INSPInspire Medical Systems, Inc.

Surgical & Medical Instruments & Apparatus

Revenue: $912M; 14% YoY
Operating margin: 5.6%; 24% YoY
EBITDA: $65M; 52% YoY
Market cap: $2.0B
Employees: 1,333; $684K revenue each
Net debt / EBITDA: -2.6×; −$169M net debt
AI in 10-K: 1.8; mentions per 10K words

Takeover score 5 of 13

Fixable underperformance 3 of 7

TSR below peersNo
—
3+ of last 5 years
High CEO pay despite TSRNo
—
Median CEO pay ≥ $15M while TSR trails
Earnings not backed by cashNo
80% of net income
Cash flow under 80% of net income
Dilutive SBCYes
14% of revenue
Over 10% of revenue
Payouts exceed cash flowYes
150% of cash flow
Buybacks + dividends over cash flow
Goodwill-heavyNo
—
Over 40% of assets
Shareholder dissentYes
75% lowest support
Any vote under 80% support

Buyer economics 2 of 4

Low revenue per employeeNo
$684K · 81st pct
Bottom quartile of its SIC industry
Quiet on AINo
1.8 per 10K words · 52nd pct
Bottom quartile of AI mentions in 10-Ks
Net cashYes
Net cash · 2.6× EBITDA
More cash than debt, positive EBITDA
Buyout-sizedYes
$2.0B market cap
Market cap $500M–$5B

Catalysts 0 of 2

Active 13DNo
0 filings
Active-intent 13D in 18 months
Net insider sellingNo
−$666K net
Net sales over $10M in 12 months

Financials

Metric	FY2021	FY2022	FY2023	FY2024	FY2025	YoY	Trend
Revenue	$233M	$408M	$625M	$803M	$912M	14%
Operating income	−$40M	−$48M	−$40M	$36M	$51M	41%
Net income	−$42M	−$45M	−$21M	$54M	$145M	172%
Operating cash flow	−$20M	$12M	$25M	$130M	$117M	10%
Capex	$5M	$9M	$24M	$39M	$38M	1.6%
Stock-based comp	$26M	$52M	$82M	$116M	$130M	12%
Buybacks	—	$0	$0	$0	$175M

Deal filings

None.

13D filers

None on file.

Insider trading

Open-market buys, 12 mo: $0 · 0
Open-market sells, 12 mo: $666K · 7
Net: −$666K

Pay vs performance

No pay-versus-performance disclosure yet.