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 JUNESEPTEMBER 30, 2019
or
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: 1-10864
__________________________________________________________ 
    uhglogo1a01a01a25.jpg
UnitedHealth Group Incorporated
(Exact name of registrant as specified in its charter)
 __________________________________________________________ 
Delaware 41-1321939
(State or other jurisdiction of
incorporation or organization)
 
(I.R.S. Employer
Identification No.)
UnitedHealth Group Center 55343
9900 Bren Road East 
Minnetonka,Minnesota 
(Address of principal executive offices) (Zip Code)
(952) 936-1300
(Registrant’s telephone number, including area code)
_________________________________________________________  
Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading Symbol(s)Name of each exchange on which registered
Common Stock, $.01 par valueUNHNYSE
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 No
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 (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).    Yes  No
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a 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 Fileraccelerated filer Accelerated filer Non-accelerated filer
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.
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    Yes No 
Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading Symbol(s)Name of each exchange on which registered
Common Stock, $.01 par valueUNHNYSE
As of JulyOctober 31, 2019, there were 947,680,609947,414,929 shares of the registrant’s Common Stock, $.01 par value per share, issued and outstanding.
     



UNITEDHEALTH GROUP
Table of Contents
 
   Page   Page
  
  
 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  




PART I
ITEM 1.    FINANCIAL STATEMENTS
UnitedHealth Group
Condensed Consolidated Balance Sheets
(Unaudited)
(in millions, except per share data) June 30,
2019
 December 31,
2018
 September 30,
2019
 December 31,
2018
Assets        
Current assets:        
Cash and cash equivalents $13,745
 $10,866
 $12,363
 $10,866
Short-term investments 3,524
 3,458
 3,455
 3,458
Accounts receivable, net 9,741
 11,388
 10,964
 11,388
Other current receivables, net 8,434
 6,862
 10,152
 6,862
Assets under management 2,943
 3,032
 3,051
 3,032
Prepaid expenses and other current assets 3,651
 3,086
 3,556
 3,086
Total current assets 42,038
 38,692
 43,541
 38,692
Long-term investments 35,696
 32,510
 36,840
 32,510
Property, equipment and capitalized software, net 8,681
 8,458
 8,501
 8,458
Goodwill 62,000
 58,910
 65,205
 58,910
Other intangible assets, net 9,999
 9,325
 10,521
 9,325
Other assets 8,786
 4,326
 9,101
 4,326
Total assets $167,200
 $152,221
 $173,709
 $152,221
Liabilities, redeemable noncontrolling interests and equity        
Current liabilities:        
Medical costs payable $20,907
 $19,891
 $20,939
 $19,891
Accounts payable and accrued liabilities 17,128
 16,705
 18,570
 16,705
Commercial paper and current maturities of long-term debt 7,800
 1,973
 6,387
 1,973
Unearned revenues 2,019
 2,396
 2,500
 2,396
Other current liabilities 14,474
 12,244
 14,245
 12,244
Total current liabilities 62,328
 53,209
 62,641
 53,209
Long-term debt, less current maturities 34,473
 34,581
 38,507
 34,581
Deferred income taxes 2,908
 2,474
 2,902
 2,474
Other liabilities 9,435
 5,730
 9,912
 5,730
Total liabilities 109,144
 95,994
 113,962
 95,994
Commitments and contingencies (Note 7) 


 


 


 


Redeemable noncontrolling interests 2,202
 1,908
 1,991
 1,908
Equity:        
Preferred stock, $0.001 par value - 10 shares authorized; no shares issued or outstanding 
 
 
 
Common stock, $0.01 par value - 3,000 shares authorized; 948 and 960 issued and outstanding 9
 10
Common stock, $0.01 par value - 3,000 shares authorized; 947 and 960 issued and outstanding 9
 10
Retained earnings 56,367
 55,846
 58,696
 55,846
Accumulated other comprehensive loss (3,273) (4,160) (3,709) (4,160)
Nonredeemable noncontrolling interests 2,751
 2,623
 2,760
 2,623
Total equity 55,854
 54,319
 57,756
 54,319
Total liabilities, redeemable noncontrolling interests and equity $167,200
 $152,221
 $173,709
 $152,221

See Notes to the Condensed Consolidated Financial Statements

UnitedHealth Group
Condensed Consolidated Statements of Operations
(Unaudited)
 Three Months Ended June 30, Six Months Ended June 30, Three Months Ended September 30, Nine Months Ended September 30,
(in millions, except per share data) 2019 2018 2019 2018 2019 2018 2019 2018
Revenues:                
Premiums $47,164
 $44,458
 $94,677
 $88,542
 $47,397
 $44,613
 $142,074
 $133,155
Products 8,353
 7,004
 16,425
 13,706
 7,546
 7,344
 23,971
 21,050
Services 4,496
 4,269
 8,814
 8,373
 4,942
 4,217
 13,756
 12,590
Investment and other income 582
 355
 987
 653
 466
 382
 1,453
 1,035
Total revenues 60,595
 56,086
 120,903
 111,274
 60,351
 56,556
 181,254
 167,830
Operating costs:                
Medical costs 39,184
 36,427
 78,123
 72,290
 39,041
 36,158
 117,164
 108,448
Operating costs 8,415
 8,386
 16,932
 16,892
 8,960
 8,479
 25,892
 25,371
Cost of products sold 7,598
 6,471
 14,979
 12,655
 6,627
 6,718
 21,606
 19,373
Depreciation and amortization 654
 598
 1,293
 1,180
 709
 611
 2,002
 1,791
Total operating costs 55,851
 51,882
 111,327
 103,017
 55,337
 51,966
 166,664
 154,983
Earnings from operations 4,744
 4,204
 9,576
 8,257
 5,014
 4,590
 14,590
 12,847
Interest expense (418) (344) (818) (673) (449) (353) (1,267) (1,026)
Earnings before income taxes 4,326
 3,860
 8,758
 7,584
 4,565
 4,237
 13,323
 11,821
Provision for income taxes (941) (850) (1,816) (1,650) (936) (953) (2,752) (2,603)
Net earnings 3,385
 3,010
 6,942
 5,934
 3,629
 3,284
 10,571
 9,218
Earnings attributable to noncontrolling interests (92) (88) (182) (176) (91) (96) (273) (272)
Net earnings attributable to UnitedHealth Group common shareholders $3,293
 $2,922
 $6,760
 $5,758
 $3,538
 $3,188
 $10,298
 $8,946
Earnings per share attributable to UnitedHealth Group common shareholders:                
Basic $3.47
 $3.04
 $7.09
 $5.98
 $3.73
 $3.31
 $10.82
 $9.29
Diluted $3.42
 $2.98
 $6.97
 $5.85
 $3.67
 $3.24
 $10.65
 $9.09
Basic weighted-average number of common shares outstanding 950
 961
 954
 963
 949
 962
 952
 963
Dilutive effect of common share equivalents 14
 21
 16
 21
 14
 21
 15
 21
Diluted weighted-average number of common shares outstanding 964
 982
 970
 984
 963
 983
 967
 984
Anti-dilutive shares excluded from the calculation of dilutive effect of common share equivalents 11
 6
 9
 7
 12
 7
 10
 7

See Notes to the Condensed Consolidated Financial Statements

 
UnitedHealth Group
Condensed Consolidated Statements of Comprehensive Income
(Unaudited)

 Three Months Ended June 30, Six Months Ended June 30, Three Months Ended September 30, Nine Months Ended September 30,
(in millions) 2019 2018 2019 2018 2019 2018 2019 2018
Net earnings $3,385
 $3,010
 $6,942
 $5,934
 $3,629
 $3,284
 $10,571
 $9,218
Other comprehensive income (loss):        
Other comprehensive (loss) income:        
Gross unrealized gains (losses) on investment securities during the period 493
 (43) 1,013
 (421) 230
 (91) 1,243
 (512)
Income tax effect (113) 10
 (232) 96
 (53) 21
 (285) 117
Total unrealized gains (losses), net of tax 380
 (33) 781
 (325) 177
 (70) 958
 (395)
Gross reclassification adjustment for net realized gains included in net earnings (5) (36) (1) (55) (69) (3) (70) (58)
Income tax effect 1
 9
 
 13
 16
 
 16
 13
Total reclassification adjustment, net of tax (4) (27) (1) (42) (53) (3) (54) (45)
Total foreign currency translation gains (losses) 109
 (1,069) 107
 (1,070)
Other comprehensive income (loss) 485
 (1,129) 887
 (1,437)
Total foreign currency translation losses (560) (233) (453) (1,303)
Other comprehensive (loss) income (436) (306) 451
 (1,743)
Comprehensive income 3,870
 1,881
 7,829
 4,497
 3,193
 2,978
 11,022
 7,475
Comprehensive income attributable to noncontrolling interests (92) (88) (182) (176) (91) (96) (273) (272)
Comprehensive income attributable to UnitedHealth Group common shareholders $3,778
 $1,793
 $7,647
 $4,321
 $3,102
 $2,882
 $10,749
 $7,203

See Notes to the Condensed Consolidated Financial Statements

UnitedHealth Group
Condensed Consolidated Statements of Changes in Equity
(Unaudited)
 Common Stock Additional Paid-In Capital Retained Earnings 
Accumulated Other Comprehensive
Income (Loss)
 Nonredeemable Noncontrolling Interests 
Total
Equity
 Common Stock Additional Paid-In Capital Retained Earnings 
Accumulated Other Comprehensive
Income (Loss)
 Nonredeemable Noncontrolling Interests 
Total
Equity
Three months ended June 30,
(in millions)
 Shares Amount Net Unrealized Gains (Losses) on Investments 
Foreign Currency Translation (Losses)
Gains
 
Balance at March 31, 2019 953
 $10
 $
 $55,472
 $140
 $(3,898) $2,727
 $54,451
Three months ended September 30,
(in millions)
 Shares Amount Additional Paid-In Capital Retained Earnings Net Unrealized Gains (Losses) on Investments Foreign Currency Translation Losses Nonredeemable Noncontrolling Interests 
Total
Equity
Balance at June 30, 2019 948
 $9
 $516
 $(3,789) 
Net earnings       3,293
     54
 3,347
       3,538
     82
 3,620
Other comprehensive income         376
 109
   485
Other comprehensive income (loss)         124
 (560)   (436)
Issuances of common stock,
and related tax effects
 1
 
 105
         105
 2
 
 277
         277
Share-based compensation     152
         152
     130
         130
Common share repurchases (6) (1) (124) (1,374)       (1,499) (3) 
 (415) (185)       (600)
Cash dividends paid on common shares ($1.08 per share)       (1,024)       (1,024)       (1,024)       (1,024)
Redeemable noncontrolling interests fair value and other adjustments     (133)         (133)     8
         8
Acquisition and other adjustments of nonredeemable noncontrolling interests             32
 32
             (7) (7)
Distribution to nonredeemable noncontrolling interests             (62) (62)             (66) (66)
Balance at June 30, 2019 948
 $9
 $
 $56,367
 $516
 $(3,789) $2,751
 $55,854
Balance at September 30, 2019 947
 $9
 $
 $58,696
 $640
 $(4,349) $2,760
 $57,756
                                
Balance at March 31, 2018 962
 $10
 $
 $50,494
 $(296) $(2,655) $2,483
 $50,036
Balance at June 30, 2018 962
 $10
 $
 $52,363
 $(356) $(3,724) $2,490
 $50,783
Net earnings       2,922
     59
 2,981
       3,188
     71
 3,259
Other comprehensive loss         (60) (1,069)   (1,129)         (73) (233)   (306)
Issuances of common stock, and related tax effects 2
 
 107
         107
 2
 
 239
         239
Share-based compensation     141
         141
     146
         146
Common share repurchases (2) 
 (313) (187)       (500) (2) 
 (201) (299)       (500)
Cash dividends paid on common shares ($0.90 per share)       (866)       (866)       (866)       (866)
Redeemable noncontrolling interests fair value and other adjustments     65
         65
     (184)         (184)
Acquisition and other adjustments of nonredeemable noncontrolling interests             (7) (7)             102
 102
Distribution to nonredeemable noncontrolling interests             (45) (45)             (77) (77)
Balance at June 30, 2018 962
 $10
 $
 $52,363
 $(356) $(3,724) $2,490
 $50,783
Balance at September 30, 2018 962
 $10
 $
 $54,386
 $(429) $(3,957) $2,586
 $52,596

