IQVIA HOLDINGS INC. 10-Q

Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations Cautionary Statement for Forward-Looking Information You should read the following discussion and analysis of our financial condition and results of operations together with our condensed consolidated financial statements and the related notes included elsewhere in this Quarterly Report on Form 10-Q and with our audited consolidated financial statements and the notes thereto included in our Annual Report on Form 10-K for the fiscal year ended December 31, 2021 (our “2021 Form 10-K”). In addition to historical condensed consolidated financial information, the following discussion contains or incorporates by reference forward-looking statements within the meaning of the federal securities laws, including Section 27A of the Securities Act of 1933, as amended (“Securities Act”), and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), that are not historical facts but reflect, among other things, our current expectations, our forecasts and our anticipated results of operations, all of which are subject to known and unknown risks, uncertainties and other factors that may cause our actual results, performance or achievements, market trends, or industry results to differ materially from those expressed or implied by such forward-looking statements. Therefore, any statements contained herein that are not statements of historical fact may be forward-looking statements and should be evaluated as such. Without limiting the foregoing, the words “anticipates,” “believes,” “estimates,” “expects,” “intends,” “may,” “forecasts,” “plans,” “projects,” “should,” “targets,” “will” and similar words and expressions, and variations and negatives of these words are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. We assume no obligation to update any such forward-looking information to reflect actual results or changes in our outlook or the factors affecting such forward-looking information. We caution you that any such forward-looking statements are further qualified by important factors that could cause our actual operating results to differ materially from those in the forward-looking statements, including without limitation, business disruptions caused by natural disasters, pandemics such as the COVID-19 (coronavirus) outbreak, including any variants, and the public health policy responses to the outbreak, and international conflicts or other disruptions outside of our control such as the current situation in Ukraine and Russia; our ability to accurately model or forecast the impact of the spread and/or containment of COVID-19, including any variants, among other sources of business interruption, on our operations and financial results; most of our contracts may be terminated on short notice, and we may lose or experience delays with large client contracts or be unable to enter into new contracts; the market for our services may not grow as we expect; we may be unable to successfully develop and market new services or enter new markets; imposition of restrictions on our use of data by data suppliers or their refusal to license data to us; any failure by us to comply with contractual, regulatory or ethical requirements under our contracts, including current or future changes to data protection and privacy laws; breaches or misuse of our or our outsourcing partners’ security or communications systems; failure to meet our productivity or business transformation objectives; failure to successfully invest in growth opportunities; our ability to protect our intellectual property rights and our susceptibility to claims by others that we are infringing on their intellectual property rights; the expiration or inability to acquire third party licenses for technology or intellectual property; any failure by us to accurately and timely price and formulate cost estimates for contracts, or to document change orders; hardware and software failures, delays in the operation of our computer and communications systems or the failure to implement system enhancements; the rate at which our backlog converts to revenue; our ability to acquire, develop and implement technology necessary for our business; consolidation in the industries in which our clients operate; risks related to client or therapeutic concentration; government regulators or our customers may limit the number or scope of indications for medicines and treatments or withdraw products from the market, and government regulators may impose new regulatory requirements or may adopt new regulations affecting the biopharmaceutical industry; the risks associated with operating on a global basis, including currency or exchange rate fluctuations and legal compliance, including anti-corruption laws; risks related to changes in accounting standards; general economic conditions