Neuronetics, Inc. Aktie

Good day, and thank you for standing by. Welcome to the Neuronetics Reports Third Quarter 2026 Financial and Operating Results Conference Call. [Operator Instructions] Please be advised that today's call is being recorded. I would now like to hand the conference over to your first speaker today, Aman Patel with ICR Healthcare. Please go ahead.

Good morning, and thank you for joining us for the Neuronetics Third Quarter 2026 Conference Call. Joining me on today's call are the Neuronetics President and Chief Executive Officer, Dan Reuvers; and Chief Financial Officer, Nir Naor.

Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements related to our business strategy, financial and revenue guidance and other operational issues and metrics. Actual results can differ materially from the company's business. For a discussion of risks and uncertainties associated with Neuronetics business, I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's annual report on Form 10-K, which was filed in March and the company's quarterly report on Form 10-Q for the quarter ending March 31, 2026.

The company disclaims any obligation to update any forward-looking statements made during the course of this call, except as required by law. During the call, we will also discuss certain information on a non-GAAP basis, including EBITDA. Management believes that non-GAAP financial information taken in conjunction with U.S. GAAP financial measures provides useful information for both management and investors by excluding certain noncash and other expenses that are not indicative of trends in our operating results. Reconciliation between U.S. GAAP and non-GAAP results are presented in the tables accompanying our press release, which can be viewed on our website.

With that, it's my pleasure to turn the call over to Neuronetics' President and Chief Executive Officer, Dan Reuvers.

Thanks, Aman, and good morning, everyone. Thank you for joining us for our third quarter 2026 earnings call. I'll first walk you through the quarter, reviewing our results on each side of the business, and then I'll turn it over to Nir to discuss our financial results in greater detail. I'll then come back with how we're thinking about the rest of the year and the setup for 2027 before opening it up for questions.

Turning to the quarter. We continue to execute against the profitability and operating cash goals we outlined earlier in the year, and we made meaningful progress on both fronts. Total revenue for the quarter was approximately $42 million, up over 12% versus the third quarter of last year. The results reflect a record quarter for NeuroStar system sales, driven by a welcome reception from customers toward our expanded go-to-market strategy as well as continued strength within our Greenbrook clinics as we realize ongoing impacts of our revenue cycle management efforts.

Diving deeper into our NeuroStar performance, let me start there. Total worldwide revenue was $15.8 million, up approximately 2% year-over-year. This was primarily driven by our capital equipment business, where we had a record quarter of system sales. We saw strong double-digit year-over-year performance here, and I believe it's being positively impacted by the go-to-market changes we introduced earlier this year. Notably, we believe many of these placements are with customers we would not have been able to compete for with our prior approach, including a recently awarded sole-source agreement with a large national player.

The strength of our capital business was partly offset by sessions revenue being down versus last year, which was expected as we implement our new sales strategy. We continue to expect the overall revenue mix to be weighed more towards NeuroStar Capital versus sessions going forward as we execute on our plan. As such, we expect session revenue to continue to trend slightly downwards. We believe that our go-to-market changes position us well to compete in a broader segment of the market and expect to yield higher overall net growth in 2027 and beyond.

It's also worth reiterating that for customers preferring our treatment session model built around a high-touch partnership with Neuronetics, nothing changes. We believe this sessions model continues to set us apart as we believe we're uniquely equipped to help emerging TMS practices establish a profitable therapy adjunct.

NeuroStar customers perform almost twice as many treatments per chair as the competitive landscape, a velocity differentiator we believe directly reflects the support and affirmation of value we bring. During the quarter, we also had several noteworthy advances that reinforced our commitment to growing the NeuroStar platform. On the regulatory front, in August, we submitted a 510(k) to the FDA for an accelerated TMS protocol and it's currently under review. We expect that condensed protocols can be an advantage for some patients, and this could be another way to expand access to TMS for even more patients.

We also had an important publication in the TMS Journal titled The Impact of Treatment Gaps on the Effectiveness of Transcranial Magnetic Stimulation in Major Depressive Disorder. The paper reflected analysis of over 6,400 patients whose depression was treated with NeuroStar under real-world conditions. It showed that approximately 15% of patients completed their treatment course with no gaps, leaving 85% of patients who missed 1 or more scheduled treatment days. Since missed days can be common, patients and physicians often wonder if a missed treatment day may negatively affect outcomes. The analysis found that there was no statistically significant difference in outcome between patients that experienced a gap in their treatment versus those that didn't. It further concluded that missing treatment for up to 13 days did not reduce effectiveness.

This is an important consideration as patients may otherwise put off initiating treatment based on their availability to commit to an uninterrupted sequence of days. Lastly, we signed a distribution agreement with Wave Neuroscience to integrate its MeRT system with NeuroStar. MeRT uses EEG data to personalize TMS protocols and received FDA clearance in June for treating adults with post-traumatic stress disorder, achieving 68% remission in its pivotal trial.

Prior to launch, we plan to seek FDA clearance to add NeuroStar as a TMS system compatible with Wave Neuroscience's PTSD indication. Approximately 9 million U.S. adults experience PTSD annually with an estimated 4-plus million of those seeking treatment. Thus, this partnership represents a significant opportunity to expand NeuroStar's clinical application. On the operational front, we announced in September what we believe is the first ever integration between a TMS system and an Electronic Health Record, or EHR, connecting our TrakStar practice management platform with AdvancedMD, a cloud-based EHR, practice management and revenue cycle platform serving more than 65,000 practitioners across 13,000 independent practices, including our own Greenbrook clinics.

Delivering TMS means coordinating care across a multi-session course of treatment, along with documentation and clinical notes, while claims and authorizations are often managed in separate systems. This creates duplicate work for practices. With this integration, treatment data flows into the same system where a practice manages its schedule, clinical records and notes and revenue cycle. It will be available in the fourth quarter to NeuroStar providers already using AdvancedMD.

We use AdvancedMD as our EHR at our Greenbrook clinics. So we expect to benefit from this efficiency just like our NeuroStar customers. This inaugural integration further paves the way for us to integrate TrakStar into additional EHRs, extending additional practice efficiencies to NeuroStar customers and prospects alike.

Moving to Greenbrook. Revenue was approximately $26 million, up over 20% year-over-year. Our work on revenue cycle management continued to produce results with better patient qualification, cleaner claims, and more efficient collections, all helping us convert more of each billed dollar to cash. This quarter, we also began deploying Skypoint, an AI-enabled coding optimization tool, which builds on automation technology established earlier this year. This advances the operational discipline we've been building throughout the organization by ensuring insurance claims are submitted quickly and accurately. We are very encouraged by the early results and believe there's still runway ahead for us.

We continue to believe that filling the capacity in our existing clinics remains an important profitability lever. Our focus will continue to be on finding the most efficient ways to serve even more qualified patients that can benefit from our therapies. Two key measures that we monitor closely are relative return on our direct-to-consumer advertising and field sales team effectiveness. We determined, based on what we're seeing to date, that field sales personnel deliver the better return and give us more control over patient acquisition cost and yield. As a result, we're shifting a portion of our direct-to-consumer ad spend towards expanding our Greenbrook field sales team. We expect this to sponsor a bigger sales team without increasing overall sales and marketing expense. We plan to begin this process in the fourth quarter.

We expect the new reps to be fully ramped up and contribute meaningfully by mid-'27. As we execute this strategy, we will update you on our progress. Overall, this quarter, we continued doing what matters most, executing against our new go-to-market strategy for NeuroStar while competing for customers who were previously out of reach, running our Greenbrook clinics more efficiently and delivering on our goals towards profitability and cash generation.

With that, I'll turn it over to Nir to take you through the financials, and then I'll come back with our outlook for the rest of the year. Nir?

Thank you, Dan, and good morning, everyone. Unless otherwise noted, all comparisons are third quarter 2026 versus third quarter 2025. Total revenue in the third quarter was $42 million, an increase of 12.5% compared to $37.3 million in the third quarter of 2025. The increase was primarily driven by higher Greenbrook revenue. Greenbrook revenue was $26.2 million, a 20.1% increase. These results reflect continued growth of our Greenbrook business and operational gains across our clinics.

NeuroStar revenue was $15.8 million, an increase of 1.8%. As Dan explained, strong capital sales were partially offset by a decline in session revenue as we implement our new go-to-market strategy. Gross margin was 52.2% in the third quarter of 2026 compared to 45.9% in the prior year quarter. The increase was driven by a positive impact of our new go-to-market strategy and improved revenue cycle management within the Greenbrook clinic.

Operating expenses during the quarter were $21.3 million, a decrease of $3.1 million or 12.6% compared to $24.4 million in the third quarter of 2025. This was primarily due to lower sales and marketing expenses, partially offset by higher general and administrative expenses. Income from operations was $0.5 million compared to a loss of $7.3 million in the prior year quarter, an improvement of $7.9 million. Net loss attributable to Neuronetics stockholders was $1.7 million or $0.02 per share as compared to a net loss of $9 million or $0.13 per share in the prior year.

