Liquidity is tightening as cash reserves fell to $28.4 million in 2026Q1 from $152.8 million in 2023Q4, reflecting the heavy capital deployment required for ongoing acquisitions.
| 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 | 83.74M | 75.06M | 74.94M | 81.98M | 58.54M | 76.41M | 100M | 62.45M | 73M | 56.53M | 51.05M | 41.24M | 45.19M | 44.8M | 39.25M | 32.66M | 30.52M | 30.94M | 30.17M | 19.05M | 18.47M | 18.25M | 17.88M | 17.53M | 19.52M | 15.17M | 8.86M | 5.05M | 5M | 3.8M | 4.7M |
| Operating CF Margin % | - | 9.61% | 11.16% | 13.55% | 10.58% | 15.43% | 23.64% | 12.96% | 16.08% | 13.65% | 14.32% | 12.45% | 14.81% | 16.96% | 15.57% | 13.78% | 14.45% | 15.36% | 16.08% | 12.56% | 13.66% | 13.81% | 15.12% | 16.61% | 20.61% | 18.74% | 14.02% | 10.11% | 11.36% | 9.79% | 14.6% |
| Operating CF Growth % | 223.79% | 0.16% | -8.59% | 40.04% | -23.39% | -23.59% | 60.13% | -14.46% | 29.15% | 10.73% | 23.78% | -8.74% | 0.89% | 14.13% | 20.19% | 6.99% | -1.37% | 2.56% | 58.41% | 3.11% | 1.21% | 2.06% | 2.01% | -10.2% | 28.68% | 71.22% | 75.47% | 1% | 31.58% | -19.15% | 95.83% |
| Net Income | 10.55M | 58.01M | 45.6M | 37.22M | 43.41M | 57.92M | 52.49M | 57.26M | 48.84M | 27.72M | 26.27M | 31.69M | 30.42M | 21M | 26.22M | 29.78M | 24.7M | 19.97M | 10M | 8.74M | 6.3M | 8.79M | 6.68M | 7.33M | 8.49M | 7.07M | 3.73M | 2.39M | 1.6M | 2.4M | 1.6M |
| Depreciation & Amortization | 22.52M | 22.39M | 18.68M | 15.7M | 14.74M | 11.59M | 10.53M | 10.1M | 9.76M | 9.71M | 8.78M | 7.95M | 6.74M | 5.56M | 5.29M | 5.45M | 5.67M | 5.9M | 5.97M | 4.99M | 4.49M | 4.31M | 4.32M | 3.59M | 2.96M | 2.57M | 2.33M | 2.09M | 2.1M | 1.9M | 1.7M |
| Stock-Based Compensation | 6.5M | 8.27M | 7.82M | 7.24M | 7.26M | 7.87M | 7.92M | 6.99M | 5.94M | 5.03M | 4.96M | 4.49M | 3.36M | 2.74M | 2.1M | 2.03M | 1.29M | 1.57M | 1.57M | 1.28M | 1.04M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Deferred Taxes | 9.45M | 11.41M | 5.37M | 4.49M | 4.31M | 5.69M | -258K | 4.65M | 4.81M | -4.55M | 2.98M | 7M | 6.28M | 2.37M | 3.74M | 3.83M | 452K | 714K | 1.92M | 313K | -373K | 44K | 146K | 474K | -319K | -351K | 0 | 0 | 300K | 0 | 0 |
| Other Non-Cash Items | 24.46M | 2.18M | 9.88M | 22.27M | 10.24M | 5.12M | 5.67M | -560K | 2.92M | 4.29M | 4.19M | 3.49M | 3.33M | 11.02M | 6.37M | -1.25M | 2.16M | 2.93M | 9.93M | 7.84M | 8.16M | 7.06M | 7.79M | 8.01M | 10.83M | 10.25M | 5.35M | 3.75M | -100K | 2.8M | 2.1M |
| Working Capital Changes | -18.33M | -27.19M | -12.4M | -4.93M | -21.43M | -11.78M | 23.64M | -15.98M | 732K | 14.32M | 3.87M | -13.38M | -4.94M | 2.1M | -4.47M | -7.19M | -3.75M | -148K | 772K | -4.11M | -1.15M | -1.95M | -1.05M | -1.87M | -2.43M | -4.36M | -2.56M | -3.19M | -2.1M | -3.3M | -700K |
