing Activities
- Cash flows from financing activities are highly variable. Common share repurchases consistently represent a significant cash outflow, although they are absent in some quarters. Cash dividends paid also contribute to consistent negative cash flow. The company utilizes both debt issuance and repayment, with notable debt issuances in June 2021 ($6,934 million) and June 2022 ($5,922 million). Customer funds administered represent a significant and fluctuating component of financing cash flows, with substantial inflows and outflows throughout the period.
- Overall Cash Position
- The increase or decrease in cash and cash equivalents mirrors the volatility observed in operating and financing activities. Periods of strong positive operating cash flow, such as through September 2023, generally coincide with increases in cash. Conversely, the negative operating cash flow in late 2023 and 2024, coupled with significant investing and financing outflows, resulted in substantial decreases in the cash balance. Exchange rate changes have a relatively minor impact on cash flow.
The company’s cash flow profile is characterized by substantial variability, driven by fluctuations in net earnings, working capital, investing activities related to acquisitions and investments, and financing activities involving share repurchases, debt management, and customer funds. The dramatic shift to a net loss in March 2024 significantly impacted operating cash flow and overall liquidity.
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