Free cash flow turned negative at -$1.9M in 2026Q2 as capex jumped to 23.0% of revenue, despite operating cash flow of $41.8M, reflecting heavy reinvestment and working capital swings.
TransMedics Group, Inc. (TMDX) cash flow statement — 10-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 |
|---|
| Cash from Operations | 170.46M | 192.84M | 48.8M | -13.03M | -45.82M | -28.86M | -30.27M | -32.29M | -25.98M | -23.1M | -24.11M |
| Operating CF Margin % | - | 31.85% | 11.05% | -5.39% | -49.02% | -95.38% | -118.04% | -136.78% | -199.62% | -300.56% | -388.29% |
| Operating CF Growth % | 1895.12% | 295.14% | 474.6% | 71.57% | -58.73% | 4.63% | 6.26% | -24.25% | -12.49% | 4.19% | - |
| Net Income | 151.7M | 190.29M | 35.46M | -25.03M | -36.23M | -44.22M | -28.75M | -33.55M | -23.76M | -20.82M | -24.07M |
| Depreciation & Amortization | 48.29M | 27.18M | 19.76M | 8.18M | 3.48M | 1.82M | 1.58M | 1.22M | 769K | 630K | 426K |
| Stock-Based Compensation | 47.04M | 36.86M | 33.22M | 19.79M | 10.32M | 6.88M | 2.41M | 854K | 144K | 70K | 45K |
| Deferred Taxes | -77.61M | -83.54M | 0 | -1.66M | 0 | 0 | -431K | 336K | 1.01M | -316K | 292K |
| Other Non-Cash Items | 18.89M | 4.79M | 5.36M | 30.04M | 3.37M | 3.65M | 511K | 475K | 177K | 93K | 65K |
| Working Capital Changes | -25.16M | 17.25M | -45M | -44.35M | -26.76M | 3M | -5.59M | -1.63M | -4.33M | -2.75M | -872K |
| Change in Receivables | -5.9M | 13.95M | -34.31M | -33.82M | -21.68M | 840K | -218K | -3.17M | -2.51M | 454K | -758K |
| Change in Inventory | -27.57M | -7.72M | -8.35M | -28.09M | -8.02M | -4.89M | -1.74M | -4.12M | -2.7M | -2.5M | -1.59M |
| Change in Payables | 4.24M | -19K | -1.4M | 6.96M | -3.27M | 5.09M | -5.8M | 3.44M | 164K | -735K | 1.06M |
| Cash from Investing | -103.54M | -59.25M | -129.3M | -193.95M | 54.51M | 29.27M | -41.6M | -60.5M | 12.31M | 24.86M | -39.67M |
| Capital Expenditures | -103.54M | -59.25M | 0 | -151.85M | -11.91M | -3.52M | -455K | -165K | -418K | -263K | -1.48M |
| CapEx % of Revenue | 15.49% | 9.79% | 29.38% | 62.84% | 12.74% | 11.63% | 1.77% | 0.7% | 3.21% | 3.42% | 23.8% |
| Acquisitions | 0 | 0 | 441K | -14.89M | 107K | 0 | 41.14M | 60.34M | 0 | 0 | 0 |
| Investments | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | 0 | 0 | -129.74M | -27.21M | -107K | 0 | -41.14M | -60.34M | 12.72M | 25.12M | -38.19M |
| Cash from Financing | 15.23M | 16.86M | 22.87M | 400.42M | 167.93M | 1.39M | 75.55M | 92.72M | 22.06M | 3K | 63.54M |
| Debt Issued (Net) | 0 | 0 | 0 | 445.38M | 22.46M | 0 | 0 | 0 | 24.36M | 0 | 0 |
| Equity Issued (Net) | 15.69M | -138K | 22.87M | 7.11M | 139.85M | 1.39M | 74.97M | 97.37M | 0 | 0 | 63.61M |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Share Repurchases | 0 | -138K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Other Financing | -453K | 17M | 0 | -52.07M | 5.61M | 0 | 584K | -4.64M | -2.3M | 3K | -64K |
| Net Change in Cash | 81.35M | 151.72M | -58.16M | 193.63M | 175.6M | 999K | 4.49M | -149K | 8.3M | 2.1M | -243K |
| Free Cash Flow | 66.92M | 133.59M | -80.94M | -192.09M | -57.72M | -32.38M | -30.72M | -32.45M | -26.4M | -23.36M | -25.59M |
| FCF Margin % | 10.01% | 22.06% | -18.33% | -79.5% | -61.76% | -107.01% | -119.82% | -137.48% | -202.83% | -303.98% | -412.1% |
| FCF Growth % | 285.64% | 265.04% | 57.86% | -232.77% | -78.25% | -5.41% | 5.33% | -22.91% | -13.02% | 8.7% | - |
| FCF per Share | 1.64 | 3.30 | -2.30 | -5.91 | -1.95 | -1.17 | -1.24 | -2.28 | -1.37 | -1.61 | -1.77 |
| FCF Conversion (FCF/Net Income) | 0.44x | 1.01x | 1.38x | 0.52x | 1.26x | 0.65x | 1.05x | 0.96x | 1.09x | 1.11x | 1.00x |
| Interest Paid | 0 | 0 | 0 | 8.09M | 0 | 3.33M | 0 | 0 | 0 | 0 | 0 |
| Taxes Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Quick answers to the most common questions about buying TMDX stock.
