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ATEC, Alphatec Holdings
We are a medical technology company, headquartered in Carlsbad, California, focused on the design, development, and advancement of technology for better surgical treatment of spine disorders.
The sophisticated approaches that we create from the ground up integrate with our expanding InformatiX ("IX") platform to objectively inform surgery and achieve the goals of spine surgery more predictably and more reproducibly.
We have a comprehensive product portfolio designed to address the spine's various pathologies and we are perpetually innovating to accomplish our vision to be the standard bearer in spine.
The business
What it sells, where the money comes from, the kind of company it is.
The business in brief
read the 10-K →What this business is and what moves its needle, from its own SEC filings.
- Situation
- Unprofitable. No sustained operating profit across the record; an earnings multiple has nothing to rest on. What the record does show is revenue, the gross-margin trajectory, and the burn against the cash on hand. Distress / turnaround. Thin interest coverage, or operating cash burned against real debt, across the record. The balance sheet carries this situation; the debt schedule sets the clock.
- What moves the needle
- Operating margin has run around −36% through the cycle on a 67% gross margin, the operating line in the red even at its best — so the lever is whether the spending below the gross line can come down enough to clear a profit: revenue growth against the cost curve, and the cash runway until it does. Inventory runs near 29% of sales, so how fast it turns back into cash — and the risk of writing it down when demand softens — sits alongside the margin. Read this kind of business on the installed base and what follows it. On its own account, the filing leans hardest on pricing power & competition, set against the numbers in what the filing emphasizes, below.
- Is it a good business?
- Return on capital has rarely cleared the cost of capital (median −47%, above 15% in 0 of 8 years). Owner earnings, the cash-based check, have been thin too. This is price-taker territory, where the balance sheet and the cycle matter more than any multiple; the rest is in the 10-K.
Every line is arithmetic on the company's filings, shown in full in the sections below.
The record
Ten years of arithmetic, read across the cycle.
The record, 2016–2025
realized figures from each filing · older years to the left| 2016’16 | 2017’17 | 2018’18 | 2019’19 | 2020’20 | 2021’21 | 2022’22 | 2023’23 | 2024’24 | 2025’25 | TTMTTMMar 2026 | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Income statement | |||||||||||
| $120M | $102M | $92M | $113M | $145M | $243M | $351M | $482M | $612M | $764M | $787M | RevenueRevenue |
| 63% | 67% | 69% | 68% | 71% | 65% | 66% | 64% | 69% | 70% | 70% | Gross marginGross mgn |
| 22% | 69% | 79% | 90% | 89% | 94% | 86% | 78% | 74% | 65% | 65% | SG&A / revenueSG&A/rev |
| 8% | 5% | 11% | 12% | 13% | 13% | 13% | 15% | 13% | 10% | 10% | R&D / revenueR&D/rev |
| ($15M) | ($9M) | ($22M) | ($47M) | ($59M) | ($128M) | ($147M) | ($173M) | ($136M) | ($82M) | ($60M) | Operating incomeOp. inc. |
| −12.8% | −8.8% | −24.5% | −41.7% | −40.6% | −52.7% | −41.9% | −36.0% | −22.3% | −10.7% | −7.7% | Operating marginOp. mgn |
| ($30M) | ($2M) | ($29M) | ($57M) | ($79M) | ($143M) | ($151M) | ($187M) | ($162M) | ($143M) | ($125M) | Net incomeNet inc. |
| Cash flow & returns | |||||||||||
| ($10M) | ($9M) | ($26M) | ($33M) | ($46M) | ($73M) | ($75M) | ($78M) | ($45M) | $45M | $52M | Operating cash flowOp. cash |
| $12M | $7M | $7M | $8M | $11M | $27M | $41M | $56M | $78M | $77M | $77M | DepreciationDeprec. |
| $6M | ($18M) | ($9M) | $5M | $4M | $7M | ($6M) | ($29M) | ($34M) | $37M | $25M | Working capital & otherWC & other |
| $9M | $8M | $7M | $13M | $23M | $69M | $49M | $81M | $83M | $42M | $45M | CapexCapex |
| 7.4% | 7.5% | 7.1% | 11.5% | 16.0% | 28.2% | 14.1% | 16.7% | 13.6% | 5.6% | 5.7% | Capex / revenueCapex/rev |
| ($19M) | ($16M) | ($32M) | ($41M) | ($57M) | ($100M) | ($125M) | ($135M) | ($128M) | $3M | $7M | Owner earningsOwner earn. |
| −15.7% | −16.0% | −35.0% | −35.9% | −39.6% | −41.1% | −35.5% | −27.9% | −20.9% | 0.4% | 0.9% | Owner earnings marginOE mgn |
| ($19M) | ($16M) | ($32M) | ($46M) | ($70M) | ($142M) | ($125M) | ($159M) | ($128M) | $3M | $7M | Free cash flowFCF |
| −15.7% | −16.0% | −35.0% | −40.7% | −48.0% | −58.3% | −35.5% | −33.0% | −20.9% | 0.4% | 0.9% | Free cash flow marginFCF mgn |
| — | — | $15M | — | — | $62M | — | $55M | $0 | $0 | $0 | AcquisitionsAcquis. |
| — | — | -52% | -74% | -72% | -46% | -47% | -37% | -25% | -16% | -11% | ROICROIC |
| — | — | -165% | -131% | -61% | -177% | — | -239% | — | -1154% | — | Return on equityROE |
| — | — | −165% | −131% | −61% | −177% | — | −239% | — | n/m | — | Retained to equityRetained/eq |
| Balance sheet | |||||||||||
| $20M | $22M | $29M | $47M | $108M | $187M | $85M | $221M | $139M | $161M | $140M | Cash & investmentsCash+inv |
| $19M | $15M | $15M | $16M | $24M | $42M | $60M | $73M | $83M | $97M | $106M | ReceivablesReceiv. |
| $30M | $27M | $29M | $35M | $46M | $92M | $102M | $137M | $175M | $169M | $186M | InventoryInvent. |
| $9M | $4M | $4M | $8M | $18M | $26M | $35M | $49M | $53M | $41M | $46M | Accounts payablePayables |
| $40M | $38M | $39M | $43M | $52M | $108M | $127M | $160M | $205M | $226M | $246M | Operating working capitalOper. WC |
| $73M | $66M | $76M | $108M | $184M | $331M | $256M | $451M | $417M | $451M | $456M | Current assetsCur. assets |
| $40M | $30M | $31M | $36M | $58M | $101M | $139M | $158M | $153M | $219M | $240M | Current liabilitiesCur. liab. |
| 1.8× | 2.2× | 2.5× | 3.0× | 3.2× | 3.3× | 1.8× | 2.9× | 2.7× | 2.1× | 1.9× | Current ratioCurr. ratio |
| $0 | — | $14M | $14M | $14M | $40M | $47M | $73M | $71M | $75M | $74M | GoodwillGoodwill |
| $94M | $85M | $129M | $170M | $261M | $572M | $521M | $805M | $776M | $791M | $799M | Total assetsAssets |
| $46M | $41M | $46M | $54M | $42M | $327M | $364M | $513M | $576M | $566M | $573M | Total debtDebt |
| $27M | $19M | $17M | $7M | ($66M) | $140M | $280M | $292M | $437M | $405M | $433M | Net debt / (cash)Net debt |
| -2.9× | — | — | -4.8× | -4.8× | -18.0× | -26.7× | -10.4× | -5.5× | -1.8× | -1.2× | Interest coverageInt. cov. |
| ($42M) | ($27M) | $18M | $44M | $130M | $81M | ($35M) | $78M | ($14M) | $12M | ($5M) | Shareholders’ equityEquity |
| 1.4% | 3.9% | 5.8% | 9.7% | 12.2% | 15.0% | 11.6% | 16.8% | 12.0% | 9.6% | 9.5% | Stock comp / revenueSBC/rev |
| Per share | |||||||||||
| 12.9M | 13.3M | 35.3M | 52.2M | 67.0M | 96.2M | 103M | 121M | 143M | 150M | 154M | Shares out (diluted)Shares |
| $9.34 | $7.66 | $2.60 | $2.17 | $2.16 | $2.53 | $3.39 | $3.98 | $4.28 | $5.09 | $5.11 | Revenue / shareRev/sh |
| $-2.32 | $-0.17 | $-0.82 | $-1.09 | $-1.18 | $-1.49 | $-1.46 | $-1.54 | $-1.13 | $-0.96 | $-0.81 | EPS (diluted)EPS |
| $-1.46 | $-1.23 | $-0.91 | $-0.78 | $-0.86 | $-1.04 | $-1.21 | $-1.11 | $-0.89 | $0.02 | $0.05 | Owner earnings / shareOE/sh |
| $-1.46 | $-1.23 | $-0.91 | $-0.88 | $-1.04 | $-1.47 | $-1.21 | $-1.31 | $-0.89 | $0.02 | $0.05 | Free cash flow / shareFCF/sh |
| $0.69 | $0.57 | $0.18 | $0.25 | $0.35 | $0.71 | $0.48 | $0.66 | $0.58 | $0.28 | $0.29 | Cap. spending / shareCapex/sh |
| $-3.22 | $-2.01 | $0.50 | $0.84 | $1.94 | $0.84 | $-0.34 | $0.64 | $-0.10 | $0.08 | $-0.03 | Book value / shareBVPS |
Share counts before 2017 are restated ×1.5 for a stock split, so per-share figures sit on one basis.
The diluted share count moved ×2.66 into 2018 — shares issued, not a split the totals corroborate — and the per-share figures carry the counts as filed.
The diluted share count moved ×1.48 into 2019 — shares issued, not a split the totals corroborate — and the per-share figures carry the counts as filed.
The diluted share count moved ×1.44 into 2021 — shares issued, not a split the totals corroborate — and the per-share figures carry the counts as filed.
| 9-yr | 5-yr | |
|---|---|---|
| Revenue / share | −6.5%/yr | +18.7%/yr |
| Capital spending / share | −9.4%/yr | −3.9%/yr |
| Book value / share | — | −46.8%/yr |
The record, charted
FY2016–2025Each measure over its full record; the current point and the worst year marked. Share counts on the current split basis.
Owner earnings vs. net income
Owner earningsNet incomeThe accountant's number, and the cash an owner can take; the gap is the tell.
Net income is the accountant's number; owner earnings is the cash an owner could take out. The walk between them, off the cash-flow statement, and whether the gap is widening or holding.
In fiscal 2025 the business turned a $143M loss into $3M of owner earnings: more cash than the profit line showed, after the non-cash charges and the capital it put back in.
| FY2025 | FY2024 | FY2023 | FY2022 | FY2021 | |
|---|---|---|---|---|---|
| Reported net income | ($143M) | ($162M) | ($187M) | ($151M) | ($143M) |
| Depreciation & amortizationnon-cash charge added back | +$77M | +$78M | +$56M | +$41M | +$27M |
| Stock-based compensationreal costnon-cash, but a real cost | +$74M | +$73M | +$81M | +$41M | +$36M |
| Working capital & othertiming of cash in and out, other non-cash items | +$37M | −$34M | −$29M | −$6M | +$7M |
| Cash from operations | $45M | ($45M) | ($78M) | ($75M) | ($73M) |
| Maintenance capital expenditurethe spending needed just to hold position and volume | −$42M | −$83M | −$56M | −$49M | −$27M |
| Owner earnings | $3M | ($128M) | ($135M) | ($125M) | ($100M) |
| Growth capital expenditurediscretionary; spent to get bigger, not to stand still | — | — | −$24M | — | −$42M |
| Free cash flow | $3M | ($128M) | ($159M) | ($125M) | ($142M) |
| Owner-earnings marginowner earnings ÷ revenue | 0% | -21% | -28% | -36% | -41% |
Owner earnings is the cash an owner could pull out without starving the business: operating cash less the capital it must spend to hold its position . The cash-flow statement also adds stock comp back as non-cash, but it is a real cost paid in shares; counted as the expense it is (less $74M), owner earnings is nearer ($71M).
Maintenance capex is estimated as depreciation where a growing business invests above it; free cash flow is the figure the scorecard's free-cash margin reads.
Quality & stewardship
Returns, the balance sheet, capital allocation, and pay.
Owner’s Scorecard
Will it survive?
- Can it pay its interest? -1.8×Does not cover its interestOperating income ($82M) ÷ interest expense $46M
What this means
A full year of operating profit didn't cover the interest bill. This is the zombie zone: the business depends on refinancing, asset sales, or forbearance to service its debt.
- Net debt against an operating lossCash $161M − debt $566M
What this means
Netting $161M of cash and short-term investments against $566M of debt leaves $405M owed, with no operating profit this year to measure it against — understand that combination before anything else about the company. Net debt is the leverage figure that matters: the cash is already set against the debt. Strategic or illiquid investments aren't counted here.
- Long (60+ days)DSO 46 + DIO 266 − DPO 64 days
What this means
Days cash is tied up between paying suppliers and collecting from customers. Lower is better; a long cycle means growth itself eats cash.
Is it a good business?
- Below average through the cycle8-yr median, range -74%–-16%; -16% latest = NOPAT ($65M) ÷ invested capital $418MIndustry peers: median -8%
What this means
The rate the business earns on the money tied up in it, Buffett's north star, because over time a stock tracks the ROIC beneath it. Above ~15% sustained hints at a moat; a return below the cost of capital (~8%) erodes value as a business grows rather than building it — the test Buffett weighs most. The headline is the median of the last 8 years (it ran -16% most recently), so one peak or trough year doesn't set the verdict. Asset-light businesses (R&D expensed, little capital) read artificially high, pair this with Owner Earnings.
- Positive this year, negative across the cyclelatest $3M = operating cash $45M − maintenance capex $42M (positive this year), after an earlier loss stretch (10-yr median -35%)Industry peers: median -3%
What this means
What an owner could take out without starving the business: operating cash less the maintenance capital it must spend to hold its position — Buffett's owner earnings. That's 0% of revenue this year, a -35% median across 10 years. Treating stock comp as the real expense it is (less $74M of SBC) leaves ($71M).
- Loss, but cash-generativeNet income ($143M) · cash from operations $45M
What this means
The company reported a net loss, so a conversion ratio isn't meaningful. What matters then is whether operations still threw off cash, here, they did.
How is the cash used?
- Returned more than it generatedDividends + buybacks $25M ÷ Owner Earnings $3M
What this means
The company returned more than it generated: against $3M of Owner Earnings, $25M (901%) went back to shareholders, $0 dividends, $25M buybacks — the excess came from the balance sheet or borrowing, not the year's operations. But the buybacks barely exceed stock issued to employees ($74M SBC), net of dilution, little was truly returned. Sustained, that pattern draws down cash or adds debt; the net-debt line above shows where it stands.
- Investing or harvesting? 0.55×HarvestingCapex $42M ÷ depreciation $77M
What this means
Descriptive, not a grade. Above ~1× means investing faster than assets wear out (growth, or, sustained for years, today's earnings carrying less depreciation than tomorrow's will). Below means spending less than it's wearing out (efficiency, or a melting asset base). The ratio won't tell you which; the filings will.
Graham’s defensive tests · 1 of 5 met
Graham’s numerical criteria for the defensive investor (The Intelligent Investor, ch. 14), run on the filings. A floor of safety, not a buy signal; many fine modern businesses fail his strictest liquidity rules by design.
- Adequate size MissRevenue ≥ $2B · $764M
What this means
Big enough to weather a storm. Graham's 1972 floor was ~$100M of sales (≈ $700M today); we use a $2B revenue line as a conservative modern stand-in.
- Strong liquidity PassCurrent ratio ≥ 2× · 2.06×
What this means
Current assets at least twice current liabilities, near-term bills covered without touching the business. Strict by design: many cash-rich modern firms run leaner and miss it, holding their cushion in longer-dated securities.
- Conservative debt MissDebt ≤ working capital · $566M vs $232M WC
What this means
Graham's rule that borrowings not exceed net current assets. Capital-heavy and buyback-heavy firms routinely fail it, read it next to interest coverage, not alone.
- Earnings stability MissA profit every year (10-yr record) · 10 loss years
What this means
Graham wanted earnings in each of the past ten years, the stability a defensive owner leans on.
- Dividend record MissUninterrupted dividends · none paid
What this means
An unbroken dividend was Graham's mark of durability. He wanted twenty years; the filings show about ten, and a single suspension breaks the streak. Non-payers, many fine modern compounders, fall outside his defensive net by design.
- Earnings growth —Earnings +33% over the record · —
What this means
Earnings were negative early in the record, a growth rate isn't meaningful.
- Moderate price —P/E ≤ 15 and P/E × P/B ≤ 22.5 · decided by the price
What this means
Graham's valuation gate, the wall he kept between a sound business and a sound investment. Three-year average earnings are $-1.08/share (latest year $-0.95), the averaged base the calculator's gate runs on, and book value is $0.08/share. Enter a price in “What the price implies” just below for the P/E, P/B, and whether it clears. But this is the rule Buffett outgrew: there's no hard P/E law, and a wonderful business can deserve a far richer multiple if the thesis holds, treat it as the bargain-hunter's floor, not a verdict on the price.
Durability & moat, 2016–2025
Whether the record’s returns held, and what the capital reinvested earned.
- Profitable years 0 of 10
What this means
Lost money in 10 year(s), look at what happened there before trusting the average.
- Return on capital ≥ 15% 0 of 8 yrs
What this means
A moat shows up as a high return on invested capital that holds year after year, not one good vintage.
- Operating margin −15% → −23% (3-yr avg ends)
What this means
The recent-years average (−23%) sits below the early years (−15%), but the latest year (−11%) is back near the early level: a cyclical trough dragging the window down, not a one-way slide. The through-cycle median is −36% — read it across the cycle, not on the dip.
- Reinvestment, incremental ROIC −26%
What this means
Reinvested capital came back at a negative incremental return over this window — the invested base grew while operating profit did not. The filings show where it went.
- Worst year 2021 · −52.7% op. margin
What this means
Operations went underwater in 2021, understand why before trusting the good years.
Does AI threaten the moat?
Low contestabilityThe moat is physical, regulated or balance-sheet-funded, the kind AI cuts costs within but does not contest.
The filing raises AI among its risks, but in other terms (security, regulation, energy or the like), not as a competitor to its product.
AI is unlikely to contest a moat that is physical, regulated or balance-sheet-funded; here it reads more as a cost tool than a threat.
Read from the filing's own risk factors, paired with the industry's structure under its SIC code; the durability is read above, the price below.
All figures as filed; the source filing is linked above.
Current Position
as of the latest quarter, Mar 31, 2026Can the business pay what it owes this year, off the freshest balance sheet: the quality of the assets, the debt actually coming due, and what a low ratio means here.
- Cash & short-term investments$140M
- Receivables$106M
- Inventory$186M
- Other current assets$24M
- Debt due within a year$66M
- Accounts payable$46M
- Other current liabilities$129M
From the company's latest filing.
Acquisitions & goodwill
from the balance sheet & the 10-year cash-flow recordGoodwill grows only when a company acquires and falls only when it concedes it overpaid. The size of that bet, the cash put into buying rather than building, and how much has already been written off.
None written down over the record; the goodwill is still carried at full cost. That is the deals holding their value on the books so far; whether they keep doing so is the test an owner watches, since the write-down, when it comes, is the admission the price was too high.
Goodwill, acquired intangibles and equity from the latest balance sheet; acquisition spend and write-downs summed across the 10-year record, from the company's own filings.
Management, ownership & pay
read the proxy →From the proxy: how much of the business the people running it own, and how they are paid, beside what the business earned for its owners in the same years.
| Fiscal year | Chief executive | Pay, as filed | “Actually paid” | Owner earnings |
|---|---|---|---|---|
| 2021 | Patrick S. Miles | $5.3M | $8.3M | ($100M) |
| 2022 | Patrick S. Miles | $5.9M | $7.4M | ($125M) |
| 2023 | Patrick S. Miles | $9.5M | $23.3M | ($135M) |
| 2024 | Patrick S. Miles | $6.2M | $4.1M | ($128M) |
| 2025 | Patrick S. Miles | $10.3M | $29.7M | $3M |
Both pay figures are the company’s own, from the pay-versus-performance table its proxy statement files. “As filed” is the Summary Compensation Table total: salary, bonus, and equity awards at their value on the day of grant. “Actually paid” is the SEC’s prescribed recalculation, which re-marks those equity awards to what they became as they vested; it can swing far above or below the filed figure in either direction, and negative years occur. Owner earnings are the whole business's, from the record above, for the same fiscal years.
- Insider ownership13.5%
The stake all directors and executive officers hold together, per the 2026 proxy: skin in the game, the first thing Munger reads.
- Stock-based compensation$74M
The slice of the business handed to employees in shares this year, 10% of revenue. Buffett's oldest accounting fight: this is compensation, compensation is an expense, real whether or not the headline earnings admit it. One trap: the cash-flow statement adds SBC back, so the operating cash, and the owner earnings drawn from it, are flattered by exactly this amount; counted as the cost it is, what an owner keeps is lower.
Inverting the record
Invert: instead of why Alphatec Holdings is a good business, the question is what would make owning it a mistake, and whether those marks are in the record. Disconfirming tests across 2016–2025.
1 of the 4 tests turned up something to look into; the other 3 came back clean.
- Look hereDid debt outgrow the business?$46M → $573M
Debt rose from $46M to $573M while owner earnings went from about ($22M) to ($87M): the borrowing grew and the earnings that would carry it are not there now. Debt raised for buybacks or deals rather than growth is the kind that bites in a downturn.
- Is it less profitable than it was?
- Did receivables and inventory outpace sales?
- Are "one-time" charges a yearly habit?
Each test is read from the filings and is noisy alone; a flag can mark a cyclical trough or a year of heavy investment as easily as a problem. The filing says which.
What an owner would ask, FY2025
read the 10-K →- Which reported numbers are a judgment call?Management names Revenue recognition, Income taxes, Inventory, Acquisitions as critical estimates
each rests partly on management's judgment; the filing's note sets out the assumptionsverify →
The questions the record and the charts do not answer on their own; each carries the figure and the place to look.
Peers, Medical Devices & Equipment
The same industry, side by side on owner economics. Each figure is a through-cycle median, so a peak or trough year can’t distort it; the group median at the foot is the line to read each against.
| Company | Revenue | Gross margin | Op. margin | ROIC | Owner earn. margin |
|---|---|---|---|---|---|
| TNDMTandem Diabetes Care | $1.0B | 52% | -15.0% | -24% | -1% |
| INSPInspire Medical Systems | $912M | 84% | -28.7% | -19% | -23% |
| OFIXOrthofix Medical Inc. Common Stock (DE) | $822M | 75% | -2.3% | -3% | 1% |
| ATECAlphatec Holdings | $764M | 68% | -30.2% | -47% | -31% |
| NVCRNovoCure | $655M | 75% | -19.4% | -23% | -5% |
| BVSBioventus Inc. | $568M | 68% | 2.8% | -3% | 7% |
| ATRCAtriCure | $535M | 75% | -10.8% | -8% | -8% |
| GKOSGlaukos Corporation | $507M | 76% | -25.2% | -8% | -3% |
| Group median | — | 75% | -17.2% | -14% | -4% |
The price
What a price has to assume.
What the price implies
reverse-DCFType today's close and see the owner-earnings growth you'd have to believe to justify it, beside what Alphatec Holdings has delivered.
—
9.0% = the 4.55% 10-year Treasury (Jul 15, 2026) + 4.45 points of equity premium. The rate you require is yours to set.
Enter a price above to run it.
A dated snapshot of the price you typed, the assumptions you set, and what the page showed for them. A snapshot is never edited after it is saved. Your notebook is yours alone — the commitment states what is stored and what we will never do.
Graham capped the multiple at 15×; Buffett and Munger let that rule go: a wonderful business can deserve 50× if the thesis holds. The gate marks the bargain-hunter's floor.
Prefilled with the 10-year Treasury (4.55%, as of Jul 15, 2026). Edit it for today’s exact figure, or a AAA corporate yield.
Graham measured a stock against the bond you could own instead, the heart of his margin of safety. Enter a price above to weigh the owner-earnings yield against this bond.
Owner earnings $7M on 151M shares outstanding, per the 10-K cover, as of 2026-02-17; net debt $433M. The base is the latest year by default; Normalize values it on the through-cycle median owner-earnings margin (to avoid paying on a peak year). Net of stock comp treats option pay as the expense it is. The dials set the multiple a growth belief justifies; the price, and every dollar on this page, is yours.
Manual order: ← ATAI its page in the Manual ATEN →
Industry order: ← APT the Medical Devices & Equipment chapter ATRC →