Astrana Health, Inc. Reports Fourth Quarter and Year End 2025 Results

Rhea-AI Impact

(High)

Rhea-AI Sentiment

(Neutral)

Rhea-AI Summary

Astrana Health (NASDAQ: ASTH) reported 2025 total revenue of $3,181.8 million, up 56% year-over-year, adjusted EBITDA of $205.4 million, and free cash flow of $104.5 million. Fourth-quarter revenue was $950.5 million with adjusted EBITDA of $52.5 million. The company filed a Form 12b-25 extension for its 2025 Form 10-K due to a material weakness in internal controls related to acquisition and purchase accounting. The Board increased the share repurchase authorization to $100 million. 2026 guidance targets ~24% revenue growth midpoint and adjusted EBITDA growth at midpoint.

Positive

Total revenue +56% to $3,181.8M in 2025
Adjusted EBITDA $205.4M, up 21% year-over-year
Free cash flow $104.5M in 2025
Buyback authorization increased to $100M

Negative

Material weakness in internal control over financial reporting tied to acquisition accounting
Form 10-K filing extended under Rule 12b-25

News Market Reaction – ASTH

+29.46%

35 alerts

+29.46% News Effect

+23.5% Peak in 2 hr 34 min

+$303M Valuation Impact

$1.33B Market Cap

0.7x Rel. Volume

On the day this news was published, ASTH gained 29.46%, reflecting a significant positive market reaction. Argus tracked a peak move of +23.5% during that session. Our momentum scanner triggered 35 alerts that day, indicating elevated trading interest and price volatility. This price movement added approximately $303M to the company's valuation, bringing the market cap to $1.33B at that time.

Data tracked by StockTitan Argus on the day of publication.

Key Figures

2025 total revenue: $3,181.8M 2025 Care Partners revenue: $3,022.6M 2025 adjusted EBITDA: $205.4M +5 more

8 metrics

2025 total revenue $3,181.8M Year ended Dec 31, 2025; up 56% YoY and at high end of guidance

2025 Care Partners revenue $3,022.6M Year ended Dec 31, 2025; up 55% from $1,949.0M

2025 adjusted EBITDA $205.4M Year ended Dec 31, 2025; up 21% from $170.4M

2025 free cash flow $104.5M Year ended Dec 31, 2025; non‑GAAP metric

2025 net income $22.5M Net income attributable to Astrana; full year 2025

Q4 2025 total revenue $950.5M Quarter ended Dec 31, 2025; up 43% from $665.2M

Q4 2025 adjusted EBITDA $52.5M Quarter ended Dec 31, 2025; up 50% from $35.0M

2026 revenue guidance $3,800–$4,100M Company guidance for year ending Dec 31, 2026

Market Reality Check

Price: $20.35 Vol: Volume 429,179 is 0.82x t...

normal vol

$20.35 Last Close

Volume Volume 429,179 is 0.82x the 20-day average of 524,296 shares. normal

Technical Shares at $20.35 are trading below the 200-day MA of $25.89 and well under the $36.13 52-week high.

Peers on Argus

ASTH was down 2.77% pre‑earnings while peers were mixed: MD +1.35%, SEM +1.35%, ...

ASTH was down 2.77% pre‑earnings while peers were mixed: MD +1.35%, SEM +1.35%, PACS -4.92%, PIII -4.93%, TVTY flat. This points to stock-specific factors rather than a uniform sector move.

Historical Context

5 past events · Latest: Jan 26 (Neutral)

Pattern 5 events

Date	Event	Sentiment	Move	Catalyst
Jan 26	Earnings call timing	Neutral	+0.2%	Scheduled Q4 and full‑year 2025 release and conference call details.
Jan 06	Investor conference	Positive	+2.1%	Participation in J.P. Morgan 2026 Healthcare Conference with webcast access.
Nov 06	Q3 2025 earnings	Positive	-23.5%	Strong Q3 growth and updated 2025 guidance after Prospect acquisition.
Oct 15	Earnings call timing	Neutral	+2.8%	Announced Q3 2025 release date and conference call logistics.
Sep 02	Investor conferences	Neutral	-3.7%	Planned participation in several September 2025 healthcare conferences.

Pattern Detected

Earnings releases have shown the largest moves, including a sharp selloff on Q3 2025 results, while conference and scheduling headlines have produced smaller, mixed reactions.

Recent Company History

Recent news has focused on financial reporting and investor outreach. Q3 2025 results on Nov 6, 2025 showed strong revenue and Adjusted EBITDA growth but led to a -23.46% move, highlighting sensitivity around guidance and profitability. The Prospect acquisition and updated 2025 outlook set the stage for today’s full‑year 2025 report with $3,181.8M revenue and $205.4M Adjusted EBITDA at the high end of earlier guidance. Multiple investor conference appearances and call scheduling releases have driven only modest price changes.

Market Pulse Summary

The stock surged +29.5% in the session following this news. A strong positive reaction aligns with t...

