Table of Contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
FORM 10-Q

(Mark One)
☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended SeptemberJune 30, 20202021

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 001-12215

Quest Diagnostics Incorporated
Delaware16-1387862
(State of Incorporation)(I.R.S. Employer Identification Number)
500 Plaza Drive
Secaucus,NJ07094
(973)520-2700
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, $0.01 Par ValueDGXNew York Stock Exchange
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 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 ☒
As of OctoberJuly 15, 2020,2021, there were outstanding 134,765,984122,180,759 shares of the registrant’s common stock, $.01 par value.

Table of Contents
PART I - FINANCIAL INFORMATION
 Page
Item 1. Financial Statements (unaudited) 
  
Index to unaudited consolidated financial statements filed as part of this report: 
  
2
  
3
4
  
5
6
8
 
 
  
3023
 
 
  
4536
 
 
  
4536
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1
Table of Contents
QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF OPERATIONS
FOR THE THREE AND NINESIX MONTHS ENDED SEPTEMBERJUNE 30, 20202021 AND 20192020
(unaudited)
(in millions, except per share data)

Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
20202019202020192021202020212020
Net revenuesNet revenues$2,786 $1,956 $6,435 $5,800 Net revenues$2,550 $1,827 $5,270 $3,649 
Operating costs and expenses and other operating income:Operating costs and expenses and other operating income:    Operating costs and expenses and other operating income:    
Cost of servicesCost of services1,580 1,264 4,071 3,773 Cost of services1,565 1,221 3,191 2,491 
Selling, general and administrativeSelling, general and administrative396 362 1,103 1,108 Selling, general and administrative429 360 836 707 
Amortization of intangible assetsAmortization of intangible assets27 23 77 72 Amortization of intangible assets25 25 52 50 
Other operating expense (income), net65 (6)8 (21)
Other operating income, netOther operating income, net(2)(62)(2)(57)
Total operating costs and expenses, netTotal operating costs and expenses, net2,068 1,643 5,259 4,932 Total operating costs and expenses, net2,017 1,544 4,077 3,191 
Operating incomeOperating income718 313 1,176 868 Operating income533 283 1,193 458 
Other income (expense):Other income (expense):    Other income (expense):    
Interest expense, netInterest expense, net(42)(44)(124)(133)Interest expense, net(38)(41)(76)(82)
Other income, net77 1 74 13 
Other income (expense), netOther income (expense), net322 13 326 (3)
Total non-operating income (expense), netTotal non-operating income (expense), net35 (43)(50)(120)Total non-operating income (expense), net284 (28)250 (85)
Income from continuing operations before income taxes and equity in earnings of equity method investees753 270 1,126 748 
Income before income taxes and equity in earnings of equity method investeesIncome before income taxes and equity in earnings of equity method investees817 255 1,443 373 
Income tax expenseIncome tax expense(177)(62)(269)(175)Income tax expense(177)(66)(330)(92)
Equity in earnings of equity method investees, net of taxesEquity in earnings of equity method investees, net of taxes15 18 33 48 Equity in earnings of equity method investees, net of taxes10 4 27 18 
Income from continuing operations591 226 890 621 
Income from discontinued operations, net of taxes0 0 0 20 
Net incomeNet income591 226 890 641 Net income650 193 1,140 299 
Less: Net income attributable to noncontrolling interestsLess: Net income attributable to noncontrolling interests23 11 38 36 Less: Net income attributable to noncontrolling interests19 8 40 15 
Net income attributable to Quest DiagnosticsNet income attributable to Quest Diagnostics$568 $215 $852 $605 Net income attributable to Quest Diagnostics$631 $185 $1,100 $284 
Amounts attributable to Quest Diagnostics’ common stockholders:    
Income from continuing operations$568 $215 $852 $585 
Income from discontinued operations, net of taxes0 0 0 20 
Net income$568 $215 $852 $605 
Earnings per share attributable to Quest Diagnostics’ common stockholders - basic:    
Income from continuing operations$4.20 $1.59 $6.33 $4.33 
Income from discontinued operations0 0 0 0.15 
Net income$4.20 $1.59 $6.33 $4.48 
Earnings per share attributable to Quest Diagnostics’ common stockholders - diluted:    
Income from continuing operations$4.14 $1.56 $6.25 $4.27 
Income from discontinued operations0 0 0 0.15 
Net income$4.14 $1.56 $6.25 $4.42 
Earnings per share attributable to Quest Diagnostics’ common stockholders:Earnings per share attributable to Quest Diagnostics’ common stockholders:    
BasicBasic$5.05 $1.38 $8.52 $2.12 
DilutedDiluted$4.96 $1.36 $8.38 $2.09 
Weighted average common shares outstanding:Weighted average common shares outstanding:    Weighted average common shares outstanding:    
BasicBasic135 135 134 135 Basic125 134 129 134 
DilutedDiluted137 137 136 136 Diluted127 136 131 135 










The accompanying notes are an integral part of these statements.

2
Table of Contents
QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME
FOR THE THREE AND NINESIX MONTHS ENDED SEPTEMBERJUNE 30, 20202021 AND 20192020
(unaudited)
(in millions)
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
20202019202020192021202020212020
Net incomeNet income$591 $226 $890 $641 Net income$650 $193 $1,140 $299 
Other comprehensive income (loss):Other comprehensive income (loss):Other comprehensive income (loss):
Foreign currency translation adjustmentForeign currency translation adjustment10 (6)(6)(6)Foreign currency translation adjustment21 3 18 (16)
Net change in available-for-sale debt securities, net of taxesNet change in available-for-sale debt securities, net of taxes0 8 0 8 Net change in available-for-sale debt securities, net of taxes0 0 (7)0 
Net deferred gain on cash flow hedges, net of taxes3 1 3 2 
Other comprehensive income (loss)Other comprehensive income (loss)13 3 (3)4 Other comprehensive income (loss)21 3 11 (16)
Comprehensive incomeComprehensive income604 229 887 645 Comprehensive income671 196 1,151 283 
Less: Comprehensive income attributable to noncontrolling interestsLess: Comprehensive income attributable to noncontrolling interests23 11 38 36 Less: Comprehensive income attributable to noncontrolling interests19 8 40 15 
Comprehensive income attributable to Quest DiagnosticsComprehensive income attributable to Quest Diagnostics$581 $218 $849 $609 Comprehensive income attributable to Quest Diagnostics$652 $188 $1,111 $268 





















The accompanying notes are an integral part of these statements.

3
Table of Contents
QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
CONSOLIDATED BALANCE SHEETS
SEPTEMBERJUNE 30, 20202021 AND DECEMBER 31, 20192020
(unaudited)
(in millions, except per share data)
September 30,
2020		December 31,
2019		June 30,
2021		December 31,
2020
AssetsAssets  Assets  
Current assets:Current assets:  Current assets:  
Cash and cash equivalentsCash and cash equivalents$1,605 $1,192 Cash and cash equivalents$560 $1,158 
Accounts receivable, net of allowance for credit losses of $27 and $15 as of September 30, 2020 and December 31, 2019, respectively1,421 1,063 
Accounts receivable, net of allowance for credit losses of $29 and $28 as of June 30, 2021 and December 31, 2020, respectivelyAccounts receivable, net of allowance for credit losses of $29 and $28 as of June 30, 2021 and December 31, 2020, respectively1,255 1,520 
InventoriesInventories205 123 Inventories199 223 
Prepaid expenses and other current assetsPrepaid expenses and other current assets117 112 Prepaid expenses and other current assets132 157 
Total current assetsTotal current assets3,348 2,490 Total current assets2,146 3,058 
Property, plant and equipment, netProperty, plant and equipment, net1,544 1,453 Property, plant and equipment, net1,622 1,627 
Operating lease right-of-use assetsOperating lease right-of-use assets535 518 Operating lease right-of-use assets589 604 
GoodwillGoodwill6,880 6,619 Goodwill7,045 6,873 
Intangible assets, netIntangible assets, net1,192 1,121 Intangible assets, net1,172 1,167 
Investments in equity method investeesInvestments in equity method investees480 482 Investments in equity method investees111 521 
Other assetsOther assets164 160 Other assets176 176 
Total assetsTotal assets$14,143 $12,843 Total assets$12,861 $14,026 
Liabilities and Stockholders’ EquityLiabilities and Stockholders’ Equity  Liabilities and Stockholders’ Equity  
Current liabilities:Current liabilities:  Current liabilities:  
Accounts payable and accrued expensesAccounts payable and accrued expenses$1,686 $1,041 Accounts payable and accrued expenses$1,404 $1,633 
Current portion of long-term debtCurrent portion of long-term debt555 804 Current portion of long-term debt2 2 
Current portion of long-term operating lease liabilitiesCurrent portion of long-term operating lease liabilities148 145 Current portion of long-term operating lease liabilities145 141 
Total current liabilitiesTotal current liabilities2,389 1,990 Total current liabilities1,551 1,776 
Long-term debtLong-term debt4,018 3,966 Long-term debt4,008 4,013 
Long-term operating lease liabilitiesLong-term operating lease liabilities428 413 Long-term operating lease liabilities492 499 
Other liabilitiesOther liabilities782 711 Other liabilities792 847 
Commitments and contingenciesCommitments and contingenciesCommitments and contingencies00
Redeemable noncontrolling interestRedeemable noncontrolling interest80 76 Redeemable noncontrolling interest78 82 
Stockholders’ equity:Stockholders’ equity:  Stockholders’ equity:  
Quest Diagnostics stockholders’ equity:Quest Diagnostics stockholders’ equity:  Quest Diagnostics stockholders’ equity:  
Common stock, par value $0.01 per share; 600 shares authorized as of both September 30, 2020 and December 31, 2019; 217 shares issued as of both September 30, 2020 and December 31, 20192 2 
Common stock, par value $0.01 per share; 600 shares authorized as of both June 30, 2021 and December 31, 2020; 217 shares issued as of both June 30, 2021 and December 31, 2020Common stock, par value $0.01 per share; 600 shares authorized as of both June 30, 2021 and December 31, 2020; 217 shares issued as of both June 30, 2021 and December 31, 20202 2 
Additional paid-in capitalAdditional paid-in capital2,801 2,722 Additional paid-in capital2,555 2,841 
Retained earningsRetained earnings8,800 8,174 Retained earnings10,246 9,303 
Accumulated other comprehensive lossAccumulated other comprehensive loss(42)(39)Accumulated other comprehensive loss(10)(21)
Treasury stock, at cost; 82 and 84 shares as of September 30, 2020 and December 31, 2019, respectively(5,161)(5,218)
Treasury stock, at cost; 95 and 84 shares as of June 30, 2021 and December 31, 2020, respectivelyTreasury stock, at cost; 95 and 84 shares as of June 30, 2021 and December 31, 2020, respectively(6,894)(5,366)
Total Quest Diagnostics stockholders’ equityTotal Quest Diagnostics stockholders’ equity6,400 5,641 Total Quest Diagnostics stockholders’ equity5,899 6,759 
Noncontrolling interestsNoncontrolling interests46 46 Noncontrolling interests41 50 
Total stockholders’ equityTotal stockholders’ equity6,446 5,687 Total stockholders’ equity5,940 6,809 
Total liabilities and stockholders’ equityTotal liabilities and stockholders’ equity$14,143 $12,843 Total liabilities and stockholders’ equity$12,861 $14,026 


The accompanying notes are an integral part of these statements.

4
Table of Contents
QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS
FOR THE NINESIX MONTHS ENDED SEPTEMBERJUNE 30, 20202021 AND 20192020
(unaudited)
(in millions)
Nine Months Ended September 30,
20202019
Cash flows from operating activities:  
Net income$890 $641 
Adjustments to reconcile net income to net cash provided by operating activities:  
Depreciation and amortization263 247 
Provision for credit losses18 9 
Deferred income tax provision12 15 
Stock-based compensation expense63 44 
Other, net(60)(44)
Changes in operating assets and liabilities:  
Accounts receivable(355)(113)
Accounts payable and accrued expenses514 80 
Income taxes payable95 9 
Termination of interest rate swap agreements40 0 
Other assets and liabilities, net(16)7 
Net cash provided by operating activities1,464 895 
Cash flows from investing activities:  
Business acquisitions, net of cash acquired(329)(56)
Capital expenditures(256)(228)
Increase in investments and other assets(19)(27)
Net cash used in investing activities(604)(311)
Cash flows from financing activities:  
Proceeds from borrowings749 1,484 
Repayments of debt(1,002)(1,448)
Purchases of treasury stock(75)(153)
Exercise of stock options144 98 
Employee payroll tax withholdings on stock issued under stock-based compensation plans(13)(16)
Dividends paid(222)(215)
Distributions to noncontrolling interest partners(34)(39)
Other financing activities, net6 4 
Net cash used in financing activities(447)(285)
Net change in cash and cash equivalents and restricted cash413 299 
Cash and cash equivalents and restricted cash, beginning of period1,192 135 
Cash and cash equivalents and restricted cash, end of period$1,605 $434 

Six Months Ended June 30,
20212020
Cash flows from operating activities:  
Net income$1,140 $299 
Adjustments to reconcile net income to net cash provided by operating activities:  
Depreciation and amortization201 174 
Provision for credit losses2 13 
Deferred income tax (benefit) provision(89)23 
Stock-based compensation expense39 31 
Gain on disposition of investment(314)0 
Other, net1 3 
Changes in operating assets and liabilities:  
Accounts receivable265 (75)
Accounts payable and accrued expenses(199)42 
Income taxes payable85 51 
Termination of interest rate swap agreements0 40 
Other assets and liabilities, net60 1 
Net cash provided by operating activities1,191 602 
Cash flows from investing activities:  
Business acquisitions, net of cash acquired(231)(228)
Capital expenditures(170)(165)
Proceeds from disposition of investment755 0 
Increase in investments and other assets(10)(18)
Net cash provided by (used in) investing activities344 (411)
Cash flows from financing activities:  
Proceeds from borrowings0 749 
Repayments of debt(1)(1,001)
Purchases of treasury stock(1,910)(75)
Exercise of stock options68 117 
Employee payroll tax withholdings on stock issued under stock-based compensation plans(22)(13)
Dividends paid(156)(146)
Distributions to noncontrolling interest partners(53)(10)
Other financing activities, net(59)(16)
Net cash used in financing activities(2,133)(395)
Net change in cash and cash equivalents and restricted cash(598)(204)
Cash and cash equivalents and restricted cash, beginning of period1,158 1,192 
Cash and cash equivalents and restricted cash, end of period$560 $988 





The accompanying notes are an integral part of these statements.

5
Table of Contents
QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY
FOR THE THREE AND NINESIX MONTHS ENDED SEPTEMBERJUNE 30, 20202021 AND 20192020
(unaudited)
(in millions)
For the Three Months Ended September 30, 2020Quest Diagnostics Stockholders’ Equity
For the Three Months Ended June 30, 2021For the Three Months Ended June 30, 2021Quest Diagnostics Stockholders’ Equity
Shares of
Common Stock
Outstanding		Common
Stock		Additional
Paid-In
Capital		Retained
Earnings		Accumulated
Other
Compre-
hensive Loss		Treasury
Stock, at
Cost		Non-
controlling
Interests		Total
Stock-
holders’
Equity		Redeemable Non-controlling InterestShares of
Common Stock
Outstanding		Common
Stock		Additional
Paid-In
Capital		Retained
Earnings		Accumulated
Other
Compre-
hensive Loss		Treasury
Stock, at
Cost		Non-
controlling
Interests		Total
Stock-
holders’
Equity		Redeemable Non-controlling Interest
Balance, June 30, 2020134 $2 $2,764 $8,307 $(55)$(5,187)$50 $5,881 $77 
Balance, March 31, 2021Balance, March 31, 2021131 $2 $2,824 $9,690 $(31)$(5,740)$45 $6,790 $79 
Net incomeNet income56818 586 5 Net income63117 648 2 
Other comprehensive income, net of taxesOther comprehensive income, net of taxes13 13 Other comprehensive income, net of taxes21 21 
Dividends declaredDividends declared(75)(75)Dividends declared(75)(75)
Distributions to noncontrolling interest partnersDistributions to noncontrolling interest partners(22)(22)(2)Distributions to noncontrolling interest partners(21)(21)(3)
Issuance of common stock under benefit plansIssuance of common stock under benefit plans11 3 4 Issuance of common stock under benefit plans2 4 6 
Stock-based compensation expenseStock-based compensation expense32 32 Stock-based compensation expense21 21 
Exercise of stock optionsExercise of stock options4 23 27 Exercise of stock options9 42 51 
Shares to cover employee payroll tax withholdings on stock issued under stock-based compensation plansShares to cover employee payroll tax withholdings on stock issued under stock-based compensation plans(1)(1)
Purchases of treasury stockPurchases of treasury stock(9)(300)(1,200)(1,500)
Balance, June 30, 2021Balance, June 30, 2021122 $2 $2,555 $10,246 $(10)$(6,894)$41 $5,940 $78 
For the Six Months Ended June 30, 2021For the Six Months Ended June 30, 2021Quest Diagnostics Stockholders’ Equity
Shares of
Common Stock
Outstanding		Common
Stock		Additional
Paid-In
Capital		Retained
Earnings		Accumulated
Other
Compre-
hensive Loss		Treasury
Stock, at
Cost		Non-
controlling
Interests		Total
Stock-
holders’
Equity		Redeemable Non-controlling Interest
Balance, September 30, 2020135 $2 $2,801 $8,800 $(42)$(5,161)$46 $6,446 $80 
For the Nine Months Ended September 30, 2020Quest Diagnostics Stockholders’ Equity
Shares of
Common Stock
Outstanding		Common
Stock		Additional
Paid-In
Capital		Retained
Earnings		Accumulated
Other
Compre-
hensive Loss		Treasury
Stock, at
Cost		Non-
controlling
Interests		Total
Stock-
holders’
Equity		Redeemable Non-controlling Interest
Balance, December 31, 2019133 $2 $2,722 $8,174 $(39)$(5,218)$46 $5,687 $76 
Balance, December 31, 2020Balance, December 31, 2020133 $2 $2,841 $9,303 $(21)$(5,366)$50 $6,809 76 $82 
Net incomeNet income85231 883 7 Net income1,100 34 1,134 6 
Other comprehensive loss, net of taxes(3)(3)
Other comprehensive income, net of taxesOther comprehensive income, net of taxes11 11 
Dividends declaredDividends declared(226)(226)Dividends declared(157)(157)
Distributions to noncontrolling interest partnersDistributions to noncontrolling interest partners(31)(31)(3)Distributions to noncontrolling interest partners(43)(43)(10)
Issuance of common stock under benefit plansIssuance of common stock under benefit plans1 7 10 17 Issuance of common stock under benefit plans(27)38 11 
Stock-based compensation expenseStock-based compensation expense63 63 Stock-based compensation expense39 39 
Exercise of stock optionsExercise of stock options2 22 122 144 Exercise of stock options1 12 56 68 
Shares to cover employee payroll tax withholdings on stock issued under stock-based compensation plansShares to cover employee payroll tax withholdings on stock issued under stock-based compensation plans(13)(13)Shares to cover employee payroll tax withholdings on stock issued under stock-based compensation plans(10)(12)(22)
Purchases of treasury stockPurchases of treasury stock(1)(75)(75)Purchases of treasury stock(12)(300)(1,610)(1,910)
Balance, September 30, 2020135 $2 $2,801 $8,800 $(42)$(5,161)$46 $6,446 $80 
Balance, June 30, 2021Balance, June 30, 2021122 $2 $2,555 $10,246 $(10)$(6,894)$41 $5,940 $78 




The accompanying notes are an integral part of these statements.


6
Table of Contents
QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY
FOR THE THREE AND SIX MONTHS ENDED JUNE 30, 2021 AND 2020
(unaudited)
(in millions)
For the Three Months Ended June 30, 2020Quest Diagnostics Stockholders’ Equity
Shares of
Common Stock
Outstanding		Common
Stock		Additional
Paid-In
Capital		Retained
Earnings		Accumulated
Other
Compre-
hensive Loss		Treasury
Stock, at
Cost		Non-
controlling
Interests		Total
Stock-
holders’
Equity		Redeemable Non-controlling Interest
Balance, March 31, 2020134 $2 $2,738 $8,197 $(58)$(5,222)$46 $5,703 $76 
Net income1857 192 1 
Other comprehensive income, net of taxes3 3 
Dividends declared(75)(75)
Distributions to noncontrolling interest partners(3)(3)
Issuance of common stock under benefit plans3 4 7 
Stock-based compensation expense17 17 
Exercise of stock options6 31 37 
Balance, June 30, 2020134 $2 $2,764 $8,307 $(55)$(5,187)$50 $5,881 $77 
For the Six Months Ended June 30, 2020Quest Diagnostics Stockholders’ Equity
Shares of
Common Stock
Outstanding		Common
Stock		Additional
Paid-In
Capital		Retained
Earnings		Accumulated
Other
Compre-
hensive Loss		Treasury
Stock, at
Cost		Non-
controlling
Interests		Total
Stock-
holders’
Equity		Redeemable Non-controlling Interest
Balance, December 31, 2019133 $2 $2,722 $8,174 $(39)$(5,218)$46 $5,687 $76 
Net income28413 297 2 
Other comprehensive loss, net of taxes(16)(16)
Dividends declared(151)(151)
Distributions to noncontrolling interest partners(9)(9)(1)
Issuance of common stock under benefit plans6 7 13 
Stock-based compensation expense31 31 
Exercise of stock options218 99 117 
Shares to cover employee payroll tax withholdings on stock issued under stock-based compensation plans(13)(13)
Purchases of treasury stock(1)(75)(75)
Balance, June 30, 2020134 $2 $2,764 $8,307 $(55)$(5,187)$50 $5,881 $77 





The accompanying notes are an integral part of these statements.