| Change in Receivables | -10.98M | -9.06M | -11.89M | -6M | -10.28M | -10.96M | 2.56M | -6.38M | -3.43M | -3.45M | -3.27M | -5.52M | -5.39M | -5.39M | -1.66M | -6.14M | -4.47M | -303K | -1.57M | -3.54M | -3.43M | -3.22M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Change in Inventory | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 4.21M | -742K | -794K | -1.45M | -2.33M | -2.15M | 1.8M | -1.15M | 0 | -24.04M | -19.97M | 252K | -87K | -73K | -29.5M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Change in Payables | -2.57M | -7.8M | 0 | 15K | -7.75M | 0 | 0 | -4.21M | 4.88M | 6.98M | 2.99M | -7.01M | 1.87M | 4.83M | -340K | 1.19M | -292K | 1.87M | 1.87M | -655K | 1.62M | 1.04M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Cash from Investing | -70.08M | -36.71M | -149.45M | -45.02M | -81.27M | -124.14M | -51.2M | -37.99M | -23.91M | -43.58M | -32.49M | -32.24M | -22.88M | -52.45M | -14.1M | -31.61M | -21.63M | -7.33M | -24.88M | -23.54M | -8.85M | -12.18M | -4.96M | -5.03M | -6.63M | -3.38M | -2.8M | -2.1M | -2.5M | -2.1M | -2M |
| Capital Expenditures | -16.86M | -14.07M | -9.19M | -9.29M | -8.25M | -8.2M | -7.64M | -10.19M | -7.19M | -7.09M | -8.26M | -6.26M | -5.17M | -4.64M | -4.23M | -3.22M | -3.67M | -3.88M | -4.3M | -4.03M | -4.66M | -10.85M | -4.97M | -5.13M | -5.57M | -3.34M | -2.83M | -2.1M | -2.4M | -1.8M | -2M |
| CapEx % of Revenue | 2.43% | 1.8% | 1.37% | 1.54% | 1.49% | 1.66% | 1.81% | 2.11% | 1.58% | 1.71% | 2.32% | 1.89% | 1.69% | 1.76% | 1.68% | 1.36% | 1.74% | 1.92% | 2.29% | 2.66% | 3.44% | 8.21% | 4.2% | 4.86% | 5.87% | 4.13% | 4.47% | 4.2% | 5.45% | 4.64% | 6.21% |
| Acquisitions | -43.34M | 0 | -142.04M | -36.87M | -74.28M | -116.09M | -43.56M | -27.87M | -16.37M | -36.56M | -24.29M | -26.05M | -17.76M | -48.5M | -10.17M | -9.45M | -17.28M | -1.18M | -20.68M | -20.02M | -5.21M | -1.51M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Investments | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | -9.88M | -22.64M | 1.77M | 1.15M | 1.26M | 152K | 0 | 64K | -349K | 81K | 61K | 71K | 5.54M | 2.33M | 303K | -18.93M | -17.96M | 57K | 108K | 21K | -1.14M | 178K | 11K | 105K | -1.07M | -32K | 25K | 1K | -100K | -300K | 0 |
| Cash from Financing | -24.4M | -44.14M | -36.95M | 84.27M | 25.76M | 43.38M | -39.42M | -24.27M | -47.66M | -11.06M | -14.29M | -7.5M | -20.94M | 8.88M | -23.46M | -245K | -6.14M | -27.3M | -3.16M | 1.51M | -11.03M | -11.62M | -9.19M | -3.29M | -13.4M | -5.75M | -8.02M | -5.25M | -1.7M | -1.1M | -500K |
| Debt Issued (Net) | 36.83M | 8.06M | 4.3M | -39.15M | 64.19M | 93.1M | -31.04M | 6.57M | -20.04M | 6.77M | 1.2M | 8.62M | -6.33M | 22.14M | -6.53M | 17.75M | 4.09M | -12.38M | 3.51M | 6.41M | -245K | -153K | -52K | -38K | -701K | -1.54M | 862K | -32K | -100K | -100K | 200K |
| Equity Issued (Net) | -5.57M | -5.57M | 0 | 163.65M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -4.66M | -1.4M | -5.59M | 495K | 568K | -5.4M | -6.2M | -3.81M | 1.44M | -7.51M | 336K | -5.88M | -3.28M | 0 | 0 | 0 |