Analysis

The stock surged +29.5% in the session following this news. A strong positive reaction aligns with the report of record 2025 results, including total revenue of $3,181.8M, 56% year‑over‑year growth, and Adjusted EBITDA of $205.4M at the high end of prior guidance. The expanded $100M share repurchase authorization and 2026 guidance of $3.8–$4.1B revenue and $250–$280M Adjusted EBITDA could justify enthusiasm, although the disclosed material weakness in internal controls and ongoing Prospect Health integration introduce execution risk that may affect durability of gains.

Key Terms

adjusted ebitda, free cash flow, eps - diluted, form 12b-25, +4 more

8 terms

adjusted ebitda financial

"Reports adjusted EBITDA for the year ended of $205.4 million"

Adjusted EBITDA is a way companies measure how much money they make from their core operations, like running a business, by removing certain costs or income that aren’t part of regular business activities. It helps investors see how well a company is doing without distractions from unusual expenses or gains, making it easier to compare companies or track performance over time.

free cash flow financial

"and free cash flow(1) of $104.5 million"

Free cash flow is the amount of money a company has left over after paying all its expenses and investing in its business, like buying equipment or updating facilities. It shows how much cash is available to reward shareholders, pay down debt, or save for future growth. This helps investors understand if a company is financially healthy and able to grow.

eps - diluted financial

"Earnings per share ("EPS") - diluted of $0.46"

Diluted EPS is a company’s net profit divided by the total number of shares after accounting for all potential shares that could be created from stock options, warrants, or convertible securities. Think of a pizza split among current diners plus any possible extra guests — diluted EPS shows how much each slice would shrink if those extras claim their share. Investors use it to see a conservative, per-share earnings figure for valuing the company and comparing profitability over time.

form 12b-25 regulatory

"filing a Form 12b-25 with the Securities and Exchange Commission"

Form 12b-25 is a notice a publicly traded company files with the U.S. Securities and Exchange Commission when it cannot deliver a required periodic report (like a quarterly or annual financial report) on time. It explains the reason for the delay and gives the company a short, temporary window to finish the report without being marked as delinquent; investors watch it because late filings can signal accounting, operational, or control issues that may affect a company’s reliability and stock risk, much like a missed homework deadline can raise concerns about a student’s preparedness.

internal control over financial reporting financial

"material weakness in internal control over financial reporting"

Internal control over financial reporting is a company’s system of procedures and checks designed to make sure its financial statements are accurate and complete, like a set of guardrails and verification steps that catch mistakes or fraud before numbers are published. Investors care because strong controls make reported results more trustworthy, lower the risk of surprise restatements or regulatory problems, and give greater confidence when valuing the company or comparing it to peers.

10b5-1 plans regulatory

"10b5-1 plans, other transactions that may be structured"

A 10b5-1 plan is a prearranged, written schedule that lets company insiders buy or sell shares at set times or under set conditions, designed to avoid accusations of trading on nonpublic information. Think of it like scheduling automatic payments: trades happen according to a plan rather than on impulse. Investors watch these plans because they can provide predictable insider selling or buying signals but can also be structured in ways that mask true motives.

variable interest entities financial

"and variable interest entities ("VIEs") in which the Company"

A variable interest entity (VIE) is a business that a company controls through contracts or special arrangements instead of owning a majority of its shares, like steering a puppet without holding its ticket. Investors care because these arrangements can hide who really bears the financial risks and rewards, affect how assets and liabilities appear on financial statements, and create extra legal or enforcement uncertainty that can change the value and risk of an investment.

AI-generated analysis. Not financial advice.

03/02/2026 - 07:00 AM

Company to Host Conference Call on Monday, March 2, 2026, at 5:30 a.m. PT/8:30 a.m. ET

Reports total revenue for the year ended of $3,181.8 million, up 56% year-over-year, and at the higher end of guidance
Reports adjusted EBITDA for the year ended of $205.4 million and free cash flow⁽¹⁾ of $104.5 million

ALHAMBRA, Calif., March 2, 2026 /PRNewswire/ -- Astrana Health, Inc. ("Astrana," and together with its subsidiaries and affiliated entities, the "Company") (NASDAQ: ASTH), a leading physician-centric, technology-powered, risk-bearing healthcare management company enabling providers to deliver accessible, high-quality, and high-value care to all, today announced its consolidated financial results for the fourth quarter and year ended December 31, 2025.

"Astrana delivered record revenue, adjusted EBITDA, and free cash flow in 2025, demonstrating the strength and predictability of our fully delegated, payer-agnostic care model and AI-enabled technology platform in a dynamic operating environment," said Brandon Sim, President and Chief Executive Officer of Astrana Health. "Our disciplined approach to risk, strong physician alignment, and technology-enabled clinical infrastructure drove consistent performance while creating measurable value for patients through improved outcomes, greater access, and lower total cost of care. As we move through 2026, with Prospect Health integration ahead of schedule, we are confident in our ability to deliver on guidance that reflects approximately 24% revenue growth and 29% adjusted EBITDA growth at the midpoint."

Financial Highlights for Year Ended December 31, 2025:

All comparisons are to the year ended December 31, 2024 unless otherwise stated.