Third quarter adjusted EBITDA was $1.9 million as compared to a loss of $4.7 million in the prior year, an improvement of $6.6 million. Moving to the balance sheet and cash flow. As of September 30, total cash was $27.9 million, consisting of $22.1 million of cash and cash equivalents and $5.8 million of restricted cash as compared to total cash of $34.1 million as of December 31, 2025. Cash provided by operating and investing in the third quarter was $0.8 million compared to negative cash flow from operating and investing of $0.9 million in the prior year.

Now turning to guidance. For the full year 2026, we expect total revenue between $160 million and $164 million, unchanged from previous guidance. Gross margin between 49% and 50% compared to prior guidance of 48% to 50%. Operating expenses, excluding stock-based compensation of between $89 million and $92 million with estimated stock-based compensation of $3.5 million compared to prior guidance of $91 million to $96 million and stock-based compensation of $4 million.

Operating expenses between $92.5 million and $95.5 million compared to prior guidance of $95 million to $100 million. Cash flow from operating and investing in the range of negative $10 million to negative $12 million compared to prior guidance of negative $10.5 million to negative $14.5 million. We continue to target limited to no net cash utilization from operating and investing in the second half of the year.

In summary, this was a quarter of solid financial progress. We grew revenue, expanded gross margin, reduced operating expenses and delivered positive adjusted EBITDA and positive cash flow from operating and investing. Our goal is to turn this progress into sustained profitability and cash flow generation, and I look forward to building on this momentum into Q4 and next year.

With that, I'll turn it back to Dan for his closing remarks.

Thank you, Nir. I'd like to take this time to recognize and thank our Neuronetics colleagues for their efforts in the clinics, field, and across the organization. Their effort is what delivers value to our patients and the strong performance we're seeing.

As Nir discussed, we're pleased to have delivered another strong quarter, driven by both our go-to-market strategy in NeuroStar as well as our continued momentum at Greenbrook. At the same time, we're making meaningful progress toward profitability and cash generation and we believe we're well positioned for sustained overall growth in 2027.

In addition to the progress we've been making with NeuroStar, Greenbrook and operationally, we also continued our collaboration with Compass Pathways to prepare for the anticipated commercial launch of their psychedelic therapeutic for treatment-resistant depression, or TRD. Compass recently reported 52-week data from its Phase III COMP-005 trial, showing that an additional dose of COMP360 extended the benefit in TRD out to 1 year, which we believe further supports COMP360's differentiated profile and potential for long-lasting benefit.

Compass has reported that they expect to complete their FDA submission in approximately 2 weeks with the launch expected in the first half of 2027. We continue to believe therapies like this will need exactly the kind of delivery platform that we already operate for SPRAVATO, including a dignified in-office drug administration experience, along with monitoring, REMS programs, trained clinical staff, benefits investigation and prior authorization infrastructure.

Greenbrook's experience, scale, and available capacity position us to be an early leader as we look forward to providing the most comprehensive menu of interventional psychiatry options for patients. Looking to the fourth quarter, we continue to expect NeuroStar revenue mix to be weighted slightly towards NeuroStar capital as our expanded go-to-market and targeting efforts take root. For Greenbrook, we're deliberately rebalancing our sales and marketing spend with the goal of positioning us for sustained growth in 2027. And with that, operator, we're ready to open the line for questions.

[Operator Instructions] Our first question comes from the line of John Young with Canaccord.

Congratulations on the quarter. I want to focus on Greenbrook and the performance that you are seeing there. How much of the growth in Q3 was pricing or revenue cycle gains versus just overall patient volume increases? And can you talk about the unused capacity that continues to exist today?

Sure. Thanks, John, for the questions. First of all, revenue cycle management, I would say, is an area that we've continued to demonstrate really solid progress. So the growth was a combination of revenue cycle management, and we saw growth in SPRAVATO as well. I think we've described the SPRAVATO business as certainly more durable because there's a maintenance phase that patients continue within once they come into network. So it's really a combination between those 2.

I'm really -- I'm pleased with the revenue cycle progress we continue to make as well. I think it really demonstrates that we're positioning ourselves foundationally with just a better run business. From an occupancy standpoint, that continues to be an area of focus. And it's one of the reasons that we're making some of the changes in our go-to-market approach commercially trying to put more of our resources into expanding the sales team and revisiting the utility or efficiency of our direct-to-consumer ad approach.

We've got a pretty big range, John, in occupancy. I'd say it's as low as 25% probably at the bottom and as high as 75% in our highest performers. But clearly, that's a big range, and we want to continue to move that bottom quartile up. So I think the -- some of the changes that we're making, as I said, we expect will certainly have impact as we go into 2027.

Thanks, Dan. And then just to double-click on SPRAVATO, too. I think last time we checked, you were at 84 sites that you're offering it. Has that changed? And then looking at J&J and their reported sales, I believe SPRAVATO grew about 36% year-over-year. I'm not sure if you're willing to quantify the contribution in a dollar amount that it contributed in Q3. But is that a good way to think about your growth as well, that 36% year-over-year growth?

Yes. I don't know if we've given that number in SPRAVATO growth. But certainly, as I mentioned, we've seen double-digit growth in SPRAVATO. And again, I think it's a laddered approach as patients come into the network and then continue on a maintenance phase. So the growth that we do see in SPRAVATO, we expect will continue to be quite durable.

Our next question is from Madison El-Saadi with B. Riley.

Congrats on the progress. A couple from us. Maybe on the Compass pilot, have you said how many clinics would be involved in that pilot program? I'm curious how you picked them and what needs to be true before you would roll this out across the network? And Greenbrook ran a SPRAVATO pilot back in 2021. Obviously, that was in the wake of COVID, but just wondering if that's a good proxy. And then a follow-up, if I may, afterwards.

Yes. Thanks for the question, Madison. We haven't shared how many sites we're going to introduce initially, but I think it's fair to assume that we'll probably initially start with a bit of a hub-and-spoke model. I don't know that we feel obligated to provide it in every one of our 84 SPRAVATO clinics that exists today as much as we want to be in each of the MSAs that we're in. So I think that's probably the key for us.

We expect we will learn a lot with the introduction. And what we're focused on right now are the work streams that are within our control. So things like making sure that we've got training programs and curriculums clearly established for both our caregivers and our sales teams. And I think the next one is taking an extension of that once our sales teams are trained, making sure that we've got a very thoughtful and targeted approach to HCP outreach from our field teams.

And then our whole benefit investigation piece and payer relations team is also attempting to ramp up their readiness. A lot of this in the early days is still going to be hand-to-hand combat. I mean single case agreements initially will likely rule the day until we see some of the coverage components become a bit more mature. But ultimately, we're -- we've got a very dedicated work stream to each of those, and we're downstream with our mitt open and ready to catch.

Awesome. And if I may, a second question related to NeuroStar. Sorry if I missed this. But how much of the record system sales was capital and lease conversions of your existing session customers versus new accounts? And then the treatment volume on the installed base grow in 3Q?

Sure. Yes. First, the question about mix, we do continue to see our mix moving more towards capital and lease. We're not recognizing unit sales if it's an existing customer that just paid off something. So these are new boxes or new chairs and new systems that are going out when we talk about a record number of units.

I think the other thing that we saw was over half of all of our units sold in Q3 were capital or lease units. That was good for ASP. It's also good for gross margin. And I think it's also a reflection that our customers appreciate the choices that we've given them. We're allowing customers to determine where the value they think is. And while the sessions did grow among like customers, so customers that were customers a year ago, modest, but we did see growth on the session side from those customers.

What we're also seeing is that when we start to focus more on larger accounts, multisite accounts, national accounts, enterprise, some of the things that have kind of become our hallmark, which is we can help you with marketing. We can help you build your practice with co-op. We can help you with training, reimbursement assistance, benefits investigation. I mean, bigger systems, they don't need some of those things like the private practice psychiatry offices do. So that's why, again, we've made the choice to expand our aperture on how we go to market, and we've been actually quite pleased on the kind of reception we're getting from each independent type of customer. We think we've got a value proposition for them.

Congrats again on the quarter.

Our next question comes from the line of Sam Eiber with U.S. Bancorp BTIG.

Congrats on a nice quarter here. Maybe I can start on Greenbrook and coming back to the revenue cycle management improvements. I guess I'm curious the durability of some of the progress that you made there and ability to, I guess, keep advancing some of that benefit into 2027. And then I'll have a quick follow-up question.

Sure. Thanks. Sam, I think I've talked a lot about the value drivers within Greenbrook. And I think foundationally, the first one is continued demonstration of improvement in our revenue cycle management approach. I think that the short answer is I think most of these changes are quite durable.

We talked a little bit about deploying an AI-enabled new partner, Skypoint. There's a lot of components of processing a claim that are largely labor-intensive. We have to pair clinic notes depending on who the payer is, what the requirement is, making sure that we're matching up everything for each individual payer, starting to use some software tools, including some AI optimization is bearing fruit. I can tell you that when we deployed Skypoint, just that change in workflow has led to a low double-digit improvement in the first month of collections. So we don't obviously collect all of our collections in the first month.