6
Table of Contents
QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY
FOR THE THREE AND NINE MONTHS ENDED SEPTEMBER 30, 2020 AND 2019
(unaudited)
(in millions)
For the Three Months Ended September 30, 2019Quest Diagnostics Stockholders’ Equity
Shares of
Common Stock
Outstanding		Common
Stock		Additional
Paid-In
Capital		Retained
Earnings		Accumulated
Other
Compre-
hensive Loss		Treasury
Stock, at
Cost		Non-
controlling
Interests		Total
Stock-
holders’
Equity		Redeemable Non-controlling Interest
Balance, June 30, 2019135 $2 $2,686 $7,849 $(58)$(5,020)$50 $5,509 $76 
Net income21510 225 1 
Other comprehensive income, net of taxes3 3 
Dividends declared(72)(72)
Distributions to noncontrolling interest partners(11)(11)(1)
Issuance of common stock under benefit plans3 3 6 
Stock-based compensation expense12 12 
Exercise of stock options1 4 28 32 
Purchases of treasury stock(1)(50)(50)
Balance, September 30, 2019135 $2 $2,705 $7,992 $(55)$(5,039)$49 $5,654 $76 
For the Nine Months Ended September 30, 2019Quest Diagnostics Stockholders’ Equity
Shares of
Common Stock
Outstanding		Common
Stock		Additional
Paid-In
Capital		Retained
Earnings		Accumulated
Other
Compre-
hensive Loss		Treasury
Stock, at
Cost		Non-
controlling
Interests		Total
Stock-
holders’
Equity		Redeemable Non-controlling Interest
Balance, December 31, 2018135 $2 $2,667 $7,602 $(59)$(4,996)$51 $5,267 $77 
Net income60532 637 4 
Other comprehensive income, net of taxes4 4 
Dividends declared(215)(215)
Distributions to noncontrolling interest partners(34)(34)(5)
Issuance of common stock under benefit plans7 12 19 
Stock-based compensation expense43 1 44 
Exercise of stock options24 94 98 
Shares to cover employee payroll tax withholdings on stock issued under stock-based compensation plans(16)(16)
Purchases of treasury stock(2)(150)(150)
Balance, September 30, 2019135 $2 $2,705 $7,992 $(55)$(5,039)$49 $5,654 $76 


The accompanying notes are an integral part of these statements.

7
QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
(unaudited)
(in millions, unless otherwise indicated)

1.    DESCRIPTION OF BUSINESS
    
    Background
    
    Quest Diagnostics Incorporated and its subsidiaries ("Quest Diagnostics" or the "Company") empower people to take action to improve health outcomes.  The Company uses its extensive database of clinical lab results to derive diagnostic insights that reveal new avenues to identify and treat disease, inspire healthy behaviors and improve healthcare management.  The Company's diagnostic information services business ("DIS") provides information and insights based on thean industry-leading menu of routine, non-routine and advanced clinical testing and anatomic pathology testing, and other diagnostic information services. The Company provides services to a broad range of customers, including patients, clinicians, hospitals, independent delivery networks ("IDNs"), health plans, employers, and accountable care organizations ("ACOs"), and direct contract entities ("DCEs"). The Company offers the broadest access in the United States to diagnostic information services through its nationwide network of laboratories, patient service centers and phlebotomists in physician offices and the Company's connectivity resources, including call centers and mobile paramedics, nurses and other health and wellness professionals. The Company is the world's leading provider of diagnostic information services. The Company provides interpretive consultation with one of the largest medical and scientific staffs in the industry and hundreds of M.D.s and Ph.D.s, many of whom are recognized leaders in their fields.industry. The Company's Diagnostic Solutions businesses ("DS") are the leading provider of risk assessment services for the life insurance industry and offer healthcare organizations and clinicians robust information technology solutions.

2.    SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

    Basis of Presentation
    
    The interim unaudited consolidated financial statements reflect all adjustments which in the opinion of management are necessary for a fair statement of results of operations, comprehensive income, financial condition, cash flows and stockholders' equity for the periods presented. Except as otherwise disclosed, all such adjustments are of a normal recurring nature. Operating results for the interim periods are not necessarily indicative of the results that may be expected for the full year. These interim unaudited consolidated financial statements should be read in conjunction with the audited consolidated financial statements included in the Company’s 20192020 Annual Report on Form 10-K. The year-end balance sheet data was derived from the audited consolidated financial statements as of December 31, 2019,2020, but does not include all the disclosures required by accounting principles generally accepted in the United States (“GAAP”).

    The accounting policies of the Company are the same as those set forth in Note 2 to the audited consolidated financial statements contained in the Company’s 20192020 Annual Report on Form 10-K except for the impact of the adoption of new accounting standards discussed under New Accounting Pronouncements.10-K.

    A novel strain of coronavirus (“COVID-19”) continues to spread and severely impact the economy of the United States and other countries around the world. Since March 2020, federal, stateThe Company's testing volume and local governmental policiesrevenues have been materially impacted by the COVID-19 pandemic, including periods of decline in testing volume in the Company's base business (which excludes COVID-19 testing) compared to historical 2019 levels and initiatives designed to reduce the transmissionperiods of COVID-19 have resulted in, among other things, a significant reduction in physician office visits, the cancellation of elective medical procedures, customers closing or severely curtailing their operations (voluntarily or in response to government orders), and the adoption of work-from-home policies, all of which have had, and the Company believes will continue to have, an impact on the Company’s consolidated results of operations, financial position, and cash flows. Additionally, beginning during the second quarter of 2020, the Company experienced growing demand for COVID-19 molecular and antibody testing services and has expanded its capacity in order to satisfy such demand.testing. As a result, operating results for the three and ninesix months ended SeptemberJune 30, 20202021 may not be indicative of the results that may be expected for the full year.

    Use of Estimates
    
    The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.


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(unaudited)
(in millions, unless otherwise indicated)


    Earnings Per Share

    The Company's unvested restricted stock units that contain non-forfeitable rights to dividends are participating securities and, therefore, are included in the earnings allocation in computing earnings per share using the two-class method. Basic earnings per common share is calculated by dividing net income attributable to Quest Diagnostics, adjusted for earnings allocated to participating securities, by the weighted average number of common shares outstanding. Diluted earnings per

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common share is calculated by dividing net income attributable to Quest Diagnostics, adjusted for earnings allocated to participating securities, by the weighted average number of common shares outstanding after giving effect to all potentially dilutive common shares outstanding during the period. Potentially dilutive common shares include the dilutive effect of outstanding stock options and performance share units granted under the Company's Amended and Restated Employee Long-Term Incentive Plan and its Amended and Restated Non-Employee Director Long-Term Incentive Plan.Plan, as well as the dilutive effect of accelerated share repurchase agreements ("ASRs"). Earnings allocable to participating securities include the portion of dividends declared as well as the portion of undistributed earnings during the period allocable to participating securities.

    New Accounting Pronouncements
    Adoption of New Accounting Standards
    On January 1, 2020, the Company adopted a new accounting standard issued by the Financial Accounting Standards Board ("FASB") which aligns the requirements for deferring implementation costs incurred in a cloud computing arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software. The adoption of this standard, which the Company elected to do on a prospective basis, did not have a material impact on the Company's consolidated results of operations, financial position or cash flows.

    On January 1, 2020, the Company adopted a new accounting standard issued by the FASB that changes the impairment model for most financial instruments, including trade receivables, from an incurred loss method to a new forward-looking approach, based on expected losses. The estimate of expected credit losses requires entities to incorporate considerations of historical information, current information and reasonable and supportable forecasts. The adoption of this new standard, which was done using a modified retrospective transition approach, did not have a material impact on the Company's consolidated results of operations, financial position or cash flows. See Note 15 for further details on the Company's allowance for credit losses policy.

New Accounting Standards to be Adopted

    In March 2020, the FASBFinancial Accounting Standards Board issued a new accounting standard which provides temporary optional guidance to ease the potential burden in accounting for reference rate reform due to the risk of cessation of the London Interbank Offered Rate ("LIBOR"). The amendments apply only to contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued because of reference rate reform. The pronouncement is effective immediately and can be applied through December 31, 2022. The adoption of this standard is not expected to have a material impact on the Company’s consolidated results of operations, financial position or cash flows.

3.    EARNINGS PER SHARE

    The computation of basic and diluted earnings per common share was as follows (in millions, except per share data):
Three Months Ended June 30,Six Months Ended June 30,
 2021202020212020
Amounts attributable to Quest Diagnostics’ common stockholders:    
Net income attributable to Quest Diagnostics$631 $185 $1,100 $284 
Less: Earnings allocated to participating securities3 1 4 1 
Earnings available to Quest Diagnostics’ common stockholders – basic and diluted$628 $184 $1,096 $283 
Weighted average common shares outstanding – basic125 134 129 134 
Effect of dilutive securities:    
Stock options and performance share units2 2 2 1 
Weighted average common shares outstanding – diluted127 136 131 135 
Earnings per share attributable to Quest Diagnostics’ common stockholders:    
Basic$5.05 $1.38 $8.52 $2.12 
Diluted$4.96 $1.36 $8.38 $2.09 
    The following securities were not included in the calculation of diluted earnings per share due to their antidilutive effect:
Three Months Ended June 30,Six Months Ended June 30,
2021202020212020
Stock options and performance share units1 1 1 2 

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3.    EARNINGS PER SHARE

    The computationIn April 2021, the Company entered into ASRs with several financial institutions to repurchase $1.5 billion of basic and diluted earnings perthe Company's common stock as part of the Company's share was as follows (in millions, except per share data):
Three Months Ended September 30,Nine Months Ended September 30,
 2020201920202019
Amounts attributable to Quest Diagnostics’ common stockholders:    
Income from continuing operations$568 $215 $852 $585 
Income from discontinued operations, net of taxes0 0 0 20 
Net income attributable to Quest Diagnostics’ common stockholders$568 $215 $852 $605 
Income from continuing operations$568 $215 $852 $585 
Less: Earnings allocated to participating securities2 1 3 2 
Earnings available to Quest Diagnostics’ common stockholders – basic and diluted$566 $214 $849 $583 
Weighted average common shares outstanding – basic135 135 134 135 
Effect of dilutive securities:    
Stock options and performance share units2 2 2 1 
Weighted average common shares outstanding – diluted137 137 136 136 
Earnings per share attributable to Quest Diagnostics’ common stockholders - basic:    
Income from continuing operations$4.20 $1.59 $6.33 $4.33 
Income from discontinued operations0 0 0 0.15 
Net income$4.20 $1.59 $6.33 $4.48 
Earnings per share attributable to Quest Diagnostics’ common stockholders – diluted:    
Income from continuing operations$4.14 $1.56 $6.25 $4.27 
Income from discontinued operations0 0 0 0.15 
Net income$4.14 $1.56 $6.25 $4.42 
    The following securities were not included in the calculation of diluted earnings per share due to their antidilutive effect:
Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Stock options1 2 1 3 

repurchase program. See Note 9 for further details. The sum of basic and diluted earnings per share attributable to Quest Diagnostics' common stockholders for the first threetwo quarters of 20202021 did not equal the totalstotal for the ninesix months ended SeptemberJune 30, 20202021 due to both quarterly fluctuations in the Company's earnings and in the weighted average common shares outstanding throughout the period as a result of the impact of COVID-19 (see Note 2 for further details) and the temporary cessation of repurchases under the Company's share repurchase program (see Note 10 for further details).ASRs.


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4.    RESTRUCTURING ACTIVITIES

Invigorate Program

    The Company is committed to a program called Invigorate which is designed to reduce its cost structure and improve performance. Invigorate consists of several flagship programs, with structured plans in each, to drive savings and improve performance across the customer value chain. These flagship programs include: organization excellence; information technology excellence; procurement excellence; service excellence; lab excellence; and revenue services excellence. In addition to these programs, the Company identified key themes to change how it operates including reducing denials and patient concessions; further digitizing the business; standardization and automation; and optimization initiatives in the areas of lab network and patient service center network. The Invigorate program is intended to partially offset reimbursement pressures and labor and benefit cost increases; free up additional resources to invest in science, innovation and other growth initiatives; and enable the Company to improve service quality and operating profitability.

Restructuring Charges

    The following table provides a summary of the Company's pre-tax restructuring charges for the three and nine months ended September 30, 2020 and 2019:
Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Employee separation costs$6 $0 $13 $(3)
    The restructuring charges incurred for the three and nine months ended September 30, 2020 were primarily associated with various workforce reduction initiatives as the Company continued to simplify and restructure its organization. The $6 million of restructuring charges incurred during the three months ended September 30, 2020 were recorded in cost of services. Of the total restructuring charges incurred during the nine months ended September 30, 2020, $9 million and $4 million were recorded in cost of services and selling, general and administrative expenses, respectively.

    The restructuring activity recorded in the nine months ended September 30, 2019 represents a release of the liability relating to restructuring charges recorded in prior periods, which were determined to no longer be required. Of the total restructuring release recorded in the nine months ended September 30, 2019, $(1) million and $(2) million were recorded in cost of services and selling, general and administrative expenses, respectively.

    Charges for all periods presented were primarily recorded in the Company's DIS business.    

    The restructuring liability as of both September 30, 2020 and December 31, 2019, which is included in accounts payable and accrued expenses, was $9 million.


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5.     BUSINESS ACQUISITIONS

    On January 21, 2020,June 1, 2021, the Company completed itsthe acquisition of Blueprint Genetics Oy ("Blueprint Genetics"), in an all cash transaction for $108 million, net of $3 million cash acquired. Blueprint Genetics is a leading specialty genetic testing company with deep expertise in gene variant interpretation based on next generation sequencing and proprietary bioinformatics. Through the acquisition, the Company acquired all of Blueprint Genetics' operations. Based on the preliminary purchase price allocation, which may be revised as additional information becomes available during the measurement period, the assets acquired and liabilities assumed primarily consist of $77 million of goodwill (0ne of which is tax-deductible), $43 million of intangible assets, an $11 million deferred tax liability, and $2 million of property, plant and equipment and working capital. The intangible assets primarily consist of technology and customer-related assets which are being amortized over a useful life of 10 years and 15 years, respectively.

On April 6, 2020, the Company completed its acquisition of select assets which constitute substantially all of the operations of Memorial Hermann Diagnostic Laboratories, the outreach laboratory divisionservices business of Memorial HermannMercy Health, System ("Memorial Hermann"),which serves providers and patients in Arkansas, Kansas, Missouri and Oklahoma, in an all cashall-cash transaction for $120$225 million. Memorial Hermann is a not-for-profit health system in Southeast Texas. Based on the preliminary purchase price allocation, which may be revised as additional information becomes available during the measurement period, the assets acquired primarily consist of $27$54 million of customer-related intangible assets and $93$171 million of tax-deductible goodwill. The intangible assets are being amortized over a useful life of 15 years.

    On August 1, 2020, the Company completed itsThe acquisition of the remaining 56% interest in Mid America Clinical Laboratories, LLC ("MACL") from its joint venture partners in an all cash transaction for $93 million, net of $18 million cash acquired. The final consideration is subject to post closing adjustments related to working capital. MACL is the largest independent clinical laboratory provider in Indiana. Prior to the acquisition, the Company accounted for its 44% interest in MACL as an equity method investment, which was remeasured to its fair value of $87 million on the acquisition date, resulting in a gain of $70 million that was recognized in other income, net in the consolidated statements of operations. The fair value of the previously held equity interest was determined using a discounted cash flow analysis that takes into account, among other items, MACL's expected future cash flows, long-term growth rate (1.5%), and a discount rate commensurate with economic risk (7.5%). Based on the preliminary purchase price allocation, which may be revised as additional information becomes available during the measurement period, the assets acquired and liabilities assumed consist of $84 million of goodwill (of which $47 million is tax-deductible), $74 million of intangible assets, $11 million of working capital and $11 million of property, plant and equipment. The intangible assets consist of customer-related assets which are being amortized over a useful life of 15 years. As a result of the acquisition, MACL became a wholly owned subsidiary of the Company.

    The acquisitions were accounted for under the acquisition method of accounting. As such, the assets acquired and liabilities assumed were recorded based on their estimated fair values as of the closing date. Supplemental pro forma combined financial information has not been presented as the impact of the acquisitionsacquisition is not material to the Company's consolidated financial statements. The goodwill recorded primarily includes the expected synergies resulting from combining the operations of the acquired entitiesentity with those of the Company and the value associated with an assembled workforce and other intangible assets that do not qualify for separate recognition. All of the goodwill acquired in connection with these acquisitionsthe acquisition has been allocated to the Company's DIS business. For further details regarding business segment information, see Note 13.12.

    For details regarding the Company's 20192020 acquisitions, see Note 6 to the audited consolidated financial statements in the Company's 20192020 Annual Report on Form 10-K.    

5.    DISPOSITION

    On April 1, 2021, the Company sold its 40% ownership interest in Q2 Solutions® ("Q2 Solutions"), its clinical trials central laboratory services joint venture, to IQVIA Holdings, Inc. ("IQVIA"), its joint venture partner, for $760 million in an all-cash transaction. The sales price is subject to customary post-closing adjustments. Prior to the transaction, the Company accounted for its minority interest as an equity method investment. As a result of the transaction, during the three months ended June 30, 2021, the Company recorded a $314 million pre-tax gain in other income (expense), net in the consolidated statement of operations based on the difference between the net sales proceeds and the carrying value of the investment, including $20 million of cumulative translation losses which were previously recorded in accumulated other comprehensive loss. During the three months ended June 30, 2021, the Company also recorded $55 million of income tax expense related to the gain, consisting of $127 million of current income tax expense, partially offset by $72 million of deferred income tax benefit.

    Under a multi-year agreement, the Company will remain the strategic preferred laboratory provider for Q2 Solutions' clients, providing a range of lab testing capabilities to augment Q2 Solutions' core offerings and extend its industry leading suite of services.




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6.     FAIR VALUE MEASUREMENTS

    Assets and Liabilities Measured at Fair Value on a Recurring Basis

    The following table provides a summary of the recognized assets and liabilities that are measured at fair value on a recurring basis:
Basis of Fair Value MeasurementsBasis of Fair Value Measurements
Quoted Prices in Active Markets for Identical Assets/LiabilitiesSignificant Other Observable InputsSignificant Unobservable InputsQuoted Prices in Active Markets for Identical Assets/LiabilitiesSignificant Other Observable InputsSignificant Unobservable Inputs
September 30, 2020TotalLevel 1Level 2Level 3
June 30, 2021June 30, 2021TotalLevel 1Level 2Level 3
Assets:Assets:    Assets:    
Trading securitiesTrading securities$60 $60 $0 $0 Trading securities$75 $75 $0 $0 
Cash surrender value of life insurance policiesCash surrender value of life insurance policies45 0 45 0 Cash surrender value of life insurance policies55 0 55 0 
Available-for-sale debt securitiesAvailable-for-sale debt securities12 0 0 12 Available-for-sale debt securities1 0 0 1 
TotalTotal$117 $60 $45 $12 Total$131 $75 $55 $1 
Liabilities:Liabilities:    Liabilities:    
Deferred compensation liabilitiesDeferred compensation liabilities$114 $0 $114 $0 Deferred compensation liabilities$140 $0 $140 $0 
Redeemable noncontrolling interestRedeemable noncontrolling interest$80 $0 $— $80 Redeemable noncontrolling interest$78 $0 $— $78 
Basis of Fair Value MeasurementsBasis of Fair Value Measurements
December 31, 2019TotalLevel 1Level 2Level 3
December 31, 2020December 31, 2020TotalLevel 1Level 2Level 3
Assets:Assets:       Assets:       
Trading securitiesTrading securities$59 $59 $0 $0 Trading securities$67 $67 $0 $0 
Cash surrender value of life insurance policiesCash surrender value of life insurance policies43 0 43 0 Cash surrender value of life insurance policies50 0 50 0 
Available-for-sale debt securitiesAvailable-for-sale debt securities12 0 0 12 Available-for-sale debt securities12 0 0 12 
TotalTotal$114 $59 $43 $12 Total$129 $67 $50 $12 
Liabilities:Liabilities:    Liabilities:    
Deferred compensation liabilitiesDeferred compensation liabilities$110 $0 $110 $0 Deferred compensation liabilities$126 $0 $126 $0 
Fixed-to-variable interest rate swaps28 0 28 0 
Contingent consideration7 0 0 7 
Total$145 $0 $138 $7 
Redeemable noncontrolling interestRedeemable noncontrolling interest$76 $0 $— $76 Redeemable noncontrolling interest$82 $0 $— $82 
    
    A detailed description regarding the Company's fair value measurements is contained in Note 7 to the audited consolidated financial statements in the Company's 20192020 Annual Report on Form 10-K.    

    The Company offers certain employees the opportunity to participate in a non-qualified supplemental deferred compensation plan. A participant's deferrals, together with Company matching credits, are invested in a variety of participant-directed stock and bond mutual fundsinvestment options that are classified as trading securities. The trading securities are classified within Level 1 of the fair value hierarchy because the changes in the fair value of these securities are measured using quoted prices in active markets based on the market price per unit multiplied by the number of units held, exclusive of any transaction costs. A

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corresponding adjustment for changes in fair value of the trading securities is also reflected in the changes in fair value of the deferred compensation obligation. The deferred compensation liabilities are classified within Level 2 of the fair value hierarchy because their inputs are derived principally from observable market data by correlation to the trading securities.


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    The Company offers certain employees the opportunity to participate in a non-qualified deferred compensation program. A participant's deferrals, together with Company matching credits, are “invested” at the direction of the employee in a hypothetical portfolio of investments which are tracked by an administrator. The Company purchases life insurance policies, with the Company named as beneficiary of the policies, for the purpose of funding the program's liability. Changes in the cash surrender value of the life insurance policies are based upon earnings and changes in the value of the underlying investments. Changes in the fair value of the deferred compensation obligation are derived using quoted prices in active markets based on the market price per unit multiplied by the number of units. The cash surrender value and the deferred compensation obligation are classified within Level 2 of the fair value hierarchy because their inputs are derived principally from observable market data by correlation to the hypothetical investments. Deferrals under the plan currently may only be made by participants who made deferrals under the plan in 2017.