in the markets in which we operate, including financial market conditions, inflation, and risks related to sales to government entities; the impact of changes in tax laws and regulations; and our ability to successfully integrate, and achieve expected benefits from, our acquired businesses. For a further discussion of the risks relating to our business, see Part I—Item 1A—“Risk Factors” in our 2021 Form 10-K, as updated in our subsequently filed Quarterly Reports on Form 10-Q. Overview IQVIA is a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry. IQVIA creates intelligent connections across all aspects of healthcare through its analytics, transformative technology, big data resources and extensive domain expertise. IQVIA Connected Intelligence™ delivers powerful insights with speed and agility — enabling customers to accelerate the clinical development and commercialization of innovative medical treatments that improve healthcare outcomes for patients. With approximately 85,000 employees, we conduct operations in more than 100 countries. 22 Table of conten t s We are a global leader in protecting individual patient privacy. We use a wide variety of privacy-enhancing technologies and safeguards to protect individual privacy while generating and analyzing information on a scale that helps healthcare stakeholders identify disease patterns and correlate with the precise treatment path and therapy needed for better outcomes. Our insights and execution capabilities help biotech, medical device and pharmaceutical companies, medical researchers, government agencies, payers and other healthcare stakeholders tap into a deeper understanding of diseases, human behaviors and scientific advances, in an effort to advance their path toward cures. We are managed through three reportable segments, Technology & Analytics Solutions, Research & Development Solutions and Contract Sales & Medical Solutions. Technology & Analytics Solutions provides mission critical information, technology solutions and real world insights and services to our life science clients. Research & Development Solutions, which primarily serves biopharmaceutical customers, provides outsourced clinical research and clinical trial related services. Contract Sales & Medical Solutions provides health care provider (including contract sales) and patient engagement services to both biopharmaceutical clients and the broader healthcare market. Sources of Revenue Total revenues are comprised of revenues from the provision of our services. We do not have any material product revenues. Costs and Expenses Our costs and expenses are comprised primarily of our cost of revenues including reimbursed expenses and selling, general and administrative expenses. Cost of revenues includes compensation and benefits for billable employees and personnel involved in production, trial monitoring, data management and delivery, and the costs of acquiring and processing data for our information offerings; costs of staff directly involved with delivering technology-related services offerings and engagements, related accommodations and the costs of data purchased specifically for technology services engagements; and other expenses directly related to service contracts such as courier fees, laboratory supplies, professional services and travel expenses. Reimbursed expenses, which are included in cost of revenues, are comprised principally of payments to investigators who oversee clinical trials and travel expenses for our clinical monitors and sales representatives. Selling, general and administrative expenses include costs related to sales, marketing and administrative functions (including human resources, legal, finance, quality assurance, compliance and general management) for compensation and benefits, travel, professional services, training and expenses for information technology and facilities. We also incur costs and expenses associated with depreciation and amortization. Foreign Currency Translation In the first nine months of 2022, approximately 35% of our revenues were denominated in currencies other than the United States dollar, which represents approximately 60 currencies. Because a large portion of our revenues and expenses are denominated in foreign currencies and our financial statements are reported in United States dollars, changes in foreign currency exchange rates can significantly affect our results of operations. The revenues and expenses of our foreign operations are generally denominated in local currencies and translated into United States dollars for financial reporting purposes. Accordingly, exchange rate fluctuations will affect the translation of foreign results into United States dollars for purposes of reporting our condensed consolidated results. As a result, we believe that reporting results of operations that