HCA Healthcare, Inc. (HCA) Cash Flow Statement
Where HCA’s cash came from and went, 2025
December 31, 2025 · U.S. dollars- Cash from operations
- $12.64B +20.2% vs 2024
- Capital expenditures
- $4.94B 6.5% of revenue
- Free cash flow
- $7.69B 10.2% margin
- Returned to shareholders
- $10.75B 140% of free cash flow
- Change in cash
- −$893.0M cash at year-end $1.04B
Drawn to scale: where the cash came from and how it was used. Hover for values.
HCA operating cash flow, capex and free cash flow
HCA cash flow trends, 2016–2025
| Metric | Trend | Then | Latest | Change |
|---|---|---|---|---|
| Operating cash flow | $5.65B2016 | $12.64B2025 | +9.3%/yr | |
| Capital expenditures | $2.76B2016 | $4.94B2025 | +6.7%/yr | |
| Free cash flow | $2.89B2016 | $7.69B2025 | +11.5%/yr | |
| Free cash flow margin | 7.0%2016 | 10.2%2025 | +3.2 pts | |
| Operating cash flow / net income | 1.652016 | 1.862025 | +0.22 | |
| Stock-based compensation | $251.0M2016 | $401.0M2025 | +5.3%/yr | |
| Dividends paid | $434.0M2016 | $679.0M2025 | +5.1%/yr | |
| Share buybacks (net) | $2.75B2016 | $10.07B2025 | +15.5%/yr | |
| Capex / revenue | 6.7%2016 | 6.5%2025 | −0.1 pts |
Change is the average annual growth (CAGR) or the difference between the first and latest year.
HCA cash flow by activity
HCA 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).
HCA cash flow statement
| 2025 | 2024 | 2023 | 2022 | 2021 | 2020 | 2019 | 2018 | 2017 | 2016 | |
|---|---|---|---|---|---|---|---|---|---|---|
| Operating activities | ||||||||||
| Net income | $6.78B | $6.66B | $5.24B | $6.83B | $7.72B | $4.39B | $4.14B | $4.39B | $2.74B | $3.43B |
| Depreciation & amortization | $3.52B | $3.31B | $3.08B | $2.97B | $2.85B | $2.72B | $2.60B | $2.28B | $2.13B | $1.97B |
| Stock-based compensation | $401.0M | $360.0M | $262.0M | $341.0M | $440.0M | $362.0M | $347.0M | $268.0M | $270.0M | $251.0M |
| Change in working capital | $728.0M | −$106.0M | −$457.0M | −$1.15B | −$503.0M | $1.28B | −$88.0M | $33.0M | −$296.0M | $42.0M |
| Other non-cash items | $1.20B | $291.0M | $1.31B | −$470.0M | −$1.55B | $484.0M | $602.0M | −$207.0M | $578.0M | −$38.0M |
| Cash from operating activities | $12.64B | $10.51B | $9.43B | $8.52B | $8.96B | $9.23B | $7.60B | $6.76B | $5.43B | $5.65B |
| Investing activities | ||||||||||
| Capital expenditures | −$4.94B | −$4.88B | −$4.74B | −$4.39B | −$3.58B | −$2.83B | −$4.16B | −$3.57B | −$3.02B | −$2.76B |
| Investments (net) | $72.0M | −$4.93B | −$5.32B | −$3.39B | −$117.0M | −$588.0M | −$1.66B | −$1.20B | −$1.28B | −$512.0M |
| Acquisitions & other investing | −$116.0M | $4.88B | $4.74B | $4.39B | $1.05B | $30.0M | $95.0M | $868.0M | $21.0M | $32.0M |
| Cash from investing activities | −$4.99B | −$4.93B | −$5.32B | −$3.39B | −$2.64B | −$3.39B | −$5.72B | −$3.90B | −$4.28B | −$3.24B |
| Financing activities | ||||||||||
| Dividends paid | −$679.0M | −$690.0M | −$661.0M | −$653.0M | −$624.0M | −$153.0M | −$550.0M | −$487.0M | −$448.0M | −$434.0M |