See Notes to the Condensed Consolidated Financial Statements

UnitedHealth Group
Condensed Consolidated Statements of Changes in Equity
(Unaudited)
 Common Stock Additional Paid-In Capital Retained Earnings 
Accumulated Other Comprehensive (Loss)
Income
 Nonredeemable Noncontrolling Interests 
Total
Equity
 Common Stock Additional Paid-In Capital Retained Earnings 
Accumulated Other Comprehensive (Loss)
Income
 Nonredeemable Noncontrolling Interests 
Total
Equity
Six months ended June 30,
(in millions)
 Shares Amount Net Unrealized (Losses) Gains on Investments Foreign Currency Translation (Losses)
Gains
 
Nine months ended September 30,
(in millions)
 Shares Amount Additional Paid-In Capital Retained Earnings Net Unrealized (Losses) Gains on Investments Foreign Currency Translation Losses Nonredeemable Noncontrolling Interests 
Total
Equity
Balance at January 1, 2019 960
 $10
 $
 $55,846
 $(264) $(3,896) $2,623
 $54,319
 960
 $10
 $(264) $(3,896) 
Adjustment to adopt ASU 2016-02       (13)     (5) (18)       (13)     (5) (18)
Net earnings       6,760
     114
 6,874
       10,298
     196
 10,494
Other comprehensive income         780
 107
   887
Other comprehensive income (loss)         904
 (453)   451
Issuances of common stock,
and related tax effects
 6
 
 161
         161
 8
 
 438
         438
Share-based compensation     391
         391
     521
         521
Common share repurchases (18) (1) (158) (4,342)       (4,501) (21) (1) (573) (4,527)       (5,101)
Cash dividends paid on common shares ($1.98 per share)       (1,884)       (1,884)
Cash dividends paid on common shares ($3.06 per share)       (2,908)       (2,908)
Redeemable noncontrolling interests fair value and other adjustments     (285)         (285)     (277)         (277)
Acquisition and other adjustments of nonredeemable noncontrolling interests     (109)       164
 55
     (109)       157
 48
Distribution to nonredeemable noncontrolling interests             (145) (145)             (211) (211)
Balance at June 30, 2019 948
 $9
 $
 $56,367
 $516
 $(3,789) $2,751
 $55,854
Balance at September 30, 2019 947
 $9
 $
 $58,696
 $640
 $(4,349) $2,760
 $57,756
                                
Balance at January 1, 2018 969
 $10
 $1,703
 $48,730
 $(13) $(2,654) $2,057
 $49,833
 969
 $10
 $1,703
 $48,730
 $(13) $(2,654) $2,057
 $49,833
Adjustment to adopt ASU 2016-01       (24) 24
     
       (24) 24
     
Net earnings       5,758
     112
 5,870
       8,946
     183
 9,129
Other comprehensive loss         (367) (1,070)   (1,437)         (440) (1,303)   (1,743)
Issuances of common stock, and related tax effects 7
 
 522
         522
 9
 
 761
         761
Share-based compensation     347
         347
     493
         493
Common share repurchases (14) 
 (2,637) (513)       (3,150) (16) 
 (2,838) (812)       (3,650)
Cash dividends paid on common shares ($1.65 per share)       (1,588)       (1,588)
Cash dividends paid on common shares ($2.55 per share)       (2,454)       (2,454)
Redeemable noncontrolling interests fair value and other adjustments     65
         65
     (119)         (119)
Acquisition and other adjustments of nonredeemable noncontrolling interests             416
 416
             518
 518
Distribution to nonredeemable noncontrolling interests             (95) (95)             (172) (172)
Balance at June 30, 2018 962
 $10
 $
 $52,363
 $(356) $(3,724) $2,490
 $50,783
Balance at September 30, 2018 962
 $10
 $
 $54,386
 $(429) $(3,957) $2,586
 $52,596

See Notes to the Condensed Consolidated Financial Statements

UnitedHealth Group
Condensed Consolidated Statements of Cash Flows
(Unaudited)
 Six Months Ended June 30, Nine Months Ended September 30,
(in millions) 2019 2018 2019 2018
Operating activities        
Net earnings $6,942
 $5,934
 $10,571
 $9,218
Noncash items:        
Depreciation and amortization 1,293
 1,180
 2,002
 1,791
Deferred income taxes 195
 (158) 177
 9
Share-based compensation 398
 358
 525
 512
Other, net (127) 10
 (181) (136)
Net change in other operating items, net of effects from acquisitions and changes in AARP balances:        
Accounts receivable 2,196
 (1,021) 957
 (984)
Other assets (1,774) (2,369) (2,181) (1,641)
Medical costs payable 447
 1,263
 223
 1,745
Accounts payable and other liabilities (33) 2,233
 105
 2,783
Unearned revenues (429) 4,946
 60
 20
Cash flows from operating activities 9,108

12,376
 12,258

13,317
Investing activities        
Purchases of investments (7,649) (8,182) (13,386) (11,316)
Sales of investments 2,680
 2,003
 6,198
 2,872
Maturities of investments 3,315
 3,211
 5,160
 4,715
Cash paid for acquisitions, net of cash assumed (4,751) (2,636) (8,200) (5,824)
Purchases of property, equipment and capitalized software (977) (960) (1,421) (1,505)
Other, net 504
 (134) 338
 (187)
Cash flows used for investing activities (6,878) (6,698) (11,311) (11,245)
Financing activities        
Common share repurchases (4,501) (3,150) (5,101) (3,650)
Cash dividends paid (1,884) (1,588) (2,908) (2,454)
Proceeds from common stock issuances 448
 478
 740
 745
Repayments of long-term debt (1,250) (1,100) (1,250) (2,600)
Proceeds from (repayments of) commercial paper, net 6,924
 (181) 3,998
 (164)
Proceeds from issuance of long-term debt 
 3,964
 5,444
 3,964
Customer funds administered 1,435
 3,082
 420
 1,552
Other, net (529) (718) (756) (1,086)
Cash flows from financing activities 643
 787
Cash flows from (used for) financing activities 587
 (3,693)
Effect of exchange rate changes on cash and cash equivalents 6
 (78) (37) (97)
Increase in cash and cash equivalents 2,879
 6,387
Increase (decrease) in cash and cash equivalents 1,497
 (1,718)
Cash and cash equivalents, beginning of period 10,866
 11,981
 10,866
 11,981
Cash and cash equivalents, end of period $13,745
 $18,368
 $12,363
 $10,263
        

See Notes to the Condensed Consolidated Financial Statements

UnitedHealth Group
Notes to the Condensed Consolidated Financial Statements
(Unaudited)
1.    Basis of Presentation
UnitedHealth Group Incorporated (individually and together with its subsidiaries, “UnitedHealth Group” and the “Company”) is a diversified health care company dedicated to helping people live healthier lives and helping make the health system work better for everyone.
Through its diversified family of businesses, the Company leverages core competencies in data and health information; advanced technology; and clinical expertise. These core competencies are deployed within two distinct, but strategically aligned, business platforms: health benefits operating under UnitedHealthcare and health services operating under Optum.
The Company has prepared the Condensed Consolidated Financial Statements according to U.S. Generally Accepted Accounting Principles (GAAP) and has included the accounts of UnitedHealth Group and its subsidiaries. The year-end condensed consolidated balance sheet was derived from audited financial statements, but does not include all disclosures required by GAAP. In accordance with the rules and regulations of the U.S. Securities and Exchange Commission (SEC), the Company has omitted certain footnote disclosures that would substantially duplicate the disclosures contained in its annual audited Consolidated Financial Statements. Therefore, these Condensed Consolidated Financial Statements should be read together with the Consolidated Financial Statements and the Notes included in Part II, Item 8, “Financial Statements and Supplementary Data” in the Company’s Annual Report on Form 10-K for the year ended December 31, 2018 as filed with the SEC (2018 10-K). The accompanying Condensed Consolidated Financial Statements include all normal recurring adjustments necessary to present the interim financial statements fairly.
Use of Estimates
These Condensed Consolidated Financial Statements include certain amounts based on the Company’s best estimates and judgments. The Company’s most significant estimates include medical costs payable and goodwill. Certain of these estimates require the application of complex assumptions and judgments, often because they involve matters that are inherently uncertain and will likely change in subsequent periods. The impact of any change in estimates is included in earnings in the period in which the estimate is adjusted.
Recently Adopted Accounting Standards
In February 2016, the Financial Accounting Standards Board (FASB) issued Accounting Standard Update (ASU) No. 2016-02, “Leases (Topic 842)” as modified by ASUs 2018-01, 2018-10, 2018-11, 2018-20 and 2019-01 (collectively, ASU 2016-02). Under ASU 2016-02, an entity is required to recognize assets and liabilities for the rights and obligations created by leases on the entity’s balance sheet for both finance and operating leases. The Company adopted ASU 2016-02 using a cumulative-effect upon adoption approach as of January 1, 2019. Upon adoption, the Company recognized $3.3 billion of lease right-of-use (ROU) assets and liabilities for operating leases on its Condensed Consolidated Balance Sheet, of which, $668 million were classified as current liabilities. The adoption of ASU 2016-02 was immaterial to the Company’s consolidated results of operations, equity and cash flows. The Company has included the disclosures required by ASU 2016-02 below and in Note 7, “Commitments and Contingencies.”
The Company leases facilities and equipment under long-term operating leases that are non-cancelable and expire on various dates. At the lease commencement date, lease ROU assets and lease liabilities are recognized based on the present value of the future minimum lease payments over the lease term, which includes all fixed obligations arising from the lease contract. If an interest rate is not implicit in a lease, the Company utilizes its incremental borrowing rate for a period that closely matches the lease term.
The Company’s ROU assets are included in other assets, and lease liabilities are included in other current liabilities and other liabilities in the Company’s Condensed Consolidated Balance Sheet.
The Company has determined that there have been no other recently adopted or issued accounting standards that had, or will have, a material impact on its Condensed Consolidated Financial Statements.

2.    Investments
A summary of debt securities by major security type is as follows:
(in millions) 
Amortized
Cost
 
Gross
Unrealized
Gains
 
Gross
Unrealized
Losses
 
Fair
Value
 
Amortized
Cost
 
Gross
Unrealized
Gains
 
Gross
Unrealized
Losses
 
Fair
Value
June 30, 2019        
September 30, 2019        
Debt securities - available-for-sale:                
U.S. government and agency obligations $3,684
 $80
 $(5) $3,759
 $3,591
 $83
 $(2) $3,672
State and municipal obligations 6,532
 237
 (1) 6,768
 5,657
 256
 (3) 5,910
Corporate obligations 16,597
 265
 (12) 16,850
 17,824
 352
 (9) 18,167
U.S. agency mortgage-backed securities 5,662
 83
 (15) 5,730
 6,361
 113
 (6) 6,468
Non-U.S. agency mortgage-backed securities 1,593
 39
 (1) 1,631
 1,685
 48
 (1) 1,732
Total debt securities - available-for-sale 34,068
 704
 (34) 34,738
 35,118
 852
 (21) 35,949
Debt securities - held-to-maturity:                
U.S. government and agency obligations 275
 2
 
 277
 272
 2
 
 274
State and municipal obligations 31
 1
 
 32
 32
 1
 
 33
Corporate obligations 435
 1
 
 436
 547
 
 
 547
Total debt securities - held-to-maturity 741
 4
 
 745
 851
 3
 
 854
Total debt securities $34,809
 $708
 $(34) $35,483
 $35,969
 $855
 $(21) $36,803
December 31, 2018                
Debt securities - available-for-sale:                
U.S. government and agency obligations $3,434
 $13
 $(42) $3,405
 $3,434
 $13
 $(42) $3,405
State and municipal obligations 7,117
 61
 (57) 7,121
 7,117
 61
 (57) 7,121
Corporate obligations 15,366
 14
 (218) 15,162
 15,366
 14
 (218) 15,162
U.S. agency mortgage-backed securities 4,947
 11
 (106) 4,852
 4,947
 11
 (106) 4,852
Non-U.S. agency mortgage-backed securities 1,376
 2
 (20) 1,358
 1,376
 2
 (20) 1,358
Total debt securities - available-for-sale 32,240
 101
 (443) 31,898
 32,240
 101
 (443) 31,898
Debt securities - held-to-maturity:                
U.S. government and agency obligations 255
 1
 (2) 254
 255
 1
 (2) 254
State and municipal obligations 11
 
 
 11
 11
 
 
 11
Corporate obligations 355
 
 
 355
 355
 
 
 355
Total debt securities - held-to-maturity 621
 1
 (2) 620
 621
 1
 (2) 620
Total debt securities $32,861
 $102
 $(445) $32,518
 $32,861
 $102
 $(445) $32,518

The Company held $2.2 billion and $2.0 billion of equity securities as of Juneboth September 30, 2019 and December 31, 2018, respectively.2018. The Company’s investments in equity securities primarily consist of employee savings plan related investments, shares of Brazilian real denominated fixed-income funds and dividend paying stocks with readily determinable fair values. Additionally, the Company’s investments included $1.4 billion and $1.5 billion of equity method investments in operating businesses in the health care sector as of both JuneSeptember 30, 2019 and December 31, 2018.2018, respectively.