    The Company's available-for-sale debt securities are measured at fair value using discountedbased on estimated future cash flows. These fair value measurements are classified within Level 3 of the fair value hierarchy as the fair value is based on significant inputs that are not observable. Significant inputs includeobservable, including cash flows projections and a discount rate.flow projections.
        
    The fair value measurements of the Company's fixed-to-variable interest rate swaps, which were terminated during April 2020 (see Note 9), were classified within Level 2 of the fair value hierarchy and were based on model-derived valuations as of a given date in which all significant inputs are observable in active markets, including certain financial information and certain assumptions regarding past, present and future market conditions.

    In connection with previous business acquisitions, the Company has contingent consideration liabilities that are to be paid based on the achievement of certain testing volume or revenue benchmarks. As of September 30, 2020, the fair value of these contingent consideration liabilities was immaterial. These contingent consideration liabilities are measured at fair value using an option-pricing method and are classified within Level 3 of the fair value hierarchy as the fair value is determined based on significant inputs that are not observable. Significant inputs include management’s estimate of volume or revenue and other market inputs including comparable company revenue volatility and a discount rate. A summary of the significant inputs as of September 30, 2020 is as follows:
Business AcquisitionBenchmarkComparable Company Revenue VolatilityDiscount rateMaximum Contingent Consideration Payment
ReproSource, Inc.Revenue8.5%6.5%$10 
    For further details regarding the Company's acquisitions, see Note 6 to the audited consolidated financial statements in the Company's 2019 Annual Report on Form 10-K and Note 5 to the interim unaudited consolidated financial statements.

    The following table provides a reconciliation of the beginning and ending balances of liabilities using significant unobservable inputs (Level 3 of the fair value hierarchy):
Contingent Consideration
Balance, December 31, 2019$7 
Settlements(6)
Total (gains)/losses included in earnings - realized/unrealized(1)
Balance, September 30, 2020$0 
    The $1 million net gain included in earnings associated with the change in the fair value of contingent consideration for the nine months ended September 30, 2020 is reported in other operating expense (income), net.

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    In connection with the sale of an 18.9% noncontrolling interest in a subsidiary to UMass Memorial Medical Center ("UMass") on July 1, 2015, the Company granted UMass the right to require the Company to purchase all of its interest in the subsidiary at fair value commencing July 1, 2020. As of SeptemberJune 30, 2020,2021, the redeemable noncontrolling interest was presented at its fair value. The fair value measurement of the redeemable noncontrolling interest is classified within Level 3 of the fair value hierarchy because the fair value is based on a discounted cash flow analysis that takes into account, among other items, the joint venture's expected future cash flows, long term growth rates, and a discount rate commensurate with economic risk.

    During the six months ended June 30, 2021, the Company recorded an $8 million impairment charge, which is included in equity in earnings of equity method investees, net of taxes, in order to adjust to fair value an investment that is accounted for under the equity method of accounting. Following the impairment charge, the carrying value of the investment is not material. The fair value measurement was classified within Level 3 of the fair value hierarchy as it was based on significant inputs that are not observable, including cash flow projections.
    
    The carrying amounts of cash and cash equivalents, accounts receivable, and accounts payable and accrued expenses approximate fair value based on the short maturities of these instruments. As of SeptemberJune 30, 20202021 and December 31, 2019,2020, the fair value of the Company’s debt was estimated at $5.2$4.5 billion and $5.1$4.6 billion, respectively. Principally all of the Company's debt is classified within Level 1 of the fair value hierarchy because the fair value of the debt is estimated based on rates currently offered to the Company with identical terms and maturities, using quoted active market prices and yields, taking into account the underlying terms of the debt instruments.

7.    GOODWILL AND INTANGIBLE ASSETS

    The changes in goodwill for the ninesix months ended SeptemberJune 30, 20202021 and for the year ended December 31, 20192020 were as follows:
September 30, 2020December 31, 2019June 30, 2021December 31, 2020
Balance, beginning of periodBalance, beginning of period$6,619 $6,563 Balance, beginning of period$6,873 $6,619 
Goodwill acquired during the periodGoodwill acquired during the period258 43 Goodwill acquired during the period174 247 
Adjustments to goodwillAdjustments to goodwill3 13 Adjustments to goodwill(2)7 
Balance, end of periodBalance, end of period$6,880 $6,619 Balance, end of period$7,045 $6,873 
    
    Principally all of the Company’s goodwill as of SeptemberJune 30, 20202021 and December 31, 20192020 was associated with its DIS business.

    For the ninesix months ended SeptemberJune 30, 2020,2021, goodwill acquired during the period was primarilyprincipally associated with the acquisitionsacquisition of Blueprint Genetics, Memorial Hermann and MACL (see Note 5)the outreach laboratory services business of Mercy Health, and adjustments to goodwill primarily related to foreign currency translation. For the year ended December 31, 2019,2020, goodwill acquired was principally associated with the acquisitions of certain assetsBlueprint Genetics Oy; Memorial Hermann Diagnostic Laboratories, the outreach laboratory division of Memorial Hermann Health System; and the clinical laboratory services business of Boyce & Bynum Pathologyremaining 56% interest in Mid America Clinical Laboratories, P.C. and adjustments to goodwill primarily related to the finalization of the purchase price allocation for the acquisition of the U.S. laboratory services business of Oxford Immunotec, Inc.LLC (see Note 6 to the audited consolidated financial statements in the Company's 2019 Annual Report on Form 10-K).     


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consolidated financial statements in the Company's 2020 Annual Report on Form 10-K). For the year ended December 31, 2020, adjustments to goodwill primarily related to foreign currency translation.     

    Intangible assets at Septemberas of June 30, 20202021 and December 31, 20192020 consisted of the following:
Weighted
Average
Amortization
Period
(in years)		September 30, 2020December 31, 2019Weighted
Average
Amortization
Period
(in years)		June 30, 2021December 31, 2020
CostAccumulated
Amortization		NetCostAccumulated
Amortization		NetWeighted
Average
Amortization
Period
(in years)		CostAccumulated
Amortization		NetCostAccumulated
Amortization		Net
Amortizing intangible assets:Amortizing intangible assets:      Amortizing intangible assets:      
Customer-relatedCustomer-related17$1,479 $(617)$862 $1,367 $(556)$811 Customer-related17$1,535 $(682)$853 $1,479 $(638)$841 
Non-compete agreementsNon-compete agreements93 (2)1 3 (2)1 Non-compete agreements93 (2)1 3 (2)1 
TechnologyTechnology15140 (63)77 104 (56)48 Technology14143 (70)73 141 (65)76 
OtherOther9110 (94)16 110 (85)25 Other5108 (99)9 108 (95)13 
TotalTotal171,732 (776)956 1,584 (699)885 Total171,789 (853)936 1,731 (800)931 
Intangible assets not subject to amortization:Intangible assets not subject to amortization:     Intangible assets not subject to amortization:     
Trade namesTrade names 235 — 235 235 — 235 Trade names 235 — 235 235 — 235 
OtherOther 1 — 1 1 — 1 Other 1 — 1 1 — 1 
Total intangible assetsTotal intangible assets$1,968 $(776)$1,192 $1,820 $(699)$1,121 Total intangible assets$2,025 $(853)$1,172 $1,967 $(800)$1,167 
    
    The estimated amortization expense related to amortizable intangible assets for each of the five succeeding fiscal years and thereafter as of SeptemberJune 30, 20202021 is as follows:
Year Ending December 31, 
Remainder of 2020$27 
2021101 
202298 
202396 
202493 
202591 
Thereafter450 
Total$956 

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8.    DEBT
    Long-term debt (including finance lease obligations) as of September 30, 2020 and December 31, 2019 consisted of the following:
September 30, 2020December 31, 2019
4.75% Senior Notes due January 2020$0 $500 
2.50% Senior Notes due March 20200 300 
4.70% Senior Notes due April 2021551 554 
4.25% Senior Notes due April 2024317 308 
3.50% Senior Notes due March 2025623 593 
3.45% Senior Notes due June 2026513 490 
4.20% Senior Notes due June 2029499 499 
2.95% Senior Notes due June 2030798 798 
2.80% Senior Notes due June 2031549 0 
6.95% Senior Notes due July 2037175 175 
5.75% Senior Notes due January 2040245 245 
4.70% Senior Notes due March 2045300 300 
Other32 34 
Debt issuance costs(29)(26)
Total long-term debt4,573 4,770 
Less: Current portion of long-term debt555 804 
Total long-term debt, net of current portion$4,018 $3,966 
Retirement of Debt

During January 2020, the Company redeemed in full the outstanding indebtedness under the Company's senior notes due January 2020 and senior notes due March 2020 using proceeds from the issuance, in December 2019, of the 2.95% senior notes due June 2030, along with cash on hand. For the nine months ended September 30, 2020, the Company recorded a loss on retirement of debt, principally comprised of premiums paid, of $1 million in other income, net.

May 2020 Senior Notes Offering

    During May 2020, the Company completed a senior notes offering, consisting of $550 million aggregate principal amount of 2.80% senior notes due June 2031 (the "2031 Senior Notes"), which were issued at an original issue discount of $1 million. The 2031 Senior Notes are unsecured obligations of the Company that rank equally with the Company's other senior unsecured obligations. The 2031 Senior Notes do not have a sinking fund requirement. The Company incurred $5 million of debt issuance costs associated with the 2031 Senior Notes, which are included as a reduction to the carrying amount of long-term debt and which are being amortized over the term of the related debt.

    During October 2020, the Company issued a redemption notice to the holders of the Company's $550 million aggregate principal amount of 4.70% senior notes due April 2021. The Company intends to use the net proceeds from the 2031 Senior Notes, along with cash on hand, to satisfy the redemption. See Note 18 for further details.

    Credit Facilities

    As of September 30, 2020, the Company had cash and cash equivalents on hand of $1,605 million and had $1.3 billion of borrowing capacity available under its existing credit facilities, including $529 million available under its secured receivables credit facility and $750 million available under its senior unsecured revolving credit facility. There were 0 outstanding borrowings under the Company's existing credit facilities as of September 30, 2020. The secured receivables credit facility was amended in October 2020 in order to extend the maturity dates for each underlying commitment by one year, while maintaining

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the borrowing capacity at $600 million. See Note 18 for further details. The senior unsecured revolving credit facility matures in March 2023. For further details regarding the credit facilities, see Note 13 to the audited consolidated financial statements in the Company's 2019 Annual Report on Form 10-K.

    The secured receivables credit facility is subject to customary affirmative and negative covenants, and certain financial covenants with respect to the receivables that comprise the borrowing base and secure the borrowings under the facility. The Company's senior unsecured revolving credit facility is also subject to certain financial covenants and limitations on indebtedness. On April 30, 2020, the Company entered into an amendment to the senior unsecured revolving credit facility in order to provide for increased flexibility. Pursuant to the amendment, the leverage ratio covenant (as defined in the senior unsecured revolving credit facility) was increased as follows:
As of:Applicable Covenant:
September 30, 2020no more than 5.5 times EBITDA
December 31, 2020no more than 6.5 times EBITDA
March 31, 2021no more than 6.25 times EBITDA
June 30, 2021no more than 4.5 times EBITDA

    Thereafter, the leverage ratio covenant reverts to no more than 3.5 times EBITDA. During the period that the increased covenant applies, which period may be terminated early by the Company provided that it is in compliance with the historical 3.5 times EBITDA leverage ratio, the amended credit agreement contains certain additional limitations and restrictions including, but not limited to, repurchases of the Company's common stock, the amount of funds that can be used on business acquisitions, the incurrence of secured indebtedness and the payment of dividends. As of September 30, 2020, the Company was in compliance with all such applicable financial covenants. Interest on the amended senior unsecured revolving credit facility is subject to a pricing schedule that can fluctuate based on changes in the Company's credit ratings and its leverage ratio.

    During the nine months ended September 30, 2020, the Company borrowed $100 million under its secured receivables credit facility and $100 million under its senior unsecured revolving credit facility, both of which were repaid prior to September 30, 2020.

    Maturities of Long-Term Debt

    As of September 30, 2020, long-term debt matures as follows:
Year Ending December 31,
Remainder of 2020$1 
2021553 
20223 
20232 
2024302 
Thereafter3,696 
Total maturities of long-term debt4,557 
Unamortized discount(11)
Debt issuance costs(29)
Fair value basis adjustments attributable to hedged debt56 
Total long-term debt4,573 
Current portion of long-term debt555 
Total long-term debt, net of current portion$4,018 


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(in millions, unless otherwise indicated)


Year Ending December 31, 
Remainder of 2021$52 
2022102 
2023101 
202498 
202596 
202691 
Thereafter396 
Total$936 

9.8.    FINANCIAL INSTRUMENTS

    The Company uses derivative financial instruments to manage its exposure to market risks for changes in interest rates and, from time to time, foreign currencies. This strategy includes the use of interest rate swap agreements, forward-starting interest rate swap agreements, treasuryinterest rate lock agreements and foreign currency forward contracts to manage its exposure to movements in interest and currency rates. The Company has established policies and procedures for risk assessment and the approval, reporting and monitoring of derivative financial instrument activities. These policies prohibit holding or issuing derivative financial instruments for speculative purposes. The Company does not enter into derivative financial instruments that contain credit-risk-related contingent features or requirements to post collateral.


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    Interest Rate Risk
    
    The Company is exposed to interest rate risk on its cash and cash equivalents and its debt obligations. Interest income earned on cash and cash equivalents may fluctuate as interest rates change; however, due to their relatively short maturities, the Company does not hedge these assets or their investment cash flows and the impact of interest rate risk is not material. The Company's debt obligations consist of fixed-rate and variable-rate debt instruments. The Company's primary objective is to achieve the lowest overall cost of funding while managing the variability in cash outflows within an acceptable range. In order to achieve this objective, the Company entershas historically entered into interest rate swaps.swap agreements.

    Interest rate swaps involve the periodic exchange of payments without the exchange of underlying principal or notional amounts. Net settlements between the counterparties are recognized as an adjustment to interest expense.expense, net.

    Interest Rate Derivatives – Cash Flow Hedges

    From time to time, the Company has entered into various interest rate lock agreements and forward-starting interest rate swap agreements to hedge part of the Company's interest rate exposure associated with the variability in future cash flows attributable to changes in interest rates.

    During March 2020, the Company entered into a forward-starting interest rate swap agreement with a financial institution for a total notional amount of $25 million. Additionally, during May 2020, the Company entered into interest rate lock agreements with several financial institutions for a total notional amount of $275 million. The forward-starting interest rate swap agreement and the interest rate lock agreements were entered into in order to hedge a portion of the Company's interest rate exposure associated with variability in future cash flows attributable to changes in interest rates over a ten-year period related to an anticipated issuance of debt and were accounted for as cash flow hedges. In connection with the issuance of the 2031 Senior Notes (see Note 8), these agreements were settled and the Company received net proceeds of $1 million. The net gain is deferred in stockholders' equity, net of taxes, as a component of accumulated other comprehensive loss, and is being amortized as an adjustment to interest expense, net over a ten-year period.

    The total net loss, net of taxes, recognized in accumulated other comprehensive loss, related to the Company's cash flow hedges was $1 million and $4 million as of Septemberboth June 30, 20202021 and December 31, 2019, respectively.2020. The net amount of deferred losses on cash flow hedges that is expected to be reclassified from accumulated other comprehensive loss into interest expense, net within the next twelve months is $1 million.

    Interest Rate Derivatives – Fair Value Hedges

    As of December 31, 2019,Historically, the Company hadhas entered into various fixed-to-variable interest rate swap agreements outstanding with an aggregate notional amount of $1.2 billion, which were entered into in order to convert a portion of the Company's long-term debt into variable interest rate debt. In April 2020, the Company terminated these existingAll such fixed-to-variable interest rate swap agreements have been terminated and received proceeds of $40 million. Such amount wasfrom the terminations have been reflected as a basis adjustmentadjustments to the hedged debt instruments and isare being amortized as a reduction of interest expense, net over theirthe remaining terms.terms of such debt instruments.

    As of SeptemberJune 30, 20202021 and December 31, 2019,2020, the following amounts were recorded on the consolidated balance sheets related to cumulative basis adjustments for fair value hedges included in the carrying amount of long-term debt:
Hedge Accounting Basis Adjustment (a)
Balance Sheet ClassificationJune 30, 2021December 31, 2020
Long-term debt$45 $51 

(a) As of both June 30, 2021 and December 31, 2020, the entire balance is associated with remaining unamortized hedging adjustments on discontinued relationships.


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Carrying Amount of Hedged Long-Term DebtHedge Accounting Basis Adjustment (a)Carrying Amount of Hedged Long-Term DebtHedge Accounting Basis Adjustment (a)
Balance Sheet ClassificationSeptember 30, 2020September 30, 2020December 31, 2019December 31, 2019
Long-term debt$0 $56 $1,186 $(3)

(a) As of September 30, 2020, the entire balance is associated with remaining unamortized hedging adjustments on discontinued relationships. As of December 31, 2019, the balance includes $25 million of remaining unamortized hedging adjustments on discontinued relationships.

    The following table presents the effect of fair value hedge accounting on the Company's consolidated statements of operations for the three and ninesix months ended SeptemberJune 30, 20202021 and 2019:2020:
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
20202019202020192021202020212020
Other income, netOther income, netOther income, netOther income, netOther income (expense), netOther income (expense), netOther income (expense), netOther income (expense), net
Total for line item in which the effects of fair value hedges are recordedTotal for line item in which the effects of fair value hedges are recorded$77 $1 $74 $13 Total for line item in which the effects of fair value hedges are recorded$322 $13 $326 $(3)
Gain (loss) on fair value hedging relationships:Gain (loss) on fair value hedging relationships:Gain (loss) on fair value hedging relationships:
Hedged items (Long-term debt)Hedged items (Long-term debt)$0 $(20)$(68)$(76)Hedged items (Long-term debt)$0 $1 $0 $(68)
Derivatives designated as hedging instrumentsDerivatives designated as hedging instruments$0 $20 $68 $76 Derivatives designated as hedging instruments$0 $(1)$0 $68 
    
    A detailed description regarding the Company's use of derivative financial instruments is contained in Note 15 to the audited consolidated financial statements in the Company's 20192020 Annual Report on Form 10-K.        

10.9.    STOCKHOLDERS’ EQUITY AND REDEEMABLE NONCONTROLLING INTEREST
    
    Stockholders' Equity    

Changes in Accumulated Other Comprehensive Loss by Component

Comprehensive income (loss) includes:

•Foreign currency translation adjustments;
•Net deferred gaingains (losses) on cash flow hedges, which representsrepresent deferred gains/losses,gains (losses), net of tax, on interest rate-related derivative financial instruments designated as cash flow hedges, net of amounts reclassified to interest expense (see Note 9)8); and
•Net change onchanges in available-for-sale debt securities, which representsrepresent unrealized holding gains (losses), net of taxestax on available-for-sale debt securities.

    For the three and ninesix months ended SeptemberJune 30, 20202021 and 2019,2020, the tax effects related to the deferred gains/lossesgains (losses) on cash flow hedges and net change onchanges in available-for-sale debt securities were not material. Foreign currency translation adjustments related to indefinite investments in non-U.S. subsidiaries are not adjusted for income taxes.

    On April 1, 2021, the Company sold its 40% ownership interest in Q2 Solutions, its clinical trials central laboratory services joint venture, to IQVIA, its joint venture partner. As a result of the transaction, during the three months ended June 30, 2021, $20 million of cumulative translation losses were reclassified from accumulated other comprehensive loss to other income (expense), net. See Note 5 for further details.

Dividend Program
    
    During the first and second quarters of 2021, the Company's Board of Directors declared a quarterly cash dividend of $0.62 per common share. During each of the first threefour quarters of 2020, the Company's Board of Directors declared a quarterly cash dividend of $0.56 per common share. During
Share Repurchase Program
    In each of the four quarters of 2019,February 2021 and March 2021, the Company's Board of Directors declared a quarterly cash dividendincreased the size of $0.53 per common share.its share repurchase program by $1 billion. As of June 30, 2021, $1.3 billion remained available under the Company’s share repurchase authorization. The share repurchase authorization has no set expiration or termination date.

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Share Repurchase Program
    As of September 30, 2020, $1.2 billion remained available under the Company’s share repurchase authorizations; however, in April 2020, the Company temporarily suspended additional share repurchases under the existing authorization. The share repurchase authorization has no set expiration or termination date.
Share Repurchases

    For the ninesix months ended SeptemberJune 30, 2021, the Company repurchased 12.5 million shares of its common stock for $1.6 billion, including 9.1 million shares repurchased under ASRs as follows.

    In April 2021, the Company entered into ASRs with several financial institutions to repurchase $1.5 billion of the Company's common stock as part of the Company's share repurchase program. Each of the ASRs was structured to permit the Company to purchase shares immediately with the final purchase price of those shares determined by the volume-weighted average price of the Company's common stock during the repurchase period, less a fixed discount and was accounted for as two transactions: (1) a treasury stock repurchase and (2) a forward contract. For the three months ended June 30, 2021, the Company paid $1.5 billion to the financial institutions and received 9.1 million shares of its common stock, at an initial price of $132.27 per share for a value of $1.2 billion, which represents 80% of the total value of shares to be repurchased under the ASRs. The ASR contracts will settle the remaining shares, based on the volume-weighted average price of the Company's common stock during the repurchase period, less a fixed discount, upon the completion of the ASRs over the third and fourth quarters of 2021. The Company recorded the transactions as an increase to treasury stock of $1.2 billion and it recorded the remaining $300 million as a decrease to additional paid-in capital in the Company’s consolidated balance sheet. The $300 million recorded in additional paid-in capital will be included in treasury stock upon completion of the ASRs.