Total revenue of $3,181.8 million, up 56% from $2,034.5 million
Care Partners revenue of $3,022.6 million, up 55% from $1,949.0 million
Net income attributable to Astrana of $22.5 million
Earnings per share ("EPS") - diluted of $0.46
Adjusted EBITDA⁽²⁾ of $205.4 million, up 21% from $170.4 million
Adjusted EPS - diluted⁽³⁾ of $2.20

Financial Highlights for the Fourth Quarter 2025:

All comparisons are to the quarter ended December 31, 2024 unless otherwise stated.

Total revenue of $950.5 million, up 43% from $665.2 million
Care Partners revenue of $892.5 million up 38% from $647.7 million
Net income attributable to Astrana of $6.0 million
EPS - diluted of $0.12
Adjusted EBITDA⁽²⁾ of $52.5 million, up 50% from $35.0 million
Adjusted EPS - diluted⁽³⁾ of $0.54

⁽¹⁾	See reconciliation provided with the condensed consolidated statements of cash flow and "Use of Non-GAAP Financial Measures" below for additional information.
⁽²⁾	See "Reconciliation of Net Income (Loss) to Adjusted Net Income Attributable to Astrana and Adjusted EPS - Diluted" and "Use of Non-GAAP Financial Measures" below for additional information.
⁽³⁾	See "Reconciliation of Net Income (Loss) to EBITDA, Adjusted EBITDA and Adjusted EBITDA Margin" and "Use of Non-GAAP Financial Measures" below for additional information.

Update on Annual Report Filing

The Company will be filing a Form 12b-25 with the Securities and Exchange Commission to extend the deadline for its Annual Report on Form 10-K for the year ended December 31, 2025 (the "2025 Form 10-K") due to a material weakness in internal control over financial reporting, which is expected to relate to, but may not be limited to, the Company's acquisition and purchase accounting processes. This matter relates to the timing and documentation of certain control procedures and does not reflect any material misstatement of the Company's financial results, nor does it result in any restatements of historical periods. The Company currently expects to file the 2025 Form 10-K within the fifteen-day extension period provided under Rule 12b-25 of the Securities Exchange Act of 1934, as amended, and is making targeted investments in our accounting organization to accelerate remediation.

Stock Repurchase Program

The Board of Directors has increased the maximum aggregate amount of shares of the Company's common stock that may be purchased under the Company's existing share repurchase program from $50 million to $100 million. Repurchases may be made through a variety of methods, which could include open market purchases, accelerated share repurchase transactions, negotiated block transactions, 10b5-1 plans, other transactions that may be structured through investment banking institutions or privately negotiated, or a combination of the foregoing. The amount and timing of future repurchases, if any, may vary depending on management's assessment of the intrinsic value of the Company's common stock, the market price of the Company's common stock, general market and economic conditions, available liquidity, compliance with the Company's debt and other agreements, applicable legal requirements, the level of operating, financing and other investing activities, and other considerations. The repurchase authorization does not have an expiration date.

The Company is not obligated to purchase any shares under the repurchase program, and the program may be suspended, modified, or discontinued at any time without prior notice. During the three months ended December 31, 2025, 633,844 shares were repurchased under the Company's share repurchase plan. As of December 31, 2025, $35.9 million remained available under the repurchase plan. The Company may determine to continue to make repurchases under the program following the filing of the Form 10-K for the year ended December 31, 2025.

Segment Results for Year Ended December 31, 2025:

All comparisons are to the year ended December 31, 2024 unless otherwise stated.

	Year Ended December 31, 2025
*(in thousands)*	Care Partners			Care Delivery			Care Enablement			Intersegment Elimination			Corporate Costs		Consolidated Total
Total revenues	$	3,022,602		$	250,742		$	246,660		$	(338,235)		$	—	$	3,181,769
% change vs. prior year		55	%		83	%		59	%

Cost of services		2,615,578			203,895			148,629			(127,863)			—		2,840,239
General and administrative		217,656			45,004			52,130			(210,400)			112,866		217,256
Depreciation and amortization		34,401			3,858			6,185			—			1,305		45,749
Total expenses		2,867,635			252,757			206,944			(338,263)			114,171		3,103,244

Income (loss) from operations	$	154,967		$	(2,015)		$	39,716		$	28	⁽¹⁾	$	(114,171)	$	78,525
% change vs. prior year		10	%	*				117	%

⁽¹⁾	Income from operations for the intersegment elimination represents rental income from segments renting from other segments. Rental income is presented within other income which is not presented in the table.
*	Percentage change of over 500%

2026 Guidance:

Astrana is providing the following guidance for total revenue and Adjusted EBITDA for the three months ending March 31, 2026 and the year ending December 31, 2026 based on the Company's existing business, current view of existing market conditions, and assumptions.

*($ in millions)*	Three Months Ending March 31, 2026				Year Ending December 31, 2026
	Guidance Range				Guidance Range
	Low		High		Low		High
Total revenue	$	900	$	1,000	$	3,800	$	4,100
Adjusted EBITDA	$	60	$	70	$	250	$	280

See "Guidance Reconciliation of Net Income to EBITDA and Adjusted EBITDA" and "Use of Non-GAAP Financial Measures" below for additional information. There can be no assurance that actual amounts will not be materially higher or lower than these expectations. See "Forward-Looking Statements" below for additional information.