There's some that gets -- comes in, in month 2, month 3, month 4. But importantly, the faster we can collect, the better it is for the business, of course. And we saw meaningful progress from some of those changes. It also reduced some of the headcount in the back office which we were able to redirect into some other roles. So I do think that there is both durable impact from our efforts and I think there's continued improvement available to us. But I would also add, we're going to have to keep climbing a little higher on the tree to find the fruit. As we continue to get better, the improvements will become a bit more modest, but I do think that there's more runway ahead for us.

Build on that, Sam. So yes, as Dan mentioned, the very nice improvements that we have done, some further improvements that we can do just built off of them. And basically, the only thing if you look at our, say, gross margin compared to the prior year, those improvements are, for the most part, durable. The ones that are not are simply some prior period RCM catch-ups. But otherwise, yes, they are durable, and we're building on them.

Okay. That's great. Makes sense. And then a quick follow-up on the EHR integrations. I'm curious how much of a selling point and maybe a competitive advantage that is seamlessly integrating the EMR platform. And then I think you hinted at maybe additional integrations coming with maybe some of the bigger platforms. Curious if you're able to put any sort of time line on when that might be?

Sure. Yes, I think that the AMD-TrakStar integration was an important first step for us. And there's a fairly fragmented EHR network of providers out there. AMD is the larger of a pretty long tail of EHRs. So that's why we selected them. We also selected them in part because that's who we use at Greenbrook. So not only could we benefit from the efficiencies of integrating the EHR with TrakStar, but we can also obviously bring it to our NeuroStar customers.

Our goal is to make sure that we are focused on existing AMD customers that aren't yet NeuroStar customers because we think that we bring another very unique value proposition that's unavailable to our competitors. It's -- there's a lot of work that goes on in managing the documentation within health care, as you know. So charting, all the clinic notes, et cetera, often have to be transcribed, entered into 2 places. This allows our clinician customers to be able to do that just once. It also enriches our own TrakStar data. We've talked a lot about how rich and unique the database that we continue to collect within TrakStar is. This will allow us to start to collect even more information on each of those patient experiences, including was the patient pregnant, what medications were they on, all of which I think can continue to be a powerful pool of data that will be available to us.

I think as far as next EHR partners, we're going to monitor how we do with the existing AMD user base, assuming that we can demonstrate the improvements and our customers find value in that. Certainly, we will start to sequence the second and third and subsequent EHRs. We've got a pretty good prioritized list but I want to see that we can make sure that we demonstrate the value through the AMD partnership as a bit of a predicate.

Our final question comes from the line of Daniel Stauder with Citizens JMP.

I just wanted to follow up on some of the questions for -- on the segment level in terms of margin, specifically on clinics. So strong improvement in gross margin, even more so on the operating margin, and you gave some commentary there already. But was there anything else beyond your progress on efficiency and workflow there that led to a benefit, maybe broader change in the average occupancy or some product mix benefits within clinics.

And it sounds like you still think there's room to improve, but with that incremental sales rep investment, do you think that's going to be absorbed pretty well into margins? Just how should we think about that?

Sure. I think there's probably 2 components to the margin, and let me just revisit the rep cost issue. On Greenbrook, most of the margin improvement was better revenue cycle management, more so than mix. I think on the NeuroStar side, it's a mix function. We continue to see, as I said, more than half of our capital units went out -- more than half of our units went out as capital or lease purchases. And when that happens, they go out at a premium. So I think the combination between those 2 were probably the most significant contributors on the gross margin side. Just back to the rep cost. Our goal is to add 8 reps to our already base of 20 that would take us to 28 by sometime in Q1. We don't expect any incremental cost associated with that. And it doesn't -- it's not magic. It's just we're going to repurpose a number of the dollars that are going into direct-to-consumer adds and sponsor more salespeople.

And we've done enough data dive to be quite convinced that our return on our field salespeople is much higher. First of all, they have access to pharma data. We know who the prescribers are at a primary care or psychiatry office in the communities where we have Greenbrook clinics. We also know how many patients each of them treat with 2 or more MDD drugs. So it's easier to target the right audience. And what we find is the patients that are referred to us from those practices are come in much better qualified and more likely for us to be able to help them.

Patients who come in through DTC, while they're well intentioned and we'd love to help them if they don't qualify, if they haven't failed on 2 meds, we can't, yet it can clog up our intake teams as well, trying to help patients that ultimately won't qualify and we can't get them into a treatment room. So I think that we expect the yield to be better and we also expect that our allocation of sales and marketing dollars to provide a better return for us.

That's great color. And just a follow-up there. You hit on NeuroStar margins. Just with some of the shifting dynamics with capital, even within capital and session mix, how should we think about a more steady state gross margin here as this normalizes the levels we've seen this quarter and in 2Q, what we should think about going forward? Or is there any puts and takes we should consider?

Yes. I don't know that I would predict any dramatic swings in gross margin on NeuroStar. I think we're already starting to see the mix settle in a little bit more to a predictable future state mix. So I think we're starting to see a reflection of what that margin might look like. So I think it continues to depend on what the adoption rates are in our offering. But at this point, I don't know that I would expect any dramatic swings either way on gross margin from what we've seen more recently.

Great. And I'll try to squeeze one more in here. Just you talked about some of that data on gap in treatment and missed days. Do you feel that this could alter how providers think about treatment regimens in the future? And how could that give patients more flexibility and optionality? And what's the pathway for that potential change becoming a reality?

Yes. I think that's a great question. And I think it's an important one. This is the reference to the article in the TMS Journal that we had published demonstrating that a patient could miss days as many as 13 days. It doesn't mean that they don't get their full treatment. It just means that there could be lapses in those days. And with up to 13 days of missed treatments, there was no demonstrated reduction in effectiveness.

And I think the relevance there is that for patients that have been reluctant to say, yes, I will go ahead and start a regimen of TMS. I think a lot of them may -- like all of us in life, life is busy. And gee, I've got a commitment next week or there's a holiday trip I'm going to take or my kids are off school that day or I can't get off work, whatever it might be, it's a commitment to be in TMS therapy for 7 weeks. The ability to be able to understand that I can actually take a break and still get the benefit, I think it's a welcome mat for patients that have been reluctant to start or for referral sources for the same reasons, who've been reluctant to send them our way.

And then even in the fourth quarter, you think about holidays, a lot of times, patients may be reluctant to start. The message that I think this sends resoundingly is start now, don't wait. If there has to be a break, there has to be a break but suffering from depression can be a debilitating condition. So we want to help patients start to initiate the therapy as quickly as we can.

This concludes the question-and-answer session. I would now like to turn it back to Dan Reuvers for final remarks. Dan?

Thank you, and thanks for everybody for participating and joining us for the call. We're delighted to continue to demonstrate progress, and we certainly look forward to sharing our full year results once they're completed in 2027. Until then, thank you again.

We appreciate you for participating in today's conference call. This does conclude the presentation. You may now disconnect. Thank you.

Good day and thank you for standing by. Welcome to the Neuronetics Second Quarter 2026 Financial and Operating Results Conference Call. [Operator Instructions] Please be advised that today's conference is being recorded.

I would now like to hand the conference over to your first speaker today, [ Mike Valley ] from ICR Healthcare. Please go ahead.

Good morning and thank you for joining us for the Neuronetics second quarter 2026 conference call. Joining me on today's call are the Neuronetics President and Chief Executive Officer, Dan Reuvers, and the company's recently appointed Chief Financial Officer, Nir Naor. Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements covered under the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements related to our business, strategy, financial and revenue guidance, and other situational issues and metrics. Actual results can differ materially from those stated or implied by these forward-looking statements due to risks and uncertainties associated with the company's business.

For discussion of risks and uncertainties associated with Neuronetics' business, I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's annual report on Form 10-K, which was filed in March, and the company's quarterly report on Form 10-Q for the quarter ending June 30, 2026. The company disclaims any obligation to update any forward-looking statements made during the course of this call except as required by law. During the call, we'll also discuss certain information on a non-GAAP basis, including EBITDA.

Management believes that non-GAAP financial information taken in conjunction with U.S. GAAP financial measures provides useful information for both management and investors by excluding certain non-cash and other expenses that are not indicative of trends in our operating results. Reconciliations between U.S. GAAP and non-GAAP results are presented in the tables accompanying our press release, which can be viewed on our website. With that, it's my pleasure to turn the call over to Neuronetics President and Chief Executive Officer, Dan Reuvers.

Thanks, Mike, and good morning, everyone. Thank you for joining us. I'll walk you through the quarter and each side of the business, and then I'll turn it to Nir to cover the financials in greater detail. Then I'll come back with how we're thinking about the rest of the year before opening it up for questions. Having now spent several months in the role, meeting with customers, spending time in our clinics and working alongside our field team, I've gained a clearer view of where the business is performing and where opportunities exist. I'm pleased to report the second quarter began to reflect our steady execution against the goals I cited last quarter. Total revenue was $41.6 million, up approximately 9% versus the second quarter of last year. The results reflect the continued strength of Greenbrook and some early impacts of our NeuroStar TMS go-to-market pilot.

