Detailed financial statements for Inspire Medical Systems, Inc. (INSP): income statement, balance sheet and cash-flow summary. Track margins, debt, liquidity and profitability trends year over year: ten fiscal years free and up to 20 with Premium.
Inspire Medical Systems, Inc. operates as a medical technology enterprise, concentrating on the development and commercialization of advanced, minimally intrusive therapies for patients diagnosed with obstructive sleep apnea (OSA) across both domestic U.S. and international markets.
Analysis Summary
Inspire Medical Systems, Inc. reported revenue of $912.0M in the most recent fiscal year, growing at a 5-year CAGR of 51.2%.
Trailing-twelve-month margins: gross margin 86.1%, operating margin 6.0%, net margin 15.0%.
At $68.10 (closing price, October 30, 2026), INSP trades at a P/E of 14.74 and an ROE of 17.62%. Market capitalisation stands at $2.0B.
Balance sheet quality for INSP: debt-to-equity ratio of 0.04, current ratio of 8.55 over the last 12 months, net cash position of $276.1M at the end of the last fiscal year. A debt-to-equity below 1.0 typically signals conservative capital structure, while a current ratio above 1.5 indicates comfortable short-term liquidity.
Cash flow quality is below average: free cash flow of $78.5M represents 54% conversion of reported net income. High conversion (above 90%) suggests earnings translate cleanly into cash; lower conversion may indicate working capital tightness or accounting timing differences.
Income Statement (10y)
| Year | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|---|---|---|---|---|---|
| Revenue | $16.4M | $28.6M | $50.6M | $82.0M | $115.4M | $233.4M | $407.9M | $624.8M | $802.8M | $912.0M |
| Cost of Revenue | $3.9M | $6.0M | $10.1M | $13.6M | $17.6M | $33.3M | $66.1M | $96.6M | $123.0M | $133.2M |
| Gross Profit | $12.5M | $22.5M | $40.5M | $68.4M | $97.8M | $200.1M | $341.7M | $528.2M | $679.8M | $778.8M |
| Research & Development | $7.1M | $6.2M | $7.4M | $12.8M | $26.1M | $37.4M | $68.6M | $116.5M | $114.1M | $103.2M |
| Selling, General & Admin | $22.7M | $32.4M | $53.5M | $90.5M | $127.9M | $202.6M | $320.7M | $452.0M | $529.6M | $624.6M |
| Operating Expenses | $29.8M | $38.6M | $60.9M | $103.3M | $154.0M | $240.0M | $389.3M | $568.5M | $643.7M | $727.8M |
| Operating Income | -$17.3M | -$16.0M | -$20.4M | -$34.9M | -$56.2M | -$39.9M | -$47.6M | -$40.3M | $36.1M | $51.0M |
| EBITDA | -$17.1M | -$15.5M | -$18.1M | -$29.7M | -$54.1M | -$38.6M | -$40.7M | -$17.1M | $65.0M | $79.8M |
| Interest Expense | $1.3M | $1.8M | $3.3M | $2.1M | $2.1M | $2.1M | $1.7M | 0 | $22,000 | $137,000 |
| Pre-tax Income | -$18.5M | -$17.5M | -$21.8M | -$33.2M | -$57.1M | -$42.0M | -$44.3M | -$19.9M | $58.5M | $65.7M |
| Income Tax | 0 | 0 | 0 | $40,000 | $115,000 | $72,000 | $613,000 | $1.2M | $4.9M | -$79.7M |
