Astrana Health, Inc. (ASTH) Cash Flow Statement
Where ASTH’s cash came from and went, 2025
December 31, 2025 · U.S. dollars- Cash from operations
- $114.6M +119.5% vs 2024
- Capital expenditures
- $10.1M 0.3% of revenue
- Free cash flow
- $104.5M 3.3% margin
- Returned to shareholders
- $23.3M 22% of free cash flow
- Change in cash
- $144.9M cash at year-end $434.0M
Drawn to scale: where the cash came from and how it was used. Hover for values.
ASTH operating cash flow, capex and free cash flow
ASTH cash flow trends, 2016–2025
| Metric | Trend | Then | Latest | Change |
|---|---|---|---|---|
| Operating cash flow | −$8.1M2016 | $114.6M2025 | — | |
| Capital expenditures | $297,5612016 | $10.1M2025 | +47.9%/yr | |
| Free cash flow | −$8.4M2016 | $104.5M2025 | — | |
| Free cash flow margin | −14.7%2016 | 3.3%2025 | +18.0 pts | |
| Operating cash flow / net income | 2.062017 | 4.762025 | +2.70 | |
| Stock-based compensation | $1.1M2016 | $38.6M2025 | +48.4%/yr | |
| Dividends paid | $1.2M2016 | $7.9M2025 | +23.3%/yr | |
| Share buybacks (net) | $02016 | $15.4M2025 | — | |
| Capex / revenue | 0.5%2016 | 0.3%2025 | −0.2 pts |
Change is the average annual growth (CAGR) or the difference between the first and latest year.
ASTH cash flow by activity
ASTH net income vs operating cash flow
Operating cash flow above net income usually means earnings are backed by cash (depreciation and stock-based pay are non-cash expenses).
ASTH cash flow statement
| 2025 | 2024 | 2023 | 2022 | 2021 | 2020 | 2019 | 2018 | 2017 | 2016 | |
|---|---|---|---|---|---|---|---|---|---|---|
| Operating activities | ||||||||||
| Net income | $24.1M | $49.9M | $57.8M | $50.5M | $49.3M | $122.3M | $17.7M | $10.8M | $25.8M | −$8.7M |
| Depreciation & amortization | $45.7M | $27.9M | $17.7M | $17.5M | $17.5M | $18.4M | $18.8M | $19.3M | $19.1M | $645,742 |
| Stock-based compensation | $38.6M | $34.5M | $22.0M | $16.1M | $6.7M | $3.4M | $1.5M | $1.4M | $2.7M | $1.1M |
| Change in working capital | −$3.1M | −$63.6M | −$23.4M | −$9.6M | −$20.1M | $10.8M | −$22.8M | −$63.0M | $16.0M | $120,545 |
| Other non-cash items | $9.3M | $3.4M | −$6.0M | $7.5M | $16.9M | −$108.7M | −$1.5M | $57.6M | −$10.5M | −$1.3M |
| Cash from operating activities | $114.6M | $52.2M | $68.2M | $82.1M | $70.3M | $46.2M | $13.7M | $26.1M | $53.1M | −$8.1M |
| Investing activities | ||||||||||
| Capital expenditures | −$10.1M | −$8.0M | −$28.5M | −$22.9M | −$19.2M | −$1.2M | −$1.0M | −$1.2M | −$2.1M | −$297,561 |
| Investments (net) | — | −$192.4M | −$65.5M | $34.3M | $32.4M | $108.0M | −$129.7M | −$23.6M | −$8.5M | −$1.4M |
| Acquisitions & other investing | −$528.9M | $8.0M | $28.5M | −$18.5M | $3.4M | −$11.3M | −$49.9M | −$985,111 | $17.4M | $297,560 |
| Cash from investing activities | −$539.0M | −$192.4M | −$65.5M | −$7.1M | $16.5M | $95.5M | −$180.6M | −$25.8M | $6.7M | −$1.4M |
| Financing activities | ||||||||||
| Dividends paid | −$7.9M | −$4.0M | −$62.1M | −$14.0M | −$31.1M | −$51.3M | −$61.7M | −$17.8M | −$10.4M | −$1.2M |