exclude the effects of foreign currency rate fluctuations on certain financial results can facilitate analysis of period to period comparisons. This constant currency information assumes the same foreign currency exchange rates that were in effect for the comparable prior-year period were used in translation of the current period results. As such, the differences noted below between reported results of operations and constant currency information is wholly attributable to the effects of foreign currency rate fluctuations. Consolidated Results of Operations For information regarding our results of operations for Technology & Analytics Solutions, Research & Development Solutions and Contract Sales & Medical Solutions, refer to “Segment Results of Operations” later in this section. Revenues Three Months Ended September 30, Change (in millions) 2022 2021 $ % Revenues $ 3,562 $ 3,391 $ 171 5.0 % 23 Table of conten t s For the third quarter of 2022, our revenues increased $171 million, or 5.0%, as compared to the same period in 2021. This increase was comprised of constant currency revenue growth of approximately $355 million, or 10.5%, reflecting an $155 million increase in Technology & Analytics Solutions, an $198 million increase in Research & Development Solutions, and a $2 million increase in Contract Sales & Medical Solutions. Nine Months Ended September 30, Change (in millions) 2022 2021 $ % Revenues $ 10,671 $ 10,238 $ 433 4.2 % For the first nine months of 2022, our revenues increased $433 million, or 4.2%, as compared to the same period in 2021. This increase was comprised of constant currency revenue growth of approximately $830 million, or 8.1%, reflecting a $414 million increase in Technology & Analytics Solutions, a $399 million increase in Research & Development Solutions, and a $17 million increase in Contract Sales & Medical Solutions. Cost of Revenues, exclusive of Depreciation and Amortization Three Months Ended September 30, Nine Months Ended September 30, (in millions) 2022 2021 2022 2021 Cost of revenues, exclusive of depreciation and amortization $ 2,321 $ 2,253 $ 6,975 $ 6,869 % of revenues 65.2 % 66.4 % 65.4 % 67.1 % The $68 million increase in cost of revenues, exclusive of depreciation and amortization, for the three months ended September 30, 2022 as compared to the same period in 2021 included a constant currency increase of approximately $237 million, or 10.5%, reflecting an $86 million increase in Technology & Analytics Solutions, an $144 million increase in Research & Development Solutions, and a $7 million increase in Contract Sales & Medical Solutions. The $106 million increase in cost of revenues, exclusive of depreciation and amortization, for the nine months ended September 30, 2022 as compared to the same period in 2021 included a constant currency increase of approximately $466 million, or 6.8%, reflecting an $188 million increase in Technology & Analytics Solutions, a $250 million increase in Research & Development Solutions, and a $28 million increase in Contract Sales & Medical Solutions. Selling, General and Administrative Expenses Three Months Ended September 30, Nine Months Ended September 30, (in millions) 2022 2021 2022 2021 Selling, general and administrative expenses $ 517 $ 498 $ 1,488 $ 1,422 % of revenues 14.5 % 14.7 % 13.9 % 13.9 % The $19 million increase in selling, general and administrative expenses for the three months ended September 30, 2022 as compared to the same period in 2021 included a constant currency increase of approximately $54 million, or 10.8%, reflecting a $34 million increase in Technology & Analytics Solutions, a $9 million increase in Research & Development Solutions, a $4 million increase in Contract Sales & Medical Solutions, and a $7 million increase in general corporate and unallocated expenses. The $66 million increase in selling, general and administrative expenses for the nine months ended September 30, 2022 as compared to the same period in 2021 included a constant currency increase of approximately $137 million, or 9.6%, reflecting a $90 million increase in Technology & Analytics Solutions, a $55 million increase in Research & Development Solutions, a $9 million increase in Contract Sales & Medical Solutions, offset by a $(17) million decrease in general corporate and unallocated expenses. 