Importantly, we began to show meaningful progress towards profitability and reduced our cash burn significantly. Starting with NeuroStar, total worldwide NeuroStar revenue was $14.7 million. On the capital side, we had a strong quarter. This reflected an encouraging early reception to our second quarter go-to-market pilot, including a deliberate change in how we compete for customers. For most of our history, we offered essentially 1 way to work with us, a treatment session model built around a high-touch partnership between Neuronetics and our customer. It's a model we believe in and 1 that continues to set us apart, with NeuroStar customers performing almost twice as many treatments per chair as the competitive landscape.

This is a velocity improvement that directly reflects our unparalleled support. But as the TMS market has matured, we've seen that customers value different levels of support. Some want that full partnership. Others simply want to own the system outright, the way they would any other piece of capital equipment. Our prior strategy did not allow us to compete within this broader customer universe. To address this, while we're continuing to offer the treatment session model, along with our comprehensive support program, we've also introduced new and different ways a customer can choose to acquire a NeuroStar system. Specifically, they can purchase 1 outright or opt for a lease-financed option, which allows a customer to use the system over time without a significant upfront capital commitment.

For customers who elect to purchase a system, we now offer support on an a la carte basis, allowing them to select the specific elements of our clinical and operational support that they want, rather than accessing it through a treatment session model. In each case, customers gain access to the same market-leading technology, and those who choose the session model retain the high-touch support that's always distinguished us. We introduced these approaches on a limited basis earlier this year and expanded the pilot through the second quarter. The early reception was encouraging, and we have since moved to a broader rollout. Over time, as more customers choose to own their systems, more of that value will be reflected in capital revenue, consumables, and service, and less in treatment session revenue.

That shift reflects both the demand we're seeing for a capital model and our ability to compete for business that was previously out of reach. Consistent with our expectations, NeuroStar revenue was down slightly versus prior year, with capital revenue up double digits, while treatment session revenue was down double digits versus a year ago. Almost half of the reduction in the sessions revenue reflected the continued normalization of customer inventory, now at the lower levels we'd expect to maintain. The balance was from units no longer active. Underneath that, demand for treatment sessions remained strong within accounts that were active a year ago, with utilization up approximately 10% among them.

The broader point is the TMS market itself continues to grow both across the industry and within our accounts. The decline in our session revenue reflects the change in our model, not the demand for the therapy. Ultimately, as we introduce new commercial options and we see some mix shifts, our second-half revenue may be a bit choppier, but the changes position us for renewed and sustainable growth as we enter 2027. We're also continuing to invest in the platform itself. In May, we announced a strategic collaboration with ANT Neuro to co-promote their FDA-cleared neuronavigation technology with NeuroStar. Providers are looking for tools that bring more visualization, consistency, and personalization into how they plan and deliver treatment. And this partnership lets us offer that alongside the NeuroStar system. We have the largest installed base of TMS systems in the country, which gives us the ability to bring innovations like this to market and scale them across the field.

Moving to Greenbrook, which was the star of the quarter. The operational discipline that we'd been building into the clinic business continued. Greenbrook revenue was $26.9 million, up approximately 17% year-over-year. Beyond the top-line growth at Greenbrook, our work on revenue cycle management continued to produce results, with cash collections growing even faster than revenue. Focusing on better qualifying patients' eligibility, cleaner claims submissions, and more efficient collections were key contributors, along with improved reimbursement rates through more effective payer contracting across both TMS and Spravato. We also began using AI in the insurance authorization process, which has helped us reduce operating costs. This reflects the operational discipline that we've been building into these clinics, and it's converting into cash, not just billings. And we believe there's still runway ahead of us.

The other lever is occupancy. These clinics carry a largely fixed cost base, so the more efficiently we can run each site and the more patients we treat, the more profitable each location becomes. That's where much of our operational focus continues to sit today. With available capacity, we're closely examining our sales methods, including number of field reps, direct-to-consumer ad spend, and peer-to-peer education events, attempting to improve referrals while doing so with the most efficient patient acquisition cost. This, too, remains a meaningful incremental profitability driver.

Before we move on, I wanted to provide an update on changes to our senior leadership team. As you might imagine, I spent a fair amount of time in my first 100 days evaluating our leadership team and structure. As a result, I made some changes to our leadership team, including reducing executive headcount and flattening our structure. This should allow us to get and stay closer to the details of the business. Some of the key changes include the recent appointment of Nir Naor as Chief Financial Officer. Nir brings more than 20 years of finance experience across medical device and care delivery businesses, including at his last company, where he helped the business reach profitability and achieve positive cash flow within a year. That experience is directly relevant to our priorities at this stage of our business, and I'm confident he'll be a key thought partner as we execute on our priorities.

We also promoted [ Corey Anderson ] to Executive Vice President and General Manager of Greenbrook. [ Lori ]'s been with us more than 5 years overseeing both our technology and clinical data efforts, as well as leading the commercial readiness efforts of psychedelics with our partners at Compass Pathways. Putting a dedicated leader with a rich understanding of the interventional psychiatry space as the head of Greenbrook reflects its importance to our future and the types of initiatives that will help us continue to drive growth in that part of the business. And in June, we appointed [ Rob Green ] as Senior Vice President of Sales. Rob spent his career leading commercial organizations across healthcare and medical technology, including in capital equipment and service. As we roll out new commercial models for NeuroStar, Rob's experience will be central to executing that strategy.

Separately, we consolidated roles in marketing and operations, and [ Andy McCann ] will be stepping down as Chief Legal Officer later this month. With this team in place, we're well-positioned to execute our strategy and the priorities that we're reviewing this morning. Stepping back, we moved forward this quarter on what matters most, competing for NeuroStar customers who were previously out of reach, running our Greenbrook clinics more efficiently, and advancing our goals towards profitability and cash generation. I'll turn it over to Nir to take you through the financials and I'll come back with our outlook for the rest of the year. Nir?

Thank you, Dan, and good morning, everyone. Let me start with a few thoughts on why I joined and then walk you through the quarter. I came to Neuronetics because I saw a business with a strong core, leading technology, and a national clinical network, as well as a clear opportunity to improve how it converts that into profitability and cash. That is what I've spent my career doing and that is what I intend to focus on here. Turning to our financials. Unless otherwise noted, all performance comparisons are being made to the second quarter of 2026 versus the second quarter of 2025.

Total revenue in the second quarter was $41.6 million, an increase of 9.1% compared to revenue of $38.1 million in the second quarter of 2025. The increase in revenue was primarily driven by higher Greenbrook revenue. With the commercial model update that Dan mentioned in his comments, we intend to update our financial reporting on a go-forward basis to better align with the relevant operational metrics. As customers move between owning a system, financing 1, purchasing support on an a la carte basis, or opting for the traditional session model, the split between capital and treatment session revenue no longer reflects the business in a consistent manner.

We plan to manage the total growth of the NeuroStar franchise. With a host of contributing revenue lines such as sessions, capital, lease, service, consumables, and others, comparisons versus the past become less relevant for us. As a result, we will look at our NeuroStar business more holistically and intend to report it as a single revenue line going forward. Accordingly, total revenue from our NeuroStar business was $14.7 million in the second quarter of 2026, a decrease of 2.7%. For context, our session revenue was down double digits and our capital sales were up double digits. Greenbrook revenue was $26.9 million, a 16.8% increase. The results were driven by strong continuous provider growth and overall pricing improvement.

Gross margin was 51.1% in the second quarter of 2026 compared to 46.6% in the prior year. This was a function of mix and our improving revenue cycle management efforts. Operational expenses during the quarter were $22.7 million, a decrease of $3.1 million, or 12%, compared to $25.8 million in the second quarter of 2025. This was largely due to lower general and administrative expenses and lower sales and marketing expenses. Continued cost efficiency measures were 1 of the key drivers for that change. Net loss for the quarter was $3.4 million, or $0.05 per share, compared to a net loss of $10.1 million, or $0.15 per share in the prior year. Adjusted EBITDA was positive $0.3 million as compared to negative $5.6 million in the prior year, an improvement of $5.9 million.

Moving to the balance sheet and cash flow. As of June 30, total cash was $25 million, consisting of cash, cash equivalents, and restricted cash, as compared to $19 million as of March 31, 2026. Cash used by operations and investing in the second quarter was $1.4 million. This compares to cash used from operations and investing of $3.8 million in Q2 of 2025. During the quarter, we also raised $7.6 million in net proceeds through our at-the-market equity offering.

Now turning to guidance. We're narrowing our total revenue range to $160 million to $164 million compared to prior guidance of $160 million to $166 million. We now expect gross margin range to be between 48% and 50% compared to prior guidance of 47% to 49%. We're lowering our OPEX guidance to $95 million to $100 million versus our prior guidance of $100 million to $105 million. The majority of this change is driven by decreased expectation of share-based compensation. Since share-based compensation fluctuates significantly, it's a non-cash component and is difficult to forecast going forward. We're going to guide to OPEX excluding share-based compensation. On this basis, we would expect this number to be $91 million to $96 million for the year. Our current estimate of share-based compensation is $4 million for the year.

