Accendra Health Inc/VA has historically generated multi‑billion dollar quarterly revenues but currently exhibits a capital‑intensive profile with volatile earnings and recent negative cash flow.
On the positive side, gross margin has trended higher over time, reaching 20.6% for the period ending 2023‑12‑31 after climbing from single‑digits in earlier years, reflecting some improvement in underlying product/service economics. Quarterly top‑line consistency was a strength through 2015–2024, with many quarters in a roughly $2.3B–$2.7B range prior to 2025, demonstrating historically stable scale (Revenue & Net Income). The company also reports effectively no net debt by the owner‑earnings leverage metric (reported as 0.0000), which indicates limited net indebtedness on that measure (Strategic Capital Allocation).
Material weaknesses are evident in liquidity, leverage, and earnings quality. The current ratio is 0.5785, below 1.0, signaling short‑term liquidity pressure, while debt‑to‑equity is 3.2746, indicating high leverage on the balance sheet. Profitability and returns have deteriorated sharply: trailing twelve‑month net income reached -$365.8M and operating cash flow is -$101.8M in the latest TTM reading, and trailing twelve‑month ROE is deeply negative at -64.1% (Revenue & Net Income; Strategic Capital Allocation; Return on Equity (ROE)). Earnings quality flags are also present—cash flow trails earnings (metric 0.5604) and net income variability is high (volatility metric 0.1300), consistent with the large swings in quarterly net income and recent widening losses (Earnings Quality Analysis).
The foundation of business quality and long-term value creation
ACCENDRA HEALTH INC/VA/’s quarterly revenue shows a clear inflection in 2025: after reporting $2.63B for the quarter ended , revenue dropped to $681.9M in the quarter ended and was $697.3M in the quarter ended . Prior to 2025, quarterly revenue was relatively stable in a roughly $2.3B–$2.7B range across multiple years (several quarters from 2015 through 2024 show amounts around $2.3B–$2.7B).
Net income has been volatile over the period, with positive results in some historical quarters (for example $17.8M in and $107.9M in ) and large losses in others. Recent quarters show widening losses: a net loss of -$25.0M in and a larger net loss of -$150.3M in ; there was an earlier large loss of -$308.9M reported for . The most recent quarterly revenue was $697.3M and the most recent quarterly net income (loss) was -$150.3M.
Why Growth Matters
Consistent revenue and earnings growth are the lifeblood of successful long-term investments. Companies that can grow their top line (revenue) and bottom line (net income) over many years demonstrate they have products or services customers value and are willing to pay for repeatedly.
Revenue Growth shows whether the company is expanding its market reach, gaining market share, or successfully launching new products.Net Income Growth demonstrates the company can convert that revenue into actual profits while managing costs effectively.
Look for steady, sustainable growth rather than erratic spikes. The best businesses compound earnings year after year, creating tremendous value for shareholders over time. Companies that can grow earnings faster than revenue are improving their profitability—a sign of operational excellence and competitive strength.
Year-over-year growth rates for revenue and earnings per share
Reading the Growth Rate Chart
This chart converts the absolute per-share figures into year-over-year percentage changes, making it easy to see whether growth is accelerating, decelerating, or reverting to trend — regardless of the company's absolute size.
Revenue per Share Growth (1-year, split-adjusted) measures how quickly the top line is expanding on a per-share basis. Sustained positive growth signals that the company continues to win customers and grow its addressable market.EPS Diluted Growth (1-year, split-adjusted) measures how quickly earnings are compounding for each shareholder. When EPS growth consistently outpaces revenue growth, operating leverage and margin expansion are at work.
Look for consistency, not just magnitude. A company that reliably grows EPS 10–15% per year is far more valuable than one that alternates between 50% spikes and deep contractions. Negative EPS growth during a period of positive revenue growth is a red flag — costs are rising faster than sales. Quarters where both lines converge near zero or go negative deserve close scrutiny.
How revenue converts to net income for the most recent annual period
Over the period Jan 2023 to Dec 2023, Accendra Health Incva converts approximately 21¢ of every revenue dollar into gross profit (gross margin: 20.6%).After accounting for operating expenses and taxes and expenses, the company retains -0.4% as net profit margin, resulting in $-0.04B in net earnings.
Period Information
Report Type: Annual (10-K)
Period: Jan 2023 to Dec 2023
Analyzing long-term margin stability and competitive positioning
ACCENDRA HEALTH INC/VA/ showed rising gross margins through 2023, with the gross margin increasing to 20.6% for the period ending 2023-12-31, up from 19.2% at 2023-09-30 and 18.3% at 2022-12-31. Over the multi-year span provided, gross margin climbed from roughly 9.9% in the early 2010s to mid-teens by 2018 and into the high teens/low twenties by 2022–2023.