The amortized cost and fair value of debt securities as of JuneSeptember 30, 2019, by contractual maturity, were as follows:
 Available-for-Sale Held-to-Maturity Available-for-Sale Held-to-Maturity
(in millions) 
Amortized
Cost
 
Fair
Value
 Amortized
Cost
 Fair
Value
 
Amortized
Cost
 
Fair
Value
 Amortized
Cost
 Fair
Value
Due in one year or less $3,647
 $3,652
 $182
 $182
 $3,571
 $3,577
 $313
 $313
Due after one year through five years 12,150
 12,298
 283
 285
 11,904
 12,084
 258
 259
Due after five years through ten years 8,084
 8,394
 136
 136
 8,303
 8,669
 141
 141
Due after ten years 2,932
 3,033
 140
 142
 3,294
 3,419
 139
 141
U.S. agency mortgage-backed securities 5,662
 5,730
 
 
 6,361
 6,468
 
 
Non-U.S. agency mortgage-backed securities 1,593
 1,631
 
 
 1,685
 1,732
 
 
Total debt securities $34,068
 $34,738
 $741
 $745
 $35,118
 $35,949
 $851
 $854

The fair value of available-for-sale debt securities with gross unrealized losses by security type and length of time that individual securities have been in a continuous unrealized loss position were as follows:
 Less Than 12 Months 12 Months or Greater  Total Less Than 12 Months 12 Months or Greater  Total
(in millions) 
Fair
Value
 
Gross
Unrealized
Losses
 
Fair
Value
 Gross
Unrealized
Losses
 
Fair
Value
 Gross
Unrealized
Losses
 
Fair
Value
 
Gross
Unrealized
Losses
 
Fair
Value
 Gross
Unrealized
Losses
 
Fair
Value
 Gross
Unrealized
Losses
June 30, 2019            
September 30, 2019            
Debt securities - available-for-sale:                        
U.S. government and agency obligations $
 $
 $655
 $(5) $655
 $(5) $286
 $(1) $228
 $(1) $514
 $(2)
State and municipal obligations 
 
 366
 (1) 366
 (1) 296
 (2) 83
 (1) 379
 (3)
Corporate obligations 703
 (3) 2,352
 (9) 3,055
 (12) 1,360
 (5) 1,022
 (4) 2,382
 (9)
U.S. agency mortgage-backed securities 
 
 1,562
 (15) 1,562
 (15) 570
 (2) 518
 (4) 1,088
 (6)
Non-U.S. agency mortgage-backed securities 
 
 128
 (1) 128
 (1) 217
 (1) 
 
 217
 (1)
Total debt securities - available-for-sale $703
 $(3) $5,063
 $(31) $5,766
 $(34) $2,729
 $(11) $1,851
 $(10) $4,580
 $(21)
December 31, 2018                        
Debt securities - available-for-sale:                        
U.S. government and agency obligations $998
 $(7) $1,425
 $(35) $2,423
 $(42) $998
 $(7) $1,425
 $(35) $2,423
 $(42)
State and municipal obligations 1,334
 (11) 2,491
 (46) 3,825
 (57) 1,334
 (11) 2,491
 (46) 3,825
 (57)
Corporate obligations 8,105
 (109) 4,239
 (109) 12,344
 (218) 8,105
 (109) 4,239
 (109) 12,344
 (218)
U.S. agency mortgage-backed securities 1,296
 (22) 2,388
 (84) 3,684
 (106) 1,296
 (22) 2,388
 (84) 3,684
 (106)
Non-U.S. agency mortgage-backed securities 622
 (7) 459
 (13) 1,081
 (20) 622
 (7) 459
 (13) 1,081
 (20)
Total debt securities - available-for-sale $12,355
 $(156) $11,002
 $(287) $23,357
 $(443) $12,355
 $(156) $11,002
 $(287) $23,357
 $(443)

The Company’s unrealized losses from debt securities as of JuneSeptember 30, 2019 were generated from 5,0004,000 positions out of a total of 31,00032,000 positions. The Company believes that it will collect the principal and interest due on its debt securities that have an amortized cost in excess of fair value. The unrealized losses were primarily caused by interest rate increases and not by unfavorable changes in the credit quality associated with these securities. At each reporting period, the Company evaluates securities for impairment when the fair value of the investment is less than its amortized cost. The Company evaluated the underlying credit quality and credit ratings of the issuers, noting no significant deterioration since purchase. As of JuneSeptember 30, 2019, the Company did not have the intent to sell any of the securities in an unrealized loss position. Therefore, the Company believes these losses to be temporary.

3.    Fair Value
Certain assets and liabilities are measured at fair value in the Condensed Consolidated Financial Statements or have fair values disclosed in the Notes to the Condensed Consolidated Financial Statements. These assets and liabilities are classified into one of three levels of a hierarchy defined by GAAP.
For a description of the methods and assumptions that are used to estimate the fair value and determine the fair value hierarchy classification of each class of financial instrument, see Note 4 of Notes to the Consolidated Financial Statements in Part II, Item 8, “Financial Statements and Supplementary Data” in the 2018 10-K.
The following table presents a summary of fair value measurements by level and carrying values for items measured at fair value on a recurring basis in the Condensed Consolidated Balance Sheets:
(in millions) 
Quoted Prices
in Active
Markets
(Level 1)
 
Other
Observable
Inputs
(Level 2)
 
Unobservable
Inputs
(Level 3)
 
Total
Fair and Carrying
Value
 
Quoted Prices
in Active
Markets
(Level 1)
 
Other
Observable
Inputs
(Level 2)
 
Unobservable
Inputs
(Level 3)
 
Total
Fair and Carrying
Value
June 30, 2019        
September 30, 2019        
Cash and cash equivalents $13,562
 $183
 $
 $13,745
 $12,210
 $153
 $
 $12,363
Debt securities - available-for-sale:                
U.S. government and agency obligations 3,474
 285
 
 3,759
 3,421
 251
 
 3,672
State and municipal obligations 
 6,768
 
 6,768
 
 5,910
 
 5,910
Corporate obligations 65
 16,583
 202
 16,850
 71
 17,879
 217
 18,167
U.S. agency mortgage-backed securities 
 5,730
 
 5,730
 
 6,468
 
 6,468
Non-U.S. agency mortgage-backed securities 
 1,631
 
 1,631
 
 1,732
 
 1,732
Total debt securities - available-for-sale 3,539
 30,997
 202
 34,738
 3,492
 32,240
 217
 35,949
Equity securities 2,035
 15
 
 2,050
 1,839
 21
 
 1,860
Assets under management 1,011
 1,911
 21
 2,943
 1,116
 1,907
 28
 3,051
Total assets at fair value
$20,147
 $33,106
 $223
 $53,476

$18,657
 $34,321
 $245
 $53,223
Percentage of total assets at fair value 38% 62% % 100% 35% 65% % 100%
December 31, 2018                
Cash and cash equivalents $10,757
 $109
 $
 $10,866
 $10,757
 $109
 $
 $10,866
Debt securities - available-for-sale:                
U.S. government and agency obligations 3,060
 345
 
 3,405
 3,060
 345
 
 3,405
State and municipal obligations 
 7,121
 
 7,121
 
 7,121
 
 7,121
Corporate obligations 39
 14,950
 173
 15,162
 39
 14,950
 173
 15,162
U.S. agency mortgage-backed securities 
 4,852
 
 4,852
 
 4,852
 
 4,852
Non-U.S. agency mortgage-backed securities 
 1,358
 
 1,358
 
 1,358
 
 1,358
Total debt securities - available-for-sale 3,099
 28,626
 173
 31,898
 3,099
 28,626
 173
 31,898
Equity securities 1,832
 13
 
 1,845
 1,832
 13
 
 1,845
Assets under management 1,086
 1,938
 8
 3,032
 1,086
 1,938
 8
 3,032
Total assets at fair value $16,774
 $30,686
 $181
 $47,641
 $16,774
 $30,686
 $181
 $47,641
Percentage of total assets at fair value 35% 65% % 100% 35% 65% % 100%

There were no transfers in or out of Level 3 financial assets or liabilities during the sixnine months ended JuneSeptember 30, 2019 or 2018.

The following table presents a summary of fair value measurements by level and carrying values for certain financial instruments not measured at fair value on a recurring basis in the Condensed Consolidated Balance Sheets:
(in millions) 
Quoted Prices
in Active
Markets
(Level 1)
 
Other
Observable
Inputs
(Level 2)
 
Unobservable
Inputs
(Level 3)
 
Total
Fair
Value
 Total Carrying Value 
Quoted Prices
in Active
Markets
(Level 1)
 
Other
Observable
Inputs
(Level 2)
 
Unobservable
Inputs
(Level 3)
 
Total
Fair
Value
 Total Carrying Value
June 30, 2019          
September 30, 2019          
Debt securities - held-to-maturity $293
 $177
 $275
 $745
 $741
 $410
 $176
 $268
 $854
 $851
Long-term debt and other financing obligations $
 $38,927
 $
 $38,927
 $35,300
 $
 $45,342
 $
 $45,342
 $40,814
December 31, 2018                    
Debt securities - held-to-maturity $260
 $65
 $295
 $620
 $621
 $260
 $65
 $295
 $620
 $621
Long-term debt and other financing obligations $
 $37,944
 $
 $37,944
 $36,554
 $
 $37,944
 $
 $37,944
 $36,554

Nonfinancial assets and liabilities or financial assets and liabilities that are measured at fair value on a nonrecurring basis are subject to fair value adjustments only in certain circumstances, such as when the Company records an impairment. There were no significant fair value adjustments for these assets and liabilities recorded during either the sixnine months ended JuneSeptember 30, 2019 or 2018.
4.    Medical Costs Payable
The following table shows the components of the change in medical costs payable for the sixnine months ended JuneSeptember 30:
(in millions) 2019 2018 2019 2018
Medical costs payable, beginning of period $19,891
 $17,871
 $19,891
 $17,871
Acquisitions 522
 261
 868
 333
Reported medical costs:        
Current year 78,523
 72,570
 117,624
 108,658
Prior years (400) (280) (460) (210)
Total reported medical costs 78,123
 72,290
 117,164
 108,448
Medical payments:        
Payments for current year (60,707) (55,738) (99,487) (90,348)
Payments for prior years (16,922) (15,345) (17,497) (16,454)
Total medical payments (77,629) (71,083) (116,984) (106,802)
Medical costs payable, end of period $20,907
 $19,339
 $20,939
 $19,850

For the sixnine months ended JuneSeptember 30, 2019 and 2018, the medical cost reserve development included no individual factors that were significant. Medical costs payable included reserves for claims incurred by insured customers but not yet reported to the Company of $14.5$14.2 billion and $13.2 billion at JuneSeptember 30, 2019 and December 31, 2018, respectively.

