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TOI, The Oncology Institute Inc.

Health Care Providers & Services diversified UnprofitableDistress / turnaround

Oncology episode, our patients develop a relationship to providers in the TOI clinics, as well as a cadence of regular visits.

Lines Patient Services Fee for Service TOI provides medical care on a fee-for service basis for physician services, in-house infusion, radiation, and innovative programs like outpatient blood product transfusions, along with 24/7 patient support.

The services TOI provides in its fee for service business are generally covered under commercial and government managed care programs, which are billed retrospectively for care provided in clinics, following a typically small patient co-pay collected at the time of service.

Latest annual: FY2025 10-K

TOI · The Oncology Institute Inc.

The business

What it sells, where the money comes from, the kind of company it is.

Revenue · FY2025

$503M

+27.8% YoY · 22% 5-yr CAGR

Vital signs · TTM, with 5-yr average

Revenue $546M 5-yr avg $335M

Operating margin −6.0% 5-yr avg −20.3%

ROIC −81% 5-yr avg −73%

Owner-earnings margin −5% 5-yr avg −14%

Free cash flow margin −5% 5-yr avg −14%

The business in brief

read the 10-K →

What this business is and what moves its needle, from its own SEC filings.

What it is: Revenue is Specialty pharmacy (54%), FFS revenue (30%) and Capitated revenue (16%).
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 −23% through the cycle, the operating line deeply negative — so the lever is the path to a margin at all: revenue growth against the cost curve and the cash runway, not the level of a margin that isn't there yet. On its own account, the filing leans hardest on customer concentration, 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 −55%, above 15% in 0 of 5 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.

Where the money comes from

read the 10-K →

Revenue spreads across 4 lines, the largest Specialty pharmacy at 54%.

Revenue by product line, FY2025

Specialty pharmacy54%$269M
FFS revenue30%$149M
Capitated revenue16%$80M
Clinical trials & other1%$5M

From the segment footnote of the company's own 10-K. Shares are of total revenue; the profit bar shows each segment's share of segment operating profit, before unallocated corporate costs.

The record

Ten years of arithmetic, read across the cycle.

