Operating cash flow remains positive at $145.3M in 2026Q2, but heavy capex (22.5% of revenue) and acquisition outflows have driven FCF to -$20.9M, indicating capital allocation strain.
AdaptHealth Corp. (AHCO) cash flow statement — 9-year operating, investing & financing cash flows
| Metric | TTM | Dec'25 | Dec'24 | Dec'23 | Dec'22 | Dec'21 | Dec'20 | Dec'19 | Dec'18 | Dec'17 |
|---|
| Cash from Operations | 583.27M | 601.77M | 541.84M | 480.67M | 373.87M | 275.68M | 195.63M | 60.42M | 68.43M | 45.93M |
| Operating CF Margin % | - | 18.55% | 16.62% | 15.02% | 12.59% | 11.23% | 18.52% | 11.41% | 19.82% | 23.85% |
| Operating CF Growth % | 21.13% | 11.06% | 12.73% | 28.57% | 35.62% | 40.92% | 223.8% | -11.7% | 48.98% | - |
| Net Income | -228.23M | -66.04M | 94.78M | -678.89M | 73.13M | 158.15M | -194.09M | 12.24M | 2.09M | -690 |
| Depreciation & Amortization | 433.48M | 381.93M | 365.33M | 420.59M | 351.18M | 258.05M | 82.44M | 11.28M | 50.61M | 27.82M |
| Stock-Based Compensation | 17.23M | 21.88M | 14.88M | 22.47M | 22.4M | 25.32M | 18.67M | 11.07M | 884K | 48.75K |
| Deferred Taxes | 13.37M | 47.16M | 32.05M | -62.59M | 18.04M | 22.38M | -21.1M | 895.3K | -2.88M | 0 |
| Other Non-Cash Items | 339.7M | 150.26M | 60.85M | 804.2M | 17.12M | -34.92M | 232.8M | 43.12M | 65.91M | 12.02M |
| Working Capital Changes | 6.17M | 66.58M | -26.06M | -25.11M | -108M | -153.31M | 76.91M | -18.19M | 429.32K | 690 |
| Change in Receivables | 2.63M | 30.99M | -26.22M | -28.86M | -209K | -29.69M | -29.52M | -11.81M | -21.34M | -3.04M |
| Change in Inventory | 10.29M | -11.49M | -28.07M | 15.53M | -6.3M | -14.92M | -19.43M | -14.26M | 2.31M | 1.14M |
| Change in Payables | 13.25M | 0 | 0 | 0 | 0 | 0 | 0 | 8.78M | -19.73K | 0 |
| Cash from Investing | -624.38M | -303.19M | -310.27M | -357.28M | -411.17M | -1.82B | -815.7M | -386K | -248.87M | -15.08M |
| Capital Expenditures | -485.59M | -382.39M | -306.06M | -337.46M | -391.42M | -203.31M | -39.76M | -21.33M | -9.95M | -6.85M |
| CapEx % of Revenue | 16.14% | 11.78% | 9.39% | 10.55% | 13.18% | 8.28% | 3.76% | 4.03% | 2.88% | 3.56% |
| Acquisitions | -149.74M | -42.38M | -9.54M | -19.69M | -19.02M | -1.62B | -769.34M | 569K | -86.33M | -8.51M |
| Investments | - | - | - | - | - | - | - | - | - | - |
| Other Investing | 4.68M | 121.58M | 5.32M | 0 | 0 | 0 | 0 | 20.38M | -238.92M | 280.51K |
| Cash from Financing | 15.76M | -302.19M | -198.95M | -92.53M | -66.05M | 1.6B | 643.15M | -13.89M | 251.33M | 119.82K |
| Debt Issued (Net) | 56.75M | -268.48M | -179.87M | -51.77M | -36.18M | 1.4B | 354.74M | 205.66M | -174.24K | -29.69M |
| Equity Issued (Net) | 1.6M | 1.21M | 0 | -29.27M | -13.99M | 278.85M | 323.33M | 101.29M | 250M | 0 |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -250M | 0 | 0 |
| Share Repurchases | 0 | 0 | 0 | -29.27M | -13.99M | 0 | -44.27M | -23.71M | 0 | 25K |
| Other Financing | -42.58M | -34.92M | -19.08M | -11.48M | -15.88M | -75.68M | -34.92M | -70.84M | 1.51M | -573.96K |
| Net Change in Cash | -25.34M | -3.61M | 32.62M | 30.86M | -103.36M | 49.66M | 23.08M | -875K | 827.28K | -3.56M |
| Free Cash Flow | 97.68M | 219.38M | 235.78M | 143.2M | -17.56M | 72.37M | 155.88M | 39.09M | 58.48M | 39.08M |
| FCF Margin % | 3.25% | 6.76% | 7.23% | 4.47% | -0.59% | 2.95% | 14.76% | 7.38% | 16.94% | 20.29% |
| FCF Growth % | -57.75% | -6.96% | 64.65% | 915.69% | -124.26% | -53.57% | 298.81% | -33.16% | 49.64% | - |
| FCF per Share | 0.72 | 1.62 | 1.74 | 1.07 | -0.13 | 0.54 | 2.97 | 0.54 | 1.87 | 1.25 |
| FCF Conversion (FCF/Net Income) | -0.43x | -8.50x | 5.99x | -0.71x | 5.39x | 1.77x | -1.21x | -2.83x | 32.80x | -66277.97x |
| Interest Paid | 97.84M | 101.24M | 122.07M | 126.23M | 108.89M | 73.63M | 35.77M | 23.07M | 0 | 0 |
| Taxes Paid | 2.57M | 24.28M | 14.14M | 14.76M | 14.95M | 14.79M | 7.48M | 1.32M | 0 | 0 |
Quick answers to the most common questions about buying AHCO stock.
AdaptHealth Corp. (AHCO) generated $601.8M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
AdaptHealth Corp. (AHCO) generated $219.4M in free cash flow in 2025. Free cash flow is the cash left over after capital expenditures, which can be used to pay dividends, repurchase shares, or pay down debt.
AdaptHealth Corp. (AHCO) spent $382.4M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.
Key Metrics
Top Statement Risk
Negative margins and leverage
Metrics are mathematically derived from official filings.
Earnings Quality Masked by Depreciation
Despite persistent net losses, operating cash flow remained positive in most quarters, with OCF/NI swinging from -1.08 to 11.04, indicating that non-cash charges like D&A are the primary gap between earnings and cash generation.
The negative net income in 2026Q2 (-$133.9M) contrasts sharply with operating cash flow of $145.3M, a divergence largely attributable to $120.3M in depreciation and amortization. This suggests that the company's GAAP losses are not fully reflective of its cash-generating ability, but the reliance on D&A to bridge the gap warrants scrutiny. The wide fluctuation in OCF/NI across quarters, from -22.98 in 2024Q1 to 11.04 in 2025Q2, indicates that earnings quality is inconsistent and may be influenced by working capital timing.
Free Cash Flow Volatility Signals Instability
Free cash flow swung from -$38.9M in 2024Q1 to $116.7M in 2024Q2, but recent quarters show negative FCF in 2026Q1 and Q2, with FCF margins dropping to -3.4% and -2.8%, respectively, per reported cash flow data.
The trajectory of free cash flow has been erratic, with positive quarters in 2024Q2 through 2025Q4, but a sharp reversal to negative in the first two quarters of 2026. This pattern suggests that the company's cash generation is not stable, and the recent negative FCF may indicate increased capital intensity or operational headwinds. The FCF margin, which peaked at 19.6% in 2024Q2, has deteriorated to -2.8% in 2026Q2, implying that the company is not consistently converting revenue into free cash flow.
Capital Expenditures Outpace Cash Generation
CapEx as a percentage of revenue has risen from 9.0% in 2024Q4 to 22.5% in 2026Q2, while operating cash flow has declined, indicating that the company is investing heavily in assets that may not yet be yielding returns.
The capital intensity of AdaptHealth's business model is evident in the rising CapEx/Revenue ratio, which reached 22.5% in 2026Q2, the highest in the observed period. This increase in capital spending, coupled with a decline in operating cash flow from $198.0M in 2024Q2 to $145.3M in 2026Q2, suggests that the company is expanding its asset base, possibly in rental equipment or infrastructure, but the returns on these investments are not yet visible in cash flow. The negative FCF in recent quarters underscores the strain that elevated CapEx places on cash generation.
Working Capital Swings Reflect Billing Complexity
Working capital changes have been highly volatile, ranging from -$77.7M in 2024Q1 to +$62.8M in 2024Q2, with recent quarters showing negative changes, indicating that cash flow is sensitive to the timing of collections and payables.
The working capital adjustments in the cash flow statement show significant quarter-to-quarter swings, which is consistent with the complex billing environment in the HME industry. For instance, 2024Q2 saw a positive working capital change of $62.8M, while 2026Q1 had a negative change of -$15.6M. This volatility suggests that the company's cash flow is heavily influenced by the timing of insurance reimbursements and patient payments, and investors should monitor DSO trends as a key indicator of cash flow stability.
Acquisitions Drive Cash Outflows
Cash used for acquisitions totaled $42.7M in 2026Q2 and $84.7M in 2026Q1, while dividends and buybacks were negligible, indicating that the company is prioritizing inorganic growth over shareholder returns.
The cash flow statement reveals that the primary use of cash beyond operations is acquisitions, with net cash outflows for acquisitions in most quarters, including $42.7M in 2026Q2 and $84.7M in 2026Q1. This aligns with the company's historical roll-up strategy, but the lack of dividends or significant buybacks suggests that management is reinvesting cash into growth rather than returning capital to shareholders. Given the negative net margins and high leverage, the sustainability of this acquisition-driven deployment is questionable.
Cumulative Earnings vs Cash: A Persistent Gap
Over the ten quarters, cumulative net income is approximately -$130M, while cumulative operating cash flow is around $1.38B, a gap of over $1.5B that is primarily explained by non-cash charges like D&A.
The cumulative divergence between net income and operating cash flow is stark, with net losses totaling roughly -$130M against operating cash flow of about $1.38B. This gap is largely attributable to depreciation and amortization, which have averaged over $100M per quarter, reflecting the heavy asset base required for the rental and distribution model. However, the persistence of this gap suggests that the company's earnings quality is low, and investors should focus on cash flow metrics rather than GAAP earnings when assessing the company's financial health.
What Could Invalidate the Base Case
The cash flow statement obscures the impact of stock-based compensation and acquisition-related costs, which may understate true cash generation, while the recent divestiture of the Diabetes business could alter future cash flow dynamics.
While operating cash flow appears robust, the inclusion of stock-based compensation (SBC) as a non-cash add-back and the frequent use of adjusted EBITDA metrics may mask the true cost of employee compensation and integration expenses. The recent divestiture of the Diabetes Health business, signed in July, could reduce revenue and cash flow in the near term, even if it improves margins. Investors should monitor the sustainability of operating cash flow post-divestiture and the potential for increased capital expenditures related to the remaining core segments.