5.    Commercial Paper and Long-Term Debt
Commercial paper and senior unsecured long-term debt consisted of the following:
 June 30, 2019 December 31, 2018 September 30, 2019 December 31, 2018
(in millions, except percentages) 
Par
Value
 
Carrying
Value
 
Fair
Value
 
Par
Value
 
Carrying
Value
 
Fair
Value
 Par Value Carrying Value Fair Value Par Value Carrying Value Fair Value
Commercial paper $6,984
 $6,973
 $6,973
 $
 $
 $
 $4,082
 $4,080
 $4,080
 $
 $
 $
1.700% notes due February 2019 
 
 
 750
 750
 749
 
 
 
 750
 750
 749
1.625% notes due March 2019 
 
 
 500
 500
 499
 
 
 
 500
 500
 499
2.300% notes due December 2019 500
 498
 500
 500
 494
 497
 500
 499
 500
 500
 494
 497
2.700% notes due July 2020 1,500
 1,498
 1,506
 1,500
 1,498
 1,494
 1,500
 1,499
 1,508
 1,500
 1,498
 1,494
Floating rate notes due October 2020 300
 299
 300
 300
 299
 298
 300
 300
 300
 300
 299
 298
3.875% notes due October 2020 450
 449
 457
 450
 443
 456
 450
 450
 457
 450
 443
 456
1.950% notes due October 2020 900
 898
 896
 900
 897
 884
 900
 898
 900
 900
 897
 884
4.700% notes due February 2021 400
 404
 413
 400
 398
 412
 400
 404
 412
 400
 398
 412
2.125% notes due March 2021 750
 748
 749
 750
 747
 734
 750
 748
 752
 750
 747
 734
Floating rate notes due June 2021 350
 349
 350
 350
 349
 347
 350
 349
 349
 350
 349
 347
3.150% notes due June 2021 400
 399
 407
 400
 399
 400
 400
 399
 408
 400
 399
 400
3.375% notes due November 2021 500
 500
 512
 500
 489
 503
 500
 502
 512
 500
 489
 503
2.875% notes due December 2021 750
 752
 761
 750
 735
 748
 750
 755
 764
 750
 735
 748
2.875% notes due March 2022 1,100
 1,082
 1,117
 1,100
 1,051
 1,091
 1,100
 1,088
 1,120
 1,100
 1,051
 1,091
3.350% notes due July 2022 1,000
 997
 1,034
 1,000
 997
 1,005
 1,000
 997
 1,036
 1,000
 997
 1,005
2.375% notes due October 2022 900
 895
 903
 900
 894
 872
 900
 895
 909
 900
 894
 872
0.000% notes due November 2022 15
 13
 13
 15
 12
 13
 15
 13
 13
 15
 12
 13
2.750% notes due February 2023 625
 622
 633
 625
 602
 611
 625
 627
 637
 625
 602
 611
2.875% notes due March 2023 750
 772
 764
 750
 750
 739
 750
 776
 769
 750
 750
 739
3.500% notes due June 2023 750
 747
 782
 750
 746
 756
 750
 747
 786
 750
 746
 756
3.500% notes due February 2024 750
 745
 786
 750
 745
 755
 750
 745
 790
 750
 745
 755
2.375% notes due August 2024 750
 746
 756
 
 
 
3.750% notes due July 2025 2,000
 1,990
 2,136
 2,000
 1,989
 2,025
 2,000
 1,990
 2,150
 2,000
 1,989
 2,025
3.700% notes due December 2025 300
 298
 320
 300
 298
 303
 300
 298
 323
 300
 298
 303
3.100% notes due March 2026 1,000
 996
 1,030
 1,000
 995
 965
 1,000
 996
 1,045
 1,000
 995
 965
3.450% notes due January 2027 750
 746
 789
 750
 746
 742
 750
 746
 798
 750
 746
 742
3.375% notes due April 2027 625
 619
 653
 625
 619
 611
 625
 619
 663
 625
 619
 611
2.950% notes due October 2027 950
 939
 966
 950
 938
 898
 950
 939
 982
 950
 938
 898
3.850% notes due June 2028 1,150
 1,142
 1,246
 1,150
 1,142
 1,163
 1,150
 1,142
 1,259
 1,150
 1,142
 1,163
3.875% notes due December 2028 850
 843
 927
 850
 842
 861
 850
 843
 936
 850
 842
 861
2.875% notes due August 2029 1,000
 1,022
 1,021
 
 
 
4.625% notes due July 2035 1,000
 992
 1,149
 1,000
 992
 1,060
 1,000
 992
 1,208
 1,000
 992
 1,060
5.800% notes due March 2036 850
 838
 1,090
 850
 838
 1,003
 850
 838
 1,134
 850
 838
 1,003
6.500% notes due June 2037 500
 492
 693
 500
 492
 638
 500
 492
 711
 500
 492
 638
6.625% notes due November 2037 650
 641
 915
 650
 641
 841
 650
 641
 940
 650
 641
 841
6.875% notes due February 2038 1,100
 1,076
 1,591
 1,100
 1,076
 1,437
 1,100
 1,076
 1,625
 1,100
 1,076
 1,437
3.500% notes due August 2039 1,250
 1,241
 1,301
 
 
 
5.700% notes due October 2040 300
 296
 385
 300
 296
 355
 300
 296
 397
 300
 296
 355
5.950% notes due February 2041 350
 345
 462
 350
 345
 426
 350
 345
 476
 350
 345
 426
4.625% notes due November 2041 600
 588
 684
 600
 588
 627
 600
 589
 710
 600
 588
 627
4.375% notes due March 2042 502
 484
 556
 502
 484
 503
 502
 484
 572
 502
 484
 503
3.950% notes due October 2042 625
 607
 655
 625
 607
 596
 625
 607
 676
 625
 607
 596
4.250% notes due March 2043 750
 735
 820
 750
 734
 744
 750
 735
 844
 750
 734
 744
4.750% notes due July 2045 2,000
 1,973
 2,369
 2,000
 1,973
 2,116
 2,000
 1,973
 2,431
 2,000
 1,973
 2,116
4.200% notes due January 2047 750
 738
 820
 750
 738
 745
 750
 738
 852
 750
 738
 745
4.250% notes due April 2047 725
 717
 797
 725
 717
 719
 725
 717
 823
 725
 717
 719
3.750% notes due October 2047 950
 933
 974
 950
 933
 869
 950
 933
 1,005
 950
 933
 869
4.250% notes due June 2048 1,350
 1,329
 1,500
 1,350
 1,329
 1,349
 1,350
 1,329
 1,550
 1,350
 1,329
 1,349
4.450% notes due December 2048 1,100
 1,088
 1,267
 1,100
 1,087
 1,132
 1,100
 1,086
 1,301
 1,100
 1,087
 1,132
3.700% notes due August 2049 1,250
 1,235
 1,323
 
 
 
3.875% notes due August 2059 1,250
 1,231
 1,327
 
 
 
Total commercial paper and long-term debt $41,401
 $41,085
 $44,650
 $35,667
 $35,234
 $36,591
 $43,999
 $43,690
 $48,141
 $35,667
 $35,234
 $36,591


The Company’s long-term debt obligations included $1.2 billion and $1.3 billion of other financing obligations, of which $329$309 million and $229 million were classified as current as of JuneSeptember 30, 2019 and December 31, 2018, respectively.
Long-term Debt
In July 2019, the Company issued $5.5 billion of senior unsecured notes consisting of the following:
(in millions, except percentages) Par Value
2.375% notes due August 2024 $750
2.875% notes due August 2029 1,000
3.500% notes due August 2039 1,250
3.700% notes due August 2049 1,250
3.875% notes due August 2059 1,250

Commercial Paper and Bank Credit Facilities
Commercial paper consists of short-duration, senior unsecured debt privately placed on a discount basis through broker-dealers. As of JuneSeptember 30, 2019, the Company’s outstanding commercial paper had a weighted average annual interest rate of 2.6%2.2%.
The Company has $3.5 billion five-year, $3.5 billion three-year and $3.0 billion 364-day revolving bank credit facilities with 26 banks, which mature in December 2023, December 2021 and December 2019, respectively. The Company additionally has a $2.5 billion 364-day revolving bank credit facility with 6 banks that matures in May 2020. These facilities provide liquidity support for the Company’s commercial paper program and are available for general corporate purposes. As of JuneSeptember 30, 2019, no amounts had been drawn on any of the bank credit facilities. The annual interest rates, which are variable based on term, are calculated based on the London Interbank Offered Rate (LIBOR) plus a credit spread based on the Company’s senior unsecured credit ratings. If amounts had been drawn on the bank credit facilities as of JuneSeptember 30, 2019, annual interest rates would have ranged from 2.9%2.7% to 3.1%2.8%.
Debt Covenants
The Company’s bank credit facilities contain various covenants, including covenants requiring the Company to maintain a defined debt to debt-plus-shareholders’ equity ratio of not more than 60%. The Company was in compliance with its debt covenants as of JuneSeptember 30, 2019.
6.    Dividends
In June 2019, the Company’s Board of Directors increased the Company’s annual dividend rate to shareholders to $4.32 compared to $3.60 per share, which the Company had paid since June 2018. Declaration and payment of future quarterly dividends is at the discretion of the Board and may be adjusted as business needs or market conditions change.
The following table provides details of the Company’s 2019 dividend payments:
Payment Date Amount per Share Total Amount Paid Amount per Share Total Amount Paid
   (in millions)   (in millions)
March 19 $0.90
 $860
 $0.90
 $860
June 25 1.08
 1,024
 1.08
 1,024
September 24 1.08
 1,024

7.    Commitments and Contingencies
Leases
Operating lease costs were $247$275 million and $485$760 million for the three and sixnine months ended JuneSeptember 30, 2019, respectively, and included immaterial variable and short-term lease costs. Cash payments made on the Company’s operating lease liabilities were $363$552 million for the sixnine months ended JuneSeptember 30, 2019, which were classified within operating activities in the Condensed Consolidated Statements of Cash Flows. As of JuneSeptember 30, 2019, the Company’s weighted-average remaining lease term and weighted-average discount rate for its operating leases were 8.88.6 years and 4.0%3.9%, respectively.

As of JuneSeptember 30, 2019, future minimum annual lease payments under all non-cancelable operating leases were as follows:
(in millions) Future Operating Lease Payments Future Operating Lease Payments
2019 $396
 $198
2020 760
 782
2021 666
 693
2022 562
 580
2023 463
 477
Thereafter 1,977
 1,978
Total future minimum lease payments 4,824
 4,708
Less imputed interest (806) (758)
Total $4,018
 $3,950

Legal Matters
Because of the nature of its businesses, the Company is frequently made party to a variety of legal actions and regulatory inquiries, including class actions and suits brought by members, care providers, consumer advocacy organizations, customers and regulators, relating to the Company’s businesses, including management and administration of health benefit plans and other services. These matters include medical malpractice, employment, intellectual property, antitrust, privacy and contract claims and claims related to health care benefits coverage and other business practices.
The Company records liabilities for its estimates of probable costs resulting from these matters where appropriate. Estimates of costs resulting from legal and regulatory matters involving the Company are inherently difficult to predict, particularly where the matters: involve indeterminate claims for monetary damages or may involve fines, penalties or punitive damages; present novel legal theories or represent a shift in regulatory policy; involve a large number of claimants or regulatory bodies; are in the early stages of the proceedings; or could result in a change in business practices. Accordingly, the Company is often unable to estimate the losses or ranges of losses for those matters where there is a reasonable possibility or it is probable that a loss may be incurred.
Government Investigations, Audits and Reviews
The Company has been involved or is currently involved in various governmental investigations, audits and reviews. These include routine, regular and special investigations, audits and reviews by the Centers for Medicare and Medicaid Services (CMS), state insurance and health and welfare departments, the Brazilian national regulatory agency for private health insurance and plans (the Agência Nacional de Saúde Suplementar), state attorneys general, the Office of the Inspector General, the Office of Personnel Management, the Office of Civil Rights, the Government Accountability Office, the Federal Trade Commission, U.S. Congressional committees, the U.S. Department of Justice, the SEC, the Internal Revenue Service, the U.S. Drug Enforcement Administration, the Brazilian federal revenue service (the Secretaria da Receita Federal), the U.S. Department of Labor, the Federal Deposit Insurance Corporation, the Defense Contract Audit Agency and other governmental authorities. Certain of the Company’s businesses have been reviewed or are currently under review, including for, among other matters, compliance with coding and other requirements under the Medicare risk-adjustment model. CMS has selected certain of the Company’s local plans for risk adjustment data validation (RADV) audits to validate the coding practices of and supporting documentation maintained by health care providers and such audits may result in retrospective adjustments to payments made to the Company’s health plans.
On February 14, 2017, the Department of Justice (DOJ) announced its decision to pursue certain claims within a lawsuit initially asserted against the Company and filed under seal by a whistleblower in 2011. The whistleblower’s complaint, which was unsealed on February 15, 2017, alleges that the Company made improper risk adjustment submissions and violated the False Claims Act. On February 12, 2018, the court granted in part and denied in part the Company’s motion to dismiss. In May 2018, DOJ moved to dismiss the Company’s counterclaims, which were filed in March 2018, and moved for partial summary judgment. In March 2019, the court denied the government’s motion for partial summary judgment and dismissed the Company’s counterclaims without prejudice. The Company cannot reasonably estimate the outcome that may result from this matter given its procedural status.