The record, 2020–2025

realized figures from each filing · older years to the left

2020’20	2021’21	2022’22	2023’23	2024’24	2025’25	TTMTTMMar 2026
							Income statement
$188M	$203M	$252M	$324M	$393M	$503M	$546M	RevenueRevenue
22%	41%	47%	35%	27%	21%	20%	SG&A / revenueSG&A/rev
($8M)	($46M)	($82M)	($77M)	($60M)	($36M)	($33M)	Operating incomeOp. inc.
−4.4%	−22.6%	−32.5%	−23.8%	−15.3%	−7.2%	−6.0%	Operating marginOp. mgn
($14M)	($11M)	$152K	($83M)	($65M)	($61M)	($44M)	Net incomeNet inc.
							Cash flow & returns
$508K	($33M)	($62M)	($36M)	($27M)	($25M)	($22M)	Operating cash flowOp. cash
$3M	$3M	$4M	$6M	$6M	$7M	$7M	DepreciationDeprec.
$12M	($50M)	($94M)	$23M	$21M	$25M	$10M	Working capital & otherWC & other
$1M	$3M	$6M	$5M	$4M	$3M	$4M	CapexCapex
0.6%	1.4%	2.2%	1.4%	1.0%	0.6%	0.7%	Capex / revenueCapex/rev
($686K)	($36M)	($66M)	($41M)	($30M)	($28M)	($26M)	Owner earningsOwner earn.
−0.4%	−17.5%	−26.2%	−12.6%	−7.7%	−5.5%	−4.7%	Owner earnings marginOE mgn
($686K)	($36M)	($67M)	($41M)	($30M)	($28M)	($26M)	Free cash flowFCF
−0.4%	−17.5%	−26.6%	−12.6%	−7.7%	−5.5%	−4.7%	Free cash flow marginFCF mgn
$150K	$9M	$9M	$4M	$0	—	$0	AcquisitionsAcquis.
—	$0	$9M	$1M	$0	—	—	BuybacksBuybacks
-17%	—	-34%	-55%	-101%	-101%	-81%	ROICROIC
-51%	-10%	0%	-146%	-1802%	—	—	Return on equityROE
−51%	−10%	0%	−146%	n/m	—	—	Retained to equityRetained/eq
							Balance sheet
$900K	$115M	$74M	$83M	$50M	$34M	$30M	Cash & investmentsCash+inv
$17M	$20M	$40M	$42M	$48M	$59M	$58M	ReceivablesReceiv.
$4M	$6M	$9M	$14M	$10M	$17M	$24M	InventoryInvent.
$13M	$16M	$9M	$14M	$24M	$43M	$48M	Accounts payablePayables
$9M	$11M	$40M	$42M	$34M	$33M	$35M	Operating working capitalOper. WC
$30M	$154M	$130M	$143M	$112M	$113M	$117M	Current assetsCur. assets
$29M	$30M	$30M	$35M	$52M	$71M	$79M	Current liabilitiesCur. liab.
1.0×	5.2×	4.4×	4.1×	2.2×	1.6×	1.5×	Current ratioCurr. ratio
$14M	$27M	$21M	$7M	$7M	$7M	$7M	GoodwillGoodwill
$66M	$203M	$262M	$209M	$173M	$165M	$168M	Total assetsAssets
$12M	$183K	$81M	$87M	$93M	$77M	$79M	Total debtDebt
$11M	($115M)	$7M	$4M	$43M	$44M	$48M	Net debt / (cash)Net debt
-23.6×	-143.3×	—	-11.4×	-8.0×	-3.2×	-4.3×	Interest coverageInt. cov.
$28M	$104M	$123M	$57M	$4M	($16M)	($16M)	Shareholders’ equityEquity
0.1%	12.1%	11.0%	5.5%	2.8%	0.9%	0.9%	Stock comp / revenueSBC/rev
							Per share
59.1M	66.2M	80.6M	73.7M	75.0M	92.4M	102M	Shares out (diluted)Shares
$3.17	$3.07	$3.13	$4.40	$5.24	$5.44	$5.36	Revenue / shareRev/sh
$-0.24	$-0.16	$0.00	$-1.13	$-0.86	$-0.66	$-0.43	EPS (diluted)EPS
$-0.01	$-0.54	$-0.82	$-0.55	$-0.40	$-0.30	$-0.25	Owner earnings / shareOE/sh
$-0.01	$-0.54	$-0.83	$-0.55	$-0.40	$-0.30	$-0.25	Free cash flow / shareFCF/sh
$0.02	$0.04	$0.07	$0.06	$0.05	$0.03	$0.04	Cap. spending / shareCapex/sh
$0.48	$1.57	$1.53	$0.77	$0.05	$-0.17	$-0.16	Book value / shareBVPS

Per-share growththe realized rate an owner's share compounded

	5-yr	5-yr
Revenue / share	+11.4%/yr	+11.4%/yr
Capital spending / share	+11.4%/yr	+11.4%/yr

The record, charted

FY2020–2025

Each measure over its full record; the current point and the worst year marked.

Share count

92Mpeak FY2025

ROIC

−101%low FY2025

Owner earnings vs. net income

Owner earningsNet income

The accountant's number, and the cash an owner can take; the gap is the tell.

($28M)owner earningsvs.($61M)net incomelow FY2022

Owner-earnings bridge

FY2021–FY2025cash-flow statement, SEC EDGAR →

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 $61M loss into ($28M) 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	($61M)	($65M)	($83M)	$152K	($11M)
Depreciation & amortizationnon-cash charge added back	+$7M	+$6M	+$6M	+$4M	+$3M
Stock-based compensationreal costnon-cash, but a real cost	+$5M	+$11M	+$18M	+$28M	+$25M
Working capital & othertiming of cash in and out, other non-cash items	+$25M	+$21M	+$23M	−$94M	−$50M
Cash from operations	($25M)	($27M)	($36M)	($62M)	($33M)
Maintenance capital expenditurethe spending needed just to hold position and volume	−$3M	−$4M	−$5M	−$4M	−$3M
Owner earnings	($28M)	($30M)	($41M)	($66M)	($36M)
Growth capital expenditurediscretionary; spent to get bigger, not to stand still	—	—	—	−$1M	—
Free cash flow	($28M)	($30M)	($41M)	($67M)	($36M)
Owner-earnings marginowner earnings ÷ revenue	-6%	-8%	-13%	-26%	-18%

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 $5M), owner earnings is nearer ($32M).

