CARLSMED, INC.

CARL

Carlsmed, Inc., a commercial-stage medical technology company, designs, manufactures, and markets AI-enabled personalized spine surgery solutions. The company develops aprevo, a comprehensive technology platform for spine fusion surgery procedures. Its aprevo platform includes proprietary surgical planning software, using outcomes-based algorithms that are aided with artificial intelligence, and resulting custom-built, anatomically designed vertebral interbody implants. The company was incorporated in 2018 and is based in Carlsbad, California.

About the company

Country: United StatesPrice: $17.12Market Cap: $469.2M

Investment snapshot

12%positive consensus

Scored 1d ago

Positive

BUY / PASS

Neutral / negative

2 / 12

NEUTRAL / FAIL

Median fair value

—

No comparable estimates

Models with upside

0 / 17

Positive margin of safety

Strongest signal

9 of 12 pass — Buffett, Marks and Asness object

Key risk

No clean pass — all 16 investors flag at least one profitability criterion

Framework analysis

Verdict	Meaning
BUY	Positive purchase signal: the framework's buy requirements are met.
PASS	The company clears the framework's checklist or screen, but the framework does not produce a buy signal. For valuation frameworks this often means margin of safety is missing, insufficient, or unavailable; some screen-only frameworks have no intrinsic-value BUY state.
NEUTRAL	Neither a positive nor negative conclusion. It does not mean to hold an existing position.
FAIL	The company does not clear the framework's requirements.
Ranked	Ranked strategies do not use PASS: selected cohort is BUY, outside the cohort is FAIL, and unranked is NEUTRAL.

Current investor scores use trailing 12-month flows and the latest balance sheet where supported. Multi-year and EPS tests retain annual history; each framework shows its financial basis below. Intrinsic values use annual financials.

Metric	Graham Defensive Value	Buffett Quality Compounder	Lynch GARP	Greenblatt Magic Formula	Piotroski F-Score	Dreman Contrarian Value	Munger Quality Focus	Pabrai Dhandho Framework	Akre Three-Legged Stool	Marks Risk-Aware Value	Ackman Activist Value	Templeton Global Bargain Hunter	Sleep Scale Economies Shared	Asness Systematic Factors	Neff Low-P/E Total Return	Schloss Asset-Value Discipline	O'Shaughnessy Systematic Factor Composite
Verdict	FAIL	FAIL	FAIL	FAIL · Rank #2426 (Top 78.3%)	PASS	FAIL	PASS	FAIL	FAIL	FAIL	FAIL	FAIL	FAIL	NEUTRAL	FAIL	FAIL	NEUTRAL
Score
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Intrinsic Value (annual)	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Margin of Safety	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Financial Basis	TTM ended 2026-09-30 · Balance sheet at 2026-09-30 · Annual history · FY 2025 Latest source filing: 2026-11-10 Score computed: 2026-11-14	Annual history · FY 2025 · TTM ended 2026-09-30 Latest source filing: 2026-11-10 Score computed: 2026-11-14	Annual history · FY 2025 · Balance sheet at 2026-09-30 · TTM ended 2026-09-30 Latest source filing: 2026-11-10 Score computed: 2026-11-14	TTM ended 2026-09-30 Latest source filing: 2026-11-10 Score computed: 2026-11-14	Annual history · FY 2025 Latest source filing: 2026-02-25 Score computed: 2026-11-14	Annual history · FY 2025 · TTM ended 2026-09-30 · Balance sheet at 2026-09-30 · Market data at 2026-11-01 Latest source filing: 2026-11-10 Score computed: 2026-11-14	Qualitative assessment · Annual history · FY 2025 · TTM ended 2026-09-30 · Balance sheet at 2026-09-30 Latest source filing: 2026-11-10 Score computed: 2026-11-14	Qualitative assessment · Annual history · FY 2025 Latest source filing: 2026-02-25 Score computed: 2026-11-14	Annual history · FY 2025 · Qualitative assessment · TTM ended 2026-09-30 · Balance sheet at 2026-09-30 Latest source filing: 2026-11-10 Score computed: 2026-11-14	Annual history · FY 2025 · TTM ended 2026-09-30 · Qualitative assessment Latest source filing: 2026-11-10 Score computed: 2026-11-14	Annual history · FY 2025 · TTM ended 2026-09-30 · Balance sheet at 2026-09-30 · Market data at 2026-11-01 Latest source filing: 2026-11-10 Score computed: 2026-11-14	Annual history · FY 2025 · Price history 2025-07-01–2026-11-01 · Balance sheet at 2026-09-30 Latest source filing: 2026-11-10 Score computed: 2026-11-14	Annual history · FY 2025 · Qualitative assessment Latest source filing: 2026-02-25 Score computed: 2026-11-14	TTM ended 2026-09-30 · Balance sheet at 2026-09-30 · Price history 2025-07-01–2026-11-01 · Annual history · FY 2025 Latest source filing: 2026-11-10 Score computed: 2026-11-14	Annual history · FY 2025 · TTM ended 2026-09-30 Latest source filing: 2026-11-10 Score computed: 2026-11-14	Annual history · FY 2025 · Balance sheet at 2026-09-30 Latest source filing: 2026-11-10 Score computed: 2026-11-14	TTM ended 2026-09-30 · Annual history · FY 2025 · Price history 2025-07-01–2026-11-01 Latest source filing: 2026-11-10 Score computed: 2026-11-14

