Free cash flow margin swung from 27.2% in Q1 2026 to 7.4% in Q2 2026, while $1.0B in buybacks in Q2 2026 signals a shift toward shareholder returns.
Tenet Healthcare Corporation (THC) 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 | May'02 | May'00 | May'99 | May'98 | May'97 | May'96 | May'95 |
|---|
| Cash from Operations | 4.01B | 3.54B | 2.05B | 2.37B | 1.08B | 1.57B | 3.41B | 1.23B | 1.05B | 1.2B | 558M | 1.03B | 687M | 589M | 593M | 497M | 472M | 425M | 208M | 326M | -462M | 763M | -82M | 838M | 1.82B | 869M | 582M | 403M | 404M | 195M | -7M |
| Operating CF Margin % | - | 16.61% | 9.91% | 11.55% | 5.65% | 8.05% | 19.31% | 6.67% | 5.73% | 6.26% | 2.84% | 5.51% | 4.14% | 5.31% | 6.5% | 5.74% | 5.71% | 4.71% | 2.42% | 4.03% | -5.47% | 9.16% | -0.94% | 8.34% | 13.07% | 7.21% | 5.1% | 3.7% | 4.08% | 2.24% | -0.09% |
| Operating CF Growth % | 385.94% | 72.94% | -13.77% | 119.21% | -30.93% | -53.98% | 176.32% | 17.54% | -12.58% | 115.05% | -45.61% | 49.34% | 16.64% | -0.67% | 19.32% | 5.3% | 11.06% | 104.33% | -36.2% | 170.56% | -160.55% | 1030.49% | -109.79% | -53.91% | 109.21% | 49.31% | 44.42% | -0.25% | 107.18% | 2885.71% | -104.76% |
| Net Income | 2.24B | 1.41B | 4.06B | 1.31B | 1B | 1.48B | 768M | 171M | 459M | -320M | 176M | 78M | 76M | -104M | 133M | 94M | 1.15B | 197M | 32M | -84M | -813M | -288M | -2.81B | -1.48B | 785M | 643M | 321M | 249M | 378M | -207M | 473M |
| Depreciation & Amortization | 898M | 886M | 818M | 870M | 841M | 855M | 857M | 850M | 802M | 870M | 850M | 797M | 849M | 545M | 430M | 398M | 380M | 413M | 371M | 336M | 337M | 327M | 388M | 380M | 604M | 554M | 533M | 556M | 460M | 443M | 419M |
| Stock-Based Compensation | 88M | 104M | 67M | 66M | 56M | 56M | 44M | 42M | 46M | 59M | 68M | 69M | 51M | 36M | 32M | 24M | 22M | 23M | 33M | 40M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Deferred Taxes | 137M | 0 | -103M | 52M | 209M | 250M | -128M | 144M | 147M | 200M | 41M | 42M | 30M | -67M | 92M | 81M | -952M | 20M | -14M | 2M | -68M | -62M | -545M | -563M | 90M | 48M | 2M | 101M | 131M | -219M | 247M |
| Other Non-Cash Items | -246M | 1.19B | -2.94B | 4M | 119M | -332M | 274M | 344M | -41M | 1.9B | 1.13B | 1.68B | 1.34B | 1.32B | 826M | 885M | 758M | 519M | 520M | 660M | 1.06B | 832M | 3.87B | 3.35B | 1.55B | 1.1B | 1.21B | 1.12B | 462M | 1.39B | 150M |
| Working Capital Changes | 456M | -44M | 136M | 71M | -1.14B | -737M | 1.59B | -318M | -364M | -1.5B | -1.71B | -1.64B | -1.66B | -1.14B | -920M | -985M | -888M | -747M | -734M | -628M | -975M | -46M | -988M | -855M | -711M | -527M | -1.2B | -1.45B | -1.03B | -998M | -940M |
| Change in Receivables | -53M | 20M | 245M | -29M | -140M | -197M | 195M | -247M | -134M | -1.45B | -1.6B | -1.63B | -1.9B | -987M | -868M | -850M | -731M | -646M | -647M | -623M | -453M | -609M | -889M | -1.1B | -1.07B | -735M | -1.14B | -1.35B | -988M | -791M | -709M |