    For the six months ended June 30, 2020, the Company repurchased 0.7 million shares of its common stock for $75 million.

    For the nine months ended September 30, 2019, the Company repurchased 1.6 millionShares Reissued from Treasury Stock

    The Company's practice has been to issue shares related to its Employee Stock Purchase Plan ("ESPP") and its stock-based compensation program from shares of its common stock for $150 million.

Shares Reissuedheld in treasury or by issuing new shares of its common stock. In January 2021, the Company began to issue shares related to its ESPP and stock-based compensation program solely from Treasury Stock

common stock held in treasury. For the ninesix months ended SeptemberJune 30, 20202021 and 2019,2020, the Company reissued 2.11.2 million shares and 1.81.7 million shares, respectively from treasury stock for shares issued under the Employee Stock Purchase Plan and stock option plans.stock. For details regarding the Company's stock ownership and compensation plans, see Note 17 to the audited consolidated financial statements in the Company's 20192020 Annual Report on Form 10-K.    

    Redeemable Noncontrolling Interest

    In connection with the sale of an 18.9% noncontrolling interest in a subsidiary to UMass on July 1, 2015, the Company granted UMass the right to require the Company to purchase all of its interest in the subsidiary at fair value commencing July 1, 2020. The subsidiary performs diagnostic information services in a defined territory within the state of Massachusetts. Since the redemption of the noncontrolling interest is outside of the Company's control, it has been presented outside of stockholders' equity at the greater of its carrying amount or its fair value. As of SeptemberJune 30, 20202021 and December 31, 2019,2020, the redeemable noncontrolling interest was presented at its fair value. For further information regarding the fair value of the redeemable noncontrolling interest, see Note 6.


11.    SUPPLEMENTAL CASH FLOW AND OTHER DATA

    Supplemental cash flow and other data for the three and nine months ended September 30, 2020 and 2019 was as follows:

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Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Depreciation expense$62 $59 $186 $175 
Amortization expense27 23 77 72 
Depreciation and amortization expense$89 $82 $263 $247 
Interest expense$(42)$(45)$(126)$(136)
Interest income0 1 2 3 
Interest expense, net$(42)$(44)$(124)$(133)
Interest paid$33 $58 $136 $149 
Income taxes paid$148 $65 $168 $148 
Accounts payable associated with capital expenditures$55 $24 $55 $24 
Dividends payable$76 $72 $76 $72 
Businesses acquired:    
Fair value of assets acquired$126 $— $377 $61 
Fair value of liabilities assumed(9)0 (29)0 
Fair value of net assets acquired117 — 348 61 
Merger consideration receivable/payable2 0 2 (5)
Cash paid for business acquisitions119 0 350 56 
Less: Cash acquired18 0 21 0 
Business acquisitions, net of cash acquired$101 $— $329 $56 
Leases:
Leased assets obtained in exchange for new operating lease liabilities$40 $38 $119 $116 
Leased assets obtained in exchange for new finance lease liabilities$0 $1 $0 $1 

10.    SUPPLEMENTAL CASH FLOW AND OTHER DATA

    Supplemental cash flow and other data for the three and six months ended June 30, 2021 and 2020 was as follows:
Three Months Ended June 30,Six Months Ended June 30,
2021202020212020
Depreciation expense$75 $64 $149 $124 
Amortization expense25 25 52 50 
Depreciation and amortization expense$100 $89 $201 $174 
Interest expense$(38)$(42)$(76)$(84)
Interest income0 1 0 2 
Interest expense, net$(38)$(41)$(76)$(82)
Interest paid$46 $55 $78 $103 
Income taxes paid$328 $2 $335 $20 
Accounts payable associated with capital expenditures$20 $48 $20 $48 
Dividends payable$77 $75 $77 $75 
Businesses acquired:    
Fair value of assets acquired$234 $120 $234 $251 
Fair value of liabilities assumed(3)0 (3)(20)
Fair value of net assets acquired231 120 231 231 
Less: Cash acquired0 0 0 3 
Business acquisitions, net of cash acquired$231 $120 $231 $228 
Leases:
Leased assets obtained in exchange for new operating lease liabilities$33 $47 $69 $79 

    In March 2020, in response to the COVID-19 pandemic, the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act") was signed into law. The CARES Act provides numerous tax provisions and other stimulus measures, including temporary changes regarding the prior and future utilization of net operating losses, temporary changes to the prior and future limitations on interest deductions, temporary suspension of certain payment requirements for the employer portion of social security taxes, technical corrections from prior tax legislation for tax depreciation of certain qualified improvement property, and the creation of certain payroll tax credits associated with the retention of employees. The CARES Act also includes a number of benefits that are applicable to the Company and other healthcare providers including, but not limited to, the appropriation of $100 billion to health care providers for related expenses or lost revenues that are attributable to the COVID-19 pandemic.

In April 2020 and August 2020, the Company received approximately $65 million and $73 million, respectively, of funds that were distributed to healthcare providers for related expenses or lost revenues that are attributable to the COVID-19 pandemic under the CARES Act. In October 2020, the Company announced that it plans to return the entire $138 million of funds received.

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The Company accountsaccounted for the receipt of the funds under a gain contingency model. Accordingly, such amounts arethe amount was recognized when the funds arewere received and the Company hashad determined that it has satisfied the associated terms and conditions. During the three months ended June 30, 2020, based on the terms and conditions that were in effect at such time, the Company concluded that it had satisfied such terms and conditions for the $65 million of funds that were received in April 2020 and, therefore, the Company recognized such amount in other operating expense (income),income, net during the second quarter.quarter of 2020. During the three months ended September 30, 2020, the Company reversed the $65 million of funds that had previously been recognized in other operating expense (income), net. As of September 30,and, during the three months ended December 31, 2020, no amounts are recorded in the Company's year-to-date consolidated statement of operations and the entire $138 million of funds that the Company intends to return are recorded returned the funds.

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(in accounts payable and accrued expenses on the Company’s consolidated balance sheet. For the nine months ended September 30, 2020, net cash provided by operating activities included the $138 million that the Company received from the funds that were distributed to healthcare providers under the CARES Act.millions, unless otherwise indicated)


12.11.     COMMITMENTS AND CONTINGENCIES

    Letters of Credit

    The Company can issue letters of credit totaling $100 million under its $600 million secured receivables credit facility and $150 million under its $750 million senior unsecured revolving credit facility. For further discussion regarding the Company's secured receivables credit facility and senior unsecured revolving credit facility, seeSee Note 13 to the audited consolidated financial statements in the Company's 20192020 Annual Report on Form 10-K and Note 8 to the interim unaudited consolidated financial statements.    10-K.
    
    In support of its risk management program, to ensure the Company’s performance or payment to third parties, $71$70 million in letters of credit under the secured receivables credit facility were outstanding as of SeptemberJune 30, 2020. The letters of credit primarily represent2021, providing collateral for current and future automobile liability and workers’ compensation loss payments.

    Contingent Lease Obligations
    
    The Company remains subject to contingent obligations under certain real estate leases including leases that were entered into by certain predecessor companies of a subsidiary prior to the Company's acquisition of the subsidiary. Nofor which no liability has been recorded for any of these potential contingent obligations.recorded. For further details, see Note 18 to the audited consolidated financial statements in the Company’s 20192020 Annual Report on Form 10-K.

    Certain Legal Matters

    The Company may incur losses associated with these proceedings and investigations, but it is not possible to estimate the amount of loss or range of loss, if any, that might result from adverse judgments, settlements, fines, penalties, or other resolution of these proceedings and investigations based on the stage of these proceedings and investigations, the absence of specific allegations as to alleged damages, the uncertainty as to the certification of a class or classes and the size of any certified class, if applicable, and/or the lack of resolution of significant factual and legal issues. The Company has insurance coverage rights in place (limited in amount; subject to deductible) for certain potential costs and liabilities related to these proceedings and investigations.

401(k) Plan Lawsuit

    In June 2020, a2 putative class action lawsuit, House Johnson v. Quest Diagnostics Incorporated, et. al, waslawsuits were filed in the U.S. District Court for New Jersey against the Company and other defendants with respect to the Company’s 401(k) plan. The complaint alleges, among other things, that the fiduciaries of the 401(k) plan breached their duties by failing to disclose the expenses and risks of plan investment options, allowing unreasonable administration expenses to be charged to plan participants, and selecting and retaining high cost and poor performing investments. In July 2020, a putative class action lawsuit, Rice, et. al v. Quest Diagnostics Incorporated, et. al, was filed in the U.S. District Court for New Jersey. The plaintiffs in the Rice case named the same defendants as those named in the House Johnson case and alleged substantially similar claims to those made in the House Johnson matter. In October 2020, the court consolidated the two2 lawsuits under the caption In re: Quest Diagnostics ERISA Litigation and plaintiffs filed a consolidated amended complaint. The Company plansIn May 2021, the court denied the Company's motion to vigorously defend this matter. dismiss the complaint.


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AMCA Data Security Incident.

    On June 3, 2019, the Company reported that Retrieval-Masters Creditors Bureau, Inc./American Medical Collection Agency (“AMCA”) had informed the Company and Optum360 LLC that an unauthorized user had access to AMCA’s system between August 1, 2018 and March 30, 2019 (the “AMCA Data Security Incident”). Optum360 provides revenue management services to the Company, and AMCA provided debt collection services to Optum360. AMCA first informed the Company of the AMCA Data Security Incident on May 14, 2019. AMCA’s affected system included financial information (e.g., credit card numbers and bank account information), medical information and other personal information (e.g., social security numbers). Test results were not included. Neither Optum360’s nor the Company’s systems or databases were involved in the incident. AMCA also informed the Company that information pertaining to other laboratories’ customers was also affected. Following announcement of the AMCA Data Security Incident, AMCA sought protection under the U.S. bankruptcy laws. The bankruptcy proceeding has been dismissed.


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    Numerous putative class action lawsuits were filed against the Company related to the AMCA Data Security Incident. The U.S. Judicial Panel on Multidistrict Litigation transferred the cases still pending to, and consolidated them for pre-trial proceedings in, the U.S. District Court for New Jersey. In November 2019, the plaintiffs in the multidistrict proceeding filed a consolidated putative class action complaint against the Company and Optum360 that named additional individuals as plaintiffs and that asserted a variety of common law and statutory claims in connection with the AMCA Data Security Incident. In January 2020, the Company moved to dismiss the consolidated complaint.complaint; the motion to dismiss is pending.

    In addition, certain federal and state governmental authorities are investigating, or otherwise seeking information and/or documents from the Company related to the AMCA Data Security Incident and related matters, including the Office for Civil Rights of the U.S. Department of Health and Human Services, Attorneys General offices from numerous states and the District of Columbia, and certain U.S. senators.

    Other Legal Matters

    In the normal course of business, the Company has been named, from time to time, as a defendant in various legal actions, including arbitrations, class actions and other litigation, arising in connection with the Company's activities as a provider of diagnostic testing, information and services. These actions could involve claims for substantial compensatory and/or punitive damages or claims for indeterminate amounts of damages, and could have an adverse impact on the Company's client base and reputation.

    The Company is also involved, from time to time, in other reviews, investigations and proceedings by governmental agencies regarding the Company's business which may result in adverse judgments, settlements, fines, penalties, injunctions or other relief.

    The federal or state governments may bring claims based on the Company's current practices, which it believes are lawful. In addition, certain federal and state statutes, including the qui tam provisions of the federal False Claims Act, allow private individuals to bring lawsuits against healthcare companies on behalf of government or private payers. The Company is aware of lawsuits, and from time to time has received subpoenas, related to billing practices based on the qui tam provisions of the Civil False Claims Act or other federal and state statutes, regulations or other laws. The Company understands that there may be other pending qui tam claims brought by former employees or other "whistle blowers" as to which the Company cannot determine the extent of any potential liability.

    Management cannot predict the outcome of such matters. Although management does not anticipate that the ultimate outcome of such matters will have a material adverse effect on the Company's financial condition, given the high degree of judgment involved in establishing loss estimates related to these types of matters, the outcome of such matters may be material to the Company's consolidated results of operations or cash flows in the period in which the impact of such matters is determined or paid.

    These matters are in different stages. Some of these matters are in their early stages. Matters may involve responding to and cooperating with various government investigations and related subpoenas. As of SeptemberJune 30, 2020,2021, the Company does not believe that material losses related to legal matters are probable.

    Reserves for legal matters totaled $6 million and $1 million as of June 30, 2021 and December 31, 2020, respectively.

Reserves for General and Professional Liability Claims


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NOTES TO CONSOLIDATED FINANCIAL STATEMENTS – CONTINUED
(unaudited)
(in millions, unless otherwise indicated)


    Reserves for legal matters totaled $1 million as of both September 30, 2020 and December 31, 2019, respectively.

Reserves for General and Professional Liability Claims

    As a general matter, providers of clinical testing services may be subject to lawsuits alleging negligence or other similar legal claims. These suits could involve claims for substantial damages. Any professional liability litigation could also have an adverse impact on the Company's client base and reputation. The Company maintains various liability insurance coverages for, among other things, claims that could result from providing, or failing to provide, clinical testing services, including inaccurate testing results, and other exposures. The Company's insurance coverage limits its maximum exposure on individual claims; however, the Company is essentially self-insured for a significant portion of these claims. Reserves for such matters, including those associated with both asserted and incurred but not reported claims, are established on an undiscounted basis by considering actuarially determined losses based upon the Company's historical and projected loss experience. Such reserves totaled $134$151 million and $132$138 million as of SeptemberJune 30, 20202021 and December 31, 2019,2020, respectively. Management believes that established reserves and present insurance coverage are sufficient to cover currently estimated exposures.

13.12.    BUSINESS SEGMENT INFORMATION

    The Company's DIS business is the only reportable segment based on the manner in which the Chief Executive Officer, who is the Company's chief operating decision maker ("CODM"), assesses performance and allocates resources across the organization. The DIS business provides diagnostic information services to a broad range of customers, including patients, clinicians, hospitals, IDNs, health plans, employers, ACOs and ACOs.DCEs. The Company is the world's leading provider of diagnostic information services, which includes providing information and insights based on thean industry-leading menu of routine, non-routine and advanced clinical testing and anatomic pathology testing, and other diagnostic information services. The DIS business accounted for greater than 95% of net revenues in 20202021 and 2019.2020.

    All other operating segments include the Company's DS businesses, which consist of its risk assessment services and healthcare information technology businesses. The Company's DS businesses are the leading provider of risk assessment services for the life insurance industry and offer healthcare organizations and clinicians robust information technology solutions.
        
    As of SeptemberJune 30, 2020,2021, substantially all of the Company’s services were provided within the United States, and substantially all of the Company’s assets were located within the United States.

    The following table is a summary of segment information for the three and ninesix months ended SeptemberJune 30, 20202021 and 2019.2020. Segment asset information is not presented since it is not used by the CODM at the operating segment level. Operating earnings (loss) of each segment represents net revenues less directly identifiable expenses to arrive at operating income (loss) for the segment. General corporate activities included in the table below are comprised of general management and administrative corporate expenses, amortization and impairment of intangible assets and other operating income and expenses, net of certain general corporate activity costs that are allocated to the DIS and DS businesses. The accounting policies of the segments are the same as those of the Company as set forth in Note 2 to the audited consolidated financial statements contained in the Company’s 20192020 Annual Report on Form 10-K and Note 2 to the interim unaudited consolidated financial statements.

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NOTES TO CONSOLIDATED FINANCIAL STATEMENTS – CONTINUED
(unaudited)
(in millions, unless otherwise indicated)


Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
20202019202020192021202020212020
Net revenues:Net revenues:    Net revenues:    
DIS businessDIS business$2,709 $1,877 $6,217 $5,561 DIS business$2,474 $1,764 $5,117 $3,508 
All other operating segmentsAll other operating segments77 79 218 239 All other operating segments76 63 153 141 
Total net revenuesTotal net revenues$2,786 $1,956 $6,435 $5,800 Total net revenues$2,550 $1,827 $5,270 $3,649 
Operating earnings (loss):Operating earnings (loss):    Operating earnings (loss):    
DIS businessDIS business$840 $345 $1,325 $963 DIS business$601 $280 $1,313 $485 
All other operating segmentsAll other operating segments16 10 29 31 All other operating segments9 4 18 13 
General corporate activitiesGeneral corporate activities(138)(42)(178)(126)General corporate activities(77)(1)(138)(40)
Total operating incomeTotal operating income718 313 1,176 868 Total operating income533 283 1,193 458 
Non-operating income (expense), netNon-operating income (expense), net35 (43)(50)(120)Non-operating income (expense), net284 (28)250 (85)
Income from continuing operations before income taxes and equity in earnings of equity method investees753 270 1,126 748 
Income before income taxes and equity in earnings of equity method investeesIncome before income taxes and equity in earnings of equity method investees817 255 1,443 373 
Income tax expenseIncome tax expense(177)(62)(269)(175)Income tax expense(177)(66)(330)(92)
Equity in earnings of equity method investees, net of taxesEquity in earnings of equity method investees, net of taxes15 18 33 48 Equity in earnings of equity method investees, net of taxes10 4 27 18 
Income from continuing operations591 226 890 621 
Income from discontinued operations, net of taxes0 0 0 20 
Net incomeNet income591 226 890 641 Net income650 193 1,140 299 
Less: Net income attributable to noncontrolling interestsLess: Net income attributable to noncontrolling interests23 11 38 36 Less: Net income attributable to noncontrolling interests19 8 40 15 
Net income attributable to Quest DiagnosticsNet income attributable to Quest Diagnostics$568 $215 $852 $605 Net income attributable to Quest Diagnostics$631 $185 $1,100 $284 

    Net revenues by major service were as follows:

Three Months Ended June 30,Six Months Ended June 30,
2021202020212020
Routine clinical testing services$1,150 $812 $2,182 $1,757 
COVID-19 testing services511 582 1,339 606 
Gene-based and esoteric (including advanced diagnostics) testing services673 294 1,326 935 
Anatomic pathology testing services140 76 270 210 
All other76 63 153 141 
Total net revenues$2,550 $1,827 $5,270 $3,649 

14.    RELATED PARTIES

    The Company's equity method investees primarily consist of its clinical trials central laboratory services joint venture and its diagnostic information services joint ventures, which are accounted for under the equity method of accounting. During the three months ended September 30, 2020 and 2019, the Company recognized net revenues of $10 million and $8 million, respectively, associated with diagnostic information services provided to its equity method investees. During the nine months ended September 30, 2020 and 2019, the Company recognized net revenues of $25 million and $26 million, respectively, associated with diagnostic information services provided to its equity method investees. As of both September 30, 2020 and December 31, 2019, there was $4 million of accounts receivable from equity method investees related to such services. During both the three months ended September 30, 2020 and 2019, the Company recognized net revenues of $1 million associated with diagnostic information services provided to a noncontrolling interest partner in a joint venture. During the nine months ended September 30, 2020 and 2019, the Company recognized net revenues of $2 million and $6 million, respectively, associated with diagnostic information services provided to a noncontrolling interest partner in a joint venture. As of December 31, 2019, there was $4 million of receivables from the noncontrolling interest partner included in accounts receivable and other assets related to such services.

    During both the three months ended September 30, 2020 and 2019, the Company recognized income of $4 million associated with the performance of certain corporate services, including transition services, for its equity method investees, classified within selling, general and administrative expenses. During both the nine months ended September 30, 2020 and 2019, the Company recognized income of $12 million associated with the performance of certain corporate services, including transition services, for its equity method investees, classified within selling, general and administrative expenses. As of September 30, 2020 and December 31, 2019, there was $2 million and $1 million, respectively, of other receivables from equity method investees included in prepaid expenses and other current assets related to these service agreements and other transition related items. In addition, accounts payable and accrued expenses as of September 30, 2020 and December 31, 2019 included $1 million and $2 million, respectively, due to equity method investees.



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QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS – CONTINUED
(unaudited)
(in millions, unless otherwise indicated)


    During the nine months ended September 30, 2020 and 2019, the Company received dividends from its equity method investees of $34 million and $27 million, respectively.

15.13.    REVENUE RECOGNITION AND ALLOWANCE FOR CREDIT LOSSES

    DIS

    Net revenues in the Company’s DIS business accounted for over 95% of the Company’s total net revenues for the three and ninesix months ended SeptemberJune 30, 20202021 and 20192020 and are primarily comprised of a high volume of relatively low-dollar transactions. The DIS business, which provides clinical testing services and other services, satisfies its performance obligations and recognizes revenues primarily upon completion of the testing process when(when results are reported,reported) or when services have been rendered. The Company estimates the amount of consideration it expects to be entitled to receive from customer groups using the portfolio approach, in exchange for providing services.services using the portfolio approach. These estimates include the impact of contractual allowances including(including payer denialsdenials), and patient price concessions. The portfolios determined using the portfolio approach consist of the following groups of customers: healthcare insurers, government payers (Medicare and Medicaid programs), client payers and patients.


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QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS – CONTINUED
(unaudited)
(in millions, unless otherwise indicated)


    For further details regarding revenue recognition in the Company's DIS business, see Note 3 to the audited consolidated financial statements in the Company's 2020 Annual Report on Form 10-K.

    DS

    The Company’s DS businesses primarily satisfy their performance obligations and recognize revenues when delivery has occurred or services have been rendered.