Where It Passes

Debt & Leverage75% pass✓ 12✗ 3▾
9 of 12 pass — Buffett, Marks and Asness object
LT Debt vs Net Current AssetsLT Debt $15.4M vs NCA $87.3M
✓GrahamLT Debt <= Net Current Assets
Debt/Equity & Interest CoverageD/E: 0.20, IC: -33.3x
✗BuffettD/E < 0.5 AND Interest Coverage > 5x
Total Debt / Equity0.20
✓Lynch< 0.33
Cash - Long-term Debt$20.5M
✓LynchPositive preferred
LT Debt / Total Assets Change29.74% -> 11.79%
✓PiotroskiDecreased YoY
Current Assets / Current Liabilities5.79
✓Dreman> 1.5✓SchlossCurrent ratio >= 1.50x (app cutoff)
Total Debt / Shareholders' Equity0.20
✓Dreman< 0.8✓Templeton< 1.0 (fixed cap; proxy for below-sector-median leverage)✓SchlossD/E < 1.00x
Debt Levels0.20
✓MungerDebt/Equity < 0.5✓AkreDebt/Equity < 0.3
Interest Coverage & Debt/EBITDAIC=-33.3x, D/EBITDA=N/A
✗MarksInterest Coverage > 3x; Debt/EBITDA < 4x
Total Debt / Shareholders Equity0.20
✓Ackman<= 1.0
Negative debt-to-equity (higher means less debt)-0.2035; #1694/4210 (top 40.2%)
✗AsnessTop 30% of eligible cross-section