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.

III

Quality & stewardship

Returns, the balance sheet, capital allocation, and pay.

Owner’s Scorecard

FY2025 10-K · source on SEC EDGAR →

Will it survive?

Can it pay its interest? -3.2×

Does not cover its interest

Operating income ($36M) ÷ interest expense $11M

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.
How heavy is the debt, net of cash? $44M

Net debt against an operating loss

Cash $34M − debt $77M

What this means
Netting $34M of cash and short-term investments against $77M of debt leaves $44M 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.
How long is cash tied up? —

Not enough data

What this means
The filing data didn't include the inputs for this check.

Is it a good business?

Return on invested capital -55%

Below average through the cycle

5-yr median, range -101%–-17%; -101% latest = NOPAT ($29M) ÷ invested capital $28M

Industry peers: median 4%

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 5 years (it ran -101% 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.
Owner-earnings margin -13%

Consumes cash through the cycle

6-yr median margin, range -26%–-0%; latest ($28M) = operating cash ($25M) − maintenance capex $3M

Industry peers: median 7%

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 -6% of revenue this year, a -13% median across 6 years. Treating stock comp as the real expense it is (less $5M of SBC) leaves ($32M).
Are earnings backed by cash? ($25M)

Loss, and burning cash

Net income ($61M) · cash from operations ($25M)

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?

Where do the earnings go? —

No surplus to allocate

What this means
The business didn't generate positive Owner Earnings this year, so any distributions came from the balance sheet or borrowing, not from operations.
Investing or harvesting? 0.46×

Harvesting

Capex $3M ÷ depreciation $7M

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 · 0 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 Miss

Revenue ≥ $2B · $503M

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 Near

Current ratio ≥ 2× · 1.59×

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 Miss

Debt ≤ working capital · $77M vs $42M 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 Miss

A profit every year (6-yr record) · 5 loss years

What this means
Graham wanted earnings in each of the past ten years, the stability a defensive owner leans on.
Dividend record Miss

Uninterrupted 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 $-0.69/share (latest year $-0.61), the averaged base the calculator's gate runs on, and book value is $-0.16/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, 2020–2025

Whether the record’s returns held, and what the capital reinvested earned.

Profitable years 1 of 6

What this means
Lost money in 5 year(s), look at what happened there before trusting the average.
Return on capital ≥ 15% 0 of 5 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 −20% → −15% (3-yr avg ends)

What this means
Through the cycle the operating margin widened — about −20% early to −15% lately, median −23% — pricing power intact or improving.
Reinvestment, incremental ROIC returns capital

What this means
The capital base barely grew: this business returns cash through dividends and buybacks rather than reinvesting. Judge it on the cash returned, not on compounding.
Worst year 2022 · −32.5% op. margin

What this means
Operations went underwater in 2022, understand why before trusting the good years.
Share count +9.3%/yr

What this means
The share count is rising, dilution works against you on a per-share basis.

Does AI threaten the moat?

Moderate contestability

AI is likely to reshape costs and some products here without clearly contesting or sparing the core moat; how the company itself frames it is the tell.

The question is whether a moat the record shows as durable outlasts a technology that lowers the cost of part of what the firm sells. The durability is read in the record above, the filing's own framing of AI beside it; the industry label decides nothing on its own.

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, 2026

Can 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.