24 Table of conten t s Depreciation and Amortization Three Months Ended September 30, Nine Months Ended September 30, (in millions) 2022 2021 2022 2021 Depreciation and amortization $ 248 $ 336 $ 773 $ 1,002 % of revenues 7.0 % 9.9 % 7.2 % 9.8 % The $88 million and $229 million decrease in depreciation and amortization for the three and nine months ended September 30, 2022 as compared to the same periods in 2021 was primarily due to certain intangible assets from the merger between Quintiles and IMS Health becoming fully amortized in 2021, offset by an increase in amortization from intangible assets associated with acquisitions occurring in 2021 and 2022 as well as higher capitalized software balances. Restructuring Costs Three Months Ended September 30, Nine Months Ended September 30, (in millions) 2022 2021 2022 2021 Restructuring costs $ 4 $ 2 $ 15 $ 15 The restructuring costs incurred during 2022 and 2021 were due to ongoing efforts to streamline our global operations. The remaining actions under these plans are expected to occur throughout 2022 and into 2023 and are expected to consist of consolidating functional activities, eliminating redundant positions and aligning resources with customer requirements. Interest Income and Interest Expense Three Months Ended September 30, Nine Months Ended September 30, (in millions) 2022 2021 2022 2021 Interest income $ (4) $ (2) $ (7) $ (4) Interest expense $ 108 $ 92 $ 288 $ 285 Interest income includes interest received primarily from bank balances and investments. The increase is primarily a result of higher deposit rates. Interest expense during the three and nine months ended September 30, 2022 was higher than the same period in 2021 due primarily to higher base rate interest costs across the floating rate debt portfolio. Loss on Extinguishment of Debt Three Months Ended September 30, Nine Months Ended September 30, (in millions) 2022 2021 2022 2021 Loss on extinguishment of debt $ — $ 1 $ — $ 25 During the three and nine months ended September 30, 2021, we recognized a loss on extinguishment of debt for fees and expenses incurred related to the refinancing of our 3.250% Senior Notes due 2025 and Prior Credit Agreement. Other Expense (Income), Net Three Months Ended September 30, Nine Months Ended September 30, (in millions) 2022 2021 2022 2021 Other expense (income), net $ 8 $ (62) $ 51 $ (128) Other expense (income), net for the three and nine months ended September 30, 2022 increased as compared to the same periods in the prior year, primarily due to foreign currency losses and losses on investments. 25 Table of conten t s Income Tax Expense Three Months Ended September 30, Nine Months Ended September 30, (in millions) 2022 2021 2022 2021 Income tax expense $ 70 $ 12 $ 212 $ 104 Our effective income tax rate was 19.4% and 4.4% in the third quarter of 2022 and 2021, respectively, and 19.5% and 13.8% in the first nine months of 2022 and 2021, respectively. Our effective income tax rate in the third quarter and the first nine months of 2022 and 2021 was favorably impacted by recording a benefit related to the 2021 and 2020 U.S. Federal tax return position associated with FDII and GILTI tax credits of $6 million and $29 million, respectively. Additionally, our effective income tax rate in the third quarter and in the first nine months of 2022 and 2021 was favorably impacted as a result of excess tax benefits recognized upon settlement of share-based compensation awards. For the third quarter of 2022 and 2021 this impact was $1 million and $3 million, respectively, and for the first nine months of 2022 and 2021 this impact was $15 million and $26 million, respectively. On August 16, 2022, the U.S. government enacted the Inflation Reduction Act of 2022, which, among other things, implements a 15% minimum tax on book income of certain large corporations, a 1% excise tax on net stock repurchases and several tax incentives to promote clean energy. We are assessing these impacts on our condensed consolidated financial statements. Equity in (Losses) Earnings of Unconsolidated Affiliates Three Months Ended September 30, Nine Months Ended September 30, (in millions) 2022 2021 2022 2021 Equity in (losses) earnings of unconsolidated affiliates $ (7) $ — $ (12) $ 5 Equity in (losses) earnings of unconsolidated affiliates for the three and nine months ended September 30, 2022 decreased as compared to the same periods in the prior year due to losses in the operations of our unconsolidated affiliates. Net Income Attributable to Non-controlling Interests Three Months Ended September 30, Nine Months Ended September 30, (in millions) 2022 2021 2022 2021 Net income attributable to non-controlling interests $ — $ — $ — $ (5) Net income attributable to non-controlling interests included Quest Diagnostics Incorporated's ("Quest") interest in Q 2 Solutions. On April 1, 2021 the Company acquired the 40% non-controlling interest in Q 2 Solutions from Quest which resulted in a decrease in the net income attributable to non-controlling interests for the nine months ended September 30, 2022 as compared to the prior period. Segment Results of Operations The Company’s revenues and profit by segment are as follows: Three Months Ended September 30, 2022 and 2021 Segment Revenues Segment Profit (in millions) 2022 2021 2022 2021 Technology & Analytics Solutions $ 1,400 $ 