Persistent negative free cash flow, which reached an FCF margin of -89% in 2023Q4, underscores a critical reliance on external capital to sustain operations as cash reserves dwindle to $4.8M.
| Metric | TTM | Dec'25 | Dec'24 | Dec'23 | Dec'22 | Dec'21 | Dec'20 | Dec'19 | Dec'18 | Dec'17 | Dec'16 | Dec'15 | Dec'14 | Dec'13 | Dec'12 | Dec'11 | Dec'10 | Dec'09 | Dec'08 | Dec'07 | Dec'06 | Dec'05 |
|---|
| Cash from Operations | -10.07M | -12.38M | -14.43M | -21.66M | -28.23M | -14.01M | -5.61M | -16.76M | -10.84M | -6.46M | -6.73M | -9.01M | -6.66M | -3.49M | -3.62M | -3.83M | -2.48M | -2.67M | -2.37M | -2.63M | -2.85M | -50K |
| Operating CF Margin % | - | -33.39% | -40.53% | -69.66% | -81.39% | -34.92% | -14.23% | -73.61% | -53.52% | -48.28% | -82.02% | -222.13% | -211.8% | -424.6% | -2385.93% | -10611.81% | - | - | - | - | - | -500% |
| Operating CF Growth % | 24.26% | 14.21% | 33.37% | 23.3% | -101.59% | -149.51% | 66.51% | -54.61% | -67.78% | 4.02% | 25.29% | -35.25% | -90.9% | 3.52% | 5.54% | -54.55% | 7.38% | -13.07% | 9.99% | 7.77% | -5598.36% | - |
| Net Income | -11.85M | -8.2M | -20.72M | -28.51M | -32.81M | -24.56M | -7.84M | -19.27M | -17.21M | -8.46M | -11.94M | -8.13M | -9.32M | -4.68M | -3.66M | -5.48M | -2.91M | -2.74M | -3.02M | -3.35M | -7.67M | -80K |
| Depreciation & Amortization | 926.25K | 955K | 1.75M | 2.03M | 1.13M | 1.13M | 660.79K | 581.53K | 390.55K | 218.27K | 161.61K | 112.97K | 65.55K | 64.35K | 54.61K | 39.15K | 17.8K | 51.7K | 103.7K | 190.44K | 1.26M | 10K |
| Stock-Based Compensation | 1.95M | 2.77M | 3.76M | 3.7M | 3.8M | 6.2M | 4.71M | 2.84M | 0 | 3.31M | 2.76M | 382.28K | 695.84K | 65.47K | 63.13K | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Deferred Taxes | 0 | 0 | 0 | 0 | 0 | 0 | -2.71M | 422.79K | 799.51K | -1.45M | 598.87K | 386.44K | 2.12M | -65.47K | -63.13K | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Other Non-Cash Items | -1.71M | -6.87M | 5.16M | -1.24M | 3.21M | 2.58M | 322.81K | 115.21K | 734.04K | 82.05K | 30.48K | -1.35M | 378.74K | 833.65K | 534.48K | 1.81M | 198.27K | 251.59K | 407.06K | 850.44K | 3.5M | 100K |
| Working Capital Changes | 613.04K | -1.03M | -4.38M | 2.36M | -3.56M | 641.9K | -757.87K | -1.45M | -937.77K | -160.6K | 1.66M | -413.59K | -602.26K | 290.47K | -542.03K | -197K | 215.53K | -241.18K | 141.78K | -317.97K | 63.28K | -80K |
| Change in Receivables | 812.89K | 423K | -1.72M | -245.62K | -1.29M | 420.58K | -326.86K | -642.17K | -1.85M | -649.32K | -889.72K | 131.97K | -412.12K | -401.24K | -15.7K | -36.08K | 0 | 0 | 0 | 0 | 0 | -74K |
| Change in Inventory | -1.62M | -2.54M | 500.47K | -121.04K | 945.35K | -2.35M | -461.51K | -1.28M | -56.75K | 57.32K | 340.39K | -632.53K | -303.13K | 436.76K | -251.35K | -431.02K | 0 | 0 | 0 | 0 | 0 | 0 |
| Change in Payables | -246.72K | -706K | -1.81M | 1.62M | -3.25M | 2.43M | 1.42T | 470.55K | 1.7M | 523.38K | 2.06M | -83.17K | 497.45K | 118.75K | 147.95K | -30.71K | 666 | 666 | 70.84K | 23K | -421.68K | 0 |
| Cash from Investing | -413.76K | -415K | -669.43K | -936.24K | -6.46M | -4.28M | -1.68M | -1.52M | -1.52M | -1.68M | 1.6M | -890.9K | -2.31M | -216.36K | -38.81K | -52.49K | -165.45K | 185.28K | -221.66K | -33.69K | -64.86K | 0 |
| Capital Expenditures | -188.76K | -164K | -669.43K | -936.24K | -6.46M | -4.28M | -1.68M | -1.52M | -1.52M | -1.68M | -595.53K | -643.45K | -367.32K | -216.36K | -38.81K | -52.49K | -165.45K | -14.33K | -22.05K | -33.69K | -64.86K | 0 |
| CapEx % of Revenue | 0.51% | 0.44% | 1.88% | 3.01% | 18.61% | 10.67% | 4.25% | 6.68% | 7.51% | 12.54% | 7.26% | 15.87% | 11.68% | 26.33% | 25.6% | 145.49% | - | - | - | - | - | - |
| Acquisitions | 26K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 239.84K | 214.16K | 0 | 0 | 0 | 0 | 0 | 22.05K | 0 | 0 | 0 |
| Investments | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | -251K | -251K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Cash from Financing | 2.48M | 9.31M | 9.33M | 14.47M | 4.96M | 715.2K | 66.35M | 8.18M | 17.47M | 20.12M | 5.06M | 11.64M | 10.02M | 4.2M | 4.21M | 4.01M | 2.1M | 1.34M | 5.12M | -760.87K | 5.08M | 40K |
| Debt Issued (Net) | 2.48M | 2.48M | 10M | 0 | 5M | 0 | -15M | 5M | 0 | 5M | 5M | 0 | 0 | 1.84M | 700K | 1.25M | 1.34M | 0 | 225K | 0 | 0 | 0 |
| Equity Issued (Net) | -5.39M | 6.83M | 178.65K | 14.26M | -40.36K | 715.2K | 80.21M | 673.65K | 14.13M | 13.68M | 0 | 9.52M | 9.75M | 0 | 3.5M | 2.76M | 767.5K | 1.34M | 4.9M | 0 | 5.08M | 0 |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -335.73K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -704.33K | 0 | -760.87K | 0 | 0 |
| Share Repurchases | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Other Financing | 5.39M | 0 | -847.95K | 218.28K | 0 | 0 | 1.13M | 2.5M | 3.34M | 1.78M | 64.21K | 2.12M | 265.45K | 2.36M | 10.61K | 5.14K | 0 | 0 | 0 | 0 | 0 | 40K |
| Net Change in Cash | -6.77M | -1.99M | -5.85M | -8.22M | -29.99M | -17.6M | 59.19M | -10.14M | 5.05M | 12.08M | -71.67K | 1.71M | 1.42M | 453.69K | 542.69K | 130.98K | -539.96K | -1.15M | 2.54M | -2.66M | 2.17M | -20K |
| Free Cash Flow | -10.2M | -12.54M | -14.71M | -22.59M | -34.69M | -18.29M | -7.29M | -18.28M | -12.36M | -8.14M | -7.33M | -9.65M | -7.03M | -3.71M | -3.66M | -3.88M | -2.64M | -2.69M | -2.39M | -2.66M | -2.91M | -50K |
| FCF Margin % | -27.42% | -33.84% | -41.33% | -72.68% | -100% | -45.59% | -18.48% | -80.29% | -61.03% | -60.82% | -89.28% | -237.99% | -223.48% | -450.93% | -2411.53% | -10757.3% | - | - | - | - | - | -500% |
| FCF Growth % | 25.28% | 14.76% | 34.88% | 34.88% | -89.7% | -150.87% | 60.12% | -47.89% | -51.86% | -11.09% | 24.1% | -37.33% | -89.67% | -1.38% | 5.82% | -46.86% | 1.72% | -12.63% | 10.3% | 8.67% | -5728.09% | - |
| FCF per Share | -0.16 | -0.20 | -0.27 | -0.51 | -0.80 | -0.42 | -0.19 | -0.57 | -0.40 | -0.29 | -0.29 | -0.39 | -0.49 | -0.39 | -0.46 | -0.61 | -0.67 | -1.62 | -2.38 | -2.68 | -2.99 | -0.16 |
| FCF Conversion (FCF/Net Income) | 0.86x | 1.51x | 0.70x | 0.74x | 0.86x | 0.57x | 0.72x | 0.87x | 0.63x | 0.76x | 0.56x | 1.11x | 0.71x | 0.75x | 0.99x | 0.70x | 0.85x | 0.98x | 0.78x | 0.78x | 0.37x | 0.63x |
| Interest Paid | -506.25K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Taxes Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Imminent liquidity and dilution
According to quarterly financial disclosures, the OCF/NI ratio has exhibited extreme volatility, ranging from 2.34 in 2025Q1 to -0.78 in 2025Q2, indicating that net income remains a poor proxy for the company's actual cash-generating capacity during this intensive clinical trial and regulatory phase.
The frequent divergence between net income and operating cash flow suggests that non-cash charges and working capital swings are masking the true underlying burn rate. Investors should monitor this lack of correlation, as it implies that the company's accounting earnings are heavily influenced by items that do not reflect the immediate cash requirements of the business.
As reported in recent SEC filings, CTSO has consistently generated negative free cash flow over the last ten quarters, with FCF margins reaching as low as -89% in 2023Q4, underscoring the company's ongoing reliance on external financing to sustain its current operational and clinical development footprint.
The persistent negative FCF trajectory suggests that the company has yet to reach a commercial inflection point where product sales can self-fund the R&D and regulatory costs. This trend warrants further investigation into how long the current cash runway can support operations before additional dilutive capital is required.
Based on the provided cash flow statements, working capital changes have been highly erratic, swinging from a $1.3M inflow in 2026Q1 to a $2.8M outflow in 2024Q2, which suggests significant instability in the timing of collections and inventory management relative to the company's sales cycle.
These fluctuations in working capital appear to be a primary driver of the quarter-to-quarter volatility in operating cash flow. The inconsistency in these figures may indicate challenges in managing the supply chain or potential delays in receiving payments from European hospital customers, which could exacerbate liquidity pressures.
Data from recent financial statements reveals that stock-based compensation has frequently exceeded $1M per quarter, effectively acting as a non-cash subsidy that obscures the true economic cost of maintaining the company's specialized workforce during this prolonged period of negative operating cash flow.
While SBC is a standard tool for talent retention in medical technology, its magnitude relative to the company's cash burn suggests that the reported operating cash flow figures may be flatter than they would be if compensation were entirely cash-settled. Analysts should adjust for these non-cash expenses to better understand the true cash-based cost of operations.
Quick answers to the most common questions about buying CTSO stock.
Cytosorbents Corporation (CTSO) generated $-12.4M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
Cytosorbents Corporation (CTSO) reported negative free cash flow of $12.5M in 2025, indicating capital requirements exceeded cash from operations.
Cytosorbents Corporation (CTSO) spent $0.2M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.