    The approximate percentage of net revenue by type of customer was as follows:
    
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
20202019202020192021202020212020
Healthcare insurers:Healthcare insurers:Healthcare insurers:
Fee-for-serviceFee-for-service33 %32 %33 %33 %Fee-for-service38 %32 %38 %32 %
CapitatedCapitated2 3 3 3 Capitated3 3 3 3 
Total healthcare insurersTotal healthcare insurers35 35 36 36 Total healthcare insurers41 35 41 35 
Government payersGovernment payers10 15 12 15 Government payers10 12 10 13 
Client payersClient payers40 33 37 32 Client payers34 39 34 36 
PatientsPatients12 13 12 13 Patients12 11 12 12 
Total DISTotal DIS97 96 97 96 Total DIS97 97 97 96 
DSDS3 4 3 4 DS3 3 3 4 
Net revenuesNet revenues100 %100 %100 %100 %Net revenues100 %100 %100 %100 %
    
    The approximate percentage of net accounts receivable by type of customer was as follows:
September 30, 2020December 31, 2019
Healthcare Insurers30 %22 %
Government Payers6 11 
Client Payers48 42 
Patients (including coinsurance and deductible responsibilities)12 20 
Total DIS96 95 
DS4 5 
Net accounts receivable100 %100 %
June 30, 2021December 31, 2020
Healthcare Insurers31 %34 %
Government Payers6 6 
Client Payers42 46 
Patients (including coinsurance and deductible responsibilities)17 11 
Total DIS96 97 
DS4 3 
Net accounts receivable100 %100 %

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QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS – CONTINUED
(unaudited)
(in millions, unless otherwise indicated)



    Allowance for Credit Losses Policy

    When estimating its allowance for credit losses, the Company pools its trade receivables based on the following customer types: healthcare insurers, government payers, client payers and patients. 

    For the healthcare insurers and government payers, collection of the Company’s net revenues is normally a function of providing the complete and correct billing information within the various filing deadlines, and provided that the Company has billed the payers accurately with complete information prior to the established filing deadline, there has historically been little to no collection risk. 

    Client payers primarily include physicians, hospitals, IDNs, ACOs, employers, other commercial laboratories and institutions for which services are performed on a wholesale basis and are billed based on negotiated fee schedules.  Credit risk and ability to pay are more of a consideration for these payers. 

    With respect to patients, implicit price concessions, which represent differences between amounts billed and the estimated consideration the Company expects to receive from patients, are recognized as a reduction of revenue.  Estimates of implicit price concessions consider historical collection experience (including the period the receivables have been outstanding) and other factors including current market conditions.

    The Company principally estimates the allowance for credit losses by pool based on historical collection experience, the current credit worthiness of the customers, current economic conditions, expectations of future economic conditions and the period that the receivables have been outstanding.  To the extent that any individual payers are identified that have deteriorated in credit quality, the Company removes the customers from their respective pools and establishes allowances based on the individual risk characteristics of such customers.

    Although the Company believes that its estimates for contractual allowances and patient price concessions as well as its allowance for credit losses are appropriate, it is possible that the Company will experience an impact on cash collections as a result of the impact of the COVID-19 pandemic.


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QUEST DIAGNOSTICS INCORPORATED AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS – CONTINUED
(unaudited)
(in millions, unless otherwise indicated)


16.14.    TAXES ON INCOME

    For the three months ended SeptemberJune 30, 20202021 and 2019,2020, the effective income tax rate was 23.7%21.6% and 22.9%25.5%, respectively. TheFor the three months ended June 30, 2021, the effective income tax rate for the three months ended September 30, 2020, benefited from a lower effective income tax rate, associated with a $70 million17.6%, on the gain recognized as a result ofon the remeasurementsale of the Company's previously held equity40% ownership interest in MACL to fair valueQ2 Solutions (see Note 5);. In addition, the effective income tax rate benefited from $5 million and $3$4 million of excess tax benefits associated with stock-based compensation arrangements. The effective income tax ratearrangements for the three months ended SeptemberJune 30, 20192021 and 2020, respectively.

    For the six months ended June 30, 2021 and 2020, the effective income tax rate was 22.9% and 24.4%, respectively. For the six months ended June 30, 2021, the effective income tax rate benefited from a $6 millionlower effective income tax benefit due torate, 17.6%, on the releasegain on the sale of a valuation allowance associated with net operating loss carryforwards;the Company's 40% ownership interest in Q2 Solutions (see Note 5). In addition, the effective income tax rate benefited from $9 million and $3$12 million of excess tax benefits associated with stock-based compensation arrangements.

    Forarrangements for the ninesix months ended SeptemberJune 30, 2020 and 2019, the effective income tax rate was 23.9% and 23.4%, respectively. The effective income tax rate for the nine months ended September 30, 2020, benefited from a lower effective income tax rate associated with a $70 million gain recognized as a result of the remeasurement of the Company's previously held equity interest in MACL to fair value (see Note 5); and $15 million of excess tax benefits associated with stock-based compensation arrangements. The effective income tax rate for the nine months ended September 30, 2019 benefited from $11 million of excess tax benefits associated with stock-based compensation arrangements; and a $10 million income tax benefit due to the release of valuation allowances associated with net operating loss carryforwards.

    The effective income tax rate associated with the $70 million gain recognized as a result of the remeasurement of the Company's previously held equity interest in MACL to fair value was 11.8% due to a permanent difference in the financial reporting and tax basis of goodwill.

    For the three and nine months ended September 30, 2020, the Company utilized the most likely estimate of its annual income before taxes to determine the annual effective income tax rate for 2020. As a result of uncertainty associated with the impact of the COVID-19 pandemic, it is possible that the Company will experience variability in the annual projections and, as a result, the annual effective income tax rate.

17.    DISCONTINUED OPERATIONS

    During the third quarter of 2006, the Company completed the wind down of Nichols Institute Diagnostics ("NID"), a test kit manufacturing subsidiary, which was reported as a discontinued operation for the nine months ended September 30, 2019. Discontinued operations, net of taxes, for the nine months ended September 30, 2019 includes discrete tax benefits of $20 million associated with the favorable resolution of certain tax contingencies related to NID. In addition, net cash provided by operating activities in the consolidated statement of cash flows for the nine months ended September 30, 2019 included a $28 million refund from the taxing authorities related to discontinued operations.

18.    SUBSEQUENT EVENTS

    During October 2020, the Company amended its $600 million secured receivables credit facility in order to extend the maturity dates for each underlying commitment by one year while maintaining the borrowing capacity under the facility at $600 million. Under the secured receivables credit facility, the Company can borrow against a $250 million loan commitment maturing October 2021 and a $250 million loan commitment maturing October 2022. Additionally, the Company can issue up to $100 million of letters of credit through October 2022. Borrowings under the facility are collateralized by certain domestic receivables. Interest on borrowings under the facility is based on either commercial paper rates for highly-rated issuers or LIBOR, plus a spread of 0.825% to 0.95%.

    In October 2020, the Company issued a redemption notice to the holders of the Company's $550 million aggregate principal amount of 4.70% senior notes due April 2021, to redeem such notes in November 2020. Upon redemption, the Company will recognize a loss on extinguishment of debt based on the difference between the reacquisition price of the debt and the net carrying amount. The Company will pay a redemption premium in accordance with the requirements of such notes using a treasury rate calculated on the third business day preceding the redemption date.



respectively.

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Item 2.Management’s Discussion and Analysis of Financial Condition and Results of Operations

Our Company

    Diagnostic Information Services

    Quest Diagnostics empowers people to take action to improve health outcomes. We use our extensive database of clinical lab results to derive diagnostic insights that reveal new avenues to identify and treat disease, inspire healthy behaviors and improve healthcare management. Our diagnostic information services business ("DIS") provides information and insights based on thean industry-leading menu of routine, non-routine and advanced clinical testing and anatomic pathology testing, and other diagnostic information services. We provide services to a broad range of customers, including patients, clinicians, hospitals, independent delivery networks ("IDNs"), health plans, employers, and accountable care organizations ("ACOs"), and direct contract entities ("DCEs"). We offer the broadest access in the United States to diagnostic information services through our nationwide network of laboratories, patient service centers and phlebotomists in physician offices and our connectivity resources, including call centers and mobile paramedics, nurses and other health and wellness professionals. We are the world's leading provider of diagnostic information services. We provide interpretive consultation with one of the largest medical and scientific staffs in the industry. Our DIS business makes up overgreater than 95% of our consolidated net revenues.

    We assess our revenue performance for the DIS business based upon, among other factors, volume (measured by test requisitions) and revenue per requisition.

    Each requisition accompanies patient specimens, indicating the test(s) to be performed and the party to be billed for the test(s). Management utilizes requisition data to assist with assessing the growth of the business. Therefore, we believe that the change in the number of requisitions from period to period is useful information for investors as it allows them to assess our growth.

    Revenue per requisition is impacted by various factors, including, among other items, the impact of fee schedule changes (i.e., unit price), test mix, payer mix, and the number of tests per requisition. Management utilizesuses number of requisitions and revenue per requisition data in order to assist with assessing various factors impacting the growth and performance of the business, including understanding trends affecting number of requisitions, pricing and trends impactingtest mix. Therefore, we believe that the changeinformation related to changes in this metricthese metrics from period to period isare useful information for investors as it allows them to assess such factors, which are relevant to assessing the revenue performance of the business.

    Diagnostic Solutions

    In our Diagnostic Solutions ("DS") businesses, which representsrepresent the balance of our consolidated net revenues, we offer a variety of solutions for life insurers and healthcare organizations and clinicians. We are the leading provider of risk assessment services for the life insurance industry andindustry. In addition, we offer healthcare organizations and clinicians robust information technology solutions.

ThirdSecond Quarter Highlights
    
Three Months Ended June 30,
20212020
(dollars in millions, except per share data)
Net revenues$2,550$1,827
DIS revenues$2,474$1,764
Revenue per requisition change(3.6)%15.3%
Requisition volume change45.2%(17.7)%
Organic requisition volume change40.1%(18.2)%
DS revenues$76$63
Net income attributable to Quest Diagnostics$631$185
Diluted earnings per share$4.96$1.36
Net cash provided by operating activities$460$355
•Our total net revenues of $2.79 billion were up 42.5% from the prior year period.
•In DIS:
◦Revenues    For further discussion of $2.71 billion increased by 44.3%the year-over-year changes for the three months ended June 30, 2021 compared to the prior year period, driven by demand for COVID-19 molecular and antibody testing, and, to a lesser extent, the impactthree months ended June 30, 2020, see Results of recent acquisitions, partially offset by a decline in testing volume in our base business (which excludes COVID-19 molecular and antibody testing).Operations below.
◦Volume, measured by the number of requisitions, increased by 19.7% compared to the prior year period, with organic growth (which excludes the impact of recent acquisitions) and acquisitions contributing approximately 16.6% and 3.1%, respectively. Organic volume growth was driven by demand for COVID-19 molecular testing, partially offset by declines in testing volumes in the base business. Testing volumes in the base business were negatively impacted by the COVID-19 pandemic and declined by 5% compared to the prior year period.
◦Revenue per requisition increased by 20.9% compared to the prior year period driven, in large part, by COVID-19 molecular testing.
•DS revenues of $77 million decreased by 1.9% compared to the prior year period.
•Income from continuing operations attributable to Quest Diagnostics' stockholders was $568 million, or $4.14 per diluted share, in 2020, compared to $215 million, or $1.56 per diluted share, in the prior year period.
•For the nine months ended September 30, 2020, net cash provided by operating activities was $1,464 million, compared to $895 million in the prior year period.

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Impact of COVID - 19

    As a novel strain of coronavirus (“COVID-19”)(COVID-19) continues to spread and severely impact the economy of the United States and other countries around the world, we are committed to being a part of the coordinated public and private sector response to this unprecedented challenge. We have made substantial investments to expand the amount of COVID-19 testing available to the country and are currently capable of performing more than 200,000approximately 300,000 COVID-19 molecular diagnostic tests per day to aid in the diagnosis of COVID-19 and approximately 200,000350,000 COVID-19 antibody tests per day to aid in the detection of immune response. We have been effectively managing challenges in the global supply chain; and, at this point, we have sufficient supplies to conduct our business.

    We have put preparedness plans in place atDuring 2020 and the first half of 2021, our facilities to maintain continuity of operations, while also taking steps to keep colleaguestesting volume and customers healthy and safe. In line with recommendations to reduce large gatherings and increase social distancing, many of our office-based colleagues are working in a remote environment. We are evaluatingrevenues were materially impacted by the best way to bring them back into the office.COVID-19 pandemic.

During January and February 2020, we experienced growth in DIS revenues and volumesvolume compared to the prior year period. However, in March and April 2020, we experienced a material decline in testing volumesvolume due to the COVID-19 pandemic. During the last two weeks of March, volumes declined in excess of 40% compared to the prior year period, inclusive of COVID-19 testing, which continued in April with volume declines in the range of 50 to 60% compared to the prior year period as government policies were implemented to reduce the transmission of COVID-19. During May and June 2020, we began to experience a recovery in base testing volumesvolume (which excludes COVID-19 molecular and antibody testing), which continued in the thirdsecond half of 2020 and the first half of 2021 driven by people returning to the healthcare system as well as contributions from new Professional Laboratory Services offerings. For the first and second quarters of 2021, our base testing volume, excluding volume associated with recent acquisitions, was 2.8% below and 1.9% above our historical first and second quarter of 2020. Additionally, beginning2019 levels, respectively. Recent agreements associated with our Professional Laboratory Services offerings contributed 5.2% and 5.8% volume growth compared to 2019 for the first and second quarters of 2021, respectively. Unless there is a change in the severity of the COVID-19 pandemic, we believe that there will be a continued return to healthcare throughout 2021 with, in some cases, patients pursuing care delayed during the second quarter, we experienced growing demand for COVID-19 testing services and have expanded our capacity in order to satisfy such demand. Volumes in our base business for the second and third quarters of 2020 decreased approximately 34% and 5%, respectively, compared to the prior year periods.pandemic.

The decrease in base testing volumesvolume was driven by federal, state and local governmental policies and initiatives designed to reduce the transmission of COVID-19, which have resulted in, among other things, a significant reduction in physician office visits, the cancellation of elective medical procedures, customers closing or severely curtailing their operations (voluntarily or in response to government orders), and the adoption of work-from-home policies, all of which have had, and we believe willmay continue to have, an impact on our operating results, financial position and cash flows, including continued declines in base testing volumes. It is also possible that we will experience an impact on cash collections as a result of the impact of the COVID-19 pandemic. flows.

    DuringBeginning during the second quarter of 2020, we experienced growing demand for COVID-19 testing services and we expanded our capacity throughout 2020 in order to satisfy the decreasedemand, which has had a significant impact on our testing volumes. Since the fourth quarter of 2020, demand for COVID-19 testing has decreased reflecting an industry-wide trend. Compared to the fourth quarter of 2020, our net revenues associated with COVID-19 testing in basethe first and second quarters of 2021 declined by 27.9% and 55.7%, respectively. Given the significant progress of vaccinations in the U.S., we continue to expect a decline in demand for COVID-19 molecular testing volumes was partially offsetin the second half of 2021.

Additionally, our revenue per requisition has been positively impacted by COVID-19 molecular and antibody testing, including an increase in revenue per requisition driven in large part by COVID-19 molecular testing. During the third quarter of 2020, the decrease in base testing volumes was more than offset by the impact of the COVID-19 testing.

In April 2020 the Centers for Medicare and Medicaid Services ("CMS") announced that it would increase the reimbursement for certain COVID-19 molecular tests making use of high-throughput technologies developed by the private sector that allow for increased testing capacity, faster results, and more effective means of combating the spread of the virus to $100 per test, effective April 14, 2020. In October 2020, CMS announced that, beginningBeginning January 1, 2021, Medicare will changechanged the base reimbursement rate for COVID-19 diagnostic tests run on high-throughput technologies to $75 per test with an additional payment of $25 per test if certain additional requirements are met. In conjunction with our trade association, we are currently reviewing how thisthe laboratory (1) completes the test in two calendar days or less and (2) completes the majority of its COVID-19 tests that use high throughput technology in two calendar days or less for all of its patients in the previous month. Certain healthcare insurers have now moved to a similar reimbursement policy will impact laboratories and the patients we serve.model for COVID-19 molecular tests.

    In order to mitigate the impact that the COVID-19 pandemic had on our business, we implemented a series of temporary actions in April 2020 to manage our workforce costs and preserve cash including temporary salary reductions; suspension of certain benefits; reduced hours for employees whose work has significantly declined; and approved furloughs for employees with diminished work requirements who expressed an interest. As our testing volumes started to recover, we recalled the vast majority of employees from furlough and reinstated full working hours for almost all employees who were asked to work reduced hours. By the end of the third quarter of 2020, salaries were restored for all exempt employees that had temporary salary reductions.

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We believe the COVID-19 pandemic’s impact on our consolidated results of operations, financial position and cash flows will be primarily driven by: the severity and duration of the COVID-19 pandemic; healthcare insurer, government, and client payer reimbursement rates for COVID-19 molecular testing; the COVID-19 pandemic’s impact on the U.S. healthcare system and the U.S. economy; and the timing, scope and effectiveness of federal, state and local

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governmental responses to the COVID-19 pandemic.pandemic, including the impact of vaccination efforts. We may also be impacted by changes in the severity of the COVID-19 pandemic at different times in the various cities and regions where we operate and offer services. Even afteras the COVID-19 pandemic has moderatedcontinues to moderate and the business and social distancing restrictions have eased,continue to ease, we may continue to experience similar effects to our businesses, consolidated results of operations, financial position and cash flows resulting from a recessionary economic environment that may persist. flows. In the longer term, given the many challenges that hospitals will face, we may have more opportunities to partner with hospitals to help achieve their laboratory strategies, and the COVID-19 pandemic may also be a further catalyst for consolidation in the laboratory testing industry.

Acquisition of the Outreach Laboratory Services Business of Mercy Health

    On June 1, 2021, we completed the acquisition of the outreach laboratory services business of Mercy Health, which serves providers and patients in Arkansas, Kansas, Missouri and Oklahoma, in an all-cash transaction for $225 million. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act)acquired business is included in our DIS business.

    For further details, see Note 4 to the interim unaudited consolidated financial statements.

Sale of Ownership Interest in Q2 Solutions® ("Q2 Solutions") to IQVIA Holdings, Inc. ("IQVIA")

    On April 1, 2021, we sold our 40% ownership interest in QIn March 2020,2 Solutions, our clinical trials central laboratory services joint venture, to IQVIA, our joint venture partner, for $760 million in responsean all-cash transaction. The sales price is subject to customary post-closing adjustments. Prior to the COVID-19 pandemic,transaction, we accounted for our minority interest as an equity method investment. As a result of the CARES Act was signed into law. The CARES Act provides numerous tax provisions andtransaction, during the three months ended June 30, 2021, we recorded a $314 million pre-tax gain in other stimulus measures, including temporary changes regardingincome (expense), net in the prior and future utilizationconsolidated statement of operations based on the difference between the net operating losses, temporary changes to the prior and future limitations on interest deductions, temporary suspension of certain payment requirements for the employer portion of Social Security taxes, technical corrections from prior tax legislation for tax depreciation of certain qualified improvement property,sales proceeds and the creation of certain payroll tax credits associated with the retention of employees. Beginning in the second quarter of 2020, we started taking advantagecarrying value of the temporary suspension of payment requirements for the employer portion of Social Security taxes.

    The CARES Act also includes a number of benefits that are applicable to us and other healthcare providersinvestment, including but not limited to:

•providing coverage for COVID-19 testing at no out-of-pocket cost to nearly all patients;
•providing clinical laboratories a one-year reprieve from the reporting requirements under the Protecting Access to Medicare Act ("PAMA") as well as a one-year delay of reimbursement rate reductions for clinical laboratory services provided under Medicare that were scheduled to take place in 2021. Further revisions of the Medicare Clinical Laboratory Fee Schedule for years after 2021 will be based on future surveys of market rates. Reimbursement reduction from 2022-2024 is capped by PAMA at 15% annually;
•appropriating $100 billion to health care providers for related expenses or lost revenues that are attributable to the COVID-19 pandemic. In April 2020 and August 2020, we received approximately $65 million and $73 million, respectively, of funds that were distributed to healthcare providers for related expenses or lost revenues that are attributable to the COVID-19 pandemic under the CARES Act. In October 2020, we announced that we plan to return the entire $138$20 million of funds received.cumulative translation losses which were previously recorded in accumulated other comprehensive loss. During the three months ended June 30, 2020,2021, we recognized $65also recorded $55 million in other operatingof income tax expense (income), net related to the first tranchegain, consisting of funds. During the three months ended September 30, 2020, we reversed the $65$127 million of funds that had previously been recognized in other operatingcurrent income tax expense, (income), net. As of September 30, 2020, no amounts are recorded in our year-to-date consolidated statement of operations and the entire $138partially offset by $72 million of funds that we intend to return are recorded in accounts payable and accrued expenses on our consolidated balance sheet; anddeferred income tax benefit.
•
    Under a multi-year agreement, we will remain the strategic preferred laboratory provider for Qsuspending2 Solutions' clients, providing a range of lab testing capabilities to augment Q2 Solutions' core offerings and extend its industry leading suite of services.

    For further details, see Note 5 to the interim unaudited consolidated financial statements.

Accelerated Share Repurchase Agreements ("ASRs")

    In April 2021, we entered into ASRs with several financial institutions to repurchase $1.5 billion of our common stock as part of our share repurchase program. Each of the ASRs was structured to permit us to purchase shares immediately with the final purchase price of those shares determined by the volume-weighted average price of our common stock during the repurchase period, less a fixed discount. For the second quarter of 2021, we paid $1.5 billion to the financial institutions and received 9.1 million shares of our common stock, at an initial price of $132.27 per share for a value of $1.2 billion, which represents 80% of the total value of shares to be repurchased under the ASRs.

    For further details regarding the ASRs and our repurchases of our common stock, see Note 9 to the interim unaudited consolidated financial statements.

Medicare Sequestration

    In April 2021, the suspension of Medicare sequestration, from May 2020 to December 2020. The suspension of the Medicare sequestrationwhich has resulted in a small benefit to us in the form of higher reimbursement rates for diagnostic testing services performed on behalf of Medicare beneficiaries.beneficiaries, was extended through the end of 2021.

Retirement of Debt

    During January 2020, we redeemed in full the outstanding indebtedness under our senior notes due January 2020 and senior notes due March 2020 using proceeds from the issuance, in December 2019, of the 2.95% senior notes due June 2030, along with cash on hand. For the nine months ended September 30, 2020, we recorded a loss on retirement of debt, principally comprised of premiums paid, of $1 million in other income, net.

