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SI, Shoulder Innovations Inc.
We are a commercial-stage medical technology company exclusively focused on transforming the shoulder surgical care market.
We currently offer advanced implant systems for shoulder arthroplasty.
Our ecosystem is also comprised of enabling technologies, efficient instrument systems, specialized support and surgeon-to-surgeon collaboration.
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 meaningful revenue yet; the record is the cash on hand against the burn. 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. Net current asset value. Current assets alone exceed every liability combined, and the surplus is most of the balance sheet: the shape Graham called a net-net.
- What moves the needle
- The installed base and what follows it. What decides it: placing the device, then the higher-margin consumables and service it drags along, and the R&D and regulatory path to the next generation. On its own account, the filing leans hardest on pricing power & competition, set against the numbers in what the filing emphasizes, below.
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 year, in the company's words
the filing →Verbatim from the 10-K's management discussion. Each sentence is shown only because its subject, direction, and stated figures check out against the filed numbers on this page. The words are the company's; the arithmetic is the record's.
- Revenue+49.6%
“Net revenue increased $15,694 thousand, or 49.6%, to $47,317 thousand for the year ended December 31, 2025, compared to $31,623 thousand for the year ended December 31, 2024. The increase in net revenue was due to an increase in the number of implant systems sold, as well as an increase in the number of customers.”
✓ figure matches the filed record
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 earned ($32M) of owner earnings, the operating cash left after the $3M it takes just to hold its position. It put $5M more into growth; free cash flow, after that spending, was ($36M).
| FY2025 | FY2024 | |
|---|---|---|
| Reported net income | ($40M) | ($16M) |
| Depreciation & amortizationnon-cash charge added back | +$3M | +$2M |
| Stock-based compensationreal costnon-cash, but a real cost | +$996K | +$754K |
| Working capital & othertiming of cash in and out, other non-cash items | +$8M | −$1M |
| Cash from operations | ($29M) | ($14M) |
| Maintenance capital expenditurethe spending needed just to hold position and volume | −$3M | −$2M |
| Owner earnings | ($32M) | ($16M) |
| Growth capital expenditurediscretionary; spent to get bigger, not to stand still | −$5M | −$2M |
| Free cash flow | ($36M) | ($18M) |
| Owner-earnings marginowner earnings ÷ revenue | -67% | -51% |
Owner earnings is the cash an owner could pull out without starving the business: operating cash less the maintenance capital it must spend to hold its position (here about $3M, roughly its depreciation, the rate its assets wear out). The other $5M of its capital spending is growth it chose, not upkeep it owed; charged only with the maintenance it must do, the business earns well more than the year's free cash flow shows. 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 $996K), owner earnings is nearer ($33M).
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? -375.7×Does not cover its interestOperating income ($26M) ÷ interest expense $70K
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 cashCash $27M − debt $15M
What this means
Cash and short-term investments exceed every dollar of debt by $12M, on net the company owes nothing, and can act from strength when others can't. 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 64 + DIO 709 − DPO 291 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 averageNOPAT ($21M) ÷ invested capital $129M (debt + equity − cash)Industry peers: median -53%
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. Asset-light businesses (R&D expensed, little capital) read artificially high, pair this with Owner Earnings.
- Consumes cashOwner earnings ($32M) = operating cash ($29M) − maintenance capex $3MIndustry peers: median -25%
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 -67% of revenue this year. It chose to put $5M more into growth, so free cash flow this year was ($36M) — the gap is investment, not weakness. Treating stock comp as the real expense it is (less $996K of SBC) leaves ($33M).
- Are earnings backed by cash? ($29M)Loss, and burning cashNet income ($40M) · cash from operations ($29M)
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 not.
How is the cash used?
- Not enough data
What this means
The filing data didn't include the inputs for this check.
- Investing or harvesting? 2.55×ExpandingCapex $7M ÷ depreciation $3M
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 · 2 of 3 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 · $47M
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× · 11.07×
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 PassDebt ≤ working capital · $15M vs $143M 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.
- 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 $-1.35/share (latest year $-1.95), the averaged base the calculator's gate runs on, and book value is $6.79/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.
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.
Its FY2025 10-K names artificial intelligence as a competitive threat.
“It is possible that new laws and regulations will be adopted in the United States and in other jurisdictions outside the United States, or that existing laws and regulations, including competition and antitrust laws, may be interpreted in ways that would limit our ability to use AI for our business, or require us to ch…”
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, and the company is using it that way.
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$11M
- Receivables$11M
- Inventory$22M
- Other current assets$102M
- Accounts payable$6M
- Other current liabilities$6M
From the company's latest filing.
Management, ownership & pay
read the proxy →From the proxy: how much of the business the people running it own, and how they are paid.
- Insider ownership29%
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$996K
The slice of the business handed to employees in shares this year, 2% 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.
What an owner would ask, FY2025
read the 10-K →- Which reported numbers are a judgment call?Management names Revenue recognition, Inventory, Stock compensation 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 |
|---|---|---|---|---|---|
| BFLYButterfly Network Inc. | $98M | 37% | -263.0% | -134% | -179% |
| BLFSBioLife Solutions Inc. | $96M | 66% | -9.6% | -3% | 4% |
| KMTSKestra Medical Technologies Ltd. | $95M | 40% | -177.8% | -53% | -143% |
| IRMDiRadimed Corporation | $84M | 77% | 26.4% | 51% | 25% |
| FOCLEDAP TMS S.A. | $71M | 43% | -35.0% | -115% | -25% |
| APTAlpha Pro Tech Ltd. | $59M | 38% | 6.7% | 9% | 6% |
| SIShoulder Innovations Inc. | $47M | 77% | -55.6% | -16% | -67% |
| SSIISS Innovations International Inc. | $42M | 27% | -149.0% | -86% | -156% |
| Group median | — | 42% | -45.3% | -34% | -46% |
The price
What a price has to assume.
What the price implies
reverse-DCFShoulder Innovations Inc. is profitable, but owner earnings are negative this year because capital spending currently outruns operating cash, a build-out, so the owner-earnings reverse-DCF has no positive base to grow. We read the price from both ends instead: type a price to see the steady-state profitability it demands, then set the mature margin you would believe and weigh the two against each other. Nothing leaves your browser unless you enter it in your notebook.
Enter a price 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.
Two reads of one future. From your price: the owner earnings the company must reach, valued at a mature multiple and discounted back at your rate, expressed as the margin it implies on revenue grown at your rate. From your belief: the mature margin you would credit, set on the dial above. When the margin the price demands runs above the one you would believe, you are paying for a future taken on faith. For a deep cyclical at a trough, normalized through-cycle earnings are the better lens; this mode is for the genuinely unprofitable, and for the profitable business whose capital spending currently outruns its cash.
Manual order: ← SHW its page in the Manual SIBN →
Industry order: ← RMD the Medical Devices & Equipment chapter SIBN →