Conference Call and Webcast Information:

Astrana will host a conference call at 5:30 a.m. PT/8:30 a.m. ET today (Monday, March 2, 2026), during which management will discuss the results of the fourth quarter and year end December 31, 2025. To participate in the conference call, please use the following dial-in numbers about 5 minutes prior to the scheduled conference call time:

U.S. & Canada (Toll-Free):	+1 (877) 858-9810
International (Toll):	+1 (201) 689-8517

The conference call can also be accessed via webcast at: https://event.choruscall.com/mediaframe/webcast.html?webcastid=CAALhYDU

An accompanying slide presentation will be available in PDF format on the "IR Calendar" page of the Company's website (https://ir.astranahealth.com/news-events/ir-calendar) after issuance of the earnings release and will be furnished as an exhibit to Astrana's current report on Form 8-K to be filed with the SEC, accessible at www.sec.gov.

Those who are unable to attend the live conference call may access the recording at the above webcast link, which will be made available shortly after the conclusion of the call.

Note About Consolidated Entities

The Company consolidates entities in which it has a controlling financial interest. The Company consolidates subsidiaries in which it holds, directly or indirectly, more than 50% of the voting rights, and variable interest entities ("VIEs") in which the Company is the primary beneficiary. Noncontrolling interests represent third party equity ownership interests in the Company's consolidated entities (including certain VIEs). The amount of net income attributable to noncontrolling interests is disclosed in the Company's consolidated statements of income.

About Astrana Health, Inc.

Astrana Health is a physician-centric, AI-powered healthcare company committed to delivering high-quality, patient-centered care. Built from the physician's perspective, Astrana combines its scalable care delivery infrastructure, proprietary technology platform, and aligned provider networks to enable proactive, preventive care at scale - improving patient outcomes, enhancing patient experiences, supporting provider well-being, and driving greater value across the healthcare system.

Today, Astrana supports more than 20,000 providers and over 1.6 million patients in value-based care arrangements through its affiliated provider networks, management services organization, and integrated care delivery clinics spanning primary, specialty, and ancillary care. Together, Astrana is building the healthcare system we all deserve - one that delivers better care, better experiences, and better outcomes for all. For more information, visit www.astranahealth.com.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, such as statements about the Company's guidance for the year ending December 31, 2026, ability to meet operational goals, ability to meet expectations in deployment of care coordination and management capabilities, ability to decrease cost of care while improving quality and outcomes, ability to deliver sustainable revenue and EBITDA growth as well as long-term value, ability to respond to the changing environment, statements about the Company's liquidity, and successful completion and implementation of strategic growth plans, acquisition strategy, and merger integration efforts, as well as statements regarding the Company's expectations regarding the timing of filing its 2025 Form 10-K, the expected material weakness in internal control over financial reporting and the Company's ability to remediate any such material weakness in a timely manner, the consistency of the financial statements in the 2025 Form 10-K with the financial information in this earnings release and the completion of matters necessary to permit filing by the extension deadline. Forward-looking statements reflect current views with respect to future events and financial performance and therefore cannot be guaranteed. Such statements are based on the current expectations and certain assumptions of the Company's management, and some or all of such expectations and assumptions may not materialize or may vary significantly from actual results. Actual results may also vary materially from forward-looking statements due to risks, uncertainties and other factors, known and unknown, including the risk factors described from time to time in the Company's reports to the SEC, including, without limitation the risk factors discussed in the Company's last Annual Report on Form 10-K and any subsequent quarterly reports on Form 10-Q filed with the SEC. Any forward-looking statements made by the Company in this release speaks only as of the date on which it is made. The Company undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future developments or otherwise, except as may be required by any applicable securities laws.

FOR MORE INFORMATION, PLEASE CONTACT:

Investor Relations

Carolyne Sohn
investors@astranahealth.com

ASTRANA HEALTH, INC.
CONSOLIDATED BALANCE SHEETS
(in thousands, except share and per share data)

	December 31, 2025		December 31, 2024
Assets

Current assets
Cash and cash equivalents	$	429,474	$	288,455
Receivables, net (including amounts with related parties)		374,465		275,990
Income taxes receivable		1,799		19,316
Other receivables		26,385		29,496
Prepaid expenses and other current assets		26,264		25,239
Loans receivable		4,926		—

Total current assets		863,313		638,496

Non-current assets
Property and equipment, net		58,693		14,274
Intangible assets, net		270,968		118,179
Goodwill		863,944		419,253
Income taxes receivable, non-current		26,220		15,943
Loans receivable, non-current		48,724		51,266
Investments in other entities – equity method		25,637		39,319
Investments in privately held entities		2,896		8,896
Operating lease right-of-use assets		35,738		32,601
Other assets		22,528		16,667