8.    Business Combinations
During the nine months ended September 30, 2019, the Company completed several business combinations for total cash consideration of $9.7 billion.
The total consideration exceeded the estimated fair value of the net tangible assets acquired by $8.6 billion, of which $2.0 billion has been allocated to finite-lived intangible assets and $6.6 billion to goodwill. The goodwill is not deductible for income tax purposes.
Acquired tangible assets (liabilities) at acquisition date were:
(in millions)  
Cash and cash equivalents $1,537
Accounts receivable and other current assets 1,775
Property, equipment and other long-term assets 1,941
Medical costs payable (868)
Accounts payable and other current liabilities (1,669)
Other long-term liabilities (1,283)
Total net tangible assets $1,433

The preliminary purchase price allocations for the various business combinations are subject to adjustment as valuation analyses, primarily related to intangible assets and contingent and tax liabilities, are finalized.
The acquisition date fair values and weighted-average useful lives assigned to acquired finite-lived intangible assets were:
(in millions, except years) Fair Value Weighted-Average Useful Life
Customer-related $1,670
 14
Trademarks and technology 117
 4
Other 164
 10
Total acquired finite-lived intangible assets $1,951
 13


The results of operations and financial condition of acquired entities have been included in the Company’s consolidated results and the results of the corresponding operating segment as of date of acquisition. Through September 30, 2019, acquired entities’ impact on revenues and net earnings was not material.
Unaudited pro forma revenues for the nine months ended September 30, 2019 and 2018 as if the acquisitions had occurred on January 1, 2018 were immaterial for both periods. The pro forma effects of the acquisitions on net earnings were immaterial for both years.
9.    Segment Financial Information
The Company’s four4 reportable segments are UnitedHealthcare, OptumHealth, OptumInsight and OptumRx. For more information on the Company’s segments see Part I, Item I, “Business” and Note 13 of Notes to the Consolidated Financial Statements in Part II, Item 8, “Financial Statements and Supplementary Data” in the 2018 10-K. Total assets at OptumHealth increased to $38.8$40.1 billion as of JuneSeptember 30, 2019 compared to $29.8 billion as of December 31, 2018, primarily due to goodwill and other intangibles assets from a second quarter 2019 acquisition and the recognition of ROU assets from ASU 2016-02. Total assets at OptumInsight increased to $15.1 billion as of September 30, 2019 compared to $11.0 billion as of December 31, 2018, primarily due to goodwill and other intangibles assets from a third quarter 2019 acquisition.

The following tables present reportable segment financial information:
   Optum       Optum    
(in millions) UnitedHealthcare OptumHealth OptumInsight OptumRx Optum Eliminations Optum 
Corporate and
Eliminations
 Consolidated UnitedHealthcare OptumHealth OptumInsight OptumRx Optum Eliminations Optum 
Corporate and
Eliminations
 Consolidated
Three Months Ended June 30, 2019                
Three Months Ended September 30, 2019                
Revenues - unaffiliated customers:                                
Premiums $46,030
 $1,134
 $
 $
 $
 $1,134
 $
 $47,164
 $45,557
 $1,840
 $
 $
 $
 $1,840
 $
 $47,397
Products 
 9
 22
 8,322
 
 8,353
 
 8,353
 
 6
 29
 7,511
 
 7,546
 
 7,546
Services 2,188
 1,370
 790
 148
 
 2,308
 
 4,496
 2,274
 1,487
 988
 193
 
 2,668
 
 4,942
Total revenues - unaffiliated customers 48,218
 2,513
 812
 8,470
 
 11,795
 
 60,013
 47,831
 3,333
 1,017
 7,704
 
 12,054
 
 59,885
Total revenues - affiliated customers 
 4,449
 1,521
 10,439
 (381) 16,028
 (16,028) 
 
 4,630
 1,594
 10,734
 (441) 16,517
 (16,517) 
Investment and other income 376
 186
 6
 14
 
 206
 
 582
 274
 170
 6
 16
 
 192
 
 466
Total revenues $48,594
 $7,148
 $2,339
 $18,923
 $(381) $28,029
 $(16,028) $60,595
 $48,105
 $8,133
 $2,617
 $18,454
 $(441) $28,763
 $(16,517) $60,351
Earnings from operations $2,642
 $688
 $525
 $889
 $
 $2,102
 $
 $4,744
 $2,655
 $748
 $632
 $979
 $
 $2,359
 $
 $5,014
Interest expense 
 
 
 
 
 
 (418) (418) 
 
 
 
 
 
 (449) (449)
Earnings before income taxes $2,642
 $688
 $525
 $889
 $
 $2,102
 $(418) $4,326
 $2,655
 $748
 $632
 $979
 $
 $2,359
 $(449) $4,565
Three Months Ended June 30, 2018                
Three Months Ended September 30, 2018                
Revenues - unaffiliated customers:                                
Premiums $43,496
 $962
 $
 $
 $
 $962
 $
 $44,458
 $43,628
 $985
 $
 $
 $
 $985
 $
 $44,613
Products 
 12
 20
 6,972
 
 7,004
 
 7,004
 
 13
 29
 7,302
 
 7,344
 
 7,344
Services 2,142
 1,203
 776
 148
 
 2,127
 
 4,269
 2,067
 1,196
 790
 164
 
 2,150
 
 4,217
Total revenues - unaffiliated customers 45,638
 2,177
 796
 7,120
 
 10,093
 
 55,731
 45,695
 2,194
 819
 7,466
 
 10,479
 
 56,174
Total revenues - affiliated customers 
 3,640
 1,380
 9,807
 (341) 14,486
 (14,486) 
 
 3,733
 1,431
 9,960
 (352) 14,772
 (14,772) 
Investment and other income 208
 124
 9
 14
 
 147
 
 355
 242
 125
 4
 11
 
 140
 
 382
Total revenues $45,846
 $5,941
 $2,185
 $16,941
 $(341) $24,726
 $(14,486) $56,086
 $45,937
 $6,052
 $2,254
 $17,437
 $(352) $25,391
 $(14,772) $56,556
Earnings from operations $2,357
 $570
 $453
 $824
 $
 $1,847
 $
 $4,204
 $2,559
 $622
 $534
 $875
 $
 $2,031
 $
 $4,590
Interest expense 
 
 
 
 
 
 (344) (344) 
 
 
 
 
 
 (353) (353)
Earnings before income taxes $2,357
 $570
 $453
 $824
 $
 $1,847
 $(344) $3,860
 $2,559
 $622
 $534
 $875
 $
 $2,031
 $(353) $4,237

   Optum       Optum    
(in millions) UnitedHealthcare OptumHealth OptumInsight OptumRx Optum Eliminations Optum Corporate and
Eliminations
 Consolidated UnitedHealthcare OptumHealth OptumInsight OptumRx Optum Eliminations Optum Corporate and
Eliminations
 Consolidated
Six Months Ended June 30, 2019                
Nine Months Ended September 30, 2019                
Revenues - unaffiliated customers:                                
Premiums $92,531
 $2,146
 $
 $
 $
 $2,146
 $
 $94,677
 $138,088
 $3,986
 $
 $
 $
 $3,986
 $
 $142,074
Products 
 17
 45
 16,363
 
 16,425
 
 16,425
 
 23
 74
 23,874
 
 23,971
 
 23,971
Services 4,329
 2,644
 1,544
 297
 
 4,485
 
 8,814
 6,603
 4,131
 2,532
 490
 
 7,153
 
 13,756
Total revenues - unaffiliated customers 96,860
 4,807
 1,589
 16,660
 
 23,056
 
 119,916
 144,691
 8,140
 2,606
 24,364
 
 35,110
 
 179,801
Total revenues - affiliated customers 
 8,736
 2,928
 20,052
 (740) 30,976
 (30,976) 
 
 13,366
 4,522
 30,786
 (1,181) 47,493
 (47,493) 
Investment and other income 630
 318
 11
 28
 
 357
 
 987
 904
 488
 17
 44
 
 549
 
 1,453
Total revenues $97,490
 $13,861
 $4,528
 $36,740
 $(740) $54,389
 $(30,976) $120,903
 $145,595
 $21,994
 $7,145
 $55,194
 $(1,181) $83,152
 $(47,493) $181,254
Earnings from operations $5,596
 $1,314
 $957
 $1,709
 $
 $3,980
 $
 $9,576
 $8,251
 $2,062
 $1,589
 $2,688
 $
 $6,339
 $
 $14,590
Interest expense 
 
 
 
 
 
 (818) (818) 
 
 
 
 
 
 (1,267) (1,267)
Earnings before income taxes $5,596
 $1,314
 $957
 $1,709
 $
 $3,980
 $(818) $8,758
 $8,251
 $2,062
 $1,589
 $2,688
 $
 $6,339
 $(1,267) $13,323
Six Months Ended June 30, 2018                
Nine Months Ended September 30, 2018                
Revenues - unaffiliated customers:                                
Premiums $86,733
 $1,809
 $
 $
 $
 $1,809
 $
 $88,542
 $130,361
 $2,794
 $
 $
 $
 $2,794
 $
 $133,155
Products 
 24
 43
 13,639
 
 13,706
 
 13,706
 
 37
 72
 20,941
 
 21,050
 
 21,050
Services 4,181
 2,391
 1,516
 285
 
 4,192
 
 8,373
 6,248
 3,587
 2,306
 449
 
 6,342
 
 12,590
Total revenues - unaffiliated customers 90,914
 4,224
 1,559
 13,924
 
 19,707
 
 110,621
 136,609
 6,418
 2,378
 21,390
 
 30,186
 
 166,795
Total revenues - affiliated customers 
 7,246
 2,684
 19,102
 (674) 28,358
 (28,358) 
 
 10,979
 4,115
 29,062
 (1,026) 43,130
 (43,130) 
Investment and other income 391
 230
 11
 21
 
 262
 
 653
 633
 355
 15
 32
 
 402
 
 1,035
Total revenues $91,305
 $11,700
 $4,254
 $33,047
 $(674) $48,327
 $(28,358) $111,274
 $137,242
 $17,752
 $6,508
 $50,484
 $(1,026) $73,718
 $(43,130) $167,830
Earnings from operations $4,757
 $1,058
 $848
 $1,594
 $
 $3,500
 $
 $8,257
 $7,316
 $1,680
 $1,382
 $2,469
 $
 $5,531
 $
 $12,847
Interest expense 
 
 
 
 
 
 (673) (673) 
 
 
 
 
 
 (1,026) (1,026)
Earnings before income taxes $4,757
 $1,058
 $848
 $1,594
 $
 $3,500
 $(673) $7,584
 $7,316
 $1,680
 $1,382
 $2,469
 $
 $5,531
 $(1,026) $11,821