Senior Notes Offering

    During May 2020, we completed a senior notes offering, consisting of $550 million aggregate principal amount of 2.80% senior notes due June 2031 (the “2031 Senior Notes”), which were issued at an original issue discount of $1 million. In October 2020, we issued a redemption notice to the holders of our $550 million aggregate principal amount of 4.70% senior notes due April 2021, to redeem such notes in November 2020. We intend to use the net proceeds from the 2031 Senior Notes, along with cash on hand, to satisfy the redemption.

    For further details regarding our debt, see Notes 8 and 18 to the interim unaudited consolidated financial statements.

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Acquisition of Blueprint Genetics Oy

    On January 21, 2020, we completed the acquisition of Blueprint Genetics Oy ("Blueprint Genetics"), in an all cash transaction for $108 million, net of $3 million cash acquired. Blueprint Genetics is a leading specialty genetic testing company with deep expertise in gene variant interpretation based on next generation sequencing and proprietary bioinformatics. Through the acquisition, we acquired all of Blueprint Genetics' operations. The acquired business is included in our DIS business.

Acquisition of the Outreach Laboratory Services Business of Memorial Hermann Health System

    On April 6, 2020, we completed the acquisition of select assets which constitute substantially all of the operations of Memorial Hermann Diagnostic Laboratories, the outreach laboratory division of Memorial Hermann Health System ("Memorial Hermann") in an all cash transaction for $120 million. Memorial Hermann is a not-for-profit health system in Southeast Texas. The acquired business is included in our DIS business.

Acquisition of the Remaining 56% Interest in Mid America Clinical Laboratories, LLC

    On August 1, 2020, we completed the acquisition of the remaining 56% interest in Mid America Clinical Laboratories, LLC ("MACL") from our joint venture partners in an all cash transaction for $93 million, net of $18 million cash acquired. MACL is the largest independent clinical laboratory provider in Indiana. Prior to the acquisition, we accounted for our 44% interest in MACL as an equity method investment which was remeasured to its fair value of $87 million on the acquisition date, resulting in a gain of $70 million that was recognized in other income, net in the consolidated statements of operations. As a result of the acquisition, MACL became our wholly owned subsidiary. The acquired business is included in our DIS business.

    For further details regarding our acquisitions, see Note 5 to the interim unaudited consolidated financial statements and Note 6 to the audited consolidated financial statements in our 2019 Annual Report on Form 10-K.

Invigorate Program
        
    We are engaged in a multi-year program called Invigorate, which is designed to reduce our cost structure and improve our performance. We currently aim annually to savedeliver savings of approximately 3% of our costs. We are assessing whether the COVID-19 pandemic will impact our ability to achieve that objective in 2020.

    Invigorate has consisted of several flagship programs, with structured plans in each, to drive savings and improve performance across the customer value chain. These flagship programs include: organization excellence; information technology excellence; procurement excellence; field and customer service excellence; lab excellence; and revenue services excellence. In addition to these programs, we have identified key themes to change how we operate including reducing denials and patient price concessions; further digitizing our business; standardization and automation; and optimization initiatives in our lab network and patient service center network. We believe that our efforts to standardize our information technology systems, equipment and data also foster our efforts to strengthen our foundation for growth and support the value creation initiatives of our clinical franchises by enhancing our operational flexibility, empowering and enhancing the customer experience, facilitating the delivery of actionable insights and bolstering our large data platform.

    For the ninesix months ended SeptemberJune 30, 2020,2021, we incurred $34 million of pre-tax charges under our Invigorate program primarily consisting of systems conversion and integration costs, all of which result in cash expenditures. Additional restructuring charges may be incurred in future periods as we identify additional opportunities to achieve further cost savings.

    For further details of the Invigorate program and associated costs, see Note 4 to the interim unaudited consolidated financial statements.

Critical Accounting Policies and Estimates
    
    There have been no significant changes to our critical accounting policies from those disclosed in our 20192020 Annual Report on Form 10-K except for the adoption of new accounting standards as described in Note 2 to the interim unaudited consolidated financial statements.

.
    Revenues and accounts receivable associated with DIS


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    The process for estimating revenues and the ultimate collection of receivables associated with our DIS business involves significant assumptions and judgments. We recognize as revenue the amount of consideration to which we expect to be entitled primarily upon completion of the testing process, when results are reported, or when services have been rendered. We estimate the amount of consideration we expect to be entitled to receive from customer groups, using the portfolio approach, in exchange for providing services. These estimates include the impact of contractual allowances, including payer denials, and price concessions. The portfolios determined using the portfolio approach consist of the following customers:

•Healthcare Insurers
•Government Payers (Medicare and Medicaid programs)
•Client Payers
•Patients

    We have a standardized approach to estimate the amount of consideration that we expect to be entitled to; this standardized approach considers, among other things, the impact of contractual allowances, including payer denials, and price concessions. Historical collection and payer reimbursement experience (along with the period the receivables have been outstanding), as well as other factors including current market conditions, are integral parts of the estimation process related to revenues and receivables. Adjustments to our estimated contractual allowances and implicit price concessions are recorded in the current period as changes in estimates. Further adjustments, based on actual receipts, may be recorded upon settlement.

    Although we believe that our estimates for contractual allowances and patient price concessions as well as our allowance for credit losses are appropriate, it is possible that we will experience an impact on cash collections as a result of the impact of the COVID-19 pandemic. For further details on revenue and receivables, see Note 15 to the interim unaudited consolidated financial statements.

Accounting for and recoverability of goodwill

    We do not amortize goodwill, but evaluate the recoverability and measure the potential impairment of our goodwill annually, or more frequently, in the case of other events that indicate a potential impairment.
    Goodwill is evaluated for impairment annually, or more frequently if events or changes in circumstances indicate that the asset might be impaired. The annual impairment test includes an option to perform a qualitative assessment of whether it is more likely than not that a reporting unit's fair value is less than its carrying value; the qualitative analysis may be performed prior to, or as an alternative to, performing a quantitative goodwill impairment test. In evaluating whether it is more likely than not that the fair value of a reporting unit is less than its carrying value, we assess relevant events and circumstances, such as: (a) macroeconomic conditions; (b) industry and market considerations; (c) cost factors; (d) overall financial performance; (e) other relevant entity-specific events; (f) events affecting a reporting unit; and (g) a sustained decrease in share price. If, after assessing the totality of events or circumstances, we determine that it is more likely than not that the fair value of a reporting unit is less than its carrying value, we are required to perform the quantitative goodwill impairment test. Otherwise, no further analysis is required.
    On a quarterly basis, we perform a review of our business to determine if events or changes in circumstances have occurred that indicate that it is more likely than not that the fair value of a reporting unit is less than its carrying value. If such events or changes in circumstances were deemed to have occurred, we would perform an impairment test of goodwill and record any noted impairment loss. In conjunction with the preparation of our September 30, 2020 financial statements, we performed such review and concluded that no impairment test was necessary. However, should the impact of the COVID-19 pandemic be significantly worse than currently expected, it is possible that we could incur impairment charges in the future.
Impact of New Accounting Standards

    The adoption of new accounting standards, if any, is discussed in Note 2 to the interim unaudited consolidated financial statements.

    The impact of recent accounting pronouncements not yet effective on our consolidated financial statements is also discussed in Note 2 to the interim unaudited consolidated financial statements.


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Results of Operations    

    The following tables set forth certain results of operations data for the periods presented:
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
20202019$ Change% Change20202019$ Change% Change20212020$ Change% Change20212020$ Change% Change
(dollars in millions, except per share amounts)(dollars in millions, except per share amounts)
Net revenues:Net revenues:Net revenues:
DIS businessDIS business$2,709 $1,877 $832 44.3 %$6,217 $5,561 $656 11.8 %DIS business$2,474 $1,764 $710 40.2 %$5,117 $3,508 $1,609 45.9 %
DS businessesDS businesses77 79 (2)(1.9)218 239 (21)(8.6)DS businesses76 63 13 19.6 153 141 12 8.3 
Total net revenuesTotal net revenues$2,786 $1,956 $830 42.5 %$6,435 $5,800 $635 11.0 %Total net revenues$2,550 $1,827 $723 39.5 %$5,270 $3,649 $1,621 44.4 %
Operating costs and expenses and other operating income:Operating costs and expenses and other operating income:  Operating costs and expenses and other operating income:  
Cost of servicesCost of services$1,580 $1,264 $316 25.0 %$4,071 $3,773 $298 7.9 %Cost of services$1,565 $1,221 $344 28.2 %$3,191 $2,491 $700 28.1 %
Selling, general and administrativeSelling, general and administrative396 362 34 9.5 1,103 1,108 (5)(0.4)Selling, general and administrative429 360 69 18.9 836 707 129 18.0 
Amortization of intangible assetsAmortization of intangible assets27 23 4 12.8 77 72 5 5.9 Amortization of intangible assets25 25 — (0.6)52 50 2 3.8 
Other operating expense (income), net65 (6)71 NM8 (21)29 NM
Other operating income, netOther operating income, net(2)(62)60 NM(2)(57)55 NM
Total operating costs and expenses, netTotal operating costs and expenses, net$2,068 $1,643 $425 25.9 %$5,259 $4,932 $327 6.6 %Total operating costs and expenses, net$2,017 $1,544 $473 30.6 %$4,077 $3,191 $886 27.7 %
Operating incomeOperating income$718 $313 $405 129.5 %$1,176 $868 $308 35.5 %Operating income$533 $283 $250 88.4 %$1,193 $458 $735 160.5 %
Other income (expense):Other income (expense):Other income (expense):
Interest expense, netInterest expense, net$(42)$(44)$2 (3.3)%$(124)$(133)$9 (6.6)%Interest expense, net$(38)$(41)$3 (6.7)%$(76)$(82)$6 (7.4)%
Other income, net77 1 76 NM74 13 61 NM
Other income (expense), netOther income (expense), net322 13 309 NM326 (3)329 NM
Total non-operating income (expense), netTotal non-operating income (expense), net$35 $(43)$78 NM$(50)$(120)$70 NMTotal non-operating income (expense), net$284 $(28)$312 NM$250 $(85)$335 NM
Income tax expenseIncome tax expense$(177)$(62)$(115)187.2 %$(269)$(175)$(94)54.0 %Income tax expense$(177)$(66)$(111)171.2 %$(330)$(92)$(238)263.1 %
Effective income tax rateEffective income tax rate23.7 %22.9 %23.9 %23.4 %Effective income tax rate21.6 %25.5 %22.9 %24.4 %
Equity in earnings of equity method investees, net of taxesEquity in earnings of equity method investees, net of taxes$15 $18 $(3)(9.1)%$33 $48 $(15)(29.9)%Equity in earnings of equity method investees, net of taxes$10 $4 $6 178.4 %$27 $18 $9 56.2 %
Amounts attributable to Quest Diagnostics’ common stockholders:
Income from continuing operations$568 $215 $353 164.7 %$852 $585 $267 45.6 %
Income from discontinued operations, net of taxes$— $— $— NM$— $20 $(20)NM
Net income attributable to Quest DiagnosticsNet income attributable to Quest Diagnostics$631 $185 $446 240.5 %$1,100 $284 $816 287.0 %
Diluted earnings per common share from continuing operations attributable to Quest Diagnostics' common stockholders$4.14 $1.56 $2.58 164.6 %$6.25 $4.27 $1.98 46.0 %
Diluted earnings per common share attributable to Quest Diagnostics' common stockholdersDiluted earnings per common share attributable to Quest Diagnostics' common stockholders$4.96 $1.36 $3.60 264.2 %$8.38 $2.09 $6.29 300.7 %
NM - Not MeaningfulNM - Not MeaningfulNM - Not Meaningful




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    The following table sets forth certain results of operations data as a percentage of net revenues for the periods presented:
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
20202019202020192021202020212020
Net revenues:Net revenues:Net revenues:
DIS businessDIS business97.2 %96.0 %96.6 %95.9 %DIS business97.0 %96.5 %97.1 %96.1 %
DS businessesDS businesses2.8 4.0 3.4 4.1 DS businesses3.0 3.5 2.9 3.9 
Total net revenuesTotal net revenues100.0 %100.0 %100.0 %100.0 %Total net revenues100.0 %100.0 %100.0 %100.0 %
Operating costs and expenses and other operating income:Operating costs and expenses and other operating income:  Operating costs and expenses and other operating income:  
Cost of servicesCost of services56.7 %64.6 %63.3 %65.1 %Cost of services61.4 %66.8 %60.6 %68.3 %
Selling, general and administrativeSelling, general and administrative14.2 18.5 17.1 19.1 Selling, general and administrative16.8 19.7 15.8 19.4 
Amortization of intangible assetsAmortization of intangible assets1.0 1.2 1.2 1.2 Amortization of intangible assets1.0 1.4 1.0 1.4 
Other operating expense (income), net2.3 (0.3)0.1 (0.4)
Other operating income, netOther operating income, net(0.1)(3.4)— (1.6)
Total operating costs and expenses, netTotal operating costs and expenses, net74.2 %84.0 %81.7 %85.0 %Total operating costs and expenses, net79.1 %84.5 %77.4 %87.5 %
Operating incomeOperating income25.8 %16.0 %18.3 %15.0 %Operating income20.9 %15.5 %22.6 %12.5 %
    
    Operating Results
    
    Results for the three months ended SeptemberJune 30, 2021 were affected by certain items that on a net basis increased diluted earnings per share by $1.78 as follows:

•a pre-tax gain recorded in other income (expense), net of $314 million, or $2.04 per diluted share, on the sale of our 40% ownership interest in Q2 Solutions; and
•excess tax benefits associated with stock-based compensation arrangements of $5 million, or $0.04 per diluted share, recorded in income tax expense; partially offset by
•pre-tax amortization expense of $25 million in amortization of intangible assets or $0.15 per diluted share;
•pre-tax charges of $21 million ($12 million in cost of services and $9 million in selling, general and administrative expenses), or $0.12 per diluted share, primarily associated with workforce reductions, systems conversions and integration incurred in connection with further restructuring and integrating our business; and
•pre-tax charges of $5 million, or $0.03 per diluted share, associated with donations, contributions and other financial support through Quest for Health Equity, our initiative with the Quest Diagnostics Foundation to reduce health disparities in underserved communities, recorded in selling, general and administrative expenses.

Results for the six months ended June 30, 2021 were affected by certain items that on a net basis increased diluted earnings per share by $1.42 as follows:

•a pre-tax gain recorded in other income (expense), net of $314 million, or $1.98 per diluted share, on the sale of our 40% ownership interest in Q2 Solutions; and
•excess tax benefits associated with stock-based compensation arrangements of $9 million, or $0.07 per diluted share, recorded in income tax expense; partially offset by
•pre-tax amortization expense of $54 million ($52 million in amortization of intangible assets and $2 million in equity in earnings of equity method investees, net of taxes) or $0.31 per diluted share;
•pre-tax charges of $38 million ($19 million in cost of services and $19 million in selling, general and administrative expenses), or $0.22 per diluted share, primarily associated with workforce reductions, systems conversions and integration incurred in connection with further restructuring and integrating our business;
•pre-tax charges of $13 million, or $0.07 per diluted share, including $5 million associated with donations, contributions and other financial support through Quest for Health Equity recorded in selling, general and administrative expenses, and a pre-tax non-cash impairment to the carrying value of an equity method investment, recorded in equity in earnings of equity method investees, net of taxes of $8 million; and

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•pre-tax charges of $4 million in cost of services, or $0.03 per diluted share, representing the impact of certain items resulting from the COVID-19 pandemic including incremental costs incurred to protect the health and safety of our employees and customers.

For both the three and six months ended June 30, 2021, diluted earnings per share benefited from the impact of the ASRs on our weighted average shares outstanding as compared to the prior year periods.
    Results for the three months ended June 30, 2020 were affected by certain items that on a net basis reduced diluted earnings per share by $0.17$0.06 as follows:

•net pre-tax charges of $69 million (charges of $65 million in other operating expense (income), net, $3 million in cost of services and $1 million in equity in earnings of equity method investees, net of taxes), or $0.39 per diluted share, representing the impact of certain items resulting from the COVID-19 pandemic, including the reversal of $65 million of income previously recognized during the second quarter of 2020 attributable to the receipt of funds from the government that were appropriated to healthcare providers under the CARES Act and, to a lesser extent, incremental costs incurred primarily to protect the health and safety of our employees and customers;
•pre-tax amortization expense of $30$28 million ($2725 million in amortization of intangible assets and $3 million in equity in earnings of equity method investees, net of taxes) or $0.16 per diluted share; and
•pre-tax charges of $18$9 million ($113 million in cost of services and $7$6 million in selling, general and administrative expenses), or $0.10$0.06 per diluted share, representing costs primarily associated with systems conversions and integration incurred in connection with further restructuring and integrating our business; partially offset by
•a pre-tax net gain of $70$26 million or $0.46 per diluted share, recognized in other income, net based on the difference between the fair value and the carrying value of an equity interest; and
•excess tax benefits associated with stock-based compensation arrangements of $3(a $62 million or $0.02 per diluted share, recorded in income tax expense.

    Results for the nine months ended September 30, 2020 were affected by certain items that on a net basis reduced diluted earnings per share by $0.44 as follows:

•pre-tax amortization expense of $86 million ($77 million in amortization of intangible assets and $9 million in equity in earnings of equity method investees, net of taxes) or $0.47 per diluted share;
•pre-tax charges of $52 million ($38 million of charges in cost of services, $8 million of charges in selling, general and administrative expenses and $8 million of chargesgain in other operating expense (income),income, net partially offset byand a $2$3 million gain in equity in earnings of equity method investees, net of taxes)taxes, partially offset by $34 million of charges in cost of services and $5 million of charges in selling, general and administrative expenses), or $0.29$0.13 per diluted share, representing the impact of certain items resulting from the COVID-19 pandemic principally including $65 million of income recognized attributable to the receipt of the initial tranche of funds from the government that were appropriated to healthcare providers under the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act"), partially offset by expense associated with a one-time payment to eligible employees to help offset expenses they incurred as a result of COVID-19, certain asset impairment charges, and incremental costs incurred primarily to protect the health and safety of our employees and customers; and
•excess tax benefits associated with stock-based compensation arrangements of $4 million, or $0.03 per diluted share, recorded in income tax expense.

    Results for the six months ended June 30, 2020 were affected by certain items that on a net basis reduced diluted earnings per share by $0.27 as follows:

•pre-tax amortization expense of $56 million ($50 million in amortization of intangible assets and $6 million in equity in earnings of equity method investees, net of taxes) or $0.31 per diluted share; and
•pre-tax charges of $43$25 million ($2110 million in cost of services and $22$15 million in selling, general and administrative expenses), or $0.25$0.15 per diluted share, primarily associated with systems conversions and integration incurred in connection with further restructuring and integrating our business; partially offset by
•a pre-tax net gain of $70$17 million or $0.46 per diluted share, recognized(a $57 million gain in other operating income, net based on the difference between the fair value and the carrying value of an equity interest; and

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•excess tax benefits associated with stock-based compensation arrangements of $15a $3 million or $0.11 per diluted share, recorded in income tax expense.
    Results for the three months ended September 30, 2019 were affected by certain items that on a net basis reduced diluted earnings per share by $0.20 as follows:

•pre-tax amortization expense of $25 million ($23 million in amortization of intangible assets and $2 milliongain in equity in earnings of equity method investees, net of taxes) or $0.14 per diluted share; and
•pre-taxtaxes, partially offset by $35 million of charges of $16 million ($7 million in cost of services, and $9$8 million of charges in selling, general and administrative expenses), or $0.09$0.10 per diluted share, primarily associated with systems conversions and integration incurred in connection with further restructuring and integrating our business; partially offset by
•a net pre-tax gainrepresenting the impact of $3certain items resulting from the COVID-19 pandemic including $65 million (a $7 million gain in other operating expense (income), netof income recognized attributable to the receipt of the initial tranche of funds from the government that were appropriated to healthcare providers under the CARES Act, partially offset by a $4 million charge in selling, general and administrative expenses), or $0.01 per diluted share, primarily due to a gain associated with the decrease in the fair value of the contingent consideration accrualexpense associated with a previous acquisition partiallypayment to eligible employees to help offset byexpenses they incurred as a result of COVID-19, certain asset impairment charges, and incremental costs incurred relatedprimarily to a data security incident,protect the health and safety of our employees and customers; and
•excess tax benefits associated with stock-based compensation arrangements of $3$12 million, or $0.02$0.09 per diluted share, recorded in income tax expense.

    Results forFor both the ninethree and six months ended June 30, 2020, results include $65 million of income recognized attributable to the receipt of the initial tranche of funds from the government that were appropriated to healthcare providers under the CARES Act. During the three months ended September 30, 20192020, we reversed the $65 million of income and the funds were affected by certain items that on a net basis reduced diluted earnings per share by $0.62 as follows:

•pre-tax amortization expense of $84 million ($72 million in amortization of intangible assets and $12 million in equity in earnings of equity method investees, net of taxes) or $0.46 per diluted share; and
•pre-tax charges of $64 million ($29 million in cost of services and $35 million in selling, general and administrative expenses), or $0.35 per diluted share, primarily associated with systems conversions and integration incurred in connection with further restructuring and integrating our business; partially offset by
•a net pre-tax gain of $17 million (a $22 million gain in other operating expense (income), net partially offset by a $5 million charge in selling, general and administrative expenses), or $0.11 per diluted share, primarily due to a gain associated with an insurance claim for hurricane related losses, and a gain associated withreturned during the decrease in the fair value of the contingent consideration accruals associated with previous acquisitions, partially offset by non-cash asset impairment charges, and costs incurred related to a data security incident, and
•excess tax benefits associated with stock-based compensation arrangements of $11 million, or $0.08 per diluted share, recorded in income tax expense.three months ended December 31, 2020.