Total non-current assets		1,355,348		716,398

Total assets ⁽¹⁾	$	2,218,661	$	1,354,894

Liabilities, Mezzanine Deficit, and Stockholders' Equity

Current liabilities
Accounts payable and accrued expenses	$	195,912	$	106,142
Fiduciary accounts payable		3,524		8,223
Medical liabilities		335,705		209,039
Operating lease liabilities		7,809		5,350
Current portion of long-term debt		47,865		9,375
Other liabilities		24,458		27,479

Total current liabilities		615,273		365,608

Non-current liabilities
Deferred tax liability		5,491		4,555
Operating lease liabilities, net of current portion		31,552		30,654
Long-term debt, net of current portion and deferred financing costs		990,904		425,299
Other long-term liabilities		17,107		14,610

Total non-current liabilities		1,045,054		475,118

Total liabilities ⁽¹⁾	$	1,660,327	$	840,726

Mezzanine deficit
Non-controlling interest in Allied Physicians of California, a Professional Medical Corporation ("APC")		(234,962)		(202,558)

Stockholders' equity
Preferred stock, $0.001 par value per share; 5,000,000 shares authorized, and zero shares issued and outstanding as of December 31, 2025 and December 31, 2024		—		—
Common stock, $0.001 par value per share; 100,000,000 shares authorized, 48,885,358 and 47,929,872 shares issued and outstanding, excluding 10,571,011 and 10,603,849 treasury shares, as of December 31, 2025 and December 31, 2024, respectively		49		48
Additional paid-in capital		470,863		426,389
Retained earnings		308,379		286,283
Total stockholders' equity		779,291		712,720

Non-controlling interest		14,005		4,006

Total equity		793,296		716,726

Total liabilities, mezzanine deficit, and stockholders' equity	$	2,218,661	$	1,354,894

⁽¹⁾

The Company's consolidated balance sheets include the assets and liabilities of its consolidated VIEs. The consolidated balance sheets include total assets that can be used only to settle obligations of the Company's consolidated VIEs totaling $1,276.5 million and $712.3 million as of December 31, 2025 and December 31, 2024, respectively, and total liabilities of the Company's consolidated VIEs for which creditors do not have recourse to the general credit of the primary beneficiary of $376.0 million and $207.9 million as of December 31, 2025 and December 31, 2024, respectively. These VIE balances do not include $152.2 million of investment in affiliates and $58.3 million of amounts due from affiliates as of December 31, 2025, and $224.9 million of investment in affiliates and $48.1 million of amounts due to affiliates as of December 31, 2024, as these are eliminated upon consolidation and not presented within the consolidated balance sheets.

ASTRANA HEALTH, INC.
CONSOLIDATED STATEMENTS OF INCOME
(in thousands, except share and per share data)

	Three Months Ended December 31,				Years Ended December 31,
	2025		2024		2025		2024
Revenue
Capitation, net	$	862,814	$	616,900	$	2,924,265	$	1,856,785
Risk pool settlements and incentives		25,508		28,660		86,199		86,224
Management fee income		10,290		5,550		30,394		13,979
Fee-for-service, net		39,787		7,743		112,635		62,331
Other revenue		12,127		6,356		28,276		15,221

Total revenue		950,526		665,209		3,181,769		2,034,540

Operating expenses
Cost of services, excluding depreciation and amortization		855,483		614,730		2,840,239		1,763,152
General and administrative expenses		60,247		41,633		217,256		154,111
Depreciation and amortization		16,401		8,126		45,749		27,927

Total expenses		932,131		664,489		3,103,244		1,945,190

Income from operations		18,395		720		78,525		89,350

Other expense
Income from equity method investments		1,176		1,564		1,708		4,451
Interest expense		(17,520)		(8,069)		(49,928)		(33,097)
Interest income		3,987		3,221		12,157		14,508
Unrealized gain (loss) on investments		769		316		(68)		731
Other income (loss)		699		353		(2,788)		4,875

Total other expense, net		(10,889)		(2,615)		(38,919)		(8,532)

Income (loss) before provision for income taxes		7,506		(1,895)		39,606		80,818

Provision for income taxes		944		5,882		15,530		30,886

Net income (loss)		6,562		(7,777)		24,076		49,932

Net income (loss) attributable to noncontrolling interests		563		(826)		1,589		6,783

Net income (loss) attributable to Astrana Health, Inc.	$	5,999	$	(6,951)	$	22,487	$	43,149

Earnings (loss) per share – basic	$	0.12	$	(0.15)	$	0.46	$	0.91

Earnings (loss) per share – diluted	$	0.12	$	(0.15)	$	0.46	$	0.90

Weighted average shares of common stock outstanding – basic		49,230,904		47,823,360		49,075,727		47,597,295

Weighted average shares of common stock outstanding – diluted		49,527,521		47,823,360		49,369,685		47,974,334

ASTRANA HEALTH, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(in thousands)

