Intuitive Surgical Inc. (NASDAQ:ISRG)

The cash flow statement reveals a dynamic pattern of cash generation and utilization over the five-year period. While operating activities consistently provide a net cash inflow, investing and financing activities demonstrate significant fluctuations, impacting the overall cash position.

Operating Activities

Net cash provided by operating activities generally increased from US$2,089.4 million in 2021 to US$3,030.5 million in 2025. This positive trend indicates improving core business performance and efficient working capital management, although adjustments to reconcile net income show variability. Notably, adjustments were relatively high in 2021 at US$361.3 million, decreasing to US$146.4 million in 2022, then becoming negative in 2023 before recovering in subsequent years. Changes in operating assets and liabilities consistently represent a significant cash outflow, increasing in magnitude each year, suggesting growing working capital needs.

Investing Activities

Investing activities are characterized by substantial cash outflows, primarily related to the purchase of investments and property, plant, and equipment. The purchase of investments dominated cash usage, peaking at US$6,452 million in 2021, and remaining significant throughout the period. While proceeds from maturities and sales of investments partially offset these outflows, a net cash outflow was observed in all years except 2022, which saw a net cash inflow of US$1,370.8 million. The level of investment in property, plant, and equipment increased significantly from 2021 to 2023, before decreasing in 2024 and 2025.

Financing Activities

Financing activities exhibited considerable volatility. 2022 saw a large net cash outflow of US$2,572.3 million, largely driven by repurchases of common stock. Repurchases continued to be a significant outflow in 2025. Proceeds from employee stock plans consistently provided a cash inflow, but were insufficient to offset the outflows from stock repurchases and other financing uses. Taxes paid related to net share settlement of equity awards also represent a consistent, growing cash outflow. A notable shift occurred in 2024, with net cash provided by financing activities reaching US$150.9 million.

Cash Position

The net increase or decrease in cash, cash equivalents, and restricted cash fluctuated significantly. A decrease was observed in 2021, followed by increases in 2022 and 2023. 2024 saw a decrease, and 2025 experienced a substantial increase, resulting in a final cash balance of US$3,407.4 million. The beginning cash balance increased from US$1,638.5 million in 2021 to US$2,062.4 million in 2024, before increasing again in 2025.

Non-Recurring Items

Gains on the sale of businesses and investments, along with deferred income taxes, introduced variability. Gains on sales were relatively small and negative in 2022, 2024, and 2025. Deferred income taxes were consistently negative until 2025, when they became positive, indicating a change in tax-related cash flows.

Overall, the company demonstrates a capacity to generate cash from operations, but this is frequently offset by substantial investments and financing activities, particularly stock repurchases. The increasing investment in property, plant, and equipment and growing working capital needs suggest a period of expansion and growth.