TransMedics Group, Inc. (TMDX) generated $192.8M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
TransMedics Group, Inc. (TMDX) generated $133.6M 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.
TransMedics Group, Inc. (TMDX) spent $59.3M 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, TransMedics Group, Inc. (TMDX) spent $0.1M on share repurchases. This shows the company's commitment to returning capital to its equity investors.
Key Metrics
Top Statement Risk
Working capital volatility and capex intensity
Metrics are mathematically derived from official filings.
Earnings Quality Masked by Working Capital Swings
Operating cash flow exceeded net income in most quarters, with OCF/NI ratios above 2.6 in 2025Q2 and 2026Q2, but 2025Q4's ratio of 0.33 signals a one-time gain, per reported financials.
The persistent gap between net income and operating cash flow is largely driven by working capital changes, which swung from -$44.4M in 2025Q1 to +$40.2M in 2025Q2, indicating significant timing effects. The 2025Q4 net income of $105.4M versus operating cash flow of $34.5M suggests non-operating gains that may not recur, warranting scrutiny of earnings quality.
Free Cash Flow Volatility Amid Expansion
Free cash flow swung from -$47.6M in 2024Q1 to +$82.5M in 2025Q2, then turned negative again in 2026Q1, reflecting erratic capital spending and working capital needs, as per quarterly data.
FCF margins ranged from -49.2% to +52.4% over the past ten quarters, with recent quarters showing negative FCF due to elevated capex (23% of revenue in 2026Q2). This volatility suggests the company is in a heavy investment phase, and investors should monitor whether these investments translate into sustainable cash generation.
Capital Intensity Surges to Support Growth
Capital expenditures as a percentage of revenue jumped from 5.3% in 2025Q3 to 23.0% in 2026Q2, per reported figures, indicating a strategic push to expand capacity despite slowing revenue growth.
The sharp increase in capex, from $7.6M in 2025Q3 to $43.7M in 2026Q2, suggests management is investing heavily in fixed assets, possibly to support future demand. However, with revenue growth decelerating to 20.7% in 2026Q2, the payback on this investment is uncertain, and capital intensity may pressure near-term FCF.
Working Capital Swings Distort Cash Flow
Working capital changes ranged from -$44.4M in 2025Q1 to +$40.2M in 2025Q2, per financial statements, indicating significant volatility in collections, inventory, or payables that obscures underlying cash generation.
The large swings in working capital, particularly the negative contributions in 2025Q1 and 2026Q2, suggest that cash flow is heavily influenced by timing of receivables and inventory builds. This volatility complicates the assessment of operational efficiency and may indicate aggressive revenue recognition or supply chain disruptions, warranting further investigation.
No Capital Returns, All Reinvestment
TransMedics has paid no dividends and made no buybacks over the past ten quarters, per reported data, with all cash flow directed toward capex and operations.
The absence of shareholder returns indicates a reinvestment strategy focused on growth, consistent with the elevated capex. However, given the negative FCF in recent quarters, the company may need to rely on external financing or existing cash reserves to fund its expansion, which could strain the balance sheet if cash generation does not improve.
Cumulative Earnings Outpace Cash Flow
Over the past ten quarters, cumulative net income of $247.8M exceeds cumulative operating cash flow of $307.6M, but cumulative FCF is negative at -$38.3M, per reported data, highlighting heavy reinvestment.
While operating cash flow has been positive overall, the cumulative FCF deficit underscores the capital-intensive nature of the business. The gap between net income and FCF, driven by capex and working capital, suggests that reported profitability may not translate into distributable cash, and investors should focus on cash generation rather than earnings.
What the Cash Flow Statement Obscures
Stock-based compensation totaled $18.6M in 2026Q2, per reported figures, adding back to operating cash flow but not reflecting actual cash outlay, potentially overstating cash generation.
SBC is a non-cash expense that inflates operating cash flow relative to cash earnings, and with cumulative SBC of $91.8M over ten quarters, it represents a significant drag on shareholder value. Additionally, the absence of acquisition data in most quarters may hide cash outflows for M&A, and the sharp rise in capex could include capitalized costs that obscure true maintenance requirements, warranting closer scrutiny of cash flow quality.