Operating and net profitability diverged from that gross margin improvement in 2023. The most recent reported operating margin is negative: -4.6% for the period ending 2023-09-30 (also -4.2% at 2023-06-30), compared with a positive 1.4% at 2022-12-31. Net profit margin moved from 0.2% at 2022-12-31 to -0.4% at 2023-12-31. The most recent gross margin was 20.6% (); the most recent operating margin available was -4.6% (); the most recent net profit margin was -0.4% ().
Understanding Profit Margins
Between Jan 2023 and Dec 2023, Accendra Health Incva converts every dollar of revenue through the following stages:
Sustainable competitive advantages reveal themselves through consistently superior profit margins over extended periods. Companies with durable economic moats maintain pricing power and operational efficiency that competitors struggle to match.
A sign of durable competitive advantage is earning sustained higher margins than competitors.Look for margins that remain stable or improve over time, especially during economic downturns. Declining margins may signal increasing competition, pricing pressure, or deteriorating business fundamentals.
Comparing reported earnings to actual cash generation
ACCENDRA HEALTH INC/VA/ shows a marked deterioration in trailing twelve‑month net income in the most recent periods. Net income moved from modest losses around -$40M in 2023–mid‑2024 to a sharp decline by late 2024 and early 2025, with the TTM net loss widening to about -$362.7M at 2024‑12‑31 and -$365.8M at 2025‑03‑31, indicating a clear inflection point in the latter half of 2024.
Operating cash flow has also weakened versus earlier years: TTM operating cash flow was positive $124.2M at 2021‑12‑31 but is reported as negative in the latest period, reaching -$101.8M at 2025‑12‑31. In the most recent comparison the net income shortfall is larger than the cash‑flow shortfall, creating a negative gap between reported earnings and cash generation. The most recent Net Income (TTM) was $-365.8M and the most recent Operating Cash Flow (TTM) was $-101.8M.
The Earnings vs. Cash Flow Gap
Reported earnings (Net Income) doesn't always reflect actual cash generation. Companies use accrual accounting, which recognizes revenue when earned and expenses when incurred—not when cash actually changes hands. This creates timing differences and opportunities for accounting discretion that can mask underlying business health.
Net Income (the "earnings" number) can be influenced by non-cash items like depreciation, stock-based compensation, and changes in accounting estimates.Operating Cash Flow, however, shows the actual cash the business generates from its core operations—a harder number to manipulate.
Trailing Twelve Months
What to Look For
Key Insight: Companies with durable competitive advantages typically show operating cash flow that meets or exceeds net income over time, demonstrating they convert accounting profits into actual cash that can be returned to shareholders or reinvested in the business.
Measuring management's efficiency at generating profits from shareholder capital
ACCENDRA HEALTH INC/VA/'s trailing twelve-month ROE has deteriorated sharply over the past year. After ROE near -4.3% to -4.9% through early- to mid-2024, the metric fell sharply to -64.2% for the quarter ended 2024-12-31 and was essentially unchanged at -64.1% in the quarter ended 2025-03-31, representing a large negative return on shareholder equity in the most recent reported periods.
Historically the company has shown wide swings: a peak ROE of 23.6% in 2021, modestly positive ROE of 2.4% in 2022, mid‑teens to low double-digit ROE in the 2010–2016 period, and very negative readings in 2018 (-84.3%) and 2019 (-56.1%). The most recent Return on Equity (ROE) was -64.1%.
The Gold Standard of Profitability
Return on Equity (ROE) is a powerful measure of how effectively a company's management is using the money shareholders have invested. Calculated by dividing Net Income by Shareholders' Equity, it reveals how much profit is generated for every dollar of equity capital.
A consistently high ROE (typically above 15-20%) is often the signature of a "quality" business with a durable competitive advantage. It indicates that the company can generate high returns on its own capital, which it can then reinvest at these high rates to compound value over time.
What to Look For:
How the company generates and deploys its cash
ACCENDRA HEALTH INC/VA/ shows a material shift in its trailing twelve‑month cash flows in the most recent data. Operating cash flow moved to a negative TTM reading of \$-101.8M as of 2025-12-31, contrasting with a positive \$124.2M TTM observation in 2021 in the dataset. Financing cash flows display a pronounced inflection: large negative financing outflows in 2023 (\$-417.3M) and 2024 (\$-267.6M) reversed to a positive financing inflow of \$188.1M in 2025. Investing cash flow entries in the provided history are consistently negative in the periods shown (for example \$-815.8M in 2018 and \$-416.6M in 2017), with no more recent investing TTM figures in the dataset to show a later trend.