Where It Falls Short

Profitability0% pass✓ 4✗ 31▾
No clean pass — all 16 investors flag at least one profitability criterion
Positive EPS (10 years)0/3 years positive
✗GrahamPositive EPS every year for 10 years
EPS Growth (3-yr avg, 10-yr window)
✗Graham>= 33% growth
Net Income Positive (10+ years)0/3 years positive
✗BuffettPositive every year for 10+ years
ROE (up to 5-year arithmetic mean)-30.0%
✗Buffett> 15% arithmetic mean (app rule)
Operating Margin (10-yr trend)
✗BuffettStable or rising over 10 years
Free Cash Flow Proxy$-29.6M
✗BuffettPositive and growing
Earnings Variance (10-yr CoV)
✗BuffettCoV < 0.3
Retained Earnings Effectiveness
✗Buffett$1 retained -> > $1 market value created
Basic earnings-growth PEG (dividends excluded)
✗Lynch< 1.0 (ideally < 0.5)
3-5 Year EPS CAGR
✗Lynch15-30% (Fast Grower); > 0% to pass
ROE-52.9%
✗Lynch> 15%
EBIT / Enterprise Value-9.4%
✗Greenblatt> 10%
Earnings Yield + ROC AssessmentEY=-9.4%, ROC=-77.0%
✗GreenblattBoth EY > 10% and ROC > 25%
Net Income / Total Assets-22.77%
✗PiotroskiROA > 0
ROA Change YoY-46.81% -> -22.77% (delta: +24.03%)
✓PiotroskiCurrent ROA > Prior ROA
(CFO / Total Assets) vs ROACFO/Assets=-22.27%, ROA=-22.77%
✓PiotroskiCFO/Assets > ROA
Gross Margin Change YoY73.8% -> 75.3%
✓PiotroskiImproved YoY
Pre-Tax Income / Revenue
✗Dreman>= 8%
Net Income / Shareholders' Equity-52.9%
✗Dreman> 12%
Margin of SafetyP/B=4.6x
✗PabraiP/B < 1.5 or P/E < 15
Return on Equity-30.0% (3-yr avg)
✗AkreROE > 20% (3-year avg)
Discount to Intrinsic Value
✗Marks>= 20% below intrinsic value
Positive Net Income Frequency0/2 years positive
✗MarksPositive net income in >= 7 of last 10 years
Operating Income / Revenue-59.0%
✗Ackman>= 15%
Net Income / Shareholders Equity-52.9%
✗Ackman>= 15%
5-Year EPS CAGR
✗Templeton> 0% (5-year EPS CAGR)
Operating Margin Trend
✗TempletonNon-negative operating-margin trend over 3 years
Revenue growth vs. gross and operating margin trend
✗SleepRevenue rising; gross margin flat or falling; operating margin holding
Net income / market capitalization-8.54%; #4103/6340 (top 64.7%)
✗AsnessTop 30% of eligible cross-section✗OshaughnessyTop 10% of eligible cross-section
Gross profit / total assets+47.92%; #717/3702 (top 19.4%)
✓AsnessTop 30% of eligible cross-section
Net income / positive book equity-52.94%; #4241/5226 (top 81.2%)
✗AsnessTop 30% of eligible cross-section
Negative 5-year standard deviation of ROA
✗AsnessTop 30% of eligible cross-section
3-5 Year Diluted EPS CAGR
✗Neff7%-20% annualized
Positive Diluted-EPS Years
✗Schloss>= 70% positive over 5-10 observed years (app rule)
Valuation0% pass✓ 1✗ 27▾
