Medline — Income Statement, Cash Flows & Balance Sheet
Is Medline profitable?
Medline is growing revenue rapidly and improving its gross margin, though heavy interest costs and a large debt load keep reported profit relatively modest.
| Metric | 2023 | 2024 | 2025 | Change (2023–2025) |
|---|---|---|---|---|
| Net sales ($M) | $23,231 | $25,507 | $28,432 | +22% |
| Gross profit ($M) | $5,885 | $6,976 | $7,518 | +28% |
| Gross margin | 25.3% | 27.4% | 26.4% | +1.1 pp |
| Operating income ($M) | $1,250 | $2,146 | $2,212 | +77% |
| Net income ($M) | $234 | $1,200 | $1,157 | +395% |
| Interest expense, net ($M) | $(976) | $(864) | $(812) | Improving |
Revenue has grown consistently, and the business has become meaningfully more profitable at the operating level over three years. Interest costs are still a significant drag — though they are declining as Medline uses IPO proceeds to pay down debt — and they remain the primary reason net income is modest relative to the size of the business.
One-time items meaningfully distorted 2023 and 2024 results, making underlying progress easier to see in operating income.
| Item | 2023 | 2024 | 2025 |
|---|---|---|---|
| Amortization of inventory step-up ($M) | $90 | $25 | $— |
| Litigation charges, net ($M) | $161 | $2 | $(33) gain |
| Loss on debt extinguishment ($M) | $— | $32 | $58 |
Acquisition-related inventory charges suppressed 2023 and 2024 profits, while a legal settlement added a small gain in 2025. These items make year-to-year net income comparisons noisy; the cleaner story is in steadily rising operating income.
Where does Medline's revenue come from?
Medline operates two roughly equal segments, both growing well — but the Medline Brand segment is far more profitable.
| Segment | 2023 Sales | 2024 Sales | 2025 Sales | 2023 Adj. EBITDA | 2025 Adj. EBITDA |
|---|---|---|---|---|---|
| Medline Brand ($M) | $11,613 | $12,515 | $13,720 | $2,704 | $3,334 |
| Supply Chain Solutions ($M) | $11,618 | $12,992 | $14,712 | $491 | $805 |
Both segments are growing at a healthy pace, but the Medline Brand segment — which makes and sells Medline's own products — generates dramatically higher profit margins than the Supply Chain Solutions segment, which distributes third-party brands. Supply Chain Solutions is improving its profitability quickly, but is still a much thinner-margin business by nature.
Medline is overwhelmingly a U.S. business, with domestic sales accounting for the vast majority of revenue.
| Geography | 2024 Sales | 2025 Sales | Change |
|---|---|---|---|
| United States ($M) | $23,747 | $26,479 | +11% |
| International ($M) | $1,760 | $1,953 | +11% |
| Total ($M) | $25,507 | $28,432 | +12% |
Both domestic and international revenues are growing at a similar clip, but international remains a small slice of the total. There is a long runway for international expansion if Medline chooses to pursue it.
Does Medline generate cash?
Medline generates solid and consistent operating cash flow, well ahead of its reported net income.
| Metric | 2023 | 2024 | 2025 |
|---|---|---|---|
| Operating cash flow ($M) | $1,685 | $1,769 | $1,744 |
| Capital expenditures ($M) | $(275) | $(354) | $(447) |
| Free cash flow ($M) | $1,410 | $1,415 | $1,297 |
Operating cash flow is healthy and stable across all three years, comfortably exceeding net income because depreciation and amortization add back significant non-cash charges. Capital spending is rising as Medline invests in its distribution and manufacturing infrastructure, which is trimming free cash flow modestly.
The IPO transformed the financing picture — Medline raised billions and used most of it to aggressively pay down debt.
| Item | 2025 ($M) |
|---|---|
| IPO proceeds, net | $7,048 |
| Long-term debt repaid | $(11,661) |
| Purchases of stock / redemptions from pre-IPO owners | $(1,970) |
| Distributions to partners | $(518) |
The company used the IPO primarily as a deleveraging event rather than a growth-funding exercise, which is a meaningful signal about financial discipline.
How strong is Medline's balance sheet?
Medline used IPO proceeds to dramatically reduce debt, but the balance sheet still carries substantial leverage.
| Metric | 2024 | 2025 | Change |
|---|---|---|---|
| Total debt ($M) | $16,757 | $12,755 | −$4,002 |
| Cash and equivalents ($M) | $199 | $1,939 | +$1,740 |
| Net debt ($M) | ~$16,558 | ~$10,816 | −$5,742 |
The debt reduction from the IPO is substantial, and the cash position has improved dramatically. That said, over $12 billion in total debt remains — a legacy of the 2021 private equity buyout — and annual interest payments are still around $900 million, so debt management will remain a key story for investors to watch.
A new $3.5 billion Tax Receivable Agreement (TRA) liability is a meaningful obligation that did not exist before the IPO.
| Item | 2025 ($M) |
|---|---|
| TRA liability (non-current) | $3,542 |
| Intangible assets, net | $13,893 |
| Goodwill | $8,079 |
As part of going public, Medline agreed to pay pre-IPO owners 90% of certain future tax benefits — a liability recorded at $3.5 billion. Additionally, intangibles and goodwill together represent the majority of total assets, a common feature of companies built through acquisitions, and worth monitoring for any future impairment risk.