| Share repurchases & issuance (net) | −$15.4M | −$937,000 | −$10.2M | −$9.2M | −$5.7M | −$537,000 | −$7.6M | −$5.0M | −$3.2M | $172,070 |
| Net borrowing (repayment) | $624.0M | $152.7M | $79.2M | −$828,000 | −$58.0M | −$105,000 | $281.4M | $7.4M | $4.9M | $10.0M |
| Shares issued | $0 | $0 | $0 | $1,000 | $40.1M | $0 | $754,998 | $200,000 | $0 | $0 |
| Other financing | −$31.4M | −$12.6M | −$3.5M | $4.0M | $6.9M | $265,000 | −$49.5M | $4.0M | −$6.2M | −$2 |
| Cash from financing activities | $569.3M | $135.1M | $3.4M | −$20.1M | −$47.7M | −$51.7M | $163.3M | −$11.2M | −$15.0M | $8.9M |
| Summary | ||||||||||
| Net change in cash | $144.9M | −$5.1M | $6.1M | $54.9M | $39.1M | $90.0M | −$3.6M | −$12.9M | $110.5M | −$605,799 |
| Cash at end of period | $434.0M | $289.1M | $294.2M | $288.0M | $233.1M | $194.0M | $104.0M | $106.9M | $119.8M | $8.7M |
| Free cash flow | $104.5M | $44.2M | $39.7M | $59.2M | $51.1M | $45.0M | $12.6M | $24.9M | $51.0M | −$8.4M |
| Free cash flow margin | 3.3% | 2.2% | 2.9% | 5.2% | 6.6% | 12.2% | 2.3% | 4.8% | 14.3% | −14.7% |
| Capex / revenue | 0.3% | 0.4% | 2.1% | 2.0% | 2.5% | 0.3% | 0.2% | 0.2% | 0.6% | 0.5% |
| Operating cash flow / net income | 4.76 | 1.05 | 1.18 | 1.63 | 1.43 | 0.38 | 0.77 | 2.41 | 2.06 | — |
| Jun '26 | Mar '26 | Dec '25 | Sep '25 | Jun '25 | Mar '25 | Dec '24 | Sep '24 | Jun '24 | Mar '24 | Dec '23 | Sep '23 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Operating activities | ||||||||||||
| Net income | $31.6M | $14.4M | $6.6M | $1.1M | $10.2M | $6.2M | −$7.8M | $23.7M | $21.9M | $16.9M | −$94,000 | $22.1M |
| Depreciation & amortization | $15.5M | $15.5M | $16.4M | $15.6M | $6.9M | $6.8M | $8.1M | $7.3M | $7.4M | $5.1M | $4.9M | $4.3M |
| Stock-based compensation | $21.7M | $9.9M | $11.4M | $7.7M | $11.7M | $7.8M | $15.2M | $6.2M | $7.4M | $5.7M | $8.7M | $5.7M |
| Change in working capital | $18.9M | $26.5M | −$39.2M | −$15.4M | $58.9M | −$8.0M | −$29.5M | $36.1M | −$13.0M | −$23.2M | $11.4M | −$25.1M |
| Other non-cash items | $13.1M | $1.8M | $2.0M | $1.0M | $3.2M | $3.8M | $3.0M | −$39.3M | −$558,000 | $1.4M | −$5.6M | $8.4M |
| Cash from operating activities | $100.8M | $68.1M | −$2.9M | $10.0M | $90.9M | $16.6M | −$10.9M | $34.0M | $23.2M | $6.0M | $19.3M | $15.4M |
| Investing activities | ||||||||||||
| Capital expenditures | −$7.9M | −$4.0M | −$3.1M | −$2.6M | −$1.4M | −$3.1M | −$2.5M | −$2.3M | −$2.8M | −$369,000 | −$7.1M | −$4.1M |
| Investments (net) | — | — | — | −$534.5M | −$1.1M | −$2.4M | −$33.3M | −$8.1M | −$79.9M | −$71.0M | −$11.4M | −$34.9M |
| Acquisitions & other investing | −$1.2M | $1.2M | $2.0M | $2.6M | $1.4M | $3.1M | $2.5M | $2.3M | $2.8M | $494,000 | $7.1M | $4.1M |
| Cash from investing activities | −$9.1M | −$2.8M | −$1.1M | −$534.5M | −$1.0M | −$2.4M | −$33.3M | −$8.1M | −$79.9M | −$70.9M | −$11.4M | −$34.9M |
| Financing activities | ||||||||||||
| Dividends paid | −$199,000 | −$104,000 | −$1.6M | −$96,000 | −$778,000 | −$5.5M | −$1.9M | −$218,000 | −$1.8M | −$95,000 | −$59.8M | −$1.4M |