No clean pass — all 13 investors flag at least one valuation criterion
Price / 3-yr avg EPS
✗Graham<= 15x
Price-to-Book Ratio4.6x
✗Graham<= 1.5x
P/E x P/B
✗Graham<= 22.5
Basic earnings-growth PEG (dividends excluded)
✗Lynch< 1.0 (ideally < 0.5)
EBIT / Enterprise Value-9.4%
✗Greenblatt> 10%
Earnings Yield + ROC AssessmentEY=-9.4%, ROC=-77.0%
✗GreenblattBoth EY > 10% and ROC > 25%
Price / EPS
✗Dreman< 12x✗Templeton< 12x (fixed ceiling; proxy for the market's cheapest 40%)
Price / (CFO / Shares)N/A (negative CFPS)
✗Dreman< 8x
Price / Book Value per Share4.6x
✗Dreman< 1.2x✗Templeton< 1.5x✗SchlossP/B <= 0.80x (app cutoff)
Valuation ReasonablenessOE Yield=-6.6%
✗MungerP/E < 25 or Owner Earnings Yield > 5%
P/E or FCF YieldFCF Yield=-6.3%
✗PabraiP/E < 15 or FCF Yield > 10%
P/B or P/E vs. Historical AverageP/B=4.6x
✗MarksP/E < 15 or P/B < 2.0
Discount to Intrinsic Value
✗Marks>= 20% below intrinsic value
Price / FCF per ShareN/A (negative FCF)
✗Ackman<= 25
Price vs. Trailing Low193% of trailing low ($8.89)
✗Templeton<= 120% of trailing low (certified split-adjusted live window)
Net income / market capitalization-8.54%; #4103/6340 (top 64.7%)
✗AsnessTop 30% of eligible cross-section✗OshaughnessyTop 10% of eligible cross-section
Positive book equity / market capitalization+0.1613; #4402/6449 (top 68.3%)
✗AsnessTop 30% of eligible cross-section
Price / Diluted EPS
✗NeffP/E <= 15x (app proxy for a P/E 40%-60% below the market)
(EPS CAGR % + Dividend Yield %) / P/E
✗Neff> 0.7 (Neff's published traditional edge)
Price / Tangible Book Value per Share4.63x
✗SchlossP/TBV <= 1.00x (app cutoff)
Book Value per Share Change
✗SchlossLatest BVPS >= earliest BVPS over >= 3 years (app rule)
Revenue / market capitalization+0.1530; #4030/5247 (top 76.8%)
✗OshaughnessyTop 10% of eligible cross-section
(Operating cash flow - capex) / market capitalization-7.44%; #3119/4519 (top 69.0%)
✗OshaughnessyTop 10% of eligible cross-section
Trailing six-month price return through the evaluation date+91.50%; #372/6202 (top 6.0%)
✓OshaughnessyTop 10% of eligible cross-section
Cash Flow0% pass✓ 1✗ 11▾
No clean pass — all 10 investors flag at least one cash flow criterion
Free Cash Flow Proxy$-29.6M
✗BuffettPositive and growing
FCF Positive and Growing$-29.6M
✗LynchPositive and growing
Operating Cash Flow$-29.0M
✗PiotroskiCFO > 0
(CFO / Total Assets) vs ROACFO/Assets=-22.27%, ROA=-22.77%
✓PiotroskiCFO/Assets > ROA
Price / (CFO / Shares)N/A (negative CFPS)
✗Dreman< 8x
P/E or FCF YieldFCF Yield=-6.3%
✗PabraiP/E < 15 or FCF Yield > 10%
FCF Positive0/2 years FCF positive
✗MarksPositive FCF in majority of recent years
