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Consolidated Statements of Cash Flows - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Cash Flows from Operating Activities      
Net income $ 5,240.4 $ 6,244.8 $ 5,581.7
Adjustments to Reconcile Net Income to Cash Flows from Operating Activities:      
Depreciation and amortization 1,527.3 1,522.5 1,547.6
Debt extinguishment loss (Note 11) 0.0 0.0 405.2
Change in deferred income taxes (2,341.0) (2,185.2) (802.3)
Stock-based compensation expense 628.5 371.1 342.8
Net investment (gains) losses 23.5 420.0 (178.0)
Gains on sale of product rights (1,878.9) (156.5) (216.0)
Acquired in-process research and development (Note 3) 3,799.8 908.5 970.1
Other operating activities, net 295.5 461.3 727.4
Other changes in operating assets and liabilities, net of acquisitions and divestitures:      
Receivables—(increase) decrease (2,451.0) (299.6) (1,278.3)
Inventories—(increase) decrease (1,425.0) (599.7) (235.9)
Other assets—(increase) decrease (3,453.4) (793.5) 1,515.4
Accounts payable and other liabilities—increase (decrease) 4,274.4 1,692.0 (1,013.8)
Net Cash Provided by Operating Activities 4,240.1 7,585.7 7,365.9 Close
Cash Flows from Investing Activities      
Purchases of property and equipment (3,447.6) (1,854.3) (1,309.8)
Proceeds from sales and maturities of short-term investments 192.2 121.4 47.4
Purchases of short-term investments (98.2) (107.4) (83.5)
Proceeds from sales of and distributions from noncurrent investments 508.1 342.2 800.0
Purchases of noncurrent investments (730.8) (600.2) (929.9)
Proceeds from sale of product rights 1,604.3 95.8 216.0
Purchases of in-process research and development (3,944.5) (1,131.0) (668.6)
Cash paid for acquisitions, net of cash acquired (Note 3) (1,044.3) (327.2) (747.4)
Other investing activities, net (191.9) (302.2) (191.7)
Net Cash Used for Investing Activities (7,152.7) (3,762.9) (2,867.5) Close
Cash Flows from Financing Activities      
Dividends paid (4,069.3) (3,535.8) (3,086.8)
Net change in short-term borrowings 4,691.4 1,498.0 (4.0)
Proceeds from issuance of long-term debt 3,958.5 0.0 2,410.8
Repayments of long-term debt 0.0 (1,560.0) (1,905.4)
Purchases of common stock (750.0) (1,500.0) (1,250.0)
Other financing activities, net (335.0) (308.9) (295.9)
Net Cash Provided by (Used for) Financing Activities 3,495.6 (5,406.7) (4,131.3) Close
Effect of exchange rate changes on cash and cash equivalents 168.6 (167.6) (205.7) Close
Net increase (decrease) in cash and cash equivalents 751.6 (1,751.5) 161.4 Close
Cash and cash equivalents at beginning of year 2,067.0 3,818.5 3,657.1
Cash and Cash Equivalents at End of Year $ 2,818.6 $ 2,067.0 $ 3,818.5