ITEM 2.MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The following discussion should be read together with the accompanying Condensed Consolidated Financial Statements and Notes and with our 2018 10-K, including the Consolidated Financial Statements and Notes in Part II, Item 8, “Financial Statements and Supplementary Data” in that report. Unless the context indicates otherwise, references to the terms “UnitedHealth Group,” “we,” “our” or “us” used throughout this Management’s Discussion and Analysis of Financial Condition and Results of Operations refer to UnitedHealth Group Incorporated and its consolidated subsidiaries.
Readers are cautioned that the statements, estimates, projections or outlook contained in this Management's Discussion and Analysis of Financial Condition and Results of Operations, including discussions regarding financial prospects, economic conditions, trends and uncertainties contained in this Item 2, may constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 (PSLRA). These forward-looking statements involve risks and uncertainties that may cause our actual results to differ materially from the results discussed or implied in the forward-looking statements. A description of some of the risks and uncertainties is set forth in Part I, Item 1A, “Risk Factors” in our 2018 10-K and in the discussion below.
EXECUTIVE OVERVIEW
General
UnitedHealth Group is a diversified health care company dedicated to helping people live healthier lives and helping make the health system work better for everyone. Through our diversified family of businesses, we leverage core competencies in data and health information; advanced technology; and clinical expertise. These core competencies are deployed within two distinct,

but strategically aligned, business platforms: health benefits operating under UnitedHealthcare and health services operating under Optum.
Further information on our business is presented in Part I, Item 1, “Business” and Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in our 2018 10-K and additional information on our segments can be found in this Item 2 and in Note 89 of Notes to the Condensed Consolidated Financial Statements included in Part I, Item 1 of this report.
Business Trends
Our businesses participate in the United States, South American and certain other international health markets. In the United States, health care spending has grown consistently for many years and comprises approximately 18% of gross domestic product. Overall spending on health care is impacted by inflation; medical technology and pharmaceutical advancement; regulatory requirements; demographic trends in the population and national interest in health and well-being, mitigated by our continued efforts to control health care costs. The rate of market growth may be affected by a variety of factors, including macro-economic conditions and regulatory changes, which could impact our results of operations.
Pricing Trends. To price our health care benefit products, we start with our view of expected future costs, including any impact from the Health Insurance Industry Tax. We frequently evaluate and adjust our approach in each of the local markets we serve, considering all relevant factors, such as product positioning, price competitiveness and environmental, competitive, legislative and regulatory considerations, including minimum medical loss ratio (MLR) thresholds. We will continue seeking to balance growth and profitability across all of these dimensions.
The commercial risk market remains highly competitive in both the small group and large group segments. We expect broad-based competition to continue as the industry adapts to individual and employer needs amid reform changes. Pricing for contracts that cover some portion of calendar year 2020 will reflectreflects the return of the Health Insurance Industry Tax after a moratorium in 2019.
Government programs in the public and senior sector tend to receive lower rates of increase than the commercial market due to governmental budget pressures and lower cost trends.
Medical Cost Trends. Our medical cost trends primarily relate to changes in unit costs, health system utilization and prescription drug costs. We endeavor to mitigate those increases by engaging physicians and consumers with information and helping them make clinically sound choices, with the objective of helping them achieve high quality, affordable care.
Regulatory Trends and Uncertainties
Following is a summary of management’s view of regulatory trends and uncertainties. For additional information regarding regulatory trends and uncertainties, see Part I, Item 1 “Business - Government Regulation,” Part 1, Item 1A, “Risk Factors” and Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in our 2018 10-K.
Medicare Advantage Rates. Final 2020 Medicare Advantage rates resulted in an increase in industry base rates of approximately 2.5%, short of the industry forward medical cost trend, including the return of the non-reimbursable Health Insurance Industry Tax, creating continued pressure in the Medicare Advantage program.
Health Insurance Industry Tax. There is a one year moratorium on the Health Insurance Industry Tax in 2019. This moratorium impacts year-over-year comparability of our financial statements, including revenues, operating costs, medical care ratio (MCR), operating cost ratio, effective tax rate and cash flows from operations.
SELECTED OPERATING PERFORMANCE AND OTHER SIGNIFICANT ITEMS
The following summarizes select secondthird quarter 2019 year-over-year operating comparisons to secondthird quarter 2018.
Consolidated revenues grew 8%7%, UnitedHealthcare revenues grew 6%5% and Optum revenues grew 13%.
UnitedHealthcare served 705,000415,000 additional people primarily as a result of acquisitions and growth in services to self-funded employers and seniors.
EarningsConsolidated earnings from operations increased 13%9%, including increases of 12%4% at UnitedHealthcare and 14%16% at Optum.
Diluted earnings per common share increased 15%13%.
Cash flows from operations for the sixnine months ended JuneSeptember 30, 2019 were $9.1$12.3 billion.
Return on equity was 25.1%26.2%.

RESULTS SUMMARY
The following table summarizes our consolidated results of operations and other financial information:
(in millions, except percentages and per share data) Three Months Ended June 30, Increase/(Decrease) Six Months Ended June 30, Increase/(Decrease) Three Months Ended September 30, Increase/(Decrease) Nine Months Ended September 30, Increase/(Decrease)
2019 2018 2019 vs. 2018 2019 2018 2019 vs. 2018 2019 2018 2019 vs. 2018 2019 2018 2019 vs. 2018
Revenues:                                
Premiums $47,164
 $44,458
 $2,706
 6% $94,677
 $88,542
 $6,135
 7% $47,397
 $44,613
 $2,784
 6% $142,074
 $133,155
 $8,919
 7%
Products 8,353
 7,004
 1,349
 19
 16,425
 13,706
 2,719
 20
 7,546
 7,344
 202
 3
 23,971
 21,050
 2,921
 14
Services 4,496
 4,269
 227
 5
 8,814
 8,373
 441
 5
 4,942
 4,217
 725
 17
 13,756
 12,590
 1,166
 9
Investment and other income 582
 355
 227
 64
 987
 653
 334
 51
 466
 382
 84
 22
 1,453
 1,035
 418
 40
Total revenues 60,595
 56,086
 4,509
 8
 120,903
 111,274
 9,629
 9
 60,351
 56,556
 3,795
 7
 181,254
 167,830
 13,424
 8
Operating costs:                                
Medical costs 39,184
 36,427
 2,757
 8
 78,123
 72,290
 5,833
 8
 39,041
 36,158
 2,883
 8
 117,164
 108,448
 8,716
 8
Operating costs 8,415
 8,386
 29
 
 16,932
 16,892
 40
 
 8,960
 8,479
 481
 6
 25,892
 25,371
 521
 2
Cost of products sold 7,598
 6,471
 1,127
 17
 14,979
 12,655
 2,324
 18
 6,627
 6,718
 (91) (1) 21,606
 19,373
 2,233
 12
Depreciation and amortization 654
 598
 56
 9
 1,293
 1,180
 113
 10
 709
 611
 98
 16
 2,002
 1,791
 211
 12
Total operating costs 55,851
 51,882
 3,969
 8
 111,327
 103,017
 8,310
 8
 55,337
 51,966
 3,371
 6
 166,664
 154,983
 11,681
 8
Earnings from operations 4,744
 4,204
 540
 13
 9,576
 8,257
 1,319
 16
 5,014
 4,590
 424
 9
 14,590
 12,847
 1,743
 14
Interest expense (418) (344) (74) 22
 (818) (673) (145) 22
 (449) (353) (96) 27
 (1,267) (1,026) (241) 23
Earnings before income taxes 4,326
 3,860
 466
 12
 8,758
 7,584
 1,174
 15
 4,565
 4,237
 328
 8
 13,323
 11,821
 1,502
 13
Provision for income taxes (941) (850) (91) 11
 (1,816) (1,650) (166) 10
 (936) (953) 17
 (2) (2,752) (2,603) (149) 6
Net earnings 3,385
 3,010
 375
 12
 6,942
 5,934
 1,008
 17
 3,629
 3,284
 345
 11
 10,571
 9,218
 1,353
 15
Earnings attributable to noncontrolling interests (92) (88) (4) 5
 (182) (176) (6) 3
 (91) (96) 5
 (5) (273) (272) (1) 
Net earnings attributable to UnitedHealth Group common shareholders $3,293
 $2,922
 $371
 13% $6,760
 $5,758
 $1,002
 17% $3,538
 $3,188
 $350
 11 % $10,298
 $8,946
 $1,352
 15%
Diluted earnings per share attributable to UnitedHealth Group common shareholders $3.42
 $2.98
 $0.44
 15% $6.97
 $5.85
 $1.12
 19% $3.67
 $3.24
 $0.43
 13 % $10.65
 $9.09
 $1.56
 17%
Medical care ratio (a) 83.1% 81.9% 1.2 %   82.5% 81.6% 0.9 %   82.4% 81.0% 1.4 %   82.5% 81.4% 1.1 %  
Operating cost ratio 13.9
 15.0
 (1.1)   14.0
 15.2
 (1.2)   14.8
 15.0
 (0.2)   14.3
 15.1
 (0.8)  
Operating margin 7.8
 7.5
 0.3
   7.9
 7.4
 0.5
   8.3
 8.1
 0.2
   8.0
 7.7
 0.3
  
Tax rate 21.8
 22.0
 (0.2)   20.7
 21.8
 (1.1)   20.5
 22.5
 (2.0)   20.7
 22.0
 (1.3)  
Net earnings margin (b) 5.4
 5.2
 0.2
   5.6
 5.2
 0.4
   5.9
 5.6
 0.3
   5.7
 5.3
 0.4
  
Return on equity (c) 25.1% 24.4% 0.7 %   25.9% 24.1% 1.8 %   26.2% 25.9% 0.3 %   26.0% 24.6% 1.4 %  
                   
(a)Medical care ratio is calculated as medical costs divided by premium revenue.
(b)Net earnings margin attributable to UnitedHealth Group shareholders.
(c)Return on equity is calculated as annualized net earnings attributable to UnitedHealth Group common shareholders divided by average shareholders’ equity. Average shareholders’ equity is calculated using the shareholders’ equity balance at the end of the preceding year and the shareholders’ equity balances at the end of each of the quarters in the year presented.
2019 RESULTS OF OPERATIONS COMPARED TO 2018 RESULTS OF OPERATIONS
Consolidated Financial Results
Revenue
The increases in revenue were primarily driven by the increase in the number of individuals served through various Medicare products;Advantage; pricing trends; and acquisition and organic growth across the Optum business, primarily due to expansion in pharmacy care services and care delivery; partially offset by the moratorium of the Health Insurance Industry Tax in 2019.
Medical Costs and MCR
Medical costs increased due to growth in people served through Medicare productsAdvantage and medical cost trends, partially offset by increased prior year favorable medical cost development. The MCR increased primarily due to the revenue effects of the Health Insurance Industry Tax moratorium.
Operating Cost Ratio
The operating cost ratio decreased due to the impact of the Health Insurance Industry Tax moratorium and effective operating cost management.