(OCF - CapEx) / Market Cap-7.6%
✗Ackman>= 4%
Price / FCF per ShareN/A (negative FCF)
✗Ackman<= 25
Positive Operating Cash Flow frequency0/2 years positive
✗SleepPositive OCF in >= 70% of available years
Operating Cash Flow - Capital Expenditures$-34.9M
✗Neff> $0 (app proxy for a strong fundamental case)
(Operating cash flow - capex) / market capitalization-7.44%; #3119/4519 (top 69.0%)
✗OshaughnessyTop 10% of eligible cross-section
Growth0% pass✓ 2✗ 11▾
No clean pass — all 8 investors flag at least one growth criterion
EPS Growth (3-yr avg, 10-yr window)
✗Graham>= 33% growth
Basic earnings-growth PEG (dividends excluded)
✗Lynch< 1.0 (ideally < 0.5)
3-5 Year EPS CAGR
✗Lynch15-30% (Fast Grower); > 0% to pass
Inventory Growth vs Revenue GrowthInv: 85.4% vs Rev: 85.9%
✓LynchInventory growth < Revenue growth
EPS Growth Direction
✗DremanPositive over recent years
EPS CAGR
✗Dreman> 5% annualized
Positive Net Income Frequency0/2 years positive
✗MarksPositive net income in >= 7 of last 10 years
3yr Median Revenue Growth85.9%
✓Ackman>= 5%
Positive EPS Growth Frequency
✗AckmanPositive EPS growth in >= 3 of last 5 years
5-Year EPS CAGR
✗Templeton> 0% (5-year EPS CAGR)
Revenue growth vs. gross and operating margin trend
✗SleepRevenue rising; gross margin flat or falling; operating margin holding
5-year Revenue CAGR
✗SleepCAGR > 7%
3-5 Year Diluted EPS CAGR
✗Neff7%-20% annualized
Verdicts13% pass✓ 2✗ 13▾
Split decision: 12 FAIL · 2 PASS · 2 NEUTRAL
Overall verdict
✗GrahamFAIL (2/9)✗BuffettFAIL (0/9)✗LynchFAIL (3/7)✗GreenblattRank #2426✓PiotroskiPASS (F-Score 5)✗DremanFAIL (2/11)✓MungerPASS (2/4)✗PabraiFAIL (0/3)✗AkreFAIL (2/6)✗MarksFAIL (0/5)✗AckmanFAIL (2/9)✗TempletonFAIL (2/8)✗SleepFAIL (1/6)•AsnessNEUTRAL (Not ranked)✗NeffFAIL (0/6)✗SchlossFAIL (2/7)•OshaughnessyNEUTRAL (Not ranked)
Efficiency25% pass✓ 3✗ 8▾
6 of 8 flag CARL's efficiency — Buffett, Greenblatt, Piotroski +3 more
Current Ratio5.79
✓Graham>= 2.0
ROIC (3-5 yr avg)-85.0%
✗Buffett> 10%
ROIC - WACC-95.0%
✗BuffettPositive (WACC = 10%)
EBIT / (NWC + Net Fixed Assets)-77.0%
✗Greenblatt> 25%
Current Ratio Change YoY5.60 -> 8.87
✓PiotroskiIncreased YoY
Revenue / Total Assets Change YoY0.52x -> 0.39x
✗PiotroskiImproved YoY
Current Assets / Current Liabilities5.79
✓Dreman> 1.5
Return on Invested Capital-36.7%
✗Munger> 15%
ROIC (high and growing)FY2023: ROIC=unavailable; FY2024: ROIC=unavailable; FY2025: ROIC=-21.1%
✗AkreLatest 3 consecutive FYs: ROIC > 15% in each
Reinvestment Rate x ROICN/A (non-positive net income)
✗AkreReinvestment Rate * ROIC > 10%
ROIC (5-year)0/1 years above 12% (latest -21.1%)
✗SleepROIC > 12% in a majority of years

