Cash flow remains volatile due to working capital swings, exemplified by a $39.2 million outflow in 2025Q4 despite a $64.1 million free cash flow in 2026Q1.
| Cash from Operations | 166.03M | 114.6M | 52.2M | 68.23M | 82.13M | 70.33M | 46.16M | 13.67M | 26.1M | 53.07M | -1.84M |
| Operating CF Margin % | - | 3.6% | 2.57% | 4.92% | 7.18% | 9.09% | 12.47% | 2.44% | 5.02% | 14.84% | -4.18% |
| Operating CF Growth % | 604.26% | 119.54% | -23.49% | -16.93% | 16.77% | 52.36% | 237.62% | -47.62% | -50.82% | 2985.82% | - |
| Net Income | 30.23M | 24.08M | 49.93M | 57.85M | 45.74M | 46.05M | 122.08M | 17.67M | 10.84M | 25.8M | -9.34M |
| Depreciation & Amortization | 54.38M | 45.75M | 27.93M | 17.75M | 17.54M | 17.52M | 18.35M | 18.28M | 19.3M | 19.08M | 351.4K |
| Stock-Based Compensation | 11.38M | 38.6M | 34.54M | 22.04M | 16.1M | 6.75M | 3.38M | 1.55M | 0 | 0 | 0 |
| Deferred Taxes | -2.02M | -4.29M | -4.25M | -12.44M | -14.28M | 7.67M | 396K | -6.8M | -8.35M | -20.68M | -127.73K |
| Other Non-Cash Items | 40.09M | 13.56M | 7.67M | 6.42M | 18.98M | 25.98M | -102.08M | 5.75M | 157.26M | 42.15M | 4.05M |
| Working Capital Changes | 31.4M | -3.1M | -63.61M | -23.39M | -1.96M | -33.64M | 4.04M | -22.77M | -63.05M | 15.98M | 2.63M |
| Change in Receivables | 0 | 0 | -11.1M | -20.57M | -33.97M | -21.63M | 3.01M | -5.8M | -28.63M | 10.7M | 272.4K |
| Change in Inventory | 0 | 0 | 0 | 12.15M | 27.61M | -2.11M | -7.71M | 0 | 0 | 0 | 0 |
| Change in Payables | 0 | 0 | -30.43M | -498K | -2.52M | 4.11M | 15.82M | -4.39M | -22.67M | -1.81M | 1.02M |
| Cash from Investing | -539.42M | -539M | -192.4M | -65.52M | -7.11M | 16.54M | 95.49M | -180.63M | -25.76M | 6.73M | -247.11K |
| Capital Expenditures | -11.04M | -10.11M | -8.03M | -28.53M | -22.94M | -19.22M | -1.16M | -1.04M | -1.17M | -2.08M | -262.11K |
| CapEx % of Revenue | 0.31% | 0.32% | 0.39% | 2.06% | 2% | 2.48% | 0.31% | 0.19% | 0.23% | 0.58% | 0.6% |
| Acquisitions | -548.58M | -548.6M | -156.13M | -7.54M | -18.46M | -3.9M | 31.42M | -53M | -16.68M | 0 | 15K |
| Investments | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | 5.17M | 4.61M | -25.74M | -23.8M | 4.47M | 56K | 16.41M | -11.19M | -7.5M | 26.8M | 0 |
| Cash from Financing | 597.53M | 569.35M | 135.15M | 3.42M | -20.09M | -47.75M | -51.7M | 163.33M | -11.2M | -14.98M | 6.34M |
| Debt Issued (Net) | 645.66M | 604.81M | 152.71M | 79.17M | -828K | -58.69M | -9.61M | 234.48M | 7.41M | 4.9M | -7.9M |
| Equity Issued (Net) | -2.4M | -15.43M | -937K | -8.67M | -9.25M | 43.46M | 10.27M | -6.82M | -850.97K | -425.28K | 15.2M |
| Dividends Paid | -2.53M | -7.88M | -4.04M | -62.07M | -14.03M | -31.09M | -51.32M | -61.72M | -17.76M | -10.45M | 0 |
| Share Repurchases | -2.1M | -15.43M | -937K | -10.19M | -9.25M | -5.74M | -537K | -7.57M | -5.05M | -3.18M | 0 |
| Other Financing | -43.2M | -12.15M | -12.59M | -5.01M | 4.02M | -1.42M | -1.04M | -2.62M | 323 | -9M | -954.49K |
| Net Change in Cash | 222.34M | 144.94M | -5.05M | 6.13M | 54.93M | 39.13M | 89.96M | -3.63M | -12.88M | 110.5M | 4.26M |
| Free Cash Flow | 154.99M | 104.49M | 44.17M | 39.7M | 59.19M | 51.11M | 45M | 12.63M | 24.93M | 50.99M | -2.1M |
| FCF Margin % | 4.4% | 3.28% | 2.17% | 2.86% | 5.17% | 6.6% | 12.15% | 2.25% | 4.8% | 14.25% | -4.77% |
| FCF Growth % | 197.39% | 136.58% | 11.26% | -32.93% | 15.8% | 13.58% | 256.26% | -49.34% | -51.1% | 2526.63% | - |
| FCF per Share | 3.16 | 2.12 | 0.92 | 0.84 | 1.30 | 1.13 | 1.20 | 0.35 | 0.66 | 1.78 | -0.40 |
| FCF Conversion (FCF/Net Income) | 5.13x | 5.10x | 1.21x | 1.12x | 1.82x | 1.02x | -1.94x | 0.97x | 2.41x | 2.06x | 0.20x |