Income Tax Rate
Our effective tax rate decreased primarily due to the impact of the moratorium of the nondeductible Health Insurance Industry Tax.
Reportable Segments
See Note 89 of Notes to the Condensed Consolidated Financial Statements included in Part I, Item 1 of this report for more information on our segments. The following table presents a summary of the reportable segment financial information:
 Three Months Ended June 30, Increase/(Decrease) Six Months Ended June 30, Increase/(Decrease) Three Months Ended September 30, Increase/(Decrease) Nine Months Ended September 30, Increase/(Decrease)
(in millions, except percentages) 2019 2018 2019 vs. 2018 2019 2018 2019 vs. 2018 2019 2018 2019 vs. 2018 2019 2018 2019 vs. 2018
Revenues                                
UnitedHealthcare $48,594
 $45,846
 $2,748
 6% $97,490
 $91,305
 $6,185
 7% $48,105
 $45,937
 $2,168
 5% $145,595
 $137,242
 $8,353
 6%
OptumHealth 7,148
 5,941
 1,207
 20
 13,861
 11,700
 2,161
 18
 8,133
 6,052
 2,081
 34
 21,994
 17,752
 4,242
 24
OptumInsight 2,339
 2,185
 154
 7
 4,528
 4,254
 274
 6
 2,617
 2,254
 363
 16
 7,145
 6,508
 637
 10
OptumRx 18,923
 16,941
 1,982
 12
 36,740
 33,047
 3,693
 11
 18,454
 17,437
 1,017
 6
 55,194
 50,484
 4,710
 9
Optum eliminations (381) (341) (40) 12
 (740) (674) (66) 10
 (441) (352) (89) 25
 (1,181) (1,026) (155) 15
Optum 28,029
 24,726
 3,303
 13
 54,389
 48,327
 6,062
 13
 28,763
 25,391
 3,372
 13
 83,152
 73,718
 9,434
 13
Eliminations (16,028) (14,486) (1,542) 11
 (30,976) (28,358) (2,618) 9
 (16,517) (14,772) (1,745) 12
 (47,493) (43,130) (4,363) 10
Consolidated revenues $60,595
 $56,086
 $4,509
 8% $120,903
 $111,274
 $9,629
 9% $60,351
 $56,556
 $3,795
 7% $181,254
 $167,830
 $13,424
 8%
Earnings from operations                                
UnitedHealthcare $2,642
 $2,357
 $285
 12% $5,596
 $4,757
 $839
 18% $2,655
 $2,559
 $96
 4% $8,251
 $7,316
 $935
 13%
OptumHealth 688
 570
 118
 21
 1,314
 1,058
 256
 24
 748
 622
 126
 20
 2,062
 1,680
 382
 23
OptumInsight 525
 453
 72
 16
 957
 848
 109
 13
 632
 534
 98
 18
 1,589
 1,382
 207
 15
OptumRx 889
 824
 65
 8
 1,709
 1,594
 115
 7
 979
 875
 104
 12
 2,688
 2,469
 219
 9
Optum 2,102
 1,847
 255
 14
 3,980
 3,500
 480
 14
 2,359
 2,031
 328
 16
 6,339
 5,531
 808
 15
Consolidated earnings from operations $4,744
 $4,204
 $540
 13% $9,576
 $8,257
 $1,319
 16% $5,014
 $4,590
 $424
 9% $14,590
 $12,847
 $1,743
 14%
Operating margin                                
UnitedHealthcare 5.4% 5.1% 0.3 %   5.7% 5.2% 0.5 %   5.5% 5.6% (0.1)%   5.7% 5.3% 0.4 %  
OptumHealth 9.6
 9.6
 
   9.5
 9.0
 0.5
   9.2
 10.3
 (1.1)   9.4
 9.5
 (0.1)  
OptumInsight 22.4
 20.7
 1.7
   21.1
 19.9
 1.2
   24.1
 23.7
 0.4
   22.2
 21.2
 1.0
  
OptumRx 4.7
 4.9
 (0.2)   4.7
 4.8
 (0.1)   5.3
 5.0
 0.3
   4.9
 4.9
 
  
Optum 7.5
 7.5
 
   7.3
 7.2
 0.1
   8.2
 8.0
 0.2
   7.6
 7.5
 0.1
  
Consolidated operating margin 7.8% 7.5% 0.3 %   7.9% 7.4% 0.5 %   8.3% 8.1% 0.2 %   8.0% 7.7% 0.3 %  
UnitedHealthcare
The following table summarizes UnitedHealthcare revenues by business:
 Three Months Ended June 30, Increase/(Decrease) Six Months Ended June 30, Increase/(Decrease) Three Months Ended September 30, Increase/(Decrease) Nine Months Ended September 30, Increase/(Decrease)
(in millions, except percentages) 2019 2018 2019 vs. 2018 2019 2018 2019 vs. 2018 2019 2018 2019 vs. 2018 2019 2018 2019 vs. 2018
UnitedHealthcare Employer & Individual $14,032
 $13,708
 $324
 2 % $28,116
 $27,122
 $994
 4% $14,291
 $13,734
 $557
 4 % $42,407
 $40,856
 $1,551
 4%
UnitedHealthcare Medicare & Retirement 20,855
 18,859
 1,996
 11
 41,951
 37,784
 4,167
 11
 20,698
 18,789
 1,909
 10
 62,649
 56,573
 6,076
 11
UnitedHealthcare Community & State 11,186
 10,746
 440
 4
 22,368
 21,417
 951
 4
 10,670
 11,054
 (384) (3) 33,038
 32,471
 567
 2
UnitedHealthcare Global 2,521
 2,533
 (12) 
 5,055
 4,982
 73
 1
 2,446
 2,360
 86
 4
 7,501
 7,342
 159
 2
Total UnitedHealthcare revenues $48,594
 $45,846
 $2,748
 6 % $97,490
 $91,305
 $6,185
 7% $48,105
 $45,937
 $2,168
 5 % $145,595
 $137,242
 $8,353
 6%

The following table summarizes the number of individuals served by our UnitedHealthcare businesses, by major market segment and funding arrangement:
 June 30, Increase/(Decrease) September 30, Increase/(Decrease)
(in thousands, except percentages) 2019 2018 2019 vs. 2018 2019 2018 2019 vs. 2018
Commercial:                
Risk-based 8,325
 8,385
 (60) (1)% 8,605
 8,450
 155
 2 %
Fee-based 19,090
 18,415
 675
 4
 19,230
 18,365
 865
 5
Total commercial 27,415
 26,800
 615
 2
 27,835
 26,815
 1,020
 4
Medicare Advantage 5,190
 4,790
 400
 8
 5,230
 4,915
 315
 6
Medicaid 6,360
 6,710
 (350) (5) 5,965
 6,630
 (665) (10)
Medicare Supplement (Standardized) 4,495
 4,505
 (10) 
 4,510
 4,540
 (30) (1)
Total public and senior 16,045
 16,005
 40
 
 15,705
 16,085
 (380) (2)
Total UnitedHealthcare - domestic medical 43,460
 42,805
 655
 2
 43,540
 42,900
 640
 1
International 6,070
 6,020
 50
 1
 5,845
 6,070
 (225) (4)
Total UnitedHealthcare - medical 49,530
 48,825
 705
 1 % 49,385
 48,970
 415
 1 %
Supplemental Data:                
Medicare Part D stand-alone 4,430
 4,730
 (300) (6)% 4,415
 4,725
 (310) (7)%
Fee-based commercial group business increased primarily due to an acquisition. Medicare Advantage increased due to growth in people served through individual and employer-sponsored group Medicare Advantage plans. The decrease in people served through Medicaid was primarily driven by proactive withdrawal from the Iowa market as well as by states adding new carriers to existing programs reduced enrollment from state efforts to manageand managing eligibility, status and the sale of our New Mexico Medicaid plan in 2018, partially offset by increases in Dual Special Needs Plans.
UnitedHealthcare’s revenue and earnings from operations increased due to growth in the number of individuals served through severalCommercial and Medicare products,Advantage, including a greater mix of people with higher revenue membership mix and rate increases for underlying medical cost trends.acuity needs. Revenue increases were partially offset by the moratorium on the Health Insurance Industry Tax in 2019. Earnings from operations were also favorably impacted by operating cost management.
Optum
Total revenues and earnings from operations increased as each segment reported increased revenues and earnings from operations as a result of productivity and overall cost management initiatives in addition to the factors discussed below.
The results by segment were as follows:
OptumHealth
Revenue increased at OptumHealth primarily due to organic growth and acquisitions in care delivery, increased care services and organic growth in behavioral health. Increased operating earnings were primarily due to care delivery and care services. OptumHealth served approximately 95 million people as of JuneSeptember 30, 2019 compared to 92 million people as of JuneSeptember 30, 2018.
OptumInsight
Revenue and earnings from operations at OptumInsight increased primarily due to organic and acquisition growth in managed services.
OptumRx
Revenue and earnings from operations at OptumRx increased primarily due to acquisitions and organic growth in specialty pharmacy, home delivery services and overall prescription growth.partially offset by an expected large client transition. Earnings from operations increased primarily due to the factors that increased revenue as well as improved supply chain management. OptumRx fulfilled 343325 million and 332331 million adjusted scripts in the second quartersthird quarter of 2019 and 2018, respectively. The decrease was due to the large client transition.

LIQUIDITY, FINANCIAL CONDITION AND CAPITAL RESOURCES
Liquidity
Summary of our Major Sources and Uses of Cash and Cash Equivalents
 Six Months Ended June 30, Increase/(Decrease) Nine Months Ended September 30, Increase/(Decrease)
(in millions) 2019 2018 2019 vs. 2018 2019 2018 2019 vs. 2018
Sources of cash:            
Cash provided by operating activities $9,108
 $12,376
 $(3,268) $12,258
 $13,317
 $(1,059)
Issuances of commercial paper and long-term debt, net of repayments 5,674
 2,683
 2,991
 8,192
 1,200
 6,992
Proceeds from common stock issuances 448
 478
 (30) 740
 745
 (5)
Customer funds administered 1,435
 3,082
 (1,647) 420
 1,552
 (1,132)
Other 504
 
 504
 338
 
 338
Total sources of cash 17,169
 18,619
   21,948
 16,814
  
Uses of cash:            
Common stock repurchases (4,501) (3,150) (1,351) (5,101) (3,650) (1,451)
Cash paid for acquisitions, net of cash assumed (4,751) (2,636) (2,115) (8,200) (5,824) (2,376)
Purchases of investments, net of sales and maturities (1,654) (2,968) 1,314
 (2,028) (3,729) 1,701
Purchases of property, equipment and capitalized software (977) (960) (17) (1,421) (1,505) 84
Cash dividends paid (1,884) (1,588) (296) (2,908) (2,454) (454)
Other (529) (852) 323
 (756) (1,273) 517
Total uses of cash (14,296) (12,154)   (20,414) (18,435)  
Effect of exchange rate changes on cash and cash equivalents 6
 (78) 84
 (37) (97) 60
Net increase in cash and cash equivalents $2,879
 $6,387
 $(3,508)
Net increase (decrease) in cash and cash equivalents $1,497
 $(1,718) $3,215
2019 Cash Flows Compared to 2018 Cash Flows
Decreased cash flows provided by operating activities were primarily driven by the increasechanges in unearned revenues in 2018 due to the June 2018 early receipt of our July CMS premium payment of $5.2 billion and the year-over-year impact of the Health Insurance Industry Tax moratorium,working capital accounts, partially offset by higher net earnings and changes in working capital accounts.
earnings. Other significant changes in sources or uses of cash year-over-year included increased cash paid for acquisitions; common stock repurchases; and issuances of commercial paper and decreased net purchases of investments partially offset by increases in cash paid for acquisitions and customer funds administered, due to the early receipt of our CMS payment in 2018 described above.common stock repurchases.
Financial Condition
As of JuneSeptember 30, 2019, our cash, cash equivalent, available-for-sale debt securities and equity securities balances of $50.7$50.4 billion included approximately $13.7$12.4 billion of cash and cash equivalents (of which $900 million$1.5 billion was available for general corporate use), $34.7$35.9 billion of debt securities and $2.2$2.0 billion of investments in equity securities. Given the significant portion of our portfolio held in cash and cash equivalents, we do not anticipate fluctuations in the aggregate fair value of our financial assets to have a material impact on our liquidity or capital position. Our available-for-sale debt portfolio had a weighted-average duration of 3.3 years and a weighted-average credit rating of “Double A” as of JuneSeptember 30, 2019. When multiple credit ratings are available for an individual security, the average of the available ratings is used to determine the weighted-average credit rating.
Capital Resources and Uses of Liquidity
In addition to cash flows from operations and cash and cash equivalent balances available for general corporate use, our capital resources and uses of liquidity are as follows:
Commercial Paper and Bank Credit Facilities. Our revolving bank credit facilities provide liquidity support for our commercial paper borrowing program, which facilitates the private placement of unsecured debt through third-party broker-dealers, and are available for general corporate purposes. For more information on our commercial paper and bank credit facilities, see Note 5 of Notes to the Condensed Consolidated Financial Statements included in Part I, Item 1 of this report.

Our revolving bank credit facilities contain various covenants, including covenants requiring us to maintain a defined debt to debt-plus-shareholders’ equity ratio of not more than 60%. As of JuneSeptember 30, 2019, our debt to debt-plus-shareholders’ equity ratio, as defined and calculated under the credit facilities, was approximately 41%.