| Share repurchases & issuance (net) | −$4.4M | −$2.9M | −$15.4M | −$509,000 | $1.3M | −$1.3M | −$220,000 | −$717,000 | −$3.6M | $0 | −$503,000 | −$150,000 |
| Net borrowing (repayment) | −$92.0M | −$12.0M | −$12.0M | $655.3M | −$3.0M | −$16.4M | −$3.9M | −$2.2M | — | — | — | — |
| Shares issued | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 |
| Other financing | −$23.5M | −$983,000 | $2.6M | −$6.2M | −$6.2M | −$21.0M | −$9.2M | −$60,000 | $52.6M | $106.3M | $72.3M | $1.1M |
| Cash from financing activities | −$120.0M | −$16.0M | −$26.3M | $648.5M | −$8.7M | −$44.2M | −$15.3M | −$3.2M | $47.3M | $106.2M | $12.0M | −$510,000 |
| Summary | ||||||||||||
| Net change in cash | −$28.3M | $48.9M | −$30.3M | $122.5M | $81.2M | −$29.9M | −$59.5M | $22.7M | −$9.5M | $41.0M | $19.9M | −$20.0M |
| Cash at end of period | $405.7M | $478.4M | $434.0M | $462.2M | $339.7M | $259.2M | $289.1M | $348.6M | $326.0M | $334.8M | $294.2M | $274.3M |
| Free cash flow | $92.9M | $64.1M | −$6.0M | $7.4M | $89.5M | $13.6M | −$13.5M | $31.7M | $20.4M | $5.6M | $12.2M | $11.3M |
| Free cash flow margin | 9.6% | 6.6% | −0.6% | 0.8% | 13.7% | 2.2% | −2.0% | 6.6% | 4.2% | 1.4% | 3.5% | 3.2% |
| Capex / revenue | 0.8% | 0.4% | 0.3% | 0.3% | 0.2% | 0.5% | 0.4% | 0.5% | 0.6% | 0.1% | 2.0% | 1.2% |
| Operating cash flow / net income | 3.19 | 4.71 | −0.44 | 9.24 | 8.90 | 2.67 | — | 1.43 | 1.06 | 0.35 | — | 0.70 |
Negative numbers are cash paid out. Quarterly columns are labeled by the month the quarter ended. Figures in U.S. dollars as reported; data from EODHD.
ASTH cash generation
In fiscal 2025 (ended December 31, 2025), Astrana Health generated $114.6 million of cash from operations (up 119.5%) and spent $10.1 million on capital expenditures, leaving free cash flow of $104.5 million, 3.3% of revenue. It returned $23.3 million to shareholders through dividends ($7.9 million) and net share buybacks ($15.4 million). Cash and equivalents rose by $144.9 million over the year.
Related: ASTH income statement, ASTH balance sheet. See the ASTH stock overview for the latest quote and news.
ASTH cash flow FAQ
What is Astrana Health's free cash flow?
Astrana Health's free cash flow was $104.5 million in fiscal 2025: $114.6 million of operating cash flow minus $10.1 million of capital expenditures It was $44.2 million a year earlier..
How much cash does Astrana Health generate from operations?
Astrana Health generated $114.6 million of cash from operating activities in fiscal 2025, 4.76 times its net income of $24.1 million.
How much does Astrana Health spend on capital expenditures?
Astrana Health spent $10.1 million on capital expenditures in fiscal 2025, 0.3% of revenue, compared with $8.0 million the year before.
How much stock does Astrana Health buy back?
Astrana Health spent $15.4 million on net share repurchases in fiscal 2025.
How much does Astrana Health pay in dividends?
Astrana Health paid $7.9 million in dividends in fiscal 2025, 7.5% of free cash flow.