| Change in Inventory | 225M | -73M | -86M | -139M | -64M | -52M | -145M | -94M | 17M | -35M | -83M | -130M | -314M | -203M | -59M | -35M | -15M | -22M | -1M | -28M | -46M | 8M | -39M | -15M | -104M | 45M | 51M | -114M | 0 | -7M | -91M |
| Change in Payables | 68M | 0 | -30M | 215M | -898M | -584M | 1.3B | 12M | -142M | -10M | -51M | 68M | 505M | 38M | 9M | -32M | -87M | 12M | -29M | -99M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Cash from Investing | -1.29B | -1.27B | 3.43B | -969M | -808M | -714M | -1.61B | -619M | -115M | 21M | -430M | -1.32B | -1.32B | -2.16B | -662M | -503M | -420M | -125M | -274M | -520M | -379M | -392M | -12M | -333M | -1.23B | -574M | -36M | -1.15B | -1.08B | -1.13B | -800M |
| Capital Expenditures | -992M | -1.01B | -931M | -751M | -762M | -658M | -540M | -670M | -617M | -707M | -875M | -842M | -933M | -691M | -508M | -475M | -463M | -456M | -547M | -743M | -693M | -578M | -558M | -833M | -889M | -630M | -657M | -1.24B | -1.21B | -406M | -472M |
| CapEx % of Revenue | 4.55% | 4.74% | 4.51% | 3.65% | 3.97% | 3.38% | 3.06% | 3.63% | 3.37% | 3.69% | 4.46% | 4.52% | 5.62% | 6.23% | 5.57% | 5.49% | 5.6% | 5.06% | 6.37% | 9.19% | 8.2% | 6.94% | 6.36% | 8.29% | 6.39% | 5.23% | 5.76% | 11.38% | 12.26% | 4.67% | 6.13% |
| Acquisitions | 105M | -308M | -571M | -224M | -234M | -1.22B | -1.18B | -25M | -113M | -50M | -156M | -1.07B | -440M | -1.52B | -211M | -84M | -78M | 0 | -92M | -36M | -28M | 0 | 0 | -39M | -324M | 0 | 0 | 0 | 0 | 0 | 0 |
| Investments | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | -385M | 40M | 4.96B | 60M | 204M | 1.24B | 94M | 56M | 564M | 823M | 539M | 539M | -1M | 31M | 40M | -3M | 37M | 232M | 159M | 174M | 352M | 139M | 549M | 646M | -14M | 56M | 621M | 91M | 130M | -719M | -328M |
| Cash from Financing | -3.18B | -2.4B | -3.69B | -1.03B | -1.78B | -936M | 385M | -763M | -1.13B | -1.33B | 232M | 454M | 715M | 1.32B | 320M | -286M | -337M | -117M | 1M | -18M | 252M | 348M | 129M | -96M | -1.11B | -1.32B | -727M | 571M | 668M | 653M | 398M |
| Debt Issued (Net) | -80M | -96M | -2.22B | -172M | -828M | -349M | 525M | -482M | -289M | -406M | 606M | 889M | 740M | 1.78B | 764M | 137M | -285M | -406M | -1M | -22M | 243M | 335M | 119M | 102M | -641M | -1.56B | -787M | 549M | 587M | 605M | -29M |
| Equity Issued (Net) | -1.66B | -1.44B | -672M | -200M | -250M | 0 | 23M | 12M | 16M | 7M | 4M | -25M | 26M | -378M | -418M | -374M | 0 | 334M | 0 | 0 | 0 | 12M | 2M | -203M | -421M | 269M | 45M | 36M | 97M | 71M | 432M |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -14M | -24M | -32M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Share Repurchases | -1.66B | -1.44B | -672M | -200M | -250M | 0 | 0 | 0 | 0 | 0 | 0 | -40M | 0 | -400M | -418M | -374M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -208M | -715M | 0 | 0 | 0 | 0 | 0 | 0 |