| Net Income | -$18.5M | -$17.5M | -$21.8M | -$33.2M | -$57.2M | -$42.0M | -$44.9M | -$21.2M | $53.5M | $145.4M |
| EPS | -$1.49 | -$1.30 | -$1.50 | -$1.40 | -$2.19 | -$1.54 | -$1.60 | -$0.72 | $1.80 | $4.95 |
| EPS (Diluted) | -$1.49 | -$1.30 | -$1.50 | -$1.40 | -$2.19 | -$1.54 | -$1.60 | -$0.72 | $1.75 | $4.89 |
| Shares Outstanding (Diluted) | 12.5 M | 13.5 M | 14.6 M | 23.8 M | 26.1 M | 27.3 M | 28.1 M | 29.3 M | 30.5 M | 29.8 M |
Income Statement (Quarterly)
| Year | 2025-Q3 | 2025-Q4 | 2026-Q1 | 2026-Q2 |
|---|---|---|---|---|
| Revenue | $224.5M | $269.1M | $204.6M | $200.6M |
| Gross Profit | $192.7M | $233.0M | $176.9M | $171.5M |
| Operating Income | $9.6M | $46.1M | -$1.1M | -$514,000 |
| EBITDA | $17.2M | $54.3M | $7.5M | $4.1M |
| Net Income | $9.9M | $136.1M | -$11.3M | $314,000 |
| EPS | $0.34 | $4.70 | -$0.39 | $0.01 |
| EPS (Diluted) | $0.34 | $4.66 | -$0.39 | $0.01 |
Balance Sheet (10y)
| Year | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|---|---|---|---|---|---|
| Cash & Equivalents | $6.7M | $9.0M | $97.3M | $22.9M | $190.5M | $214.5M | $441.6M | $185.5M | $150.2M | $104.8M |
| Short-term Investments | 0 | $7.2M | $90.9M | $126.6M | $43.8M | 0 | $9.8M | $274.8M | $295.4M | $203.5M |
| Receivables | $2.1M | $3.9M | $6.7M | $13.1M | $25.1M | $34.2M | $61.2M | $89.9M | $93.1M | $119.7M |
| Inventory | $3.4M | $3.7M | $2.7M | $5.8M | $8.5M | $17.2M | $11.9M | $33.9M | $80.1M | $145.3M |
| Total Current Assets | $12.2M | $24.1M | $199.3M | $170.6M | $269.9M | $268.5M | $530.0M | $593.7M | $630.8M | $583.7M |
| Property, Plant & Equipment | $867,000 | $994,000 | $802,000 | $4.0M | $11.1M | $16.4M | $24.1M | $62.7M | $95.2M | $121.4M |
| Goodwill | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Intangible Assets | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Total Assets | $13.1M | $25.1M | $200.1M | $181.3M | $281.2M | $295.1M | $564.9M | $676.8M | $808.4M | $907.3M |
| Accounts Payable | $1.2M | $3.0M | $3.4M | $4.5M | $7.2M | $11.7M | $26.8M | $38.8M | $38.7M | $36.6M |
| Short-term Debt | $3.3M | 0 | 0 | 0 | 0 | $9.2M | 0 | 0 | 0 | 0 |
| Total Current Liabilities | $7.3M | $7.1M | $11.2M | $16.9M | $20.7M | $41.3M | $61.2M | $78.1M | $88.5M | $96.1M |
| Long-term Debt | $12.4M | $16.5M | $24.9M | $24.5M | $24.7M | $15.8M | $7.5M | 0 | 0 | 0 |
| Total Liabilities | $19.7M | $23.6M | $36.1M | $41.4M | $51.4M | $66.0M | $68.9M | $104.3M | $118.7M | $126.2M |
| Retained Earnings | -$107.6M | -$125.1M | -$146.9M | -$180.2M | -$237.3M | -$279.4M | -$324.3M | -$345.4M | -$291.9M | -$146.5M |
| Total Equity | -$6.6M | $1.5M | $164.0M | $139.8M | $229.7M | $229.0M | $496.0M | $572.5M | $689.7M | $781.2M |
| Total Debt | $15.7M | $16.5M | $24.9M | $25.4M | $30.6M | $34.1M | $16.4M | $24.8M | $31.8M | $32.2M |