	Years ended December 31,
	2025		2024
Cash flows from operating activities
Net income	$	24,076	$	49,932
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization		45,749		27,927
Amortization of debt issuance cost		4,050		1,828
Share-based compensation		38,601		34,536
Non-cash lease expense		6,647		5,278
Deferred tax		(4,287)		(4,249)
Change in fair value of contingent consideration liabilities		5,166		3,526
Other		(2,307)		(2,967)
Changes in operating assets and liabilities, net of business combinations		(3,098)		(63,613)
Net cash provided by operating activities		114,597		52,198

Cash flows from investing activities
Payments for business and asset acquisition, net of cash acquired		(548,604)		(146,260)
Purchases of investments – equity method		—		(5,968)
Purchase of call option issued in conjunction with equity method investment		—		(3,907)
Issuance of loans receivable		(1,708)		(26,000)
Purchases of property and equipment		(10,106)		(8,031)
Proceeds from sale of equity method investment		15,100		—
Other		6,319		(2,229)
Net cash used in investing activities		(538,999)		(192,395)

Cash flows from financing activities
Dividends paid		(7,885)		(4,036)
Repayments on debt		(495,289)		(18,500)
Borrowings on debt		1,119,300		171,875
Taxes paid from net share settlement of restricted stock		(6,169)		(4,662)
Repurchase of treasury shares		(15,429)		(937)
Deferred financing cost		(19,205)		—
Payment of financing obligation		—		(8,542)
Payment of contingent consideration liabilities		(8,284)		(518)
Other		2,307		466
Net cash provided by financing activities		569,346		135,146

Net increase (decrease) in cash, cash equivalents, and restricted cash		144,944		(5,051)

Cash, cash equivalents, and restricted cash, beginning of year		289,101		294,152

Cash, cash equivalents, and restricted cash, end of year	$	434,045	$	289,101

Supplemental disclosures of cash flow information
Cash paid for income taxes	⁽¹⁾		$	43,936
Cash paid for interest	$	45,767	$	30,419

Supplemental disclosures of non-cash investing and financing activities
Right-of-use assets obtained in exchange for operating lease liabilities	$	11,875	$	14,117
Common stock issued in business combination	$	—	$	21,952
Common stock issued for contingent consideration payment	$	2,600	$	4,023
Acquisition of business through loan conversion	$	—	$	5,175
Draw on letter of credit through Revolver Loan	$	—	$	4,732
Elimination of note payable upon consolidation	$	9,488	$	—
Reclass of investment – Third Way Health	$	6,000	$	—
Repurchase of treasury shares outstanding payable	$	922	$	—
Dividend paid in form of stock	$	21,935	$	—


⁽¹⁾	Following the adoption of ASC 2023-09 "Income Taxes (Topics 740): Improvements to Income Tax Disclosures", cash paid for income taxes is presented net of tax refunds, for the year ended December 31, 2025 and prospectively, under Item 8 of the Company's Annual Report on Form 10-K.

The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the consolidated balance sheets that sum to the total amounts of cash, cash equivalents, and restricted cash shown in the condensed consolidated statements of cash flows (in thousands):

	December 31,
	2025		2024
Cash and cash equivalents	$	429,474	$	288,455
Restricted cash ⁽¹⁾		4,571		646
Total cash, cash equivalents and restricted cash shown in the statement of cash flows	$	434,045	$	289,101


⁽¹⁾	Restricted cash is included in other assets on the consolidated balance sheets.

The following table provides a reconciliation of net cash provided by operating activities to free cash flow for the years ended December 31, 2025 and 2024 (in thousands):

Reconciliation of Net Cash Provided by Operating Activities to Free Cash Flow	December 31,
	2025		2024
Net cash provided by operating activities	$	114,597	$	52,198
Cash used in purchases of property and equipment		(10,106)		(8,031)
Free cash flow	$	104,491	$	44,167

Reconciliation of Net Income (Loss) to EBITDA, Adjusted EBITDA and Adjusted EBITDA Margin

Set forth below are reconciliations of net income (loss) to EBITDA and Adjusted EBITDA as well as the reconciliation to Adjusted EBITDA margin for the three months and years ended December 31, 2025 and 2024. The Company defines Adjusted EBITDA margin as Adjusted EBITDA over total revenue.

	Three Months Ended December 31,								Years Ended December 31,
*(in thousands)*	2025				2024				2025				2024
Net income (loss)	$	6,562			$	(7,777)			$	24,076			$	49,932
Interest expense		17,520				8,069				49,928				33,097
Interest income		(3,987)				(3,221)				(12,157)				(14,508)
Provision for income taxes		944				5,882				15,530				30,886
Depreciation and amortization		16,401				8,126				45,749				27,927
EBITDA		37,440				11,079				123,126				127,334

Income from equity method investments		(1,176)				(1,564)				(1,708)				(4,451)
Other, net		4,808		⁽¹⁾		10,288		⁽²⁾		45,405		⁽³⁾		12,951		⁽⁴⁾
Stock-based compensation		11,382				15,235				38,601				34,536
Adjusted EBITDA	$	52,454			$	35,038			$	205,424			$	170,370