| Other Financing | -1.44B | -868M | -793M | -663M | -703M | -587M | -163M | -293M | -845M | -982M | -374M | -395M | -25M | -55M | -12M | -25M | -28M | -38M | 2M | 4M | 9M | 1M | 8M | 5M | -50M | -28M | 15M | -14M | -16M | -23M | -5M |
| Net Change in Cash | -455M | -136M | 1.79B | 370M | -1.51B | -82M | 2.18B | -149M | -200M | -105M | 360M | 163M | 80M | -251M | 251M | -292M | -285M | 183M | -65M | -212M | -589M | 719M | 35M | 409M | -73M | 106M | 6M | -12M | -68M | -66M | -158M |
| Free Cash Flow | 3.02B | 2.53B | 1.12B | 1.62B | 321M | 910M | 2.87B | 563M | 432M | 493M | -317M | 184M | -246M | -102M | 85M | 22M | -4M | -31M | -339M | -403M | -1.1B | 185M | -640M | -34M | 1.19B | 212M | -656M | -810M | -2M | -175M | -1.7B |
| FCF Margin % | 13.86% | 11.87% | 5.4% | 7.9% | 1.67% | 4.67% | 16.25% | 3.05% | 2.36% | 2.57% | -1.62% | 0.99% | -1.48% | -0.92% | 0.93% | 0.25% | -0.05% | -0.34% | -3.95% | -4.99% | -13.07% | 2.22% | -7.3% | -0.34% | 8.54% | 1.76% | -5.75% | -7.44% | -0.02% | -2.01% | -22.06% |
| FCF Growth % | 93.41% | 126.7% | -31.24% | 405.61% | -64.73% | -68.26% | 409.24% | 30.32% | -12.37% | 255.52% | -272.28% | 174.8% | -141.18% | -220% | 286.36% | 650% | 87.1% | 90.86% | 15.88% | 63.53% | -697.3% | 128.91% | -1782.35% | -102.86% | 460.38% | 132.32% | 19.01% | -40400% | 98.86% | 89.71% | -4373.68% |
| FCF per Share | 36.00 | 27.85 | 11.40 | 15.49 | 2.90 | 8.38 | 26.98 | 5.44 | 4.16 | 4.90 | -3.19 | 1.86 | -2.45 | -1.00 | 0.78 | 0.18 | -0.03 | -0.24 | -2.83 | -3.41 | -9.39 | 1.58 | -5.49 | -0.29 | 9.68 | 1.80 | -5.58 | -6.93 | -0.02 | -2.19 | -22.54 |
| FCF Conversion (FCF/Net Income) | 1.35x | 2.52x | 0.64x | 3.89x | 2.64x | 1.72x | 8.54x | -5.73x | 10.09x | -1.70x | -2.91x | -7.33x | 57.25x | -4.40x | 3.90x | 6.06x | 0.41x | 2.27x | 8.32x | -3.66x | 0.58x | -1.05x | 0.03x | -0.54x | 2.32x | 1.35x | 1.93x | 1.62x | 1.55x | -0.77x | -0.02x |
| Interest Paid | 490M | 865M | 851M | 882M | 848M | 937M | 962M | 946M | 976M | 939M | 932M | 859M | 726M | 426M | 376M | 347M | 402M | 439M | 391M | 395M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Taxes Paid | 95M | 0 | 1.27B | 243M | 161M | 92M | 12M | 12M | 25M | 56M | 33M | 7M | 8M | 6M | 13M | 10M | -34M | 43M | 4M | 162M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Quick answers to the most common questions about buying THC stock.
Tenet Healthcare Corporation (THC) generated $3.54B in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
Tenet Healthcare Corporation (THC) generated $2.53B 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.
Tenet Healthcare Corporation (THC) spent $1.01B 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, Tenet Healthcare Corporation (THC) spent $1.44B on share repurchases. This shows the company's commitment to returning capital to its equity investors.