| Dividends Paid | -27.36M | -27.36M | -26.54M | -24.13M | -21.32M | -18.77M | -4.11M | -14.55M | -11.66M | -10.07M | -8.51M | -7.45M | -5.87M | -4.84M | -9.02M | -3.79M | -9.58M | -9.44M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Share Repurchases | -5.57M | -5.57M | 0 | 0 | 0 | 0 | 0 | 502K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -4.66M | -1.4M | -5.59M | 0 | 0 | -5.52M | -8M | -5.58M | -20K | -10.51M | -1.94M | -6.28M | -3.41M | 0 | 0 | 0 |
| Other Financing | -28.3M | -19.27M | -14.71M | -16.1M | -17.11M | -30.96M | -4.28M | -16.29M | -15.95M | -7.77M | -6.98M | -4.94M | -8.74M | -8.42M | -7.91M | -9.55M | -8.82M | 101K | 128K | -5.47M | -5.38M | -5.27M | -5.33M | -4.7M | -5.19M | -4.54M | -3M | -1.94M | -1.6M | -1M | -700K |
| Net Change in Cash | -10.74M | -5.79M | -111.46M | 121.23M | 3.03M | -4.35M | 9.37M | 180K | 1.44M | 1.89M | 4.27M | 1.51M | 1.37M | 1.23M | 1.69M | 804K | 2.75M | -3.68M | 2.14M | -2.98M | -1.4M | -5.55M | 3.73M | 9.21M | -511K | 6.05M | -1.96M | -2.3M | 800K | 600K | 2.2M |
| Free Cash Flow | 66.87M | 60.99M | 65.75M | 72.68M | 50.29M | 68.2M | 92.36M | 52.26M | 65.81M | 49.43M | 42.79M | 34.98M | 40.03M | 40.16M | 35.02M | 29.43M | 26.85M | 27.07M | 25.87M | 15.01M | 13.82M | 7.4M | 12.91M | 12.4M | 13.96M | 11.83M | 6.03M | 2.95M | 2.6M | 2M | 2.7M |
| FCF Margin % | 9.62% | 7.81% | 9.79% | 12.02% | 9.09% | 13.78% | 21.84% | 10.84% | 14.5% | 11.94% | 12% | 10.56% | 13.12% | 15.21% | 13.89% | 12.42% | 12.71% | 13.44% | 13.79% | 9.9% | 10.22% | 5.6% | 10.92% | 11.74% | 14.73% | 14.61% | 9.54% | 5.91% | 5.91% | 5.15% | 8.39% |
| FCF Growth % | 19.23% | -7.25% | -9.53% | 44.53% | -26.27% | -26.15% | 76.73% | -20.59% | 33.14% | 15.52% | 22.33% | -12.61% | -0.33% | 14.69% | 18.97% | 9.63% | -0.81% | 4.62% | 72.34% | 8.66% | 86.62% | -42.67% | 4.15% | -11.18% | 18.02% | 96.02% | 104.33% | 13.58% | 30% | -25.93% | 200% |
| FCF per Share | 4.41 | 4.02 | 4.36 | 5.12 | 3.87 | 5.29 | 7.20 | 4.10 | 5.20 | 3.93 | 3.42 | 2.82 | 3.28 | 3.32 | 2.94 | 2.46 | 2.26 | 2.29 | 2.15 | 1.28 | 1.18 | 0.61 | 1.04 | 1.03 | 1.10 | 0.92 | 0.56 | 0.30 | 0.24 | 0.18 | 0.26 |
| FCF Conversion (FCF/Net Income) | 6.34x | 4.98x | 2.83x | 5.59x | 2.07x | 2.75x | 3.27x | 2.22x | 7.23x | 2.54x | 2.48x | 1.85x | 2.29x | 3.52x | 2.19x | 1.56x | 1.95x | 2.63x | 3.02x | 2.14x | 2.93x | 2.08x | 2.68x | 2.39x | 2.30x | 2.15x | 2.37x | 2.11x | 3.13x | 1.58x | 2.94x |
| Interest Paid | 5.1M | 0 | 7.21M | 8.65M | 5.69M | 1.35M | 1.2M | 1.89M | 2.36M | 2.11M | 784K | 884K | 1.1M | 352K | 639K | 325K | 179K | 324K | 484K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Taxes Paid | 4.45M | 0 | 4.83M | 4.93M | 7.62M | 12.21M | 7.68M | 9.86M | 9.18M | 8.54M | 10.58M | 7.78M | 9.25M | 4.11M | 6.36M | 9.04M | 7.8M | 8.45M | 4.4M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Labor cost inflation pressure
As reported in recent financial statements, USPH exhibits extreme variance in its OCF/NI ratio, which swung from a negative 3.39 in 2023Q4 to a positive 4.24 in 2024Q2, indicating that net income is a poor proxy for the company's actual cash-generating capability in any given quarter.