| Share repurchases & issuance (net) | −$10.07B | −$6.04B | −$3.81B | −$7.00B | −$8.21B | −$441.0M | −$1.03B | −$1.53B | −$2.05B | −$2.75B |
| Net borrowing (repayment) | $3.29B | $3.21B | $1.29B | $3.23B | $3.25B | −$3.25B | $494.0M | −$369.0M | $1.48B | $775.0M |
| Shares issued | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 |
| Other financing | −$1.09B | −$1.05B | −$917.0M | −$1.24B | −$1.07B | −$831.0M | −$684.0M | −$689.0M | −$45.0M | −$98.0M |
| Cash from financing activities | −$8.55B | −$4.58B | −$4.09B | −$5.66B | −$6.66B | −$4.68B | −$1.77B | −$3.08B | −$1.06B | −$2.51B |
| Summary | ||||||||||
| Net change in cash | −$893.0M | $998.0M | $27.0M | −$543.0M | −$342.0M | $1.17B | $119.0M | −$230.0M | $86.0M | −$95.0M |
| Cash at end of period | $1.04B | $1.93B | $935.0M | $908.0M | $1.45B | $1.79B | $621.0M | $502.0M | $732.0M | $646.0M |
| Free cash flow | $7.69B | $5.64B | $4.69B | $4.13B | $5.38B | $6.40B | $3.44B | $3.19B | $2.41B | $2.89B |
| Free cash flow margin | 10.2% | 8.0% | 7.2% | 6.9% | 9.2% | 12.4% | 6.7% | 6.8% | 5.5% | 7.0% |
| Capex / revenue | 6.5% | 6.9% | 7.3% | 7.3% | 6.1% | 5.5% | 8.1% | 7.7% | 6.9% | 6.7% |
| Operating cash flow / net income | 1.86 | 1.58 | 1.80 | 1.25 | 1.16 | 2.10 | 1.83 | 1.54 | 1.98 | 1.65 |
| 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 | $1.70B | $1.62B | $1.88B | $1.64B | $1.89B | $1.82B | $1.44B | $1.48B | $1.46B | $1.59B | $1.61B | $1.27B |
| Depreciation & amortization | $944.0M | $930.0M | $911.0M | $889.0M | $863.0M | $860.0M | $856.0M | $842.0M | $819.0M | $795.0M | $789.0M | $769.0M |
| Stock-based compensation | $85.0M | $86.0M | $100.0M | $104.0M | $99.0M | $98.0M | $85.0M | $76.0M | $112.0M | $87.0M | $57.0M | $72.0M |
| Change in working capital | −$240.0M | −$938.0M | $479.0M | $2.35B | $904.0M | −$1.69B | −$422.0M | $1.13B | −$282.0M | −$530.0M | −$226.0M | $269.0M |
| Other non-cash items | −$153.0M | $316.0M | −$1.01B | −$566.0M | $453.0M | $555.0M | $602.0M | −$13.0M | −$139.0M | $526.0M | $447.0M | $94.0M |
| Cash from operating activities | $2.33B | $2.01B | $2.36B | $4.42B | $4.21B | $1.65B | $2.56B | $3.52B | $1.97B | $2.47B | $2.67B | $2.48B |
| Investing activities | ||||||||||||
| Capital expenditures | −$1.23B | −$1.12B | −$1.49B | −$1.29B | −$1.18B | −$991.0M | −$1.28B | −$1.19B | −$1.28B | −$1.12B | −$1.16B | −$1.15B |
| Investments (net) | −$223.0M | $103.0M | $98.0M | −$1.39B | −$1.25B | −$1.03B | −$1.35B | −$1.35B | −$1.33B | −$903.0M | −$1.60B | −$1.31B |
| Acquisitions & other investing | −$103.0M | −$266.0M | $74.0M | $1.29B | $1.18B | $991.0M | $1.28B | $1.19B | $1.28B | $1.12B | $1.16B | $1.15B |
| Cash from investing activities | −$1.56B | −$1.28B | −$1.32B | −$1.39B | −$1.25B | −$1.03B | −$1.35B | −$1.35B | −$1.33B | −$903.0M | −$1.60B | −$1.31B |
| Financing activities | ||||||||||||
| Dividends paid | −$171.0M | −$183.0M | −$162.0M | −$166.0M | −$171.0M | −$180.0M | −$165.0M | −$169.0M | −$171.0M | −$185.0M | −$160.0M | −$162.0M |