We're also updating our cash flow guidance to include both cash flow from operations and cash flow from investing as we consider this sum a more representative view of the company's organic cash utilization and estimate it to be in the range of negative $10.5 million to negative $14.5 million for the full year. This is compared to our prior guidance of cash flow from operations only in the range of negative $13 million to negative $17 million. We continue to target limited net cash utilization for operations and investing in the second half of the year.

In summary, this was a quarter of solid financial progress. We grew revenue, improved our margins, reduced our cash burn, and strengthened our balance sheet, all while continuing to invest in the growth of the business. Our focus is on converting that progress into sustained profitability and positive operating cash flow. With that, I will turn it back to Dan for his closing remarks.

Thanks, Nir. Let me close with a few thoughts on where we go from here. During the quarter, we continued our collaboration with Compass Pathways to prepare for the anticipated commercial launch of their psychedelic therapeutic for treatment-resistant depression, or TRD. We also shared the stage with them at an investor panel last month to continue to educate the investor community about the potential market dynamics with a new treatment option for providers to prescribe for TRD patients. With their recent Phase 3 extended durability data readout, our enthusiasm for the opportunity continues to grow.

The regulatory path is Compass's to run, and I'm not going to get ahead of it, but therapies like this, when they come to market, will require exactly the kind of delivery platform that we already operate. In-office drug delivery and monitoring, REMS programs, trained clinical staff, the benefits investigation and prior authorization infrastructure that we run every day for Spravato. As new psilocybin treatments become available, they'll need places equipped to deliver them safely and at scale. Greenbrook's experience, scale, and available capacity positions us as an early leader in that space as we look forward to providing the most comprehensive menu of interventional psychiatry options for patients.

More broadly, our priorities for the rest of the year are clear. We'll continue expanding how we compete within the TMS space with NeuroStar, keep driving operational discipline and cash generation at Greenbrook while seeking to help even more patients, expanding our occupancy, and positioning for the opportunities ahead in interventional psychiatry. Ultimately, we intend to be the destination of choice for the psychiatry community looking for the most effective treatment interventions for their patients. We have real work in front of us, but we have the team, the resources, and the momentum to see it through.

Before I close, I'll note that earlier this month, we announced a constructive understanding with 1 of our largest shareholders, reflecting a shared commitment to maximizing long-term value for our shareholders. The Board and I welcome that alignment, and it reinforces the focus we all share on executing, including the priorities I've laid out this morning. I want to thank our employees for a hard-fought quarter and for the work that they do every day on behalf of the patients that we serve and our shareholders for their continued support. With that, operator, we're ready to open the line for questions.

[Operator Instructions] Our first question comes from the line of William Plovanic with Canaccord.

First of all, congratulations on a solid quarter, you know, definitely improving the cash flow. I'm going to focus on the future rather than the past. In terms of Greenbrook, as you're leaning into this really service offering for all these new psychedelics coming to market, I was wondering if you could help us understand just with the Greenbrook footprint as you go to optimize those, 1, how many rooms are typically available on average per site? 2, as you become more cash-generating, could we expect you to start opening more facilities or expanding the existing facilities? Yes, my understanding is the Compass product is like a 6-hour versus maybe Spravato at about 2 hours of observation requirements and how do you address those capacity issues and balance that against revenue. But really, it's on the Greenbrook and just leaning in there.

Yes, good question, thanks, Bill. So I think, first of all, I'll talk about psychedelics in a minute, but I think that initially, there's a lot of runway that continues to be available to us simply in improving the capacity that's available within so many of our sites. So we've got a fair amount of fixed costs, as you know, and we've talked about having available capacity as much as 40% that's still not consumed. So filling those chairs with patients that can benefit from our therapies is a top priority. And I think we have a lot of improvement to occur even while we're waiting for the psychedelics to be introduced.

That said, we think about it more as units of time and available capacity. A lot of these rooms where we treat patients for Spravato can quite easily be converted to also administer psychedelics like COMP360. So I think that we've already got the capacity in the rooms and it's a matter of making sure that we're filling these to better capacity, which is an opportunity for growth that we have even before some of the psychedelics come available. And then as they do, we have been putting a lot of energy into making sure that we're being thoughtful about how we would schedule those varying treatments. As we know, TMS is a matter of minutes, a couple of hours for Spravato, and to your point, probably closer to 6 hours for COMP360, in varying sequences for some of the other therapeutics to come later.

We're starting to use AI for scheduling to optimize how we can make sure that we do that in the most productive way. So I think there's a lot of opportunity for us to continue to fill that capacity. And once we do, once we start to get closer to that and we need more space, certainly more sites or expanding those footprints is well within our roadmap. But initially, I think there's so much unused capacity, we'll really focus there first, and then sequentially there will be an opportunity for us to look at expansion.

Excellent. If I could have 1 follow-up. Just on, you know, you've come in and you've made a lot of, you've cut a lot of costs. I mean, definitely have improved the operating structure of the business. You know, as you think of that mission from here forward with the recent announcements you've made and the changes in management, you know, are you through kind of the bulk of the changes and here it's more incremental tweaking from a cost structure? Or just how should we think about the opportunity for further efficiency gains in the operating structure?

Yes, I think that a natural thing is sometimes we don't always look in the mirror first as executives. So, starting with the leadership ranks and trying to make sure that the structure and the people that fill the right roles was established, I feel really good about where we sit today. I think we've added some really good talent. I think we've redistributed some of the assignments to some really talented up-and-coming folks within the organization. So I think that we, I feel like we sit quite well there. I think there's probably still opportunities for us. I think this is where having a new CFO flanking me with just a couple of weeks under his belt, so, he and I will have an opportunity to more comprehensively continue to examine where those additional opportunities might exist. But organizationally, I feel like we've made a lot of progress and I'm feeling very good about kind of how we've anchored ourselves at this point.

Our next question comes from the line of [ Danny Southerwood ] with Citizens Bank.

Really nice quarter, and Nir, congrats on the new role, and it's great to have you on the call. Just on my first 1, I want to make sure of understanding the NeuroStar treatment session dynamic here. So it sounds like the normalization of inventory should continue through the rest of the year. So it should continue to be down, maybe with some offset from gains in capital. So I just want to make sure that's the right way to be thinking about it. And then do you think this is more of a dynamic for just new customers or do you expect, you know, a larger portion of your existing customers to transition to some of these other models and offerings that you have?

Yes, thanks, Danny. Appreciate the question. I think on the sessions inventory, just to be clear, we feel like that the inventories are down about as low as we would expect them to be maintained. So, I don't see any continued inventory reductions in the back half of the year. I think we've, after the second quarter, I think largely equilibrated to where we think normal sustainable inventories would be. So I don't see that as much of a headwind in the back half as perhaps in the second quarter. I think from an existing customer standpoint, 1 of the things I want to make sure doesn't get lost is the comment I made in the prepared remarks, we know that our chairs receive almost twice as much patient velocity as the competitive landscape.

So we certainly think that a lot of the customers that have selected us did so largely because of the comprehensive support we provide and the kind of improvements it makes in their own practice. So I think that we expect that the majority probably of those sessions customers who have benefited from that level of comprehensive service will continue in that vein. We will certainly offer more options, and that's what we've been talking about in our new go-to-market strategy is we want to let the customer decide where they see the value and how they want to pay for it. So I think the other point to be made is that if a customer, a new customer for example, chose the capital route versus the traditional sessions route, they'll still pay for things like service and consumables and training, and those things are currently embedded in the sessions structure.

And it's 1 of the reasons that we chose to start to report on this on a more holistic basis, because there's probably going to be some noise moving back and forth, and I think that it's important to appreciate that some of the consumables, some of the service, that revenue that we've gotten has been embedded in the sessions revenue side. So, you know, we're going to give customers the option to decide how they want to pay for the value that we bring. But ultimately, I think that while we will expect to open ourselves up to new socket placements with this broader go-to-market, we're also hearing that there's a big segment of our customer base that remind us why they picked us in the first place, and that's that comprehensive support that we provide.

That's great. Appreciate that. And then this 1 quick follow-up for me. It's great to see the improvement on operating expenses and below the top line. I wanted to focus on gross margin, just that line was really strong, even with clinic revenue being the primary driver of growth and making up a larger mix of sales. So could you just give us a little bit more color on what drove that gross margin expansion here? I think you called out some pricing improvement within clinics, so any color there or just anything else on the execution would be great.

Sure, yes, that's certainly a high point for the quarter. And as you know, we raised our guidance on gross margin for the full year. So we think that some of these improvements are durable. And the good news, I think, also is that we saw support or strength in the gross margin on both the Greenbrook and the NeuroStar side. So, on the Greenbrook side, a lot of it has to do with improved revenue cycle management. And that is as we make sure that we're being more disciplined about patient qualification, which is good for the patient as well. They don't want to find out that they don't meet the right criteria when they're 3 sessions in. So that's going to focus. That leads to cleaner claims and more efficient accounts receivable.

