In certain cases, the presence of off balance sheet debt can significantly alter the investment outlook for a company. Five Star Quality Care (FVE) had the highest ratio of off-balance sheet debt to total assets in 2012. FVE's $2.3 billion in lease obligations, equivalent to $1.2 billion in debt, were added back to invested capital. Without factoring in this off-balance sheet debt, FVE would have had a top-quintile return on invested capital (ROIC) of 17%. By holding FVE accountable for this capital, however, we see that its true ROIC is a much lower 6%, less than its weighted average cost of capital (WACC). Looking at just GAAP data, FVE appears to be a profitable company. Factoring in the true amount of capital invested in the company reveals that, on the contrary, it actually makes negative economic earnings.