Understanding Company Strategy
Capital allocation refers to how management decides to spend and invest the company's cash. Analyzing the three primary categories of cash flow reveals a company's true operational strategy:
What to look for: Is the company bootstrapping (funding growth solely from operating cash)? Are they borrowing to fund aggressive expansion or dividends? Or are they capital raising by issuing new shares, potentially diluting your ownership? A healthy, mature company typically generates strong operating cash, moderately invests in growth, and returns the surplus to shareholders through financing activities.
Trailing Twelve Months
Net assets attributable to each share — the accounting floor of intrinsic value
Why Book Value per Share Matters
Book value per share is the net worth of the company — total assets minus total liabilities — divided by shares outstanding (split-adjusted). It represents the theoretical liquidation value per share if every asset were sold and every liability repaid at balance-sheet carrying values. It is the accounting foundation upon which much of equity valuation is built.
A steadily rising book value per share is one of the most reliable signals of compounding wealth creation. It means the company is retaining earnings and building net worth faster than it is returning capital or eroding it. Warren Buffett famously tracked Berkshire Hathaway's book value per share for decades as his primary measure of intrinsic value growth.
Context is essential. Asset-heavy businesses (banks, manufacturers, utilities) should be judged by book value more directly than asset-light businesses (software, consumer brands), where intangible assets like intellectual property and customer loyalty may far exceed their balance-sheet carrying values. A company trading at a large premium to book value is not necessarily overvalued — it may simply possess competitive advantages that accounting rules do not capture. Conversely, a declining book value per share — especially over multiple years — is a serious warning sign of capital destruction.
How much of the company is financed by debt versus shareholders' equity
Reading the Debt-to-Equity Ratio
The debt-to-equity (D/E) ratio compares total financial debt to shareholders' equity. A ratio of 1.0 means the company has borrowed one dollar for every dollar of equity; a ratio of 2.0 means it has borrowed twice as much as it owns. Financial leverage amplifies both returns and risk: in good times, debt turbocharges equity returns; in bad times, it accelerates losses and can threaten solvency.
Trends matter more than a single number. A rising D/E ratio can mean the company is taking on debt to fund growth — potentially value-creating if returns exceed the cost of capital. But it can also mean equity is being eroded through losses or that the business is borrowing simply to sustain operations. A falling D/E ratio generally reflects strengthening financial health: earnings are being retained, debt maturities are being paid down, or both.
Industry norms vary enormously. Capital-intensive sectors (utilities, real estate, financials) routinely carry high D/E ratios that would be alarming in, say, a technology company. Always compare against sector peers. As a rough rule of thumb, a D/E above 2× in a cyclical business warrants careful scrutiny of interest coverage and refinancing risk.
Short-term liquidity — can the company cover its near-term obligations?
Liquidity: Can the Business Pay Its Bills?
The current ratio is calculated as current assets divided by current liabilities. A ratio of 1.5 means the company has $1.50 of short-term assets — cash, receivables, inventory — for every $1.00 of obligations due within the next twelve months. It is the most direct measure of near-term financial resilience: can the business meet its obligations without needing to raise new capital or sell long-term assets at a discount?
A ratio above 1.0 is generally healthy, meaning current assets exceed current liabilities. A ratio consistently above 2.0 may indicate the company is holding excess cash or inventory that could be deployed more productively. A ratio below 1.0 is a warning sign — the company is relying on future cash generation or external financing to cover its near-term obligations, which is manageable in normal conditions but dangerous during a downturn.
Trends and context matter.A declining current ratio isn't always alarming — highly efficient businesses (e.g., large retailers with reliable daily cash flows) often run leaner balance sheets intentionally. Conversely, a rapidly rising current ratio can signal slowing sales causing inventory to build, or customers taking longer to pay. Always compare the trend against industry peers and cross-reference with the cash flow statement to assess whether the business is genuinely liquid or just holding non-cash current assets.
How much the market is paying for each dollar of company earnings
What Is the PE Ratio?
The Price-to-Earnings (PE) ratio is one of the most widely used valuation metrics in investing. It divides the current stock price by the company's earnings per share (EPS), revealing how much investors are willing to pay for each dollar of earnings. A high PE can signal that the market expects strong future growth, while a low PE may suggest undervaluation—or reflect genuine concerns about the company's prospects.
Context matters:PE ratios vary significantly across industries. High-growth technology companies routinely trade at PE ratios above 30x or 40x, while mature, low-growth sectors like utilities or financials often trade closer to 10–15x. Always compare a company's PE to its own history and its industry peers, not just an absolute number.
What to Look For:
Key Insight:The PE ratio is a snapshot of market sentiment and expectations. Tracking it over time alongside earnings trends reveals whether the market's valuation has expanded or contracted—and whether that change is justified by fundamentals.