Total revenue	$	950,526			$	665,209			$	3,181,769			$	2,034,540

Adjusted EBITDA margin		6	%			5	%			6	%			8	%


⁽¹⁾	Other, net, for the three months ended December 31, 2025 relates to $2.3 million for transaction and integration costs primarily for the acquisition of Prospect, certain costs and final settlement for some of our acquisitions, and severance fees incurred, partially offset by employer retention tax credits related to COVID-19 relief.
⁽²⁾	Other, net for the three months ended December 31, 2024 relates to transaction costs incurred for our investments, to anticipated recoveries from one time losses relating to third party payer payments associated with the Collaborative Health Systems, LLC ("CHS") transaction, and non-cash change in the fair value of our call option.
⁽³⁾	Other, net, for the year ended December 31, 2025, relates to $13.0 million for a legal matter with a provider associated with CFC HP, $25.9 million for transaction and integration costs primarily for the acquisition of Prospect, debt issuance costs incurred in connection with our Second Amended and Restated Credit Facility, certain costs and final settlement for some of our acquisitions, and severance fees incurred, partially offset by employer retention tax credits related to COVID-19 relief.
⁽⁴⁾	Other, net for the year ended December 31, 2024 relates to transaction costs incurred for our investments and tax restructuring fees, anticipated recoveries from one-time losses relating to third party payor payments associated with the CHS transaction, a financial guarantee via a letter of credit that we provided in support of two local provider-led ACOs, non-cash gain on debt extinguishment related to one of our promissory note payables, non-cash realized loss from the sale of one of our marketable equity securities, non-cash changes related to change in the fair value of our call option, non-cash change in the fair value of our financing obligation to purchase the remaining equity interests in one our investments, non-cash changes in the fair value of our contingent liabilities, non-cash changes in the fair value of the Company's Collar Agreement, and reimbursement from a related party of the Company for taxes associated with the Excluded Assets spin-off

Reconciliation of Net Income (Loss) to Adjusted Net Income Attributable to Astrana and Adjusted EPS - Diluted

Set forth below are reconciliations of net income (loss) to adjusted net income attributable to Astrana as well as the reconciliation to adjusted EPS - diluted for the three months and years ended December 31, 2025 and 2024.

	Three Months Ended December 31,						Years Ended December 31,
*(in thousands, except for share and per share data)*	2025			2024			2025			2024
Net income (loss)	$	6,562		$	(7,777)		$	24,076		$	49,932
Income from equity method investments		(1,176)			(1,564)			(1,708)			(4,451)
Other, net ⁽¹⁾		4,808			10,288			45,405			12,951
Stock-based compensation		11,382			15,235			38,601			34,536
Amortization of intangibles		14,128			7,567			40,747			25,608
Tax adjustments		(5,485)	⁽²⁾		(5,411)	⁽³⁾		(25,337)	⁽²⁾		(13,902)	⁽³⁾
Adjusted non-controlling interest		(3,300)	⁽⁴⁾		(2,186)	⁽⁵⁾		(13,203)	⁽⁴⁾		(11,629)	⁽⁵⁾
Adjusted net income attributable to Astrana Health, Inc.	$	26,919		$	16,152		$	108,581		$	93,045

Weighted average shares of common stock outstanding – diluted		49,527,521			47,823,360			49,369,685			47,974,334

Adjusted earnings per share - diluted	$	0.54		$	0.34		$	2.20		$	1.94


⁽¹⁾	The components of other, net, as set forth in the table above, are described in the footnotes to the table under "Reconciliation of Net Income (Loss) to EBITDA, Adjusted EBITDA and Adjusted EBITDA Margin". Please see the footnotes for additional information.
⁽²⁾	Tax adjustments for the three months and year ended December 31, 2025, includes the tax effect for, at a 27.1% statutory blended tax rate, the adjustments made to net income of $7.9 million and $33.3 million, respectively, partially offset by 162(m) impact of $2.4 million and $7.5 million, respectively.
⁽³⁾	Tax adjustments for the three months and year ended December 31, 2024, includes the tax effect for, at a 28.0% statutory blended tax rate, the adjustments made to net (loss) income of $8.8 million and $19.2 million, respectively, partially offset by 162(m) impact of $3.4 million and $5.3 million, respectively.
⁽⁴⁾	Includes net income attributable to non-controlling interests ("NCI") of $0.6 million and $1.6 million, respectively, and adjustments attributable to NCI of $2.7 million and $11.6 million, respectively, for the three months and year ended December 31, 2025.
⁽⁵⁾	Includes net loss and income, respectively, attributable to NCI of $0.8 million and $6.8 million, respectively, and adjustments attributable to NCI of $3.0 million and $4.8 million, respectively, for the three months and year ended December 31, 2024.