| Net Debt | $9.0M | $317,000 | -$163.3M | -$124.1M | -$203.7M | -$180.4M | -$435.0M | -$435.5M | -$413.8M | -$276.1M |
| Working Capital | $5.0M | $16.9M | $188.1M | $153.8M | $249.1M | $227.2M | $468.8M | $515.6M | $542.3M | $487.6M |
Balance Sheet (Quarterly)
| Year | 2025-Q3 | 2025-Q4 | 2026-Q1 | 2026-Q2 |
|---|---|---|---|---|
| Cash & Equivalents | $112.8M | $104.8M | $98.9M | $127.8M |
| Total Assets | $807.7M | $918.5M | $911.4M | $926.0M |
| Total Liabilities | $141.3M | $137.3M | $119.0M | $100.4M |
| Total Equity | $666.5M | $781.2M | $792.3M | $825.6M |
| Total Debt | $32.6M | $62.2M | $29.6M | $29.1M |
Cash Flow (10y)
| Year | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|---|---|---|---|---|---|
| Net Income | -$18.5M | -$17.5M | -$21.8M | -$33.2M | -$57.2M | -$42.0M | -$44.9M | -$21.2M | $53.5M | $145.4M |
| Depreciation & Amortization | $103,000 | $285,000 | $393,000 | $1.4M | $840,000 | $1.2M | $1.9M | $2.8M | $6.5M | $14.0M |
| Stock-based Compensation | $248,000 | $243,000 | $1.2M | 0 | $12.8M | $26.2M | $52.0M | $82.5M | $116.0M | $130.3M |
| Change in Working Capital | $243,000 | $777,000 | $861,000 | -$6.6M | -$10.9M | -$6.9M | $1.8M | -$40.8M | -$37.7M | -$87.4M |
| Operating Cash Flow | -$17.9M | -$15.8M | -$18.7M | -$32.8M | -$53.0M | -$20.1M | $11.6M | $24.7M | $130.2M | $117.0M |
| Capital Expenditure | -$306,000 | -$412,000 | -$250,000 | -$2.7M | -$2.5M | -$4.7M | -$9.1M | -$23.6M | -$39.1M | -$38.5M |
| Acquisitions | 0 | 0 | 0 | 0 | -$89.1M | 0 | 0 | 0 | 0 | 0 |
| Stock Repurchased | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -$75.0M | -$175.0M |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Free Cash Flow | -$18.3M | -$16.2M | -$18.9M | -$35.6M | -$55.5M | -$24.8M | $2.5M | $1.0M | $91.1M | $78.5M |
Cash Flow (Quarterly)
| Year | 2025-Q3 | 2025-Q4 | 2026-Q1 | 2026-Q2 |
|---|---|---|---|---|
| Operating Cash Flow | $68.5M | $52.5M | $12.8M | $23.2M |
| Capital Expenditure | -$10.4M | -$10.7M | -$9.7M | -$9.2M |
| Free Cash Flow | $58.1M | $41.8M | $3.1M | $14.1M |
| Dividends Paid | 0 | 0 | 0 | 0 |
| Stock-based Compensation | $29.5M | $28.0M | $30.7M | $31.2M |
Growth & Margins (10y)
| Year | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|---|---|---|---|---|---|
| Revenue Growth (YoY) | +73.9% | +77.1% | +62.2% | +40.6% | +102.3% | +74.7% | +53.2% | +28.5% | +13.6% | |
| Net Income Growth (YoY) | +5.5% | -24.7% | -52.3% | -72.1% | +26.5% | -6.8% | +52.9% | +353.0% | +171.8% | |
| EPS Growth (YoY) | +12.8% | -15.4% | +6.7% | -56.4% | +29.7% | -3.9% | +55.0% | +350.0% | +175.0% | |
| Shares Change (YoY) | +8.3% | +8.1% | +63.3% | +9.5% | +4.6% | +3.0% | +4.4% | +4.2% | -2.6% | |
| FCF Growth (YoY) | +11.2% | -16.9% | -87.8% | -56.0% | +55.3% | +110.0% | -58.6% | +8,798.7% | -13.9% | |