Long-Term Debt. In July 2019,Periodically, we issued $5.5 billion in senior unsecured notes. We intend to use the net proceeds from this offeringaccess capital markets and issue long-term debt for general corporate purposes, including refinancing commercial paper borrowings,such as to meet our working capital requirements, to refinance debt, to finance acquisitions or redeeming, repurchasing or repaying outstanding securities.for share repurchases. For more information on our long-term debt, see Note 5 of Notes to the Condensed Consolidated Financial Statements included in Part I, Item 1 of this report.
Credit Ratings. Our credit ratings as of JuneSeptember 30, 2019 were as follows:
  
Moody’s S&P Global Fitch A.M. Best
 Ratings Outlook Ratings Outlook Ratings Outlook Ratings Outlook
Senior unsecured debtA3 Stable A+ Stable A- Stable A- Stable
Commercial paperP-2 n/a A-1 n/a F1 n/a AMB-1 n/a
The availability of financing in the form of debt or equity is influenced by many factors, including our profitability, operating cash flows, debt levels, credit ratings, debt covenants and other contractual restrictions, regulatory requirements and economic and market conditions. For example, a significant downgrade in our credit ratings or adverse conditions in the capital markets may increase the cost of borrowing for us or limit our access to capital.
Share Repurchase Program. During the sixnine months ended JuneSeptember 30, 2019, we repurchased 1821 million shares at an average price of $246.84$245.18 per share. As of JuneSeptember 30, 2019, we had Board authorization to purchase up to 7674 million shares of our common stock.
Dividends. In June 2019, our Board increased our quarterly cash dividend to shareholders to an annual dividend rate of $4.32 per share. For more information on our dividend, see Note 6 of Notes to the Condensed Consolidated Financial Statements included in Part I, Item 1 of this report.
For additional liquidity discussion, see Note 10 of Notes to the Consolidated Financial Statements in Part II, Item 8, “Financial Statements and Supplementary Data” and “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in Part II, Item 7 in our 2018 10-K.
CONTRACTUAL OBLIGATIONS AND COMMITMENTS
A summary of future obligations under our various contractual obligations and commitments as of December 31, 2018 was disclosed in our 2018 10-K. During the sixnine months ended JuneSeptember 30, 2019, there were no material changes to this previously disclosed information outside the ordinary course of business. However, we continually evaluate opportunities to expand our operations, including through internal development of new products, programs and technology applications and acquisitions.
RECENTLY ISSUED ACCOUNTING STANDARDS
See Note 1 of Notes to the Condensed Consolidated Financial Statements in Part I, Item 1 of this report for a discussion of new accounting pronouncements that affect us.
CRITICAL ACCOUNTING ESTIMATES
In preparing our Condensed Consolidated Financial Statements, we are required to make judgments, assumptions and estimates, which we believe are reasonable and prudent based on the available facts and circumstances. These judgments, assumptions and estimates affect certain of our revenues and expenses and their related balance sheet accounts and disclosure of our contingent liabilities. We base our assumptions and estimates primarily on historical experience and consider known and projected trends. On an ongoing basis, we re-evaluate our selection of assumptions and the method of calculating our estimates. Actual results, however, may materially differ from our calculated estimates, and this difference would be reported in our current operations.
Our critical accounting estimates include medical costs payable and goodwill. For a detailed description of our critical accounting estimates, see “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in Part II, Item 7 in our 2018 10-K. For a detailed discussion of our significant accounting policies, see Note 2 of Notes to the Consolidated Financial Statements in Part II, Item 8, “Financial Statements and Supplementary Data” in our 2018 10-K.

FORWARD-LOOKING STATEMENTS
The statements, estimates, projections, guidance or outlook contained in this document include “forward-looking” statements within the meaning of the PSLRA. These statementswhich are intended to take advantage of the “safe harbor” provisions of the PSLRA. Generally thefederal securities law. The words “believe,” “expect,

“expect,” “intend,” “estimate,” “anticipate,” “forecast,” “outlook,” “plan,” “project,” “should” and similar expressions identify forward-looking statements, which generally are not historical in nature.statements. These statements may contain information about financial prospects, economic conditions and trends and involve risks and uncertainties. We caution that actual
Actual results could differ materially from those that management expects, depending on the outcome of certain factors.
Some factors that could cause actual results to differ materially from results discussed or implied in the forward-looking statements include:including: our ability to effectively estimate, price for and manage our medical costs, including the impact of anycosts; new coverage requirements; new laws or regulations, or changes in existing health care laws or regulations, or their enforcement or application, including increases in medical, administrative, technology or other costs or decreases in enrollment resulting from U.S., South American and other jurisdictions’ regulations affecting the health care industry; the outcome ofapplication; the DOJ’s legal action relating to the risk adjustment submission matter; our ability to maintain and achieve improvement in CMS star ratings and other quality scores that impactimpacting revenue; reductions in revenue or delays to cash flows received under Medicare, Medicaid and other government programs, including the effects of a prolonged U.S. government shutdown or debt ceiling constraints;programs; changes in Medicare, including changes in payment methodology, the CMS star ratings program or the application of risk adjustment data validation audits; cyber-attacks, or other privacy or privacy/data security incidents;incidents, or our failure to comply with privacy and data securityrelated regulations; regulatory and other risks and uncertainties ofassociated with the pharmacy benefits management industry; competitive pressures, which could affect our ability to maintain or increase our market share;pressures; changes in or challenges to our public sector contract awards; our ability to execute contractscontract on competitive terms with physicians, hospitals and other service providers; failure to achieve targeted operating cost productivity improvements, including savings resulting from technology enhancement and administrative modernization;improvements; increases in costs and other liabilities associated with increased litigation, government investigations, audits or reviews; failure to manage successfully our strategic alliances or complete or receive anticipated benefits of acquisitions and other strategic transactions,transactions; fluctuations in foreign currency exchange rates on our reported shareholders’ equity and results of operations;rates; downgrades in our credit ratings; the performance of our investment portfolio;portfolio performance; impairment of the value of our goodwill and intangible assets if estimated future results do not adequately support goodwill and intangible assets recorded for our existing businesses or the businesses that we acquire;assets; failure to maintain effective and efficient information systems or if our technology products do not operate as intended; and our ability to obtain sufficient funds from our regulated subsidiaries or the debt or capital marketsfrom external financings to fund our obligations, to maintain our debt to total capital ratio at targeted levels, to maintain our quarterly dividend payment cycle, or to continue repurchasing shares of our common stock.
This above list of important factors is not intended to be exhaustive. We discuss certain of these matters, more fully, as well asand certain risk factorsrisks that may affect our business operations, financial condition and results of operations more fully in our other periodic and current filings with the SEC, including our annual reports on FormForms 10-K, quarterly reports on Form 10-Q and current reports on Form 8-K. Any or all forward-looking statements we make may turn out to be wrong, and can be affected by inaccurate assumptions we might make or by known or unknown risks and uncertainties. By their nature, forward-looking statements are not guarantees of future performance or results and are subject to risks, uncertainties and assumptions that are difficult to predict or quantify. Actual future results may vary materially from expectations expressed or implied in this document or any of our prior communications. You should not place undue reliance on forward-looking statements, which speak only as of the date they are made. We do not undertake to update or revise any forward-looking statements, except as required by applicable securities laws.law.
ITEM 3.    QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK
We manage exposure to market interest rates by diversifying investments across different fixed-income market sectors and debt across maturities, as well as by endeavoring to match our floating-rate assets and liabilities over time, either directly or through the use of interest rate swap contracts. Unrealized gains and losses on investments in available-for-sale debt securities are reported in comprehensive income.

The following table summarizes the impact of hypothetical changes in market interest rates across the entire yield curve by 1% point or 2% points as of JuneSeptember 30, 2019 on our investment income and interest expense per annum, and the fair value of our investments and debt (in millions, except percentages):
 June 30, 2019 September 30, 2019
Increase (Decrease) in Market Interest Rate 
Investment
Income Per
Annum
 
Interest
Expense Per
Annum
 Fair Value of
Financial Assets
 
Fair Value of
Financial Liabilities
 
Investment
Income Per
Annum
 
Interest
Expense Per
Annum
 Fair Value of
Financial Assets
 
Fair Value of
Financial Liabilities
2 % $337
 $305
 $(2,456) $(5,466) $310
 $268
 $(2,607) $(6,824)
1 169
 152
 (1,233) (2,964) 155
 134
 (1,293) (3,709)
(1) (169) (152) 1,177
 3,491
 (155) (134) 1,227
 4,440
(2) (337) (305) 2,034
 7,581
 (310) (268) 1,954
 9,440

ITEM 4.    CONTROLS AND PROCEDURES
EVALUATION OF DISCLOSURE CONTROLS AND PROCEDURES
We maintain disclosure controls and procedures as defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934 (Exchange Act) that are designed to provide reasonable assurance that information required to be disclosed by us in reports that we file or submit under the Exchange Act is (i) recorded, processed, summarized and reported within the time periods specified in SEC rules and forms; and (ii) accumulated and communicated to our management, including our principal executive officer and principal financial officer, as appropriate to allow timely decisions regarding required disclosure.

In connection with the filing of this quarterly report on Form 10-Q, management evaluated, under the supervision and with the participation of our Chief Executive Officer and Chief Financial Officer, the effectiveness of the design and operation of our disclosure controls and procedures as of JuneSeptember 30, 2019. Based upon that evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures were effective at the reasonable assurance level as of JuneSeptember 30, 2019.
CHANGES IN INTERNAL CONTROL OVER FINANCIAL REPORTING
There have been no changes in our internal control over financial reporting during the quarter ended JuneSeptember 30, 2019 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
PART II. OTHER INFORMATION
ITEM 1.LEGAL PROCEEDINGS
A description of our legal proceedings is included in and incorporated by reference to Note 7 of Notes to the Condensed Consolidated Financial Statements contained in Part I, Item 1 of this report.
ITEM 1A.    RISK FACTORS
In addition to the other information set forth in this report, you should carefully consider the factors discussed in Part I, Item 1A, “Risk Factors” of our 2018 10-K, which could materially affect our business, financial condition or future results. The risks described in our 2018 10-K are not the only risks facing us. Additional risks and uncertainties not currently known to us or that we currently deem to be immaterial also may materially adversely affect our business, financial condition or future results.
There have been no material changes to the risk factors disclosed in our 2018 10-K.
ITEM 2.UNREGISTERED SALE OF EQUITY SECURITIES AND USE OF PROCEEDS
In November 1997, our Board of Directors adopted a share repurchase program, which the Board evaluates periodically. There is no established expiration date for the program. During the secondthird quarter 2019, we repurchased approximately 63 million shares at an average price of $235.77$233.38 per share. As of JuneSeptember 30, 2019, we had Board authorization to purchase up to 7674 million shares of our common stock.

ITEM 6.EXHIBITS*
The following exhibits are filed or incorporated by reference herein in response to Item 601 of Regulation S-K. The Company files Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q and Current Reports on Form 8-K pursuant to the Securities Exchange Act of 1934 under Commission File No. 1-10864.

 

 

 

 

 

 

 

 

 
101.INS
 XBRL Instance Document - the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
101.SCH
Inline XBRL Taxonomy Extension Schema Document.
101.CAL
Inline XBRL Taxonomy Extension Calculation Linkbase Document.
101.DEF
Inline XBRL Taxonomy Extension Definition Linkbase Document.
101.LAB
Inline XBRL Taxonomy Extension Label Linkbase Document.
101.PRE
Inline XBRL Taxonomy Extension Presentation Linkbase Document.
104
Cover Page Interactive Data File (formatted as Inline XBRL and embedded within Exhibit 101).
 ________________
* Pursuant to Item 601(b)(4)(iii) of Regulation S-K, copies of instruments defining the rights of certain holders of long-term debt are not filed. The Company will furnish copies thereof to the SEC upon request.


SIGNATURES
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 thereunto duly authorized.
 
UNITEDHEALTH GROUP INCORPORATED
 
/s/ DAVID S. WICHMANN
 Chief Executive Officer
(principal executive officer)
Dated:AugustNovember 6, 2019
David S. Wichmann    
   
/s/ JOHN F. REX
 
Executive Vice President and
Chief Financial Officer
(principal financial officer)
Dated:AugustNovember 6, 2019
John F. Rex    
   
/s/    THOMAS E. ROOS
 
Senior Vice President and
Chief Accounting Officer
(principal accounting officer)
Dated:AugustNovember 6, 2019
Thomas E. Roos    


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