So all of those things mean you capture a bit better revenue on a billed dollar than we did in the past. And I think those are durable, and those are clearly things that are contributing to the better gross margin on Greenbrook, along with some pricing relative to our team's work with some of the third-party payers. On the NeuroStar side, while sessions revenue was off a bit and capital was up, I think it also points to the fact that as our mix starts to equilibrate more and it's not exclusively on the sessions side, our ASP is going up. So as that growth occurs in capital, I think that that can be also a sustainable good guide for us on the gross margin side. Of course, both of those considerations are embedded in our updated guidance.

Our next question comes from the line of Sam Eiber with BTIG.

Maybe I can start on the Greenbrook side, a really strong quarter on that side of the business. Dan, wondering if you could help parse out maybe some of the underlying trends you're seeing on the Spravato side versus the TMS side of the business. And then, you know, just as I think about Compass and psilocybin entering the market, you know, perhaps next year, maybe just talk about how, you know, your model is set up best by offering, you know, Spravato, TMS, psilocybin, and why that's the best model for patients.

Yes, so just making a quick note here. So I think first of all on the Spravato versus TMS, we saw a bit more strength probably from Spravato even than TMS, but I think the fact that the overall business is growing is just a good reflection of the fact that Greenbrook's becoming an increasing destination of choice for referral sources. The Spravato business is certainly more durable, as I think I've alluded to in the past. The duration between treatments, even after an initial round, continues to be more sustainable. I guess that's good for us from a patient standpoint. It means they have to revisit us a bit more frequently. So those patients tend to stay more active for a longer period of time within our network.

I think on the Compass side, I think there's a number of things that I alluded to in our comments earlier that really position us well. I think we're really poised to be a first-mover benefactor, just in part because of the close collaboration we've had with them and some of the preparation benefits, but also the infrastructure that we talked about that already exists because of our Spravato participation. The REMS certification, the rooms, setups, the capacity availability, all of those things I think lend themselves to positioning us in kind of a pole position. And I think the other 1, Sam, is a little bit about kind of your question about the blend. We really want to position ourselves with referral sources as the destination of choice for whatever intervention is best suited for that patient within the interventional psychiatry scope.

I think that we've already done that with [ ECT ], with TMS, with Spravato, we look forward to doing it with Compass, and I think as additional new therapeutics come out, we are positioning ourselves, both infrastructure and the brand, that we really want to be the destination that they can entrust their patients. The fact that we don't do medical management and psychotherapy also gives those referral sources the confidence that they can send their patients to us and know that they'll get them back. I think all of those are important parts of kind of the ecosystem we're trying to build.

That's really helpful, Dan. Thanks for the added color there. Maybe I can just use a follow-up here on some of the comments around different sales methods you're going to be evaluating with regard to field reps and direct-to-consumer spending. Are there certain KPIs that you'll be tracking or that we should be mindful of as you, I guess, evaluate, you know, efficiently getting more patients through the door here?

Yes, I think, so externally, KPIs, I think you can ultimately look at our operating expenses, of course. The patient acquisition cost is 1 that we're taking a more scrutinizing look at. And I can say quite confidently that the account managers that support the Greenbrook community are proving to be a very effective source for referral generation. I think we want to take a closer look at the balance in spend between our field team and some of our direct-to-consumer ad spend, along with some of the other things that we do from a peer-to-peer education. And we're just trying to be a lot more thoughtful about trying to evaluate what each 1 of those costs and which ones are returning the most effectively.

I would expect that we will probably pull and push on some levers, try and rebuild some and balance our spend in the most effective paths and at the expense of some of the others. So some of that work continues to go on. There's a lot of analytics that we're working on, but at the end of the day, it really comes down to our patient acquisition cost and what's the most efficient way to get the right patient who can benefit from our therapies in a chair.

Okay, very good.

I am showing no further questions in the queue. I would now like to turn the call back over to Dan Reuvers for any closing comments.

Thanks, Operator, and thank you to everyone for joining today's call. We really look forward to updating you on our progress during our next quarterly call and hope everybody has a good rest of the summer. Thank you.

This concludes today's conference call. Thank you for your participation and you may now disconnect.

Good day, and thank you for standing by. Welcome to the Neuronetics First Quarter 2026 Financial and Operating Results Call. [Operator Instructions] Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today.

Good morning, and thank you for joining us for the Neuronetics First Quarter 2026 Conference Call. Joining me on today's call is Neuronetics' President and Chief Executive Officer, Dan Reuvers. Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements covered under the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements related to our business, strategy, financial and revenue guidance and other operational issues and metrics.

Actual results can differ materially from those stated or implied by these forward-looking statements due to risks and uncertainties associated with the company's business. For a discussion of risks and uncertainties associated with Neuronetics' business, I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's annual report on Form 10-K, which was filed in March and the company's quarterly report on Form 10-Q for the quarter ended March 31, 2026. The company disclaims any obligation to update any forward-looking statements made during the course of this call, except as required by law.

During the call, we'll also discuss certain information on a non-GAAP basis, including EBITDA and adjusted EBITDA. Management believes that non-GAAP financial information taken in conjunction with U.S. GAAP financial measures provides useful information for both management and investors by excluding certain noncash and other expenses that are not indicative of trends in our operating results. Reconciliations between U.S. GAAP and non-GAAP results are presented in the tables accompanying our press release, which can be viewed on our website.

With that, it's my pleasure to turn the call over to Neuronetics' President and Chief Executive Officer, Dan Reuvers.

Thanks, Mark, and welcome, everyone, to our first quarter 2026 earnings call. I'll begin by sharing some perspectives on my background and why I joined the company, discuss some early observations, and then I'll walk through the key drivers of our performance in the quarter. Then I'll walk through our quarterly financial results in greater detail, and I'll conclude with my perspective on the rest of 2026 before opening the line for questions.

This is my first earnings call as CEO of Neuronetics, and I'm pleased to be here. I've spent about 35 years in the med tech industry, and most of my career has been in businesses where patient impact, execution and operational rigor drive the outcome. Most recently, I served as CEO of Tactile Medical, where we grew revenue from $187 million to approximately $300 million. During that time, we expanded patient reach, grew gross margins, delivered record earnings and cash flow generation. Before that, I spent 12 years with Integra LifeScience, where I led the $1 billion Codman Neurosurgery division. And earlier in my career, I held leadership roles at several other med tech companies.

There were a couple of things that drew me to this role. First, our mission to renew lives by restoring hope for patients and their families is one that I'm passionate about. It's amazing how many people have reached out to me since taking the role, sharing their stories of how they or someone they knew have either suffered from depression or better yet benefited from one of our therapies. Second, I think my background gives me a great perspective on how to move this business forward. My experience in the device space will allow me to come up to speed on the NeuroStar business quickly. And it's notable that Tactile was vertically integrated, meaning we designed, manufactured and sold our therapy solutions, but also directly build third-party payers, an experience I expect to draw on as we continue to improve efficiency within our Greenbrook clinics.

Since stepping into the role, I've spent the bulk of the last month on a listening tour. I've been on the road with our field team, inside our clinics and meeting with customers. I've also engaged with shareholders, analysts and others, helping me shape my understanding of the business. My approach has been deliberate and comprehensive, intended to allow me to fully understand this business before making decisions about where to lean in, where to adjust and how we maximize the value of what we have. With that said, what I've seen in my first few weeks has reinforced my conviction in the underlying opportunity that exists for us.

First, on the NeuroStar side, I see a clear opportunity to broaden how we go to market and reach customer segments where we've not historically been positioned to compete. I'll talk more about that in a moment. Second, with the Greenbrook clinics, workflows are key to optimizing profitability in our clinics, not only ensuring that patients have an efficient path to initiate their treatment and gain relief, but also to minimize operational handoffs. Revenue cycle management is also an area where I've spent time in my previous role. And what I've seen inside our clinic operations tells me there is more opportunity ahead. Lastly, we have a talented team that's focused and executing. And I've been genuinely impressed with the quality of the people and the conviction toward our mission across the organization.

Now before I walk through the quarter, I'd like to briefly address 2 items. First, on our recently announced CFO transition. Steve Fansteel departed earlier this month to pursue an opportunity outside Neuronetics. We've initiated a comprehensive search to identify his successor. We appreciate Steve's contributions during his time at Neuronetics, and we'll provide updates as the search progresses. Ultimately, this allows me to select a partner that I'm confident, can help me lead our next chapter.

Second, I want to share some perspective on the comments made by certain shareholders about our business. While we believe that the integrated NeuroStar and Greenbrook businesses provide us with a strong foundation to grow from, we respect some shareholders' views that the separation of the business could potentially unlock shareholder value. The Board and I are aligned on operating this business with discipline and on making decisions that create long-term value for our shareholders. I assure you that I'm evaluating this business with an open mind, and I appreciate everyone's patience as I work through my process.