    Net Revenues

    Net revenues for the three months ended SeptemberJune 30, 20202021 increased by 42.5%39.5% compared to the prior year period.

    DIS revenues for the three months ended SeptemberJune 30, 20202021 increased by 44.3%40.2% compared to the prior year period driven by demand for COVID-19 molecular and antibody testing, and, to a lesser extent, the impact of recent acquisitions, partially offset by a decline in testing volume in our base business (which excludes COVID-19 molecular and antibody testing).period. For the three months ended SeptemberJune 30, 2020:2021:

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•Organic revenue and acquisitions contributed approximately 41.8%37.6% and 2.5%2.6%, respectively, to DIS revenue growth compared to the prior year period. Organic revenue growth was driven by growth in the base business, partially offset by a decrease in COVID-19 antibody testing.
•Revenues in the base business (including the impact of recent acquisitions) increased by 66.1% compared to the prior year period, which was negatively impacted as a result of the COVID-19 pandemic. Compared to historical levels in the second quarter of 2019, revenues in the base business, excluding revenue associated with recent acquisitions, increased by 1.4%. Recent agreements associated with our Professional Laboratory Services offerings contributed 2.1% revenue growth compared to 2019.
•DIS volume increased by 19.7%45.2% with organic volume and acquisitions contributing approximately 16.6%40.1% and 3.1%5.1%, respectively. Organic volume growth was driven by demand for COVID-19 molecular testing, partially offset by declines in testing volumes in the base business. Testing volumesgrowth in the base business, were negatively impactedpartially offset by a decrease in volume associated with COVID-19 antibody testing.
•Testing volume in the COVID-19 pandemicbase business (including the impact of recent acquisitions) continued to recover and declined by 5%was up 60.7% compared to the prior year period.period, which was negatively impacted as a result of the COVID-19 pandemic. Compared to historical levels in the second quarter of 2019, testing volume in the base business, excluding volume associated with recent acquisitions, increased 1.9%. Recent agreements associated with our Professional Laboratory Services offerings contributed 5.8% volume growth compared to 2019.
•Revenue per requisition increaseddecreased by 20.9%3.6% compared to the prior year period primarily due to favorable mix, drivengrowth in large part by COVID-19 molecular testing; partially offset by reimbursement pressure, including unit price reductions associated with PAMAour Professional Laboratory Services engagements, which carry a lower revenue per requisition than the average for the remainder of the DIS business, and all other sources,due to the impact of approximately 1.7%.recent acquisitions.

    Net revenues for the ninesix months ended SeptemberJune 30, 20202021 increased by 11.0%44.4% compared to the prior year period.

    DIS revenues for the ninesix months ended SeptemberJune 30, 20202021 increased by 11.8%45.9% compared to the prior year period driven by demand for COVID-19 molecular and antibody testing, and, to a lesser extent, the impact of recent acquisitions, partially offset by a decline in testing volume in our base business.period. For the ninesix months ended SeptemberJune 30, 2020:2021:

•Organic revenue and acquisitions contributed approximately 10.5%43.0% and 1.3%2.9%, respectively, to DIS revenue growth compared to the prior year period. Organic revenue growth was driven by growth in the base business and demand for COVID-19 molecular testing.

•
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TableRevenues in the base business (including the impact of Contents recent acquisitions) increased by 30.2% compared to the prior year period, which was negatively impacted as a result of the COVID-19 pandemic. Compared to historical levels in the first half of 2019, revenues in the base business, excluding revenue associated with recent acquisitions, decreased by 0.7%. Recent agreements associated with our Professional Laboratory Services offerings contributed 2.3% revenue growth compared to 2019.
•DIS volume decreasedincreased by 0.1%,34.7% with organic volume downand acquisitions contributing approximately 1.4%30.0% and 4.7%, partially offsetrespectively. Organic volume growth was driven by growth in the base business and, to a lesser extent, demand for COVID-19 molecular testing.
•Testing volume in the base business (including the impact of recent acquisitions) continued to recover and was up 28.0% compared to the prior year period, which was negatively impacted as a result of the COVID-19 pandemic. Compared to historical levels in the first half of 2019, testing volume in the base business, excluding volume associated with recent acquisitions, of 1.3%decreased by 0.4%. OrganicRecent agreements associated with our Professional Laboratory Services offerings contributed 5.5% volume was negatively impacted by declines in testing volumes in the base business due to the COVID-19 pandemic, partially offset by COVID-19 molecular and antibody testing and, to a lesser extent, the impact of an extra business day in 2020 and the impact of weather in the prior year period, both of which favorably impacted the comparison by approximately 1.0%. Testing volumes in the base business declined approximately 14.4% for the nine months ended September 30, 2020growth compared to the prior year period.2019.
•Revenue per requisition increased by 12.4%8.1% compared to the prior year period primarily due to favorable mix, driven in large part by COVID-19 molecular testing;testing, partially offset by reimbursement pressure, including unit price reductions associated with PAMA and all other sources,growth in our Professional Laboratory Services engagements, which carry a lower revenue per requisition than the average for the remainder of approximately 1.8%.the DIS business.

    Cost of Services

    Cost of services consists principally of costs for obtaining, transporting and testing specimens as well as facility costs used for the delivery of our services.

    For the three months ended SeptemberJune 30, 2020,2021, cost of services increased by $316$344 million compared to the prior year period. The increase was primarily driven by higher variable expenses related to increased testing volumes and, to a lesser extent, additional operating costs associated with our acquisitions, partially offset by higher incremental costs incurred in the prior year period related to the COVID-19 pandemic including expense associated with a payment to eligible employees to help offset expenses they incurred as a result of COVID-19.


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    For the six months ended June 30, 2021, cost of services increased by $700 million compared to the prior year period. The increase was primarily driven by higher variable expenses related to increased testing volumes as well as test mix and a higher supply cost associated with COVID-19 testing, and, higher performance-based compensation.
    For the nine months ended September 30, 2020, cost of services increased by $298 million compared to the prior year period. The increase was primarily driven by higher variable expenses related to test mix and a higher supply costlesser extent, additional operating costs associated with COVID-19 testing, higher performance-based compensation, and incremental costs incurred related to the COVID-19 pandemic including expense associated with a one-time payment to eligible employees to help offset expenses they incurred as a result of COVID-19. These increases were partially offset by lower compensation and benefit costs as a result of a series of temporary actions implemented to manage our workforce costs.acquisitions.

    Selling, General and Administrative Expenses ("SG&A")
    
    SG&A consist principally of the costs associated with our sales and marketing efforts, billing operations, credit loss expense and general management and administrative support as well as administrative facility costs.
    
    SG&A increased by $34$69 million for the three months ended SeptemberJune 30, 2020,2021, compared to the prior year period, primarily driven by higher variable expenses to support our increase in testing volumes as well as higher performance-based compensation.

    SG&A increased by $129 million for the six months ended June 30, 2021, compared to the prior year period, primarily driven by higher variable expenses to support our increase in testing volumes, higher performance-based compensation, costs, and higher costs associated with changes in the value of our deferred compensation obligations, partially offset by lower travel related costs.obligations.
    
    SG&A decreased by $5 million for the nine months ended September 30, 2020, compared to the prior year period primarily driven by lower compensation and benefit costs as a result of a series of temporary actions implemented to manage our workforce costs, lower travel related costs, lower costs associated with our Invigorate program, and lower costs associated with changes in the value of our deferred compensation obligations, partially offset by higher performance-based compensation costs.

    The change in the value of our deferred compensation obligations is largely offset by gains or losses due to the changes in the value of the associated investments, which are recorded in other income (expense), net. For further details regarding our deferred compensation plans, see Note 17 to the audited consolidated financial statements in our 20192020 Annual Report on Form 10-K.
    
    Amortization Expense

    For the three and ninesix months ended SeptemberJune 30, 2020,2021, amortization expense increased by $4$2 million and $5 million, respectively, compared to the prior year periodsperiod as a result of recent acquisitions.

    Other Operating Expense (Income),Income, Net

    Other operating expense (income),income, net includes miscellaneous income and expense items and other charges related to operating activities.

    For both the three months ended September 30, 2020, other operating expense (income), net primarily represents the reversal of $65 million of income that was previously recognized during the threeand six months ended June 30, 2020, relatingother operating income, net primarily represents $65 million of income recognized attributable to the receipt of the initial tranche of funds from the government that were appropriated to healthcare providers under the CARES Act (see Note 11 to the interim unaudited consolidated financial statements).


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For the nine monthsended September 30, 2020, other operating expense (income), net primarily represents impairment charges due to the impact of the COVID-19 pandemic.

ForAct. During the three months ended September 30, 2019, other operating expense (income), net primarily represents a gain associated with2020, we reversed the decrease in$65 million of income and the fair value of a contingent consideration accrual associated with a previous acquisition.

Forfunds were returned during the ninethree months ended September 30, 2019, other operating expense (income), net includes a $12 million gain associated with an insurance claim for hurricane related losses and a $12 million gain associated with the decrease in the fair value of the contingent consideration accruals associated with previous acquisitions, partially offset by non-cash asset impairment charges of $2 million.December 31, 2020.

    Interest Expense, Net

    Interest expense, net decreased for both the three and nine months ended SeptemberJune 30, 20202021 compared to the prior year periods,period, primarily due to lower average outstanding indebtedness.

    Interest expense, net decreased for the six months ended June 30, 2021 compared to the prior year period, primarily driven by lower interest rates due to recent refinancing transactions, including the termination of our interest rate swap agreements in April 2020, which resulted in a deferred gain that is being amortized as a reduction of interest expense, net over the remaining term of the associated debt, combined with our variable rate indebtedness, partially offset by higherlower average outstanding indebtedness.

    Other Income (Expense), Net

    Other income (expense), net represents miscellaneous income and expense items related to non-operating activities, such as gains and losses associated with investments and other non-operating assets.

    For the three and nine months ended SeptemberJune 30, 2020,2021, other income (expense), net increased by $76$309 million and $61 million, respectively, compared to the prior year periods. For the three months ended September 30, 2020, the increase wasperiod primarily due to a $70$314 million pre-tax gain recognized as a result ofon the remeasurementsale of our previously held equity40% ownership interest in MACLQ2 Solutions, our clinical trials central laboratory services joint venture, to fairIQVIA, our joint venture partner, partially offset by changes in the value (see Note 5 to the interim unaudited consolidated financial statements) and higher gainsof investments associated with investments in our deferred compensation plansplans.


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    For the six months ended June 30, 2021, other income (expense), net increased by $329 million compared to the prior year period. For the nine months ended September 30, 2020, the increase wasperiod primarily due to a $70 millionthe pre-tax gain recognized as a result ofon the remeasurementsale of our previously held equity40% ownership interest in MACLQ2 Solutions and, to faira lesser extent, changes in the value (see Note 5 to the interim unaudited consolidated financial statements), partially offset by lower gainsof investments associated with investments in our deferred compensation plans compared to the prior year period.plans.

    Income Tax Expense

    Income tax expense for the three months ended SeptemberJune 30, 20202021 and 20192020 was $177 million and $62 million, respectively. Income tax expense for the nine months ended September 30, 2020 and 2019 was $269 million and $175$66 million, respectively. The increase in income tax expense for both the three and nine months ended SeptemberJune 30, 20202021 compared to the prior year period was primarily driven by an increase in income from continuing operations before income taxes and equity in earnings of equity method investees.

    For the three months ended SeptemberJune 30, 20202021 and 2019,2020, the effective income tax rate was 23.7%21.6% and 22.9%25.5%, respectively. TheFor the three months ended June 30, 2021, the effective income tax rate for the three months ended September 30, 2020, benefited from a lower effective income tax rate, associated with a $70 million17.6%, on the gain recognized as a result ofon the remeasurementsale of our previously held equity40% ownership interest in MACL to fair value;Q2 Solutions. In addition, the effective income tax rate benefited from $5 million and $3$4 million of excess tax benefits associated with stock-based compensation arrangements. The effective income tax ratearrangements for the three months ended SeptemberJune 30, 20192021 and 2020, respectively.

    Income tax expense for the six months ended June 30, 2021 and 2020 was $330 million and $92 million, respectively. The increase in income tax expense for the six months ended June 30, 2021 compared to the prior year period was primarily driven by an increase in income before income taxes and equity in earnings of equity method investees.

    For the six months ended June 30, 2021 and 2020, the effective income tax rate was 22.9% and 24.4%, respectively. For the six months ended June 30, 2021, the effective income tax rate benefited from a $6 millionlower effective income tax benefit due torate, 17.6%, on the releasegain on the sale of a valuation allowance associated with net operating loss carryforwards;our 40% ownership interest in Q2 Solutions. In addition, the effective income tax rate benefited from $9 million and $3$12 million of excess tax benefits associated with stock-based compensation arrangements.

    Forarrangements for the ninesix months ended SeptemberJune 30, 2021 and 2020, and 2019, the effective income tax rate was 23.9% and 23.4%, respectively. The effective income tax rate for the nine months ended September 30, 2020, benefited from a lower effective income tax rate associated with a $70 million gain recognized as a result of the remeasurement of our previously held equity interest in MACL to fair value; and $15 million of excess tax benefits associated with stock-based compensation arrangements. The effective income tax rate for the nine months ended September 30, 2019 benefited from $11 million of excess tax benefits associated with stock-based compensation arrangements; and a $10 million income tax benefit due to the release of valuation allowances associated with net operating loss carryforwards.

    The effective income tax rate associated with the $70 million gain recognized as a result of the remeasurement of our previously held equity interest in MACL to fair value was 11.8% due to a permanent difference in the financial reporting and tax basis of goodwill.

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    For both the three and nine months ended September 30, 2020, we utilized the most likely estimate of our annual income before taxes to determine the annual effective income tax rate for 2020. As a result of uncertainty associated with the impact of the COVID-19 pandemic, it is possible that we will experience variability in the annual projections and, as a result, the annual effective income tax rate.

    Equity in Earnings of Equity Method Investees, Net of Taxes

    Equity in earnings of equity method investees, net of taxes decreasedincreased for the three and nine months ended SeptemberJune 30, 20202021 by $3$6 million and $15 million, respectively, compared to the prior year periodsperiod primarily due to recovery in the base business (which excludes COVID-19 testing) of the investees, which was negatively impacted in 2020 as a result of the COVID-19 pandemic.

    Equity in earnings of equity method investees, net of taxes increased for the six months ended June 30, 2021 by $9 million compared to the prior year period primarily due to the impactdemand for COVID-19 testing services, partially offset by an $8 million non-cash impairment to the carrying value of the COVID-19 pandemic on ouran equity method investees.investment.
    
Discontinued Operations

    During the third quarter of 2006, we completed the wind down of Nichols Institute Diagnostics ("NID"), a test kit manufacturing subsidiary, which has been classified as discontinued operations for the nine months ended September 30, 2019. Income from discontinued operations, net of taxes, for the nine months ended September 30, 2019 includes discrete tax benefits of $20 million associated with the favorable resolution of certain tax contingencies related to NID.

Quantitative and Qualitative Disclosures About Market Risk

    We address our exposure to market risks, principally the risk of changes in interest rates, through a controlled program of risk management that includes the use of derivative financial instruments. We do not hold or issue derivative financial instruments for speculative purposes. We seek to mitigate the variability in cash outflows that result from changes in interest rates by maintaining a balanced mix of fixed-rate and variable-rate debt obligations. In order to achieve this objective, we have historically entered into interest rate swaps.swap agreements. Interest rate swapsswap agreements involve the periodic exchange of payments without the exchange of underlying principal or notional amounts. Net settlements are recognized as an adjustment to interest expense.expense, net. We believe that our exposures to foreign exchange impacts and changes in commodity prices are not material to our consolidated results of operations, financial position or financial position.cash flows.
    
    As of SeptemberJune 30, 20202021 and December 31, 2019,2020, the fair value of our debt was estimated at approximately $5.2$4.5 billion and $5.1$4.6 billion, respectively, principally using quoted prices in active markets and yields for the same or similar types of borrowings, taking into account the underlying terms of the debt instruments. As of SeptemberJune 30, 20202021 and December 31, 2019,2020, the estimated fair value exceeded the carrying value of the debt by $609$463 million and $313$597 million, respectively. A hypothetical 10% increase in interest rates (representing 1721 basis points as of SeptemberJune 30, 20202021 and 2817 basis points as of December 31, 2019)2020) would potentially reduce the estimated fair value of our debt by approximately $84$87 million and $100$82 million as of SeptemberJune 30, 20202021 and December 31, 2019,2020, respectively.

    Borrowings under our secured receivables credit facility and our senior unsecured revolving credit facility are subject to variable interest rates. Interest on our secured receivables credit facility is based on either a rate that is intended to approximate commercial paper rates for highly rated issuers, or LIBOR, plus a spread. As of SeptemberJune 30, 2020,2021, interest on our senior unsecured revolving credit facility is subject to a pricing schedule that can fluctuatebased on certain published rates plus an applicable margin based on changes in our creditpublic debt ratings and our leverage ratio. As such,

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our borrowing cost under this credit arrangement will beis subject to fluctuations in interest rates, our leverage ratio and changes in our creditpublic debt ratings. As of SeptemberJune 30, 2020,2021, the borrowing rates under these debt instruments were: for our secured receivables credit facility, commercial paper rates for highly ratedhighly-rated issuers or LIBOR, plus a spread of 0.70%0.825% to 0.725%0.950%; and for our senior unsecured revolving credit facility, LIBOR plus 1.125%. During October 2020, we amended the secured receivables credit facility and the borrowing rates are now based on commercial paper rates for highly rated issuers, or LIBOR, plus a spread of 0.825% to 0.95%. As of SeptemberJune 30, 2020,2021, there were no borrowings outstanding under either our $600 million secured receivables credit facility or our $750 million senior unsecured revolving credit facility. The amendment to the secured receivables credit facility did not change the total borrowing capacity under the facility.

    In April 2020, we terminated our existing fixed-to-variable interest rate swap agreements. Based on our remaining net exposure to interest rate changes, aA hypothetical 10% change to the variable rate component of our variable rate indebtedness would not materially change our annual interest expense.

    During March 2020, we entered into a forward-starting interest rate swap agreement with a financial institution for a total notional amount of $25 million. Additionally, during May 2020, we entered into interest rate lock agreements with several financial institutions for a total notional amount of $275 million. The forward-starting interest rate swap agreement and the interest rate lock agreements were entered into in order to hedge a portion of our interest rate exposure associated with variability in future cash flows attributable to changes in interest rates over a ten-year period related to an anticipated issuance of debt and were accounted for as cash flow hedges. In connection with the issuance of the 2031 Senior Notes, these agreements were settled

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and we received net proceeds of $1 million. The net gain is deferred in stockholders' equity, net of taxes, as a component of accumulated other comprehensive loss, and is being amortized as an adjustment to interest expense, net over a ten-year period.

    For further details regarding our outstanding debt, see Notes 8 and 18 to the interim unaudited consolidated financial statements and Note 13 to the audited consolidated financial statements included in our 20192020 Annual Report on Form 10-K. For details regarding our financial instruments and hedging activities, see Note 98 to the interim unaudited consolidated financial statements and Note 15 to the audited consolidated financial statements included in our 20192020 Annual Report on Form 10-K.

    Risk Associated with Investment Portfolio

    Our investment portfolio primarily includes equity investments comprised primarilymostly of strategic holdings in privately and publicly held companies. These securities are exposed to price fluctuations and are generally concentrated in the life sciences and healthcare industries. Equity investments (except those accounted for under the equity method of accounting or those that result in consolidation of the investee) with readily determinable fair values are measured at fair value with changes in fair value recognized in net income. Equity investments that do not have readily determinable fair values are measured at cost minus impairment, if any, plus or minus changes resulting from observable price changes; wechanges. We regularly evaluate these equity investments to determine if there are any indicators that the investment is impaired. The carrying value of our equity investments that do not have readily determinable fair values was $25$26 million as of SeptemberJune 30, 2020.2021.
    
    We do not hedge our equity price risk. The impact of an adverse movement in equity prices on our holdings in privately held companies cannot be easily quantified, as our ability to realize returns on investments depends on, among other things, the enterprises’ ability to raise additional capital or derive cash inflows from continuing operations or through liquidity events such as initial public offerings, mergers or private sales.

    In conjunction with the preparation of our SeptemberJune 30, 20202021 financial statements, we considered whether the carrying values of suchour investments were impaired and concluded that no such impairment existed. However, should the impact of the COVID-19 pandemic be worse than currently expected, it is possible that we could incur impairment charges in the future.

Liquidity and Capital Resources
Nine Months Ended September 30,ChangeSix Months Ended June 30,Change
20202019Change20212020Change
(dollars in millions)(dollars in millions)
Net cash provided by operating activitiesNet cash provided by operating activities$1,464 $895 $569 Net cash provided by operating activities$1,191 $602 $589 
Net cash used in investing activities(604)(311)(293)
Net cash provided by (used in) investing activitiesNet cash provided by (used in) investing activities344 (411)755 
Net cash used in financing activitiesNet cash used in financing activities(447)(285)(162)Net cash used in financing activities(2,133)(395)(1,738)
Net change in cash and cash equivalents and restricted cashNet change in cash and cash equivalents and restricted cash$413 $299 $114 Net change in cash and cash equivalents and restricted cash$(598)$(204)$(394)
    
    Cash and Cash Equivalents

    Cash and cash equivalents consist of cash and highly-liquid short-term investments. Cash and cash equivalents as of SeptemberJune 30, 20202021 totaled $1,605$560 million, compared to $1,192$1,158 million as of December 31, 2019.2020.

    As of SeptemberJune 30, 2020,2021, approximately 2%7% of our $1,605$560 million of consolidated cash and cash equivalents were held outside of the United States.

    Cash Flows from Operating Activities

    Net cash provided by operating activities for the ninesix months ended SeptemberJune 30, 2021 and 2020 and 2019 was $1,464$1,191 million and $895$602 million, respectively. The $569$589 million increase in net cash provided by operating activities for the ninesix months ended SeptemberJune 30, 2020,2021, compared to the prior year period was primarily a result of:

•higher operating income in 20202021 as compared to 2019;
•$138 million of proceeds that we received in 2020 from funds that were appropriated2020; and, to healthcare providers under the CARES Act (during October 2020 we announced our plan to return such funds);
•timing of movements in our working capital accounts including as a result of the temporary suspension of certain payment requirements for the employer portion of Social Security taxes; and
•$40 million of proceeds received in 2020 from the termination of interest rate swaps; partially offset by
•higher performance-based compensation payments in 2020 compared to 2019; andlesser extent,

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•the timing of movements in our working capital accounts; partially offset by
•a $28$315 million refund receivedincrease in income tax payments due to higher operating income in 2021 as compared to 2020 combined with lower payments in the prior year2020 period as a result of the extension of various payment deadlines into the second half of 2020;
•higher performance-based compensation payments in 2021 compared to 2020, and
•$65 million in proceeds in the 2020 period that we received from the taxing authorities associated withinitial tranche of funds that were appropriated to healthcare providers under the favorable resolutionCARES Act, which funds were returned during the fourth quarter of certain tax contingencies related to a discontinued operation.2020.
    
    Days sales outstanding ("DSO"), a measure of billing and collection efficiency, was 4746 days as of SeptemberJune 30, 2020, 542021, 46 days as of December 31, 20192020 and 5244 days as of SeptemberJune 30, 2019. The decrease2020. Recent changes in our DSO is partially due to recent fluctuations in our monthly revenue due to the impact of the COVID-19 pandemic. Although we believe that our current revenue reserves and allowance for credit losses are appropriate, it is possible that we will experience an impact on cash collections as a result of the impact of the COVID-19 pandemic. 

    Cash Flows from Investing Activities

    Net cash used inprovided by (used in) investing activities for the ninesix months ended SeptemberJune 30, 2021 and 2020 and 2019 was $604$344 million and $311$(411) million, respectively. This $293$755 million increasechange in cash used inprovided by (used in) investing activities for the ninesix months ended SeptemberJune 30, 2020,2021, compared to the prior year period was primarily a result of:

•a $273 million increase inof net cash paid for business acquisitions; and
•proceeds received from the sale of our 40% ownership interest in Qa $28 million increase in capital expenditures.2 Solutions.

    Cash Flows from Financing Activities

    Net cash used in financing activities for the ninesix months ended SeptemberJune 30, 2021 and 2020 and 2019 was $447$2,133 million and $285$395 million, respectively. This $162$1,738 million increase in cash used in financing activities for the ninesix months ended SeptemberJune 30, 2020,2021, compared to the prior year period was primarily a result of:

•a $1,835 million increase in repurchases of our common stock (see "Share Repurchase Program" for further details); and, to a lesser extent,
•a $49 million decrease in proceeds from the exercise of stock options, which was a result of a decrease in the volume of stock options exercised compared to the prior year; and
•a $43 million increase in distributions to noncontrolling interest partners; partially offset by
•$253252 million of net debt repayments (repayments of debt less proceeds from borrowings) in 2020 compared to $36$1 million of net borrowingsdebt repayments in 2019; partially offset by
•a $78 million decrease in repurchases of our common stock (see "Share Repurchase Program" for further details); and
•a $46 million increase in proceeds from the exercise of stock options, which was a result of an increase in the volume of stock options exercised and the average exercise price compared to the prior year.2021.

    During the ninesix months ended SeptemberJune 30, 2021, there were no borrowings or repayments under our secured receivables credit facility or senior unsecured revolving credit facility.

    During the six months ended June 30, 2020, we completed the issuance of the 2031 Senior Notes.2.80% senior notes due June 2031. Additionally, during the ninesix months ended SeptemberJune 30, 2020, we redeemed in full the outstanding indebtedness under our senior notes due January 2020 and senior notes due March 2020 using proceeds from the issuance, in December 2019, of the 2.95% senior notes due June 2030, along with cash on hand. During the ninesix months ended SeptemberJune 30, 2020, we borrowed $100 million under our secured receivables credit facility and $100 million under our senior unsecured revolving credit facility, both of which were repaid prior to SeptemberJune 30, 2020.

    During the nine months ended September 30, 2019, we completed the issuance of the senior notes due June 2029 and repaid in full our $300 million senior notes due April 1, 2019 at maturity. In addition, there were $985 million in cumulative borrowings under the secured receivables credit facility primarily associated with working capital requirements as well as the funding of our 2019 acquisition and $1,145 million in repayments under our secured receivables credit facility. During the nine months ended September 30, 2019, there were no borrowings under our senior unsecured revolving credit facility.    

    Dividend Program
    
    During the first and second quarters of 2021, our Board of Directors declared a quarterly cash dividend of $0.62 per common share. During each of the first threefour quarters of 2020, our Board of Directors declared a quarterly cash dividend of $0.56 per common share. During each of the four quarters of 2019, our Board of Directors declared a quarterly cash dividend of $0.53 per common share.
    
    Share Repurchase Program

    In each of February and March 2021, our Board of Directors increased the size of our share repurchase program by $1 billion. As of SeptemberJune 30, 2020, $1.22021, $1.3 billion remained available under our share repurchase authorizations; however, in April 2020, we temporarily suspended additional share repurchases under the existing authorization. The share repurchase authorization has no set expiration or termination date.


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    Share Repurchases

    For the ninesix months ended SeptemberJune 30, 2021, we repurchased 12.5 million shares of our common stock for $1.6 billion, including 9.1 million shares repurchased under ASRs. See "Second Quarter Highlights" above for further details.

    For the six months ended June 30, 2020, we repurchased 0.7 million shares of our common stock for $75 million.


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    For the nine months ended September 30, 2019, we repurchased 1.6 million shares of our common stock for $150 million.

Contractual Obligations and Commitments

    The following table summarizes certain of our contractual obligations as of September 30, 2020:
Payments due by period
Contractual ObligationsTotalRemainder of 20201-3 years4-5 yearsAfter 5 years
(dollars in millions)
Outstanding debt$4,526 $— $551 $300 $3,675 
Finance lease obligations31 1 5 4 21 
Interest payments on outstanding debt1,716 60 321 301 1,034 
Operating leases748 41 335 215 157 
Purchase obligations1,677 86 625 494 472 
Total contractual obligations$8,698 $188 $1,837 $1,314 $5,359 

    A description of the terms of our indebtedness and related debt service requirements and future payments of our outstanding debt is contained in Note 8 to the interim unaudited consolidated financial statements and Note 13 to the audited consolidated financial statements in our 2019 Annual Report on Form 10-K.
    Interest payments on our outstanding debt include interest associated with finance lease obligations and have been calculated using the interest rates as of September 30, 2020 applied to the September 30, 2020 balances, which are assumed to remain outstanding through their maturity dates.

    Operating lease obligations include variable charges (primarily maintenance fees and utilities associated with our real estate leases) in effect as of September 30, 2020. A discussion and analysis regarding our operating lease obligations is contained in Note 14 to the audited consolidated financial statements in our 2019 Annual Report on Form 10-K.

    Purchase obligations include our noncancelable commitments to purchase products or services as described in Note 18 to the audited consolidated financial statements in our 2019 Annual Report on Form 10-K.

    As of September 30, 2020, our total liabilities associated with unrecognized tax benefits were approximately $79 million, which were excluded from the table above. We expect that these liabilities may decrease by less than $10 million within the next twelve months, primarily as a result of payments, settlements, expiration of statutes of limitations and/or the conclusion of tax examinations on certain tax positions. For the remainder, we cannot make reasonably reliable estimates of the timing of the future payments of these liabilities. See Note 8 to the audited consolidated financial statements in our 2019 Annual Report on Form 10-K for information regarding our contingent tax liability reserves.
    In connection with the sale of an 18.9% noncontrolling interest in a subsidiary to UMass Memorial Medical Center ("UMass"), we granted UMass the right to require us to purchase all of its interest in the subsidiary at fair value commencing July 1, 2020. As of September 30, 2020, the fair value of the redeemable noncontrolling interest on the interim unaudited consolidated balance sheet was $80 million, which was excluded from the table above. Since the redemption of the noncontrolling interest is outside of our control, we cannot make a reasonably reliable estimate of the timing of the future payment, if any, of the redeemable noncontrolling interest. For further details regarding the redeemable noncontrolling interest, see Note 10 to the interim unaudited consolidated financial statements and Note 16 to the audited consolidated financial statements in our 2019 Annual Report on Form 10-K.

    Equity Method Investees

    Our equity method investees primarily consist of our clinical trials central laboratory services joint venture and oura diagnostic information services joint venture whichand an investment in a fund that purchases strategic holdings in private companies in the healthcare industry. Such investees are accounted for under the equity method of accounting. Our investment in equity method investees is less than 5% of our consolidated total assets. Our proportionate share of income before income taxes associated with our equity method investees is less than 5% of our consolidated income from continuing operations before income taxes and equity in earnings of equity method investees. We partially guarantee a lease obligation of one of our equity method investees, payment under such guarantee is not likely at this time and we have no other material unconditional obligations or guarantees to, or in support of, our equity method investees and their operations.


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    In conjunction with the preparation of our SeptemberJune 30, 20202021 financial statements, we considered whether the carrying values of our equity method investments were impaired and, concluded that no suchduring the six months ended June 30, 2021, we recorded an $8 million impairment existed. However, should the impactcharge for one of the COVID-19 pandemic be worse than currently expected, it is possible that we could incur impairment charges in the future.investments.

    For further details regarding related party transactions with our equity method investees, see Note 14 to the interim unaudited consolidated financial statements and Note 20 to the audited consolidated financial statements in our 20192020 Annual Report on Form 10-K.
    
    Requirements and Capital Resources

    We estimate that we will invest approximately $400 million during 20202021 for capital expenditures, to support and grow our existing operations, principally related to investments in information technology, laboratory equipment and facilities, including COVID-19 testing equipment and completion of our new multi-year laboratory construction in New Jersey, and additional investments in our advanced diagnostics and consumer growth strategies.

    Together with the Quest Diagnostics Foundation, during 2020 we launched a multi-year initiative to reduce health disparities in underserved communities, including those impacted by the COVID-19 pandemic. As part of this initiative, we plan to donateoffer testing services and fund a range of initiatives estimated to total more than $100 million aimed at improving access to testing and awareness of the value of diagnostic insights in managing overall health.

    In April 2020 and August 2020, we received approximately $65 million and $73 million, respectively,health, a significant portion of funds from the government that were distributed to healthcare providers for related expenses or lost revenues that are attributable to the COVID-19 pandemic under the CARES Act. During October 2020, we announced our plan to return the entire $138 million of funds received.which will occur in 2021.

    As of SeptemberJune 30, 2020,2021, we had $1.3 billion of borrowing capacity available under our existing credit facilities, including $529$530 million available under our secured receivables credit facility and $750 million available under our senior unsecured revolving credit facility. There were no outstanding borrowings under these credit facilities as of SeptemberJune 30, 2020.2021. In support of our risk management program, $70 million in letters of credit under the secured receivables credit facility were outstanding as of June 30, 2021. The secured receivables credit facility includes a $250 million loan commitment which matures in October 2021, and a $250 million loan commitment and a $100 million letter of credit facility which mature in October 2022. The senior unsecured revolving credit facility matures in March 2023. For further details regarding the credit facilities, see Note 13 to the audited consolidated financial statements in our 20192020 Annual Report on Form 10-K and Notes 8 and 18 to the interim unaudited consolidated financial statements.10-K.

    Our secured receivables credit facility is subject to customary affirmative and negative covenants, and certain financial covenants with respect to the receivables that comprise the borrowing base and secure the borrowings under the facility. Our senior unsecured revolving credit facility is also subject to certain financial covenants and limitations on indebtedness. As of SeptemberJune 30, 2020,2021, we were in compliance with all such applicable financial covenants.

    We believe that the COVID-19 pandemic has had and may continue to have an impact our consolidated results of operations, financial position, and cash flows, including declines in testing volumes for our base business (which excludes COVID-19 molecular and antibody testing), the extent of which will continue to be primarily driven by: the severity and duration of the COVID-19 pandemic; the COVID-19 pandemic’s impact on the U.S. healthcare system and the U.S. economy; and the timing, scope and effectiveness of federal, state and local governmental responses to the COVID-19 pandemic. It is also possible that we will experience an impact on cash collections of our accounts receivable as a result of the impact of the COVID-19 pandemic.

    We took certain actions to preserve liquidity. We temporarily suspended share repurchases under our existing share repurchase authorization, and, in April 2020, implemented a series of temporary actions to manage our workforce costs.

    In addition, we took certain steps to ensure adequate access to liquidity. In April 2020, we entered into an amendment to our senior unsecured revolving credit facility in order to provide for increased flexibility. Pursuant to the amendment, the leverage ratio covenant was increased as follows:
As of:Applicable Covenant:
September 30, 2020no more than 5.5 times EBITDA
December 31, 2020no more than 6.5 times EBITDA
March 31, 2021no more than 6.25 times EBITDA
June 30, 2021no more than 4.5 times EBITDA

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    Thereafter, the leverage ratio covenant reverts to no more than 3.5 times EBITDA. During the period that the increased covenant applies, which period may be terminated early by us provided that we are in compliance with the historical 3.5 times EBITDA leverage ratio, the amended credit agreement contains certain additional limitations and restrictions including, but not limited to, repurchases of our common stock, the amount of funds that can be used on business acquisitions, the incurrence of secured indebtedness and the payment of dividends. Interest on the amended senior unsecured revolving credit facility is subject to a pricing schedule that can fluctuate based on changes in our credit ratings and current EBITDA leverage ratio.

    In addition, in May 2020, we completed a senior notes offering, consisting of $550 million aggregate principal amount of 2.80% senior notes due June 2031, which were issued at an original issue discount of $1 million. In October 2020, we issued a redemption notice to the holders of our $550 million aggregate principal amount of 4.70% senior notes due April 2021, to redeem such notes in November 2020. We intend to use the net proceeds from the 2031 Senior Notes, along with cash on hand, to satisfy the redemption.

    We believe that our cash and cash equivalents and cash from operations, together with our borrowing capacity under our credit facilities, will provide sufficient financial flexibility to fund seasonal and other working capital requirements, capital expenditures, debt service requirements and other obligations, cash dividends on common shares, share repurchases and additional growth opportunities for the foreseeable future. However, should it become necessary, we believe that our credit profile should provide us with access to additional financing in order to fund normal business operations, make interest payments, fund growth opportunities and satisfy upcoming debt maturities.


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Forward-Looking Statements
    
    Some statements and disclosures in this document are forward-looking statements. Forward-looking statements include all statements that do not relate solely to historical or current facts and can be identified by the use of words such as “may,” “believe,” “will,” “expect,” “project,” “estimate,” “anticipate,” “plan” or “continue.” These forward-looking statements are based on our current plans and expectations and are subject to a number of risks and uncertainties that could cause our plans and expectations, including actual results, to differ materially from the forward-looking statements. Risks and uncertainties that may affect our future results include, but are not limited to, impacts of the COVID-19 pandemic and measures taken in response, adverse results from pending or future government investigations, lawsuits or private actions, the competitive environment, the complexity of billing, reimbursement and revenue recognition for clinical laboratory testing, changes in government regulations, changing relationships with customers, payers, suppliers and strategic partners and other factors discussed in our most recently filed Annual Report on Form 10-K and subsequently filed Quarterly Reports on Form 10-Q and Current Reports on Form 8-K, including those discussed in the “Business,” “Risk Factors,” “Cautionary Factors that May Affect Future Results” and “Management’s Discussion and Analysis of Financial Condition and Results of Operations” sections of those reports.

Item 3.    Quantitative and Qualitative Disclosures About Market Risk
      
    See Item 2. "Management's Discussion and Analysis of Financial Condition and Results of Operations."

Item 4.    Controls and Procedures

    Management, including our Chief Executive Officer and our Chief Financial Officer, has evaluated the effectiveness of our disclosure controls and procedures (as defined under Rules 13a-15(e) and 15d-15(e) of the Securities Exchange Act of 1934, as amended). Based upon that evaluation, our Chief Executive Officer and our Chief Financial Officer concluded that our disclosure controls and procedures were effective as of the end of the period covered by this quarterly report.

    During the thirdsecond quarter of 2020,2021, there were no changes in our internal control over financial reporting (as defined in Rule 13a-15(f) under the Securities Exchange Act of 1934, as amended) that materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.




PART II - OTHER INFORMATION

Item 1.    Legal Proceedings
    
    See Note 1211 to the interim unaudited consolidated financial statements for information regarding the status of legal proceedings involving the Company.


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Item 1A. Risk Factors

    Item 1A. of our Annual Report on Form 10-K for the year ended December 31, 2019 and Part II, Item 1A. of our Quarterly Report on Form 10-Q for the quarter ended June 30, 2020 include a discussion of our risk factors. There have been no material changes in the risk factors described in those reports.

Item 2.    Unregistered Sales of Equity Securities and Use of Proceeds

    The table below sets forth the information with respect to purchases made by or on behalf of the Company of its common stock during the thirdsecond quarter of 2020.2021.
ISSUER PURCHASES OF EQUITY SECURITIESISSUER PURCHASES OF EQUITY SECURITIESISSUER PURCHASES OF EQUITY SECURITIES
PeriodPeriodTotal Number of
Shares
Purchased		Average Price
Paid per Share		Total Number of
Shares Purchased
as Part of Publicly
Announced Plans
or Programs
Approximate
Dollar Value of
Shares that May
Yet Be Purchased
Under the Plans
or Programs
 (in thousands)
PeriodTotal Number of
Shares
Purchased		Average Price
Paid per Share		Total Number of
Shares Purchased
as Part of Publicly
Announced Plans
or Programs
Approximate
Dollar Value of
Shares that May
Yet Be Purchased
Under the Plans
or Programs
 (in thousands)
July 1, 2020 – July 31, 2020    
April 1, 2021 – April 30, 2021April 1, 2021 – April 30, 2021    
Share Repurchase Program (A)Share Repurchase Program (A)— $— — $1,167,138 Share Repurchase Program (A)9,072,352 $132.27 9,072,352 $1,306,502 (C)
Employee Transactions (B)Employee Transactions (B)— $— N/AN/AEmployee Transactions (B)— $— N/AN/A
August 1, 2020 – August 31, 2020   
May 1, 2021 – May 31, 2021May 1, 2021 – May 31, 2021   
Share Repurchase Program (A)Share Repurchase Program (A)— $— — $1,167,138 Share Repurchase Program (A)— $— — $1,306,502 (C)
Employee Transactions (B)Employee Transactions (B)875 $120.58 N/AN/AEmployee Transactions (B)1,053 $138.28 N/AN/A
September 1, 2020 – September 30, 2020  
June 1, 2021 – June 30, 2021June 1, 2021 – June 30, 2021  
Share Repurchase Program (A)Share Repurchase Program (A)— $— — $1,167,138 Share Repurchase Program (A)— $— — $1,306,502 (C)
Employee Transactions (B)Employee Transactions (B)— $— N/AN/AEmployee Transactions (B)— $— N/AN/A
TotalTotal    Total    
Share Repurchase Program (A)Share Repurchase Program (A)— $— — $1,167,138 Share Repurchase Program (A)9,072,352 $132.27 9,072,352 $1,306,502 (C)
Employee Transactions (B)Employee Transactions (B)875 $120.58 N/AN/AEmployee Transactions (B)1,053 $138.28 N/AN/A

(A)Since the share repurchase program’s inception in May 2003, our Board of Directors has authorized $9$11 billion of share repurchases of our common stock through SeptemberJune 30, 2020.2021. The share repurchase authorization has no set expiration or termination date. In each of February and March 2021, the Company's Board of Directors increased the size of its share repurchase program by $1 billion.

(B)Includes: (1) shares delivered or attested to in satisfaction of the exercise price and/or tax withholding obligations by holders of stock options (granted under the Company’s Amended and Restated Employee Long-Term Incentive Plan) who exercised options; and (2) shares withheld (under the terms of grants under the Amended and Restated Employee Long-Term Incentive Plan) to offset tax withholding obligations that occur upon the delivery of outstanding common shares underlying restricted stock units and performance share units.


(C)

Does not include $300 million of the $1.5 billion second quarter 2021 payment associated with the April 2021 accelerated share repurchase agreements ("ASRs"), which represents 20% percent of the total value of shares expected to be repurchased under the ASRs over the third and fourth quarters of 2021. See Note 9 to the interim unaudited consolidated financial statements for further information regarding the ASRs.

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Item 6.Exhibits

    Exhibits:
22
31.1
  
31.2
  
32.1
  
32.2
  
10.1
101.INSInline 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.SCHInline XBRL Taxonomy Extension Schema Document - dgx-20200930.xsddgx-20210630.xsd
  
101.CALInline XBRL Taxonomy Extension Calculation Linkbase Document - dgx-20200930_cal.xmldgx-20210630_cal.xml
  
101.DEFInline XBRL Taxonomy Extension Definition Linkbase Document - dgx-20200930_def.xmldgx-20210630_def.xml
  
101.LABInline XBRL Taxonomy Extension Label Linkbase Document - dgx-20200930_lab.xmldgx-20210630_lab.xml
  
101.PREInline XBRL Taxonomy Extension Presentation Linkbase Document - dgx-20200930_pre.xmldgx-20210630_pre.xml
104Cover Page Interactive Data File (formatted in Inline XBRL and contained in Exhibit 101)

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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.
OctoberJuly 23, 20202021
Quest Diagnostics Incorporated
By /s/ Stephen H. Rusckowski
 Stephen H. Rusckowski
 Chairman, Chief Executive Officer
and President
 
  
By/s/ Mark J. Guinan
 Mark J. Guinan
 Executive Vice President and
Chief Financial Officer


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