| Gross Margin | 76.2% | 78.9% | 80.1% | 83.4% | 84.7% | 85.7% | 83.8% | 84.5% | 84.7% | 85.4% |
| Operating Margin | -105.0% | -56.0% | -40.3% | -42.5% | -48.7% | -17.1% | -11.7% | -6.4% | 4.5% | 5.6% |
| EBITDA Margin | -104.2% | -54.2% | -35.8% | -36.2% | -46.9% | -16.5% | -10.0% | -2.7% | 8.1% | 8.7% |
| Net Margin | -112.8% | -61.3% | -43.1% | -40.5% | -49.6% | -18.0% | -11.0% | -3.4% | 6.7% | 15.9% |
| FCF Margin | -111.1% | -56.7% | -37.4% | -43.4% | -48.1% | -10.6% | 0.6% | 0.2% | 11.4% | 8.6% |
| Effective Tax Rate | -0.0% | -0.0% | -0.0% | -0.1% | -0.2% | -0.2% | -1.4% | -6.3% | 8.5% | -121.4% |
Per-Share Data (10y)
| Year | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|---|---|---|---|---|---|
| FCF Per Share | -$1.46 | -$1.20 | -$1.30 | -$1.49 | -$2.13 | -$0.91 | $0.09 | $0.03 | $2.98 | $2.64 |
| Dividends Per Share | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Shares Outstanding (Basic) | 12.5 M | 13.5 M | 14.6 M | 23.8 M | 26.1 M | 27.3 M | 28.1 M | 29.3 M | 29.8 M | 29.4 M |
What to look at in Healthcare / Pharma
The R&D pipeline is the invisible asset. Patents expiring = revenues evaporating. Look at innovation and cash flow.
- R&D / Revenue — Shows investment in future pipeline. Serious pharma reinvests 15-20%
- 5y EPS growth — After patent expirations, are they still growing?
- Gross margin — Branded pharma >70%. Generics much lower — defines the business type
- FCF / Net Income — Earnings quality — big pharma should convert >90%
- ROIC — Capital reinvested efficiently — key in pharma due to long R&D cycles
- Net debt / EBITDA — Pharma acquisitions pile up debt — watch the post-M&A picture
- P/E vs own 10y history — The best comparison is with its own history, not with peers
Profitability
| Return on Equity | 17.62% |
| Return on Invested Capital | 6.33% |
| Return on Assets | 14.58% |
| Gross Margin | 86.13% |
| Operating Margin | 6.02% |
| Net Margin | 15.03% |
Financial Health
| Debt / Equity | 0.04 |
| Current Ratio | 8.55 |
| Piotroski F-Score | 6 |
| Altman Z-Score | 14.49 |
Key Ratios (10y)
| Year | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|---|---|---|---|---|---|
| P/E | -16.77 | -19.22 | -28.17 | -53.01 | -85.89 | -149.39 | -157.42 | -282.54 | 102.99 | 18.63 |
| P/B | -47.11 | 227.09 | 3.76 | 12.63 | 21.35 | 27.38 | 14.26 | 10.41 | 8.00 | 3.47 |
| P/S | 18.95 | 11.80 | 12.18 | 21.53 | 42.50 | 26.87 | 17.34 | 9.54 | 6.87 | 2.97 |
| Gross Margin | 76.2% | 78.9% | 80.1% | 83.4% | 84.7% | 85.7% | 83.8% | 84.5% | 84.7% | 85.4% |
| Operating Margin | -105.0% | -56.0% | -40.3% | -42.5% | -48.7% | -17.1% | -11.7% | -6.4% | 4.5% | 5.6% |
| Net Margin | -112.8% | -61.3% | -43.1% | -40.5% | -49.6% | -18.0% | -11.0% | -3.4% | 6.7% | 15.9% |
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