With that context, let me share a bit more about our performance in the quarter. Our Q1 results were largely in line with expectations, and we're making progress on the commercial and operational priorities already in motion. Starting with the NeuroStar business. During the quarter, we shipped 34 systems, up 10% year-over-year. We continue to support our installed base with the most comprehensive training and clinical resources in the category. We're also modernizing how we deliver that support with more virtual, on-demand and real-time engagement tools that provide customers with choices on how they want to be supported.

We're piloting an expanded set of commercial models for NeuroStar. Customers exist with a range of needs. And while we have a history of providing unparalleled ongoing support to our customers, we also know that not all customer's needs are the same. So expanding our go-to-market menu is a priority. I'm convinced that we can compete on a broader horizon by listening to customers and responding in kind. Early feedback has been positive, and I'll have more to share in August.

Now a few comments on Greenbrook. Clinic revenue grew 15% in the quarter. Growth in the quarter was driven by continued strength in SPRAVATO with treatment growth year-over-year and expansion of buy-and-bill. On the TMS side, within our clinics, volumes were modestly below prior year levels in the quarter, which we attribute in part to weather disruption across portions of our footprint during the first 2 months of the quarter. We saw patient flow normalize as the quarter progressed, and we expect to return to more typical volume trends as we move into the second quarter.

Within our clinic operations more broadly, the focus remains on workflow and revenue cycle management. The team has made real progress on collections and operational efficiency, and we see continued runway. We've also leveled our marketing investment across the year rather than front-loading it, which we believe is the right cadence for the business. We acted during the quarter to better align our cost structure.

These steps are expected to deliver annualized savings of approximately $2.5 million to $3 million with net savings beginning in the third quarter. Profitability and cash are top priorities and will be a focus of mine going forward. Taken together, the quarter reflects a business that's executing on the priorities already in motion while we lay the groundwork for our next phase of growth.

With that, I'll walk through the financial results in greater detail. Unless otherwise noted, all performance comparisons are being made to the first quarter of 2026 versus the first quarter of 2025. Total revenue in the first quarter was $34.5 million, an increase of 8% compared to revenue of $32 million in the first quarter of 2025. The increase in revenue was primarily driven by higher U.S. clinic revenue. Total revenue from our NeuroStar business, inclusive of our system revenue as well as treatment session revenue was $12.9 million in the first quarter of 2026. This represents a decrease of 3% versus the prior year.

U.S. NeuroStar system revenue was $3.2 million, an increase of 13% on a year-over-year basis, and we shipped 34 systems in the quarter, an increase of approximately 10% versus the prior year. U.S. treatment session revenue was $9.1 million, a decrease of 5%, while system treatment utilization increased 3.5%. This was offset primarily by a reduction in customer inventory levels. U.S. clinic revenue was $21.5 million, a 15% increase year-over-year. The results were driven by continued strong SPRAVATO growth and overall pricing improvement.

Gross margin was 46.9% in the first quarter of 2026 compared to 49.2% in the prior year quarter. The decrease in gross margin is a result of revenue mix with clinic revenues representing a higher portion of our overall revenues. We also saw some negative impact from the increase in SPRAVATO buy-and-bill from Q1 of last year when we were still launching that offering.

Operating expenses during the quarter were $25.1 million, a decrease of $1.6 million or approximately 6% compared to $26.8 million in the first quarter of 2025. The decrease is primarily attributable to savings in SG&A expenses, where we have driven and will continue to drive efficiencies.

Net loss for the quarter was $10.8 million or $0.16 per share as compared to a net loss of $12.7 million or $0.21 per share in the prior year. First quarter 2026 adjusted EBITDA was negative $6.6 million as compared to negative $8.6 million in the prior year, an improvement of $2 million.

Moving to the balance sheet and cash flow. As of March 31, total cash was $19 million, consisting of cash and cash equivalents and restricted cash as compared to $34.1 million as of December 31. Cash used by operations in the first quarter was $9.4 million. This compares to an operating cash use of $17 million in Q1 of 2025, an improvement of $7.6 million versus the prior Q1.

As previously disclosed, in March 2026, we amended our debt agreement with Perceptive Advisors, which reduces our outstanding debt obligation and interest expense. Under the amendment, we made a one-time principal payment of $5 million to Perceptive Advisors, along with adjustments to the existing debt covenants.

Now turning to guidance, which remains unchanged. We continue to expect total revenue between $160 million and $166 million, gross margins to be between 47% and 49%, operating expenses in the range of $100 million to $105 million, inclusive of approximately $8.5 million of noncash stock-based compensation. Cash flow from operations between negative $13 million and negative $17 million.

As a reminder, our operating cash flow is projected to improve beginning in the second quarter and then sequentially through the remainder of the year, with operating cash flow being flat to positive during the second half of the year. And in the second quarter, we expect to see mid-single-digit growth.

As we look ahead to the remainder of 2026, our priorities are clear. We're focused on disciplined execution, sharpening how we go to market and continuing to drive the business towards being cash flow positive. The pilots we have underway in the NeuroStar side of the business are designed to expand our reach and within our clinic operations, we'll continue to focus on workflow, collections and operational efficiency. We expect these benefits to continue building throughout the year.

Looking further out, I want to briefly touch on COMPASS Pathways pending psilocybin therapy. The regulatory process is Compasses to navigate, but the Trump administration's recent executive order prioritizing such submissions is certainly encouraging. If approved, we believe Greenbrook is among a very small number of providers genuinely equipped to deliver it. The protocol requires certified settings, trained clinical staff and a proven back-office infrastructure for benefits investigation and prior authorization, all of which we already have in place through our SPRAVATO operations. While we will be prepared to execute if the product is approved, similar to SPRAVATO, we'd expect the revenue ramp to be measured in the first year of launch, but the narrow pool of providers capable of delivering this therapy represents a durable advantage for our business.

As I mentioned earlier, my approach in these first few weeks has been deliberate. I'm committed to making decisions that balance the interest of our patients, physicians, colleagues and shareholders. And I expect to be able to share an even more grounded view of where we're headed when we report next quarter. I want to thank the Neuronetics team for the work they've put in this quarter and for the welcome they've given me. I look forward to updating you all on our progress in August.

And with that, I'll open the call for questions. Operator?

[Operator Instructions] Our first question comes from the line of Bill Plovanic from Canaccord Genuity.

So 3 questions for you, Dan, if I could. One is just clarity on the performance in the Greenbrook sites. I just want to make sure I heard that the -- was it the treatment revenue and number of treatments was down year-over-year, backing out the SPRAVATO. I just want to get -- to make sure I heard that correctly.

Yes. Overall, we were pleased with the Greenbrook performance. We were up double digits, as we said, about 15%. The TMS volumes were off a little bit, Bill. And we think that, that was related to a couple of things. One, weather, which we -- pretty concentration up here in the Northeast. And then we were a little lumpy in our ad spend as we exited last year. So smoothing that this year, I think, is going to bring that more in line with consistency. But we also saw better performance in March than we did in January and February. So it was -- we don't think that, that was a trend as much as an event. On the SPRAVATO side, we saw growth in both the buy-and-bill and the A&O segments, double digit in both segments. And yes, buy-and-bill was up as a mix compared to Q1 of last year. But I think it's worth noting that we've also seen that kind of equilibrate over the last couple of quarters as far as mix between that and A&O.

Okay. Great. And then just secondly, one of the biggest challenges new executives face when they come into a company is just making sure to keep the team intact and turnover. And I just wanted to see if you could provide any color on what you've seen thus far. I know it's only been 45 days, but just kind of what you're seeing across the organization thus far.

Yes. It's -- first of all, I've been really impressed with how much the mission permeates through the company. People are really connected with the impact that we're making on patient's lives. I mentioned in my opening comments that I was on -- I've been on a listening tour for the first month for the most part. And that gave me an opportunity to go out and spend time with folks in the field as well as having spent a good amount of time in the office. So I've met with a lot of people, have been trying to connect as best I can with things like podcasts and town halls. And so far, I've been pleased with, as I said, kind of where people's attitudes are. I think there's an anxious enthusiasm to think about how we might do things different, how we might continue to find ways to get better. So overall, I would say, quite good. And I don't -- I haven't seen anything as far as turnover spikes or anything that would have, I would say, raised an eyebrow for me.

Okay. I think just the last question is really elephant in the room. I mean you addressed it, but I just wanted to hit home on it. Just you ended the quarter with $19 million of cash, $13 million unrestricted. It sounds like given the guidance that would tell us you'll use $4 million to $8 million of that during the full year. I would expect most of that would be in the second quarter given the guidance that the back half would be positive. I just -- any thoughts, comments? Is that enough to get you through with working capital? And just how are you thinking about that today?

Yes. I mean we're always evaluating the balance sheet. But I think as we shared at the midpoint of $15 million of burn for the full year, the math would lead you to $14 million at year end. So -- and you're also right in that our assumptions are that we would be flat to positive in the second half of the year. So based on the current plan, we feel like we've got sufficient headroom in the balance sheet to get us -- to take us through the year.

Our next question comes from Adam Maeder of Piper Sandler.