1,337 $ 359 $ 343 Research & Development Solutions 1,979 1,853 445 364 Contract Sales & Medical Solutions 183 201 8 20 Total 3,562 3,391 812 727 General corporate and unallocated (88) (87) Depreciation and amortization (248) (336) Restructuring costs (4) (2) Consolidated $ 3,562 $ 3,391 $ 472 $ 302 26 Table of conten t s Nine Months Ended September 30, 2022 and 2021 Segment Revenues Segment Profit (in millions) 2022 2021 2022 2021 Technology & Analytics Solutions $ 4,247 $ 4,038 $ 1,129 $ 1,044 Research & Development Solutions 5,863 5,612 1,244 1,069 Contract Sales & Medical Solutions 561 588 33 60 Total 10,671 10,238 2,406 2,173 General corporate and unallocated (198) (226) Depreciation and amortization (773) (1,002) Restructuring costs (15) (15) Consolidated $ 10,671 $ 10,238 $ 1,420 $ 930 Certain costs are not allocated to our segments and are reported as general corporate and unallocated expenses. These costs primarily consist of stock-based compensation and expenses related to integration activities and acquisitions. We also do not allocate depreciation and amortization or impairment charges to our segments. Technology & Analytics Solutions Three Months Ended September 30, Change (in millions) 2022 2021 $ % Revenues $ 1,400 $ 1,337 $ 63 4.7 % Cost of revenues, exclusive of depreciation and amortization 828 795 33 4.2 Selling, general and administrative expenses 213 199 14 7.0 Segment profit $ 359 $ 343 $ 16 4.7 % Nine Months Ended September 30, Change (in millions) 2022 2021 $ % Revenues $ 4,247 $ 4,038 $ 209 5.2 % Cost of revenues, exclusive of depreciation and amortization 2,490 2,415 75 3.1 Selling, general and administrative expenses 628 579 49 8.5 Segment profit $ 1,129 $ 1,044 $ 85 8.1 % Revenues Technology & Analytics Solutions’ revenues were $1,400 million for the third quarter of 2022, an increase of $63 million, or 4.7%, over the same period in 2021. This increase was comprised of constant currency revenue growth of approximately $155 million, or 11.6%, reflecting revenue growth across all regions. Technology & Analytics Solutions’ revenues were $4,247 million for the first nine months of 2022, an increase of $209 million, or 5.2%, over the same period in 2021. This increase was comprised of constant currency revenue growth of approximately $414 million, or 10.3%, reflecting revenue growth across all regions. The revenue growth for the three and nine months ended September 30, 2022 was driven by higher technology, real-world and consulting and analytical services. Cost of Revenues, exclusive of Depreciation and Amortization Technology & Analytics Solutions’ cost of revenues, exclusive of depreciation and amortization, increased $33 million, or 4.2%, in the third quarter of 2022 over the same period in 2021. This increase included a constant currency increase of approximately $86 million, or 10.8%. 27 Table of conten t s Technology & Analytics Solutions’ cost of revenues, exclusive of depreciation and amortization, increased $75 million, or 3.1%, in the first nine months of 2022 over the same period in 2021. This increase included a constant currency increase of approximately $188 million, or 7.8%. The constant currency increase for the three and nine months ended September 30, 2022 was primarily related to an increase in compensation and related expenses to support revenue growth. Selling, General and Administrative Expenses Technology & Analytics Solutions’ selling, general and administrative expenses increased $14 million, or 7.0%, in the third quarter of 2022 as compared to the same period in 2021, which included a constant currency increase of approximately $34 million, or 17.1%. Technology & Analytics Solutions’ selling, general and administrative expenses increased $49 million, or 8.5%, in the first nine months of 2022 as compared to the same period in 2021, which included a constant currency increase of approximately $90 million, or 15.5%. The constant currency increase for the three and nine months ended September 30, 2022 was primarily related to an increase in compensation and related expenses. Research & Development Solutions Three Months Ended September 30, Change (in millions) 2022 2021 $ % Revenues $ 1,979 $ 1,853 $ 126 6.8 % Cost of revenues, exclusive of depreciation and amortization 1,335 1,291 44 3.4 Selling, general and administrative expenses 199 198 1 0.5 Segment profit $ 445 $ 364 $ 81 22.3 % Nine Months Ended September 30, Change (in millions) 2022 2021 $ % Revenues $ 5,863 $ 5,612 $ 251 4.5 % Cost of revenues, exclusive of depreciation and amortization 4,005 3,967 38 1.0 Selling, general and administrative expenses 614 576 38 6.6 Segment profit $ 1,244 $ 1,069 $ 175 16.4 % Backlog Research & Development Solutions’ contracted backlog increased from $24.8 billion as of December 31, 2021 to $25.8 billion as of September 30, 2022 and we expect