Current assets$117M

Cash & short-term investments$30M
Receivables$58M
Inventory$24M
Other current assets$4M

Current liabilities$79M

Accounts payable$48M
Other current liabilities$32M

Current ratio1.47×all current assets ÷ what's due · Graham looked for 2×

Quick ratio1.17×stricter: inventory excluded

Cash ratio0.38×strictest: cash alone against what's due

Working capital$38Mthe cushion left after near-term bills

Cash runway1.2 yrsthe business is consuming cash; this is how long the cash on hand lasts at that rate

Revenue, latest quarter vs. a year ago+41.2%the freshest read on whether the business is still growing

Current ratio, recent quarters3.3× → 1.5×

Deeper floors

Tangible book value($34M)equity stripped of goodwill & intangibles

Net current asset value($68M)Graham's net-net: current assets less all liabilities

Debt incl. operating leases$105M$26M of it operating leases

Deferred revenue$2Mcustomer cash collected before delivery; operating float

From the company's latest filing.

Acquisitions & goodwill

from the balance sheet & the 6-year cash-flow record

Goodwill 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.

Goodwill & intangibles$18M11% of all assets; the premium carried on the balance sheet for businesses acquired

Against book equity—goodwill is this share of book equity; the rest is the company’s own retained and paid-in capital

Cash spent acquiring$22Mover 6 years buying other businesses, against $21M of capital spent building

$27M written down across 2 years (2022, 2023): goodwill the company has already conceded it overpaid for, charged against earnings. A write-down costs no cash (the cash went out when the deal was signed), but it is management marking its own past judgment to market.

Goodwill, acquired intangibles and equity from the latest balance sheet; acquisition spend and write-downs summed across the 6-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.

Insider ownership4.4%
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$5M
The slice of the business handed to employees in shares this year, 1% 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 The Oncology Institute Inc. 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 2020–2025.

2 of the 4 tests turned up something to look into; the other 2 came back clean.

Look hereDid debt outgrow the business?$12M → $79M
Debt rose from $12M to $79M while owner earnings went from about ($34M) to ($33M): 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.
Look hereDid receivables and inventory outpace sales?11% → 15% of sales
Receivables and inventory grew from $22M to $82M while revenue grew 191%: working capital is climbing faster than sales (11% of revenue then, 15% now). That can mean customers paying slower, stock building up, or revenue pulled forward. The filing's cash-flow and receivables notes say which.

And these came back clean

Is it less profitable than it was?
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 →

How much of the revenue rides on one buyer?
≈$76M · 14% of revenue on the largest customer (TTM)
“While our relationships with payors are long-standing, we believe we have limited concentration risk as our largest customer by revenue in 2025 represented approximately 14% of our patient services revenue.”verify →
Which reported numbers are a judgment call?
Management names Revenue recognition, Income taxes, 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, Health Care Providers & Services

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
PGNYProgyny	$1.3B	21%	4.2%	13%	10%
PNTGThe Pennant Group Inc. Common Stock	$948M	—	4.8%	9%	5%
CAICaris Life Sciences Inc.	$812M	—	-62.4%	—	-62%
USPHU.S. Physical Therapy	$781M	—	12.8%	14%	12%
TOIThe Oncology Institute Inc.	$503M	—	-18.9%	-55%	-10%
FLGTFulgent Genetics Inc.	$323M	57%	-10.0%	-3%	7%
SRTAStrata Critical Medical Inc.	$197M	19%	-36.6%	-9%	-30%
AIRSAirSculpt Technologies Inc.	$152M	—	1.6%	-1%	7%
Group median	—	—	-4.2%	-1%	6%

The price

What a price has to assume.

What the price implies

reverse-DCF

The Oncology Institute 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.

Today’s price $

The assumptions Required return 9% Years to get there 10 Revenue growth 0%

Revenue, delivered23%/yr’20→’25

Mature owner-earnings margin 15%

Enter a price to run it.

Owner earnings it must reach—

Margin the price demands—

Owner-earnings margin today−5%

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.

Weigh TOI against another business →

The owners of TOI: the meeting and the votes →

Cite: Owner Scorecard, "The Oncology Institute Inc. (TOI), the owner's record," https://ownerscorecard.com/c/TOI, data as of 2026-07-09.

Manual order: ← TNL its page in the Manual TOL →

Industry order: ← THC the Health Care Providers & Services chapter UHS →