Congrats on the new role and look forward to working with you again. Two for me, one kind of housekeeping question and one bigger picture question. Just on the housekeeping item, weather. It sounded like there was an impact to TMS volumes at Greenbrook clinics. I was hoping you could kind of quantify that for us. Is it also reasonable to assume that your stand-alone NeuroStar business also saw some headwind from weather? And how do we think about how quickly these patients can potentially kind of be -- their sessions can be recaptured? And then I had a follow-up.

Yes. I'm not going to quantify on the Greenbrook side, Adam, but we did see -- we do think that there was some of the impact there, particularly because we saw more of the weakness in January and February than we did in March. It's also worth noting on the NeuroStar side that TMS patients are coming in every single day. So trying to manage a schedule around weather is more difficult than SPRAVATO patients that are coming in more episodically and have a lot more latitude in scheduling.

So I think that was one of the reasons that we saw the impact within Greenbrook. On the NeuroStar side, we think that we saw some of the same kind of impact from weather. But that said, from a total utilization standpoint, we were actually up low single digits on absolute utilization within our NeuroStar business as far as treatment sessions were concerned. We saw a little softness in the revenue [ rec ] just because we had a little bit of customer inventory on hand that folks are working through. But overall, I would say the business held up quite well in spite of the weather.

Okay. Fantastic. And then for my follow-up, Dan, in the press release, you talked about significant value in the business that's yet to be fully realized. You also have a large shareholder who issued a letter last month for -- asking for a strategic review and potentially a sale of the TMS business. And you touched on it in the prepared remarks. I think I heard you're evaluating the business with an open mind. I guess I was hoping you could share a little bit more color here on your early learnings and thoughts as you think about kind of the broader makeup of Neuronetics. And one question that I sometimes get from investors is the NeuroStar business, the stand-alone business, why can't that business grow faster given the size of the total addressable market? And what are the plans to kind of catalyze that business? And sorry for the multipart question.

Yes. Yes, no problem. So first, as it relates to the shareholder letter that we saw. As I said in my opening remarks, I mean, I really have been on a listening tour, and I've had outreach to that shareholder along with others just to make sure that I'm hearing some of their thoughts and concerns. I think there's some frustration there. And quite frankly, I appreciate it. I think that what I'm still trying to do is really look at the business through a variety of different lenses, and I'm pretty pragmatic about it. I mean I'm not wed to a predetermined conclusion, but I'm also not inclined to be impetuous and make sure that I look at the business overall.

I think as it relates to what can we do to continue to demonstrate strength and growth, which under any outcome scenario adds long-term value for shareholders, it's looking at the NeuroStar business, I do think that we probably under punched our weight here lately. The opportunity to expand our go-to-market menu is one of the things that I believe is going to be a helpful catalyst for us. And we're still in pilot phases on that, Adam. But ultimately, we have taken an approach that has conveyed what I would call unparalleled support to our TMS customers. I don't think any other competitor out there comes even close to the kind of support we provide to our customers.

But that said, not all customer's needs are the same. So I think it's important for us to expand our menu and allow customers to kind of establish which parts of value they want and make sure that we've got kind of a broader girth of go-to-market menus that they can select from. So we're in the midst of doing some pilots right now. I think we'll have a lot more clarity over the next couple of months, but it includes making sure that we're looking at incentive comp that it's aligned with our direction, that we have an opportunity to revisit our funnel and make sure that we've slotted those in the right spaces. So more work to do, but I think that as we continue to really reevaluate our go-to-market and with an open mind look at how we can make sure that we're matching the right level of support to that, which the customer wants to pay for. I think that's a ratio that I expect will bear some fruit.

Our final question comes from the line of Danny Stauder of Citizens JMP.

Just my first one, following up on kind of the TMS question. But Dan, I wanted to ask about the commercial strategy for TMS. We know there was a realignment of the capital sales team and system sales have been strong the last 2 quarters. But as you sit here in the early days of your tenure, just broadly, how do you think about the balance between focusing on driving utilization per site versus expanding the installed base? Are there any potential strategic changes here? Or how do you think about that balance?

I think continuing to drive utilization is an important one because whether we're on a sessions model or otherwise, it's what's the underlying creation of demand and the more utilization our customers continue to find more patients they can help. One way or another, that's going to lead to an expansion of our business. So I think we're going to continue to look to how we can expand our socket placement or placement of new capital units. I think that's one of the places where we've probably slipped a bit and focusing on new placements and expansion of capital and making sure that it's our unit that resides in those clinics.

Whether regardless, I guess, of what economic model is in place, we just want to make sure that we're demonstrating the most value across the competitive landscape. And I think that between the support we provide with our account managers in the field with benefits investigation, our co-marketing, training, service, the cloud-based TrakStar utility that we've got, I just don't think anybody can compare there. And we're going to, as I said, continue to work through a couple of pilots. But the things that got us there, I think, will continue to be durable areas of value and how we structure that, I think, is some of the things that we're still titrating a bit.

Great. Appreciate that. And then just one on the Compass collaboration. Obviously, the recent update from the administration is good news. But I just want to get a sense of how meaningful this could be? Obviously, Compass is already pretty far along in terms of the approval process, but do you feel this recent update could be more important on the reimbursement pathways? I know that's been a focal point for eventual contribution. So just any thoughts you have there would be appreciated.

Yes. Well, first of all, I think that the whole Compass opportunity and psychedelics at large represent a big opportunity for us given our footprint and our infrastructure. I was really excited in my first month to see the Trump executive order leaning into the FDA process on some of these. So I think that it probably adds or it shortens the fuse. How much? I don't know, but it probably shortens the fuse on the path to approval, which I think is encouraging for all of us that are in this space.

I'm not sure how much it impacts reimbursement. I think that's probably a separate track, but certainly, the pursuit of that in tandem on Compass' behalf, all of those things sort of point to faster than slower. And as we get into 2027, we'll certainly look forward to being able to try and better quantify what we think that means to us. I think if you look at the SPRAVATO rollout from the early days, as much enthusiasm as there was, it's a bit measured in its early adoption. But I think that the momentum is certainly moving in the right direction on this one.

Great. I appreciate that. And just one last one for me. I just wanted to ask on some of the TMS coverage expansion to include nurse practitioners. I was just curious, high level, if there have been any incremental conversations with accounts on this topic? Have you seen that customers are waiting for this, maybe somewhat higher demand? Just anything more on how this could impact utilization and how you think it will play out in '26 and beyond, would be great.

Yes. So that's the reference to the UHC and the Optum coverage policy change where nurse practice can now be eligible to deliver TMS versus licensed psychiatrists. I think it's a good move. We've got a lot of really quality nurse caregivers out there. I don't know that they were waiting for it as much because maybe they didn't -- sometimes you never know if it's ever coming, but there are 35 million covered lives in the 26 states that will be affected. And I think what it will allow us to do or has allowed us to do is go revisit some of those clinics that are managed by nurse practs where TMS just wasn't a viable option because of the reimbursement limitations. So I think it probably added a number of accounts to our target list, but still early days since we're, I think, a month in.

This concludes the question-and-answer session. I would now like to turn it back to Dan Reuvers for closing remarks.

Yes. I just wanted to thank all of our employees for a hard-fought quarter as they all are as we continue to try and restore hope to patients and their families. And I wanted to thank our shareholders for their support, and I look forward to sharing an update on our progress when we have an opportunity to share the results of our second quarter. Thank you.

Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.

Gentlemen, thank you for standing by, and welcome to the Neuronetics reports fourth quarter 2025 financial and operating results. [Operator Instructions] Please be advised that today's conference is being recorded.

I would now like to turn the conference over to Mark Klausner. Sir, please go ahead.

Good morning, and thank you for joining us for the Neuronetics Fourth Quarter 2025 Conference Call. Joining me on today's call are Neuronetics' President and Chief Executive Officer, Keith Sullivan; and Steve Pfanstiel, Neuronetics' Chief Financial Officer.

Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements covered under the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements related to our business, strategy, financial and revenue guidance, the Greenbrook integration and other operational issues and metrics. Actual results can differ materially from those stated or implied by these forward-looking statements due to risks and uncertainties associated with the company's business.

For a discussion of risks and uncertainties associated with Neuronetics business, I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's annual report on Form 10-K, which was filed premarket today. The company disclaims any obligation to update any forward-looking statements made during the course of this call, except as required by law.

During the call, we'll also discuss certain information on a non-GAAP basis, including EBITDA. Management believes that non-GAAP financial information taken in conjunction with U.S. GAAP financial measures provide useful information for both management and investors by excluding certain noncash and other expenses that are not indicative of trends in our operating results. Management uses non-GAAP financial measures to compare our performance relative to forecast and strategic plans, to benchmark our performance externally against competitors and for certain compensation decisions. Reconciliations between U.S. GAAP and non-GAAP results are presented in the tables accompanying our press release, which can be viewed on our website.

With that, it's my pleasure to turn the call over to Neuronetics' President and Chief Executive Officer, Keith Sullivan.

Thanks, Mark. Good morning, everyone, and thank you for joining us today. Before I get into our results, I'm pleased to announce that the Board has appointed Dan Reuvers as our next President and Chief Executive Officer of Neuronