Operating cash flow exceeded net income by 4.2x in Q2 2026, with FCF rebounding to $61.6M (11.2% margin), but cumulative OCF of $503M versus net income of -$78M over ten quarters highlights persistent non-cash charges.
ICU Medical, Inc. (ICUI) cash flow statement — 30-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 | Dec'16 | Dec'15 | Dec'14 | Dec'13 | Dec'12 | Dec'11 | Dec'10 | Dec'09 | Dec'08 | Dec'07 | Dec'06 | Dec'05 | Dec'04 | Dec'03 | Dec'02 | Dec'01 | Dec'00 | Dec'99 | Dec'98 | Dec'97 | Dec'96 |
|---|
| Cash from Operations | 279.24M | 179.85M | 204.03M | 166.2M | -62.13M | 267.54M | 222.75M | 101.92M | 160.22M | 154.42M | 89.94M | 54.87M | 60.64M | 64.02M | 66.27M | 64.49M | 33.09M | 48.61M | 30.23M | 41.51M | 31.61M | 27.37M | 25.28M | 22.83M | 28.1M | 24.33M | 12.76M | 14.8M | 6.6M | 8.7M | 6.5M |
| Operating CF Margin % | - | 8.06% | 8.57% | 7.36% | -2.73% | 20.32% | 17.53% | 8.05% | 11.44% | 11.95% | 23.71% | 16.06% | 19.61% | 20.41% | 20.91% | 21.34% | 11.63% | 21% | 14.76% | 22.06% | 15.68% | 17.38% | 33.47% | 21.27% | 32% | 35.23% | 22.71% | 31.49% | 16.58% | 28.62% | 26.42% |
| Operating CF Growth % | 717.11% | -11.85% | 22.76% | 367.51% | -123.22% | 20.11% | 118.56% | -36.39% | 3.75% | 71.69% | 63.93% | -9.52% | -5.28% | -3.4% | 2.77% | 94.85% | -31.92% | 60.81% | -27.18% | 31.33% | 15.48% | 8.26% | 10.75% | -18.75% | 15.49% | 90.67% | -13.78% | 124.24% | -24.14% | 33.85% | -7.14% |
| Net Income | 60.33M | 732K | -117.69M | -29.66M | -74.29M | 103.14M | 86.87M | 101.03M | 28.79M | 68.64M | 63.08M | 44.98M | 26.34M | 40.42M | 41.28M | 44.67M | 30.93M | 26.56M | 24.3M | 23.08M | 25.66M | 20.27M | 5M | 22.3M | 19.68M | 15.39M | 11.79M | 9.4M | 7.2M | 5.7M | 4.7M |
| Depreciation & Amortization | 203.57M | 200.74M | 219.51M | 228.77M | 235.15M | 89.7M | 94.85M | 76.92M | 74.73M | 66.57M | 19.05M | 18.07M | 19.45M | 19.51M | 19M | 18.29M | 17.34M | 15.67M | 14.22M | 11.8M | 11.23M | 9.7M | 8.6M | 7.36M | 5.29M | 5.03M | 4.61M | 3.9M | 2.4M | 2.1M | 2M |
| Stock-Based Compensation | 37.74M | 55.76M | 46.88M | 40.56M | 36.02M | 27.34M | 23.95M | 21.92M | 24.24M | 19.35M | 15.24M | 12.83M | 9.59M | 5.43M | 5.56M | 4.02M | 3.47M | 2.71M | 1.89M | 1.05M | 487K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Deferred Taxes | 0 | 0 | 0 | 0 | 0 | 0 | 3.77M | 27.62M | 20.27M | -55.96M | -110K | 3.14M | -318K | 820K | 195K | -57.01M | -530K | 0 | 653K | -1.25M | -3.15M | 1.65M | 0 | 1.45M | 528K | -37K | -888K | -1.1M | -500K | -400K | 0 |
| Other Non-Cash Items | 62.62M | 12.66M | 57.9M | 62.12M | 44.71M | 32.33M | 30.27M | -13.94M | 37.58M | -69K | 1.43M | 1.67M | 2.19M | 2.71M | 2.58M | 44.67M | 1.87M | 1K | -270K | 1.38M | 214K | -224K | 3.33M | 842K | 10.19M | 3.76M | 0 | 100K | 0 | 0 | 0 |
| Working Capital Changes | -85.02M | -90.04M | -2.57M | -135.6M | -303.73M | 15.04M | -16.97M | -111.64M | -25.41M | 55.89M | -8.76M | -25.83M | 3.4M | -4.87M | -2.35M | 9.85M | -19.99M | 3.67M | -10.57M | 5.45M | -2.84M | -4.02M | 8.36M | -9.12M | -7.59M | 181K | -2.75M | 2.5M | -2.5M | 1.3M | -200K |
| Change in Receivables | -24.61M | 8.88M | -46.84M | 48.63M | -19.15M | 13.76M | 78.05M | -23.68M | -76.74M | -54.53M | 744K | -20.52M | 4.91M | 3.56M | -5.39M | 6.23M | -8M | -9.04M | -12.38M | 523K | -2.35M | -14.66M | 15.72M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Change in Inventory | 12.28M | -26.25M | 16.83M | -6.08M | -201.09M | 20.82M | 19.2M | -25M | -21.77M | 181.7M | -5.5M | -8.34M | -3.84M | 2.32M | 4.57M | 3.17M | -3.67M | 2.01M | 1.45M | -3.03M | -785K | 3.07M | -5.03M | 3.46M | -2.87M | -159K | 621K | -100K | -200K | 500K | -700K |
| Change in Payables | -27.01M | 7M | 12.53M | -68.3M | 37.47M | 2.35M | -46.41M | -2.7M | 23.27M | 46.65M | -463K | 3.12M | -621K | -31K | -1.54M | 2.67M | -8.22M | 10.38M | -525K | 250K | 3.03M | 2.21M | -358K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Cash from Investing | -63.66M | 122.23M | -88.96M | -87.95M | -1.91B | -90.69M | -98.14M | -166.89M | -103.37M | -266.87M | 16.28M | -11.24M | -21.75M | -13.12M | -41.37M | -45.73M | 19.63M | -35.23M | 3.61M | -10.3M | -34.55M | -33.63M | -14.82M | -12.51M | -36.55M | -26.52M | -16.29M | -15.3M | -10.5M | -3.3M | -2.8M |
| Capital Expenditures | -72.41M | -88.04M | -79.37M | -83.89M | -90.31M | -68.54M | -100.39M | -106.04M | -100.78M | -79.68M | -24.55M | -13.94M | -17.59M | -19.5M | -20.3M | -15.82M | -23.17M | -16.69M | -11.35M | -23.64M | -19.61M | -5.51M | -7.1M | -10.67M | -11.89M | -6.23M | -3.99M | -14.8M | -6.7M | -800K | -1.3M |
| CapEx % of Revenue | 3.32% | 3.95% | 3.33% | 3.71% | 3.96% | 5.21% | 7.9% | 8.37% | 7.2% | 6.16% | 6.47% | 4.08% | 5.69% | 6.21% | 6.41% | 5.24% | 8.14% | 7.21% | 5.54% | 12.57% | 9.73% | 3.5% | 9.4% | 9.94% | 13.55% | 9.03% | 7.11% | 31.49% | 16.83% | 2.63% | 5.28% |
| Acquisitions | 219.2M | 0 | 0 | 0 | -1.84B | -14.45M | -8.38M | -76.13M | -1.3M | -162.45M | -2.58M | -27.82M | -989K | -1.08M | -1.15M | 0 | 0 | -5.66M | 0 | -3.22M | 6.06M | -32.61M | 0 | -5.88M | -9.48M | 0 | 0 | 0 | 0 | 0 | 0 |
| Investments | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | -210.46M | 210.27M | -10.09M | -8.28M | -8.03M | -12.41M | 14.56M | 33K | 13.77M | 5.21M | 3.27M | 3.59M | 994K | 1.13M | 1.16M | 16.2M | 1.51M | -23.43M | -5.37M | 577K | 2.88M | 2.65M | 2.66M | -8.91M | 0 | 0 | 0 | 0 | 100K | 0 | -2M |
| Cash from Financing | -209.81M | -311.52M | -55.8M | -35.98M | 1.64B | -16.87M | -40K | -10.91M | 8.02M | -44.35M | 2.47M | 25.01M | 19.35M | 24.39M | 21.63M | 2.13M | -22.88M | -17.69M | 13.98M | -36.96M | 9.28M | 7.66M | -6.94M | -12.7M | 8.72M | 4.15M | 3.58M | 400K | 3.1M | -4.5M | -3.6M |
| Debt Issued (Net) | -170.56M | -308.87M | -52.15M | -30.65M | 1.64B | -607K | -357K | 0 | 0 | -75M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Equity Issued (Net) | -8.14M | -2.66M | -1.05M | -5.33M | 8.79M | 9.37M | 317K | -10.91M | -6.25M | -4.06M | -17.23M | -1.52M | -5.84M | -3.03M | 0 | -11.96M | -28.65M | -20.44M | -5.86M | -37.51M | 2.76M | 7.66M | -6.94M | -12.7M | 8.72M | 4.15M | 3.58M | 300K | 3.1M | -4.5M | -3.6M |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Share Repurchases | -8.77M | -8.77M | -11.99M | -9.35M | 0 | 0 | -12.88M | -18.64M | -6.25M | -4.06M | -17.23M | -1.52M | -5.84M | -3.03M | 0 | -11.96M | -28.65M | -20.44M | -5.86M | -41M | -6.99M | 0 | -10.13M | -15.32M | 0 | 0 | -119K | -1.7M | -400K | -4.6M | -5.1M |
| Other Financing | -31.12M | 0 | -2.6M | 0 | -13.06M | -25.64M | 0 | 0 | 14.28M | 34.71M | 19.71M | 26.53M | 25.18M | 27.43M | 21.63M | 14.09M | 5.77M | 2.75M | 19.84M | 551K | 6.51M | 0 | 0 | 0 | 0 | 0 | 0 | 100K | 0 | 0 | 0 |
| Net Change in Cash | 2.05M | -603K | 54.34M | 45.44M | -344.04M | 156.73M | 127.43M | -76.11M | 54.71M | -155.01M | 108.92M | 60.35M | 49.79M | 79.12M | 47.31M | 20.74M | 27.6M | -4.45M | 47.82M | -5.28M | 6.3M | 1.24M | 3.83M | -2.38M | 264K | 1.96M | 44K | -100K | -800K | 900K | 100K |
| Free Cash Flow | 208.6M | 91.8M | 124.66M | 72.53M | -161.46M | 186.37M | 122.36M | -4.12M | 59.44M | 74.74M | 65.39M | 40.93M | 43.05M | 44.52M | 45.97M | 48.66M | 9.92M | 31.92M | 18.88M | 17.87M | 12M | 21.86M | 18.18M | 12.16M | 16.2M | 18.09M | 8.77M | 0 | -100K | 7.9M | 5.2M |
| FCF Margin % | 9.56% | 4.12% | 5.23% | 3.21% | -7.08% | 14.16% | 9.63% | -0.33% | 4.25% | 5.78% | 17.24% | 11.98% | 13.92% | 14.19% | 14.51% | 16.1% | 3.49% | 13.79% | 9.22% | 9.5% | 5.95% | 13.88% | 24.07% | 11.33% | 18.45% | 26.2% | 15.6% | - | -0.25% | 25.99% | 21.14% |
| FCF Growth % | 210.71% | -26.36% | 71.87% | 144.92% | -186.63% | 52.31% | 3068.51% | -106.94% | -20.48% | 14.3% | 59.76% | -4.92% | -3.32% | -3.13% | -5.54% | 390.36% | -68.91% | 69.1% | 5.65% | 48.94% | -45.13% | 20.25% | 49.51% | -24.95% | -10.46% | 106.42% | - | 100% | -101.27% | 51.92% | -1.89% |
| FCF per Share | 8.30 | 3.69 | 5.11 | 3.01 | -6.76 | 8.56 | 5.67 | -0.19 | 2.75 | 3.58 | 3.79 | 2.48 | 2.75 | 2.92 | 3.12 | 3.44 | 0.72 | 2.13 | 1.30 | 1.17 | 0.77 | 1.45 | 1.22 | 0.81 | 1.06 | 1.25 | 0.65 | - | -0.01 | 0.66 | 0.39 |
| FCF Conversion (FCF/Net Income) | 3.46x | 245.69x | -1.73x | -5.60x | 0.84x | 2.59x | 2.56x | 1.01x | 5.56x | 2.25x | 1.43x | 1.22x | 2.30x | 1.58x | 1.61x | 1.44x | 1.07x | 1.83x | 1.24x | 1.80x | 1.23x | 1.35x | 5.06x | 1.02x | 1.43x | 1.58x | 1.08x | 1.57x | 0.92x | 1.53x | 1.38x |
| Interest Paid | 0 | 0 | 99.72M | 95.91M | 63.71M | 858K | 1.75M | 549K | 709K | 2.05M | 118K | 39K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Taxes Paid | 0 | 0 | 25.25M | 35.81M | 27.5M | 19.56M | 31.63M | 9.68M | 12.6M | 5.11M | 21.1M | 23M | 8.67M | 12.17M | 16.74M | 20.11M | 15.25M | 9.03M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Quick answers to the most common questions about buying ICUI stock.
ICU Medical, Inc. (ICUI) generated $179.8M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
ICU Medical, Inc. (ICUI) generated $91.8M 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.
ICU Medical, Inc. (ICUI) spent $88.0M 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, ICU Medical, Inc. (ICUI) spent $8.8M on share repurchases. This shows the company's commitment to returning capital to its equity investors.
Key Metrics
Top Statement Risk
Revenue contraction persists
Metrics are mathematically derived from official filings.
Earnings Quality Masked by Charges
Operating cash flow exceeded net income by 4.2x in Q2 2026, per recent filings, but trailing quarters show negative net income with positive OCF, indicating heavy non-cash charges and working capital swings.
The OCF/NI ratio of 4.20 in Q2 2026 is inflated by large D&A ($49.6M) and a working capital outflow, while net income is depressed by integration costs. Over the past year, OCF has been consistently positive despite net losses, suggesting that reported earnings understate cash generation due to non-cash amortization and restructuring. Investors should monitor whether the gap narrows as integration charges fade.
FCF Recovery Hinges on Volume
Free cash flow rebounded to $61.6M in Q2 2026, a 11.2% margin, from negative FCF in Q2 2025, according to quarterly data, but revenue declined 6.4% YoY, suggesting margin expansion may be temporary.
The sequential improvement in FCF from -$10.8M in Q2 2025 to $61.6M in Q2 2026 is driven by stronger operating cash flow and controlled capex, yet the top-line contraction raises questions about sustainability. If revenue continues to fall, the margin gains from cost cuts may not offset volume losses, and FCF could revert to prior levels.
Capital Intensity Remains Moderate
Capex averaged 3.4% of revenue in Q2 2026, per financial statements, down from 3.7% a year earlier, indicating disciplined investment despite the need to maintain pump install base.
The capex-to-revenue ratio has stayed in the 2-5% range over the past ten quarters, suggesting that the company is not in a heavy investment phase. This may reflect a mature product portfolio, but it also implies limited growth capex, which could constrain future expansion if the install base needs upgrading.
Working Capital Swings Distort Cash Flow
Working capital changes were a $14.5M outflow in Q2 2026, per recent data, following a $63.9M outflow in Q1, indicating volatile cash conversion tied to inventory and receivables management.
The large swings in working capital, particularly the $63.9M outflow in Q1 2026, suggest that cash flow is heavily influenced by timing of collections and inventory builds. This volatility complicates quarterly comparisons and may indicate inefficiencies in supply chain management, especially given the IV Solutions segment's exposure to commodity inputs.
Buybacks Resume Amid Integration
Share repurchases totaled $38.8M in Q2 2026, per cash flow data, after a $38.8M issuance in Q1, while dividends remain zero, indicating a shift toward returning capital to shareholders.
The company repurchased shares in Q2 2026, a notable change from prior quarters where buybacks were minimal or negative. This suggests management confidence in cash generation, but it also consumes cash that could be used for debt reduction, especially given the company's leverage from the Smiths Medical acquisition.
Cumulative Cash Outpaces Earnings
Over the last ten quarters, cumulative operating cash flow reached $503M versus cumulative net income of -$78M, per reported data, highlighting a persistent gap driven by non-cash charges.
The divergence between cumulative OCF and net income is stark, with OCF positive every quarter while net income was negative in seven of ten quarters. This indicates that the company's cash generation is fundamentally healthier than GAAP earnings suggest, but it also raises questions about the sustainability of the non-cash adjustments and whether they will reverse.
What Could Invalidate the Base Case
The cash flow statement obscures the true cost of integration, as SBC of $11.9M in Q2 2026 and acquisition-related cash outflows may understate the economic burden of the Smiths Medical deal.
While OCF appears robust, the $219.2M acquisition outflow in Q4 2025 and ongoing SBC expenses suggest that reported cash flow may not fully reflect the capital consumed by integration. Additionally, the low debt/equity ratio of 0.66% contradicts known acquisition financing, implying that off-balance-sheet or undisclosed liabilities could pose a risk. Investors should scrutinize the sustainability of working capital improvements and the potential for reversal in non-cash adjustments.