Key Metrics
Top Statement Risk
USPI concentration and revenue deferrals
Metrics are mathematically derived from official filings.
Cash Conversion Volatility Signals Timing Distortions
Tenet's operating cash flow to net income ratio swung from 0.71 in Q2 2026 to 2.34 in Q1 2026, per reported financials, indicating significant timing effects in cash collections.
The wide quarterly swings in OCF/NI, from -1.04 in Q4 2024 to 3.25 in Q2 2025, suggest that reported net income is not consistently translating into cash. The Q2 2026 ratio of 0.71, despite strong net income, may reflect working capital outflows, while Q1 2026's 2.34 indicates catch-up collections. Investors should monitor the sustainability of cash conversion, as the gap between net income and operating cash flow appears driven by timing of receivables and payables rather than core profitability.
Free Cash Flow Rebound Masks Quarterly Volatility
Free cash flow margin improved to 27.2% in Q1 2026 from -13.0% in Q4 2024, per SEC filings, but Q2 2026 dropped to 7.4%, highlighting lumpiness.
The trajectory of FCF is highly erratic, with a negative quarter in Q4 2024 (-$661M) followed by a strong Q1 2026 ($1.5B). This volatility likely stems from working capital swings and acquisition timing, as evidenced by the $1B working capital outflow in Q4 2024. The recent improvement in FCF margins, averaging around 14% over the last four quarters, suggests operational strength, but the inconsistency warrants caution in extrapolating forward.
Capital Intensity Remains Moderate but Spikes in Q4
CapEx as a percentage of revenue averaged 4.4% over the last ten quarters, per reported data, but spiked to 6.6% in Q4 2025, indicating seasonal investment.
Tenet's capital expenditure intensity is relatively low for a hospital operator, with CapEx/Revenue ranging from 2.8% to 6.6%. The Q4 spikes in both 2024 and 2025 suggest year-end investment cycles, possibly for facility upgrades or ASC expansion. The moderate capital intensity supports the thesis that USPI is capital-light, but the elevated Q4 spending may indicate maintenance capex needs that could pressure FCF if sustained.
Working Capital Swings Drive Cash Flow Volatility
Working capital changes swung from -$1.0B in Q4 2024 to +$493M in Q1 2026, per financial statements, indicating significant timing effects on operating cash flow.
The working capital line is the primary driver of OCF volatility, with a massive outflow in Q4 2024 and large inflows in Q1 2026 and Q3 2025. This pattern suggests that Tenet's cash flow is heavily influenced by the timing of receivables collections and payables, possibly due to government supplemental payments or managed care settlements. The positive working capital contributions in recent quarters may indicate improved collections, but the inconsistency warrants monitoring for potential reversals.
Aggressive Buybacks and Acquisitions Reshape Capital Allocation
Tenet deployed over $2.5B on share repurchases in the last two quarters, per reported cash flow data, while acquisitions netted $121M in Q2 2026, signaling a shift toward shareholder returns.
The capital deployment strategy appears to favor buybacks, with $1.0B in Q2 2026 and $318M in Q1 2026, alongside ongoing acquisition activity. The net acquisition outflows in several quarters, including -$449M in Q1 2024, indicate continued portfolio reshaping, likely toward USPI. The combination of buybacks and acquisitions suggests management is confident in cash generation, but the reliance on debt for these activities could strain the balance sheet if cash flows falter.
Cash Flow Statement Obscures Timing and Non-Controlling Interests
The cash flow statement shows no dividends and minimal SBC, but non-controlling interests in USPI and revenue deferrals may obscure true cash generation, per recent risk flags.
While the reported operating cash flow appears robust, the absence of dividend payments and low SBC charges may understate the cash needs of the business. The significant non-controlling interests in USPI, as noted in the company intelligence, mean that a portion of the cash flow belongs to physician partners, not Tenet shareholders. Additionally, revenue deferral dynamics could cause reported cash flows to diverge from underlying operational performance, warranting scrutiny of the quality of cash generation.