Business & financials

Financial snapshot: annual FY 2025. Current investor scores may use newer quarterly data.

Company Profile

Industry: Medical Equipment

SIC Sector: Measuring & Medical Instruments

Size: Small Cap($469.2M)

Revenue: $50.5M+85.9% YoY

Net Income: $29.6M-22.2% YoY

Financial Snapshot

Operating Margin-60.5%

Return on Equity-30.0%

Debt / Equity0.16

Current Ratio8.87

EPS (Diluted)$-2.12

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Company Financials

Latest TTM and quarters alongside annual years

TTM sums four consecutive quarters and uses the latest quarter-end balances. Quarter columns show three-month results; annual columns show full-year totals. Growth compares the same period a year earlier. EPS is not added for TTM; full-year ratios are blank for quarters.

The latest annual period end is unavailable. Showing the latest fiscal cycle’s quarters; quarter and annual columns may overlap. Quarterly shows the full quarter history.

Metric	TTM · 2026-09-30 2025-10-01 – 2026-09-30 Sources · derived quarter values 10-K · 2026-02-25 10-Q · 2026-05-05 10-Q · 2026-08-05 10-Q · 2026-11-10 Derived from cumulative filings: revenue, net income, operating income, gross profit, ebit, interest expense, operating cash flow, depreciation amortization, capex.	Q3 FY 2026 2026-07-01 – 2026-09-30 Sources · derived quarter values 10-Q · 2026-11-10 Derived from cumulative filings: operating cash flow, depreciation amortization, capex.	Q2 FY 2026 2026-04-01 – 2026-06-30 Sources · derived quarter values 10-Q · 2026-08-05 Derived from cumulative filings: operating cash flow, depreciation amortization, capex.	Q1 FY 2026 2026-01-01 – 2026-03-31 Sources 10-Q · 2026-05-05	FY 2025 Sources 10-K · 2026-02-25	FY 2024 Sources 10-K · 2026-02-25	FY 2023 Sources 10-K · 2026-02-25
Market Cap	$469.2Mcurrent	--	--	--	$332.0Mest.	$58.2Mest.	--
Revenue	$71.8M	$21.6M↑65%	$18.9M↑57%	$16.1M	$50.5M↑86%	$27.2M	--
Operating Income	-$42.3M	-$12.7M↓41%	-$11.0M↓70%	-$9.3M	-$30.6M↓27%	-$24.1M	--
Net Income	-$40.1M	-$12.2M↓44%	-$10.5M↓55%	-$8.7M	-$29.6M↓22%	-$24.3M	--
EPS (Diluted)	--	$-0.45↓12%	$-0.39↑73%	$-0.32	$-2.12↑65%	$-6.11	--
Gross Margin	77.0%	77.3%↑2%	76.8%↑5%	77.1%	75.3%↑2%	73.8%	—
Operating Margin	-59.0%	-58.9%↑15%	-58.3%↓8%	-57.6%	-60.5%↑32%	-88.8%	—
ROE	-52.9%	—	—	—	-30.0%↓187%	34.3%	—
Total Debt	$15.4M	$15.4M	$15.4M	$15.4M	$15.3M	$15.4M	--
Shareholders' Equity	$75.7M	$75.7M↓29%	$84.2M↑201%	$92.2M	$98.9M↑240%	-$70.6M↓53%	-$46.1M
Current Ratio	5.79	5.79↓52%	8.84↑82%	11.88	8.87↑59%	5.60	—
Debt / Equity	0.20	0.20↑41%	0.18↑198%	0.17	0.16↑171%	-0.22	—
Operating Cash Flow	-$34.4M	-$8.7M↓3%	-$7.4M	-$13.0M	-$29.0M↓14%	-$25.5M	--
Free Cash Flow	-$34.9M	-$9.0M↓4%	-$7.5M	-$13.1M	-$29.6M↓15%	-$25.6M	--

Score history

Historical Score Timeline

Industry peers

Industry Peers

Similar companies in Medical Equipment

CARL vs Peers — Financial Grading

Revenue$50.5MBottom 25%

Net Income$29.6MBottom 25%

ROE-30.0%Bottom 25%

D/E0.16Top 25%

Op. Margin-60.5%Bottom 25%

Curr. Ratio8.87Top 25%

Company	Market Cap	Price	Revenue	Net Income	ROE	D/E	Op. Margin	Curr. Ratio	Graham	Buffett	Lynch	Greenblatt	Piotroski	Dreman
ALCON INCALC	$35.6B	$74.12	$10.4B	$980.0M	4.4%	0.21	13.1%	2.12	2/9	1/9	3/7	0/3	F-Score 6	4/11
KONINKLIJKE PHILIPS NVPHG	$29.7B	$30.34	$21.0B	$1.1B	8.2%	0.64	8.0%	1.32	1/9	1/9	1/7	0/3	F-Score 5	3/11
WEST PHARMACEUTICAL SERVICES INCWST	$29.0B	$416.42	$3.1B	$493.7M	15.5%	0.06	19.0%	3.02	4/9	6/9	6/7	1/3	F-Score 7	5/11
SMITH & NEPHEW PLCSNN	$13.1B	$31.28	$6.2B	$625.0M	11.8%	0.59	12.9%	2.57	2/9	0/9	1/7	0/3	F-Score 6	4/11
MSA Safety IncMSA	$6.7B	$174.17	$1.9B	$278.9M	20.4%	0.42	19.8%	3.01	5/9	5/9	4/7	1/3	F-Score 5	7/11
STAAR SURGICAL COSTAA	$1.3B	$26.39	$239.4M	$80.4M	-23.4%	—	-38.3%	4.55	2/9	2/9	2/7	0/3	F-Score 3	3/11
ARTIVION, INC.AORT	$931.9M	$19.10	$441.3M	$9.8M	2.2%	0.48	7.6%	3.53	2/9	0/9	0/7	0/3	F-Score 7	1/11
InMode Ltd.INMD	$763.6M	$13.27	$370.5M	$93.8M	13.7%	—	23.0%	9.88	5/9	3/9	0/7	3/3	F-Score 4	4/11