| Share repurchases & issuance (net) | −$2.06B | −$1.57B | −$2.56B | −$2.50B | −$2.50B | −$2.51B | −$1.70B | −$1.79B | −$1.37B | −$1.18B | −$910.0M | −$1.14B |
| Net borrowing (repayment) | $1.69B | $1.38B | $1.98B | −$36.0M | −$217.0M | $1.56B | −$64.0M | $2.08B | — | — | — | $339.0M |
| Shares issued | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 |
| Other financing | −$157.0M | −$453.0M | −$261.0M | −$267.0M | −$196.0M | −$367.0M | −$234.0M | −$231.0M | $445.0M | $149.0M | $31.0M | −$169.0M |
| Cash from financing activities | −$704.0M | −$830.0M | −$999.0M | −$2.97B | −$3.09B | −$1.50B | −$2.16B | −$110.0M | −$1.09B | −$1.22B | −$1.04B | −$1.13B |
| Summary | ||||||||||||
| Net change in cash | $73.0M | −$100.0M | $43.0M | $58.0M | −$121.0M | −$873.0M | −$955.0M | $2.06B | −$453.0M | $349.0M | $44.0M | $29.0M |
| Cash at end of period | $1.01B | $940.0M | $1.04B | $997.0M | $939.0M | $1.06B | $1.93B | $2.89B | $831.0M | $1.28B | $935.0M | $891.0M |
| Free cash flow | $1.10B | $895.0M | $870.0M | $3.13B | $3.03B | $660.0M | $1.27B | $2.32B | $690.0M | $1.35B | $1.51B | $1.33B |
| Free cash flow margin | 5.5% | 4.7% | 4.5% | 16.3% | 16.3% | 3.6% | 7.0% | 13.3% | 3.9% | 7.8% | 8.8% | 8.2% |
| Capex / revenue | 6.1% | 5.9% | 7.6% | 6.7% | 6.3% | 5.4% | 7.0% | 6.8% | 7.3% | 6.4% | 6.7% | 7.1% |
| Operating cash flow / net income | 1.37 | 1.24 | 1.26 | 2.69 | 2.23 | 0.90 | 1.78 | 2.37 | 1.35 | 1.55 | 1.66 | 1.94 |
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.
HCA cash generation
In fiscal 2025 (ended December 31, 2025), HCA Healthcare generated $12.6 billion of cash from operations (up 20.2%) and spent $4.9 billion on capital expenditures, leaving free cash flow of $7.7 billion, 10.2% of revenue. It returned $10.7 billion to shareholders through dividends ($679.0 million) and net share buybacks ($10.1 billion). Cash and equivalents fell by $893.0 million over the year.
Related: HCA income statement, HCA balance sheet, HCA dividend history. See the HCA stock overview for the latest quote and news.
HCA cash flow FAQ
What is HCA Healthcare's free cash flow?
HCA Healthcare's free cash flow was $7.7 billion in fiscal 2025: $12.6 billion of operating cash flow minus $4.9 billion of capital expenditures It was $5.6 billion a year earlier..
How much cash does HCA Healthcare generate from operations?
HCA Healthcare generated $12.6 billion of cash from operating activities in fiscal 2025, 1.86 times its net income of $6.8 billion.
How much does HCA Healthcare spend on capital expenditures?
HCA Healthcare spent $4.9 billion on capital expenditures in fiscal 2025, 6.5% of revenue, compared with $4.9 billion the year before.
How much stock does HCA Healthcare buy back?
HCA Healthcare spent $10.1 billion on net share repurchases in fiscal 2025.
How much does HCA Healthcare pay in dividends?
HCA Healthcare paid $679.0 million in dividends in fiscal 2025, 8.8% of free cash flow.