| Interest Paid | 0 | 0 | 30.42M | 14.25M | 6.67M | 4.16M | 8.51M | 4.26M | 462K | 51.04K | 176.59K |
| Taxes Paid | 0 | 0 | 43.94M | 56.57M | 47.31M | 37.2M | 62M | 20.2M | 23.64M | 24.36M | 521.34K |
Volatile working capital cycles
According to quarterly financial disclosures, the relationship between net income and operating cash flow is highly erratic, with the OCF/NI ratio swinging from a negative 0.48 in 2025Q4 to a peak of 26.69 in 2025Q3, indicating significant disconnects between accounting profits and actual cash generation.
The extreme variance in the OCF/NI ratio suggests that reported net income is a poor proxy for the company's underlying cash-generating capacity. Investors should monitor whether these fluctuations are driven by the timing of capitated payment settlements or underlying shifts in medical loss ratios that are not immediately captured in GAAP earnings.
As reported in recent cash flow statements, working capital changes have been the primary driver of quarterly cash flow volatility, ranging from a $59.6 million inflow in 2025Q2 to a $39.2 million outflow in 2025Q4, highlighting the sensitivity of the company's liquidity to timing differences in claims processing.
The significant swings in working capital suggest that the company's cash position is heavily dependent on the timing of payer settlements and the management of medical claim liabilities. This volatility warrants further investigation into whether these shifts represent structural changes in payment cycles or temporary delays in the collection of shared savings bonuses.
Based on historical data, Astrana Health maintains a low capital intensity, with CapEx/Revenue ratios consistently remaining below 0.6% in most periods, suggesting that the company's growth strategy is not reliant on heavy investment in physical infrastructure despite its integrated care delivery model.
The minimal capital expenditure requirements appear to support the company's ability to scale its platform without placing undue pressure on its cash reserves. This asset-light profile may provide management with greater flexibility to deploy capital toward strategic acquisitions or technology enhancements rather than maintenance of physical facilities.
As evidenced by recent financial statements, the company has utilized significant cash for acquisitions, including a $548.6 million outflow in 2025Q3, which underscores a management strategy focused on aggressive inorganic growth to expand its footprint in the value-based care market.
The lumpy nature of these acquisition-related cash outflows suggests that the company's cash position is subject to periodic, large-scale reductions that may temporarily limit liquidity. Investors should monitor whether these investments are successfully integrating into the core platform and contributing to long-term margin expansion, given the thin net margins currently reported.
Quick answers to the most common questions about buying ASTH stock.
Astrana Health, Inc. (ASTH) generated $114.6M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
Astrana Health, Inc. (ASTH) generated $104.5M 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.
Astrana Health, Inc. (ASTH) spent $10.1M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.
In 2025, Astrana Health, Inc. (ASTH) returned $7.9M to shareholders via cash dividends and spent $15.4M on share repurchases. This shows the company's commitment to returning capital to its equity investors.