The significant divergence between net income and operating cash flow suggests that non-cash items and accounting adjustments related to the partnership model frequently distort bottom-line performance. Investors should monitor whether these fluctuations represent genuine operational volatility or merely the timing of cash distributions to minority partners.
Based on quarterly data, USPH's free cash flow margins have demonstrated high sensitivity to operational cycles, oscillating from a negative 4.8% in 2025Q1 to a peak of 19.3% in 2025Q2, reflecting a lack of consistent cash flow generation relative to the company's revenue base.
This erratic trajectory implies that the company's ability to retain cash after capital expenditures is highly dependent on short-term working capital management rather than structural margin expansion. The inability to maintain a stable FCF margin warrants further investigation into the predictability of the company's core clinical operations.
According to recent SEC filings, USPH experienced a substantial working capital outflow of $28.3 million in 2025Q1, which directly contributed to a negative operating cash flow for that period, highlighting the company's vulnerability to timing differences in healthcare billing and collections cycles.
The recurring, large-scale swings in working capital suggest that the company's cash position is frequently impacted by the complexities of its reimbursement environment. This volatility may indicate that the firm's cash conversion cycle is susceptible to external delays, potentially complicating short-term liquidity planning.
As evidenced by the $93.4 million net acquisition spend in 2024Q4, USPH prioritizes aggressive inorganic growth, which frequently consumes the majority of available free cash flow and necessitates a disciplined approach to balancing expansion with the maintenance of its partnership-based clinic model.
The reliance on acquisitions to drive growth appears to be a double-edged sword, as it requires constant capital deployment that can leave the company cash-constrained during periods of operational underperformance. Investors should monitor whether these acquisitions provide sufficient incremental returns to justify the ongoing pressure on free cash flow.
Quick answers to the most common questions about buying USPH stock.
U.S. Physical Therapy, Inc. (USPH) generated $75.1M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
U.S. Physical Therapy, Inc. (USPH) generated $61.0M 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.
U.S. Physical Therapy, Inc. (USPH) spent $14.1M 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, U.S. Physical Therapy, Inc. (USPH) returned $27.4M to shareholders via cash dividends and spent $5.6M on share repurchases. This shows the company's commitment to returning capital to its equity investors.