Guidance Reconciliation of Net Income to EBITDA and Adjusted EBITDA

	Year Ending December 31, 2026
	Guidance Range
*(in thousands)*	Low		High
Net income	$	54,000	$	74,000
Interest expense		51,000		55,000
Provision for income taxes		38,000		44,000
Depreciation and amortization		65,000		65,000
EBITDA		208,000		238,000

Income from equity method investments		(4,000)		(4,000)
Other, net		7,000		7,000
Stock-based compensation		39,000		39,000
Adjusted EBITDA	$	250,000	$	280,000

The Company has not provided a quantitative reconciliation of EBITDA and Adjusted EBITDA for the three months ending March 31, 2026 to the most comparable GAAP measure on a forward-looking basis within this press release because the Company is unable, without unreasonable efforts, to provide reconciling information with respect to certain line items that cannot be calculated for the three month period. These items, which could materially affect the computation of forward-looking GAAP net income, are inherently uncertain and depend on various factors, some of which are outside of the Company's control.

Use of Non-GAAP Financial Measures

This press release contains the non-GAAP financial measures EBITDA, Adjusted EBITDA, adjusted net income attributable to Astrana, and adjusted EPS - diluted, of which the most directly comparable financial measure presented in accordance with U.S. generally accepted accounting principles ("GAAP") is net income (loss). This press release also contains the non-GAAP financial measure free cash flow, of which the most directly comparable financial measure presented in accordance with U.S. generally accepted accounting principles ("GAAP") is net cash provided by operating activities. These measures are not in accordance with, or alternatives to GAAP, and may be calculated differently from similar non-GAAP financial measures used by other companies. The Company uses Adjusted EBITDA, Adjusted EPS – diluted, and free cash flow as supplemental performance measures of our operations, for financial and operational decision-making, and as supplemental means of evaluating period-to-period comparisons on a consistent basis. Adjusted EBITDA is calculated as earnings before interest expense, interest income, income taxes, depreciation, and amortization, excluding income or loss from equity method investments, non-recurring and non-cash transactions, and stock-based compensation. The Company defines Adjusted EBITDA margin as Adjusted EBITDA over total revenue. Adjusted net income attributable to Astrana is calculated as net income (loss), excluding income or loss from equity method investments, non-recurring and non-cash transactions, stock-based compensation, amortization of intangibles, certain tax adjustments, and amounts related to non-controlling interest. The Company defines adjusted EPS - diluted as adjusted net income attributable to Astrana over weighted average shares of common stock outstanding - diluted. The Company defines free cash flow as net cash provided by operating activities and cash used in purchases of property and equipment.

The Company believes the presentation of these non-GAAP financial measures provides investors with relevant and useful information, as it allows investors to evaluate the operating performance of the business activities without having to account for differences recognized because of non-core or non-recurring financial information. When GAAP financial measures are viewed in conjunction with non-GAAP financial measures, investors are provided with a more meaningful understanding of the Company's ongoing operating performance. In addition, these non-GAAP financial measures are among those indicators the Company uses as a basis for evaluating operational performance, allocating resources, and planning and forecasting future periods. Non-GAAP financial measures are not intended to be considered in isolation, or as a substitute for, GAAP financial measures. Other companies may calculate EBITDA, Adjusted EBITDA, adjusted net income attributable to Astrana, adjusted EPS – diluted, and free cash flow differently, limiting the usefulness of these measures for comparative purposes. To the extent this release contains historical or future non-GAAP financial measures, the Company has provided corresponding GAAP financial measures for comparative purposes. The reconciliation between certain GAAP and non-GAAP measures is provided above.

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SOURCE Astrana Health, Inc.

FAQ

What were Astrana (ASTH) full-year 2025 revenue and adjusted EBITDA results?

Astrana reported full-year 2025 total revenue of $3,181.8 million and adjusted EBITDA of $205.4 million. According to the company, revenue grew 56% year-over-year and adjusted EBITDA increased 21% from 2024, reflecting record revenue and margin expansion for the year.

What guidance did Astrana (ASTH) provide for 2026 revenue and adjusted EBITDA?

Astrana guided 2026 revenue between $3,800M and $4,100M and adjusted EBITDA between $250M and $280M. According to the company, the ranges reflect current operations and assumptions and imply roughly 24% revenue growth at the midpoint versus 2025.

Why did Astrana (ASTH) file Form 12b-25 to extend its 2025 Form 10-K filing?

The company filed Form 12b-25 due to a material weakness in internal controls related to acquisition and purchase accounting. According to the company, the issue concerns timing and documentation of control procedures and does not require restating historical financials.

How much share repurchase capacity does Astrana (ASTH) now have after the board action?

The board raised the repurchase authorization to $100 million from $50 million. According to the company, $35.9 million remained available as of December 31, 2025, and repurchases may be executed via several methods at management's discretion.

What were Astrana (ASTH) fourth-quarter 2025 revenue and adjusted EBITDA figures?

In Q4 2025 Astrana reported revenue of $950.5 million and adjusted EBITDA of $52.5 million. According to the company, Q4 revenue increased 43% year-over-year and adjusted EBITDA rose 50% versus the prior-year quarter.

Did Astrana (ASTH) report net income and EPS for 2025 and Q4 2025?

Yes. Astrana reported net income attributable to the company of $22.5 million for 2025 and diluted EPS of $0.46 for the year. According to the company, Q4 net income was $6.0 million with diluted EPS of $0.12.

Astrana Health, Inc. Reports Fourth Quarter and Year End 2025 Results