approximately $7.1 billion of this backlog to convert to revenue in the next twelve months. Revenues Research & Development Solutions’ revenues were $1,979 million in the third quarter of 2022, an increase of $126 million, or 6.8%, over the same period in 2021. This increase was comprised of constant currency revenue growth of approximately $198 million, or 10.7%, reflecting revenue growth across all regions. Research & Development Solutions’ revenues were $5,863 million in the first nine months of 2022, an increase of $251 million, or 4.5%, over the same period in 2021. This increase was comprised of constant currency revenue growth of approximately $399 million, or 7.1%, reflecting revenue growth in the Europe and Africa and Asia-Pacific regions, partially offset by a decrease in COVID-19 related work in the Americas region. The revenue growth for the three and nine months ended September 30, 2022 was primarily the result of volume-related increases in clinical services and lab testing. 28 Table of conten t s Cost of Revenues, exclusive of Depreciation and Amortization Research & Development Solutions’ cost of revenues, exclusive of depreciation and amortization, increased $44 million, or 3.4%, in the third quarter of 2022 over the same period in 2021. This increase included a constant currency increase of approximately $144 million, or 11.2%. Research & Development Solutions’ cost of revenues, exclusive of depreciation and amortization, increased $38 million, or 1.0%, in the first nine months of 2022 over the same period in 2021. This increase included a constant currency increase of approximately $250 million, or 6.3%. The constant currency increase for the three and nine months ended September 30, 2022 was primarily related to an increase in compensation and related expenses as a result of volume-related increases in clinical services and lab testing. Selling, General and Administrative Expenses Research & Development Solutions’ selling, general and administrative expenses increased $1 million, or 0.5%, in the third quarter of 2022 as compared to the same period in 2021, which included a constant currency increase of approximately $9 million, or 4.5%. Research & Development Solutions’ selling, general and administrative expenses increased $38 million, or 6.6%, in the first nine months of 2022 as compared to the same period in 2021, which included a constant currency increase of approximately $55 million, or 9.5%. The constant currency increase for the three and nine months ended September 30, 2022 was primarily related to an increase in compensation and related expenses. Contract Sales & Medical Solutions Three Months Ended September 30, Change (in millions) 2022 2021 $ % Revenues $ 183 $ 201 $ (18) (9.0) % Cost of revenues, exclusive of depreciation and amortization 158 167 (9) (5.4) Selling, general and administrative expenses 17 14 3 21.4 Segment profit $ 8 $ 20 $ (12) (60.0) % Nine Months Ended September 30, Change (in millions) 2022 2021 $ % Revenues $ 561 $ 588 $ (27) (4.6) % Cost of revenues, exclusive of depreciation and amortization 480 487 (7) (1.4) Selling, general and administrative expenses 48 41 7 17.1 Segment profit $ 33 $ 60 $ (27) (45.0) % Revenues Contract Sales & Medical Solutions’ revenues were $183 million in the third quarter of 2022, a decrease of $18 million, or 9.0%, over the same period in 2021. This decrease included a constant currency revenue growth of approximately $2 million, or 1.0%, reflecting revenue growth in the Europe and Africa region. Contract Sales & Medical Solutions’ revenues were $561 million in the first nine months of 2022, a decrease of $27 million, or 4.6%, over the same period in 2021. This decrease included a constant currency revenue growth of approximately $17 million, or 2.9%, reflecting revenue growth in the Americas and Europe and Africa regions. The constant currency revenue growth for the three and nine months ended September 30, 2022 was largely due to volume increases in services performed. 29 Table of conten t s Cost of Revenues, exclusive of Depreciation and Amortization Contract Sales & Medical Solutions’ cost of revenues, exclusive of depreciation and amortization, decreased $9 million, or 5.4%, in the third quarter of 2022 as compared to the same period in 2021. This decrease included a constant currency increase of approximately $7 million, or 4.2%. Contract Sales & Medical Solutions’ cost of revenues, exclusive of depreciation and amortization, decreased $7 million, or 1.4%, in the first nine months of 2022 as compared to the same period in 2021. This decrease included a constant currency increase of approximately $28 million, or 5.7%. The constant currency increase for the three and nine months ended September 30, 2022 was primarily related to an increase in compensation and related expenses and reimbursed expenses. Selling, General and Administrative Expenses Contract Sales & Medical Solutions’ selling, general and administrative expenses increased $3 million, or 21.4%, in the third quarter of 2022 as compared to the same period in 2021, which included a constant currency increase of approximately $4 million, or 28.6%. Contract Sales & Medical Solutions’ selling, general and administrative expenses increased $7 million, or 17.1%, in the first nine months of 2022 as compared to the same period in 2021, which included a constant currency increase of approximately $9 million, or 22.0%. The constant currency increase for the three and nine months ended September 30, 2022 was primarily related to an increase in compensation and related expenses and IT related expenses. Liquidity and Capital Resources Overview We assess our liquidity in terms of our ability to generate cash to fund our operating, investing and financing activities. Our principal source of liquidity is operating cash flows. In addition to operating cash flows, other significant factors that affect our overall management of liquidity include: capital expenditures, acquisitions, investments, debt service requirements, equity repurchases, adequacy of our revolving credit and receivables financing facilities, and access to the capital markets. We manage our worldwide cash requirements by monitoring the funds available among our subsidiaries and determining the extent to which those funds can be accessed on a cost-effective basis. The repatriation of cash balances from certain of our subsidiaries could have adverse tax consequences; however, those balances are generally available without legal restrictions to fund ordinary business operations. We have and expect to transfer cash from those subsidiaries to the United States and to other international subsidiaries when it is cost effective to do so. We had a cash balance of $1,274 million as of September 30, 2022 ($512 million of which was in the United States), a decrease from $1,366 million as of December 31, 2021. 30 Table of conten t s Based on our current operating plan, we believe that our available cash and cash equivalents, future cash flows from operations and our ability to access funds under our revolving credit and receivables financing facilities will enable us to fund our operating requirements, capital expenditures, contractual obligations, and meet debt obligations for at least the next 12 months. We regularly evaluate our debt arrangements, as well as market conditions, and from time to time we may explore opportunities to modify our existing debt arrangements or pursue additional financing arrangements that could result in the issuance of new debt securities by us or our affiliates. We may use our existing cash, cash generated from operations or dispositions of assets or businesses and/or proceeds from any new financing arrangements or issuances of debt or equity securities to repay or reduce some of our outstanding obligations, to repurchase shares from our stockholders or for other purposes. As part of our ongoing business strategy, we also continually evaluate new acquisition, expansion and investment possibilities or other strategic growth opportunities, as well as potential dispositions of assets or businesses, as appropriate, including dispositions that may cause us to recognize a loss on certain assets. Should we elect to pursue any such transaction, we may seek to obtain debt or equity financing to facilitate those activities. Our ability to enter into any such potential transactions and our use of cash or proceeds is limited to varying degrees by the terms and restrictions contained in our existing debt arrangements. We cannot provide assurances that we will be able to complete any such financing arrangements or other transactions on favorable terms or at all. Equity Repurchase Program On February 10, 2022 the Board increased the stock repurchase authorization under the Repurchase Program with respect to the repurchase of the Company's common stock by an additional $2.0 billion, which increased the total amount that has been authorized under the Repurchase Program to $9.725 billion. The Repurchase Program does not obligate the Company to repurchase any particular amount of common stock, and it may be modified, extended, suspended or discontinued at any time. During the nine months ended September 30, 2022, we repurchased 5.3 million shares of our common stock for $1,143 million under the Repurchase Program. These amounts include approximately 0.2 million of shares valued at approximately $40 million which were accrued for as of September 30, 2022 based on when the trade and settlement dates occurred. As of September 30, 2022, we have remaining authorization to repurchase up to approximately $1.4 billion of our common stock under the Repurchase Program. In addition, from time to time, we have repurchased and may continue to repurchase common stock through private or other transactions outside of the Repurchase Program. Debt As of September 30, 2022, we had $12.4 billion of total indebtedness, excluding $1,500 million of additional available borrowings under our revolving credit facility. Our long-term debt arrangements contain customary restrictive covenants and, as of September 30, 2022, we believe we were in compliance with our restrictive covenants in all material respects. Senior Secured Credit Facilities On June 16, 2022, the Company entered into Amendment No. 1 to the Company’s Credit Agreement to borrow $1,250 million in Additional Term A Loans. The proceeds from the Additional Term A Loans were used to repay approximately $950 million of outstanding revolving credit loans under the Company's senior secured credit facilities and for general corporate purposes. See Note 7 to our condensed consolidated financial statements included elsewhere in this Quarterly Report on Form 10-Q for additional details regarding our credit arrangements. As of September 30, 2022, the Company’s Fifth Amended and Restated Credit Agreement provided financing through the senior secured credit facilities of up to approximately $8,009 million , which consisted of $6,509 million principal amounts of debt outstanding, and $1,500 million of available borrowing capacity on the revolving credit facility and standby letters of credit. Receivables Financing Facility As of September 30, 2022, no additional amounts of revolving loan commitments were available under the receivables financing facility. 31 Table of conten t s Nine months ended September 30, 2022 and 2021 Cash Flow from Operating Activities Nine Months Ended September 30, (in millions) 2022 2021 Net cash provided by operating activities $ 1,700 $ 2,250 Cash provided by operating activities decreased $550 million during the first nine months of 2022 as compared to the same period in 2021. The decrease was primarily due to a decrease in cash collections from unearned income ($444 million), a decrease in cash from accounts receivable and unbilled services ($307 million), offset by an increase in cash from other operating assets and liabilities ($122 million) and cash related net income ($79 million). Cash Flow from Investing Activities Nine Months Ended September 30, (in millions) 2022 2021 Net cash used in investing activities $ (1,529) $ (1,456) Cash used in investing activities increased $73 million during the first nine months of 2022 as compared to the same period in 2021, primarily driven by more cash used for acquisitions of property, equipment, and software ($47 million), acquisitions of businesses ($18 million) and investments in unconsolidated affiliates ($11 million), as well as less net proceeds from sale of equity securities ($5 million), offset by less purchases of marketable securities, net ($5 million) and an increase in cash from other investing activities ($3 million). Cash Flow from Financing Activities Nine Months Ended September 30, (in millions) 2022 2021 Net cash used in financing activities $ (136) $ (1,097) Cash used in financing activities decreased $961 million during the first nine months of 2022 as compared to the same period in 2021, primarily due to a decrease in debt and principal payments ($1,982 million), the absence of cash payments for the Company's acquisition of Quest's non-controlling interest in Q 2 Solutions ($758 million) and a decrease in cash payments on contingent consideration and deferred purchase price accruals ($17 million), offset by an increase in cash used to repurchase common stock ($901 million), a decrease in cash provided by proceeds from debt issuances, net of debt issuance costs ($666 million), a decrease in cash proceeds from revolving credit facilities, net of repayments ($210 million) and an increase in cash payments related to employee stock option plans ($19 million). Off-Balance Sheet Arrangements We do not have any material off-balance sheet arrangements. Contractual Obligations and Commitments We have various contractual obligations, which are recorded as liabilities in our consolidated financial statements. There have been no material changes, outside of the ordinary course of business, to our contractual obligations as previously disclosed in our 2021 Form 10-K. Application of Critical Accounting Policies There have been no material changes to our critical accounting policies as previously disclosed in our 2021 Form 10-K. Item 3. Quantitative and Qualitative Disclosures About Market Risk There have been no material changes to our quantitative and qualitative disclosures about market risk as compared to the quantitative and qualitative disclosures about market risk described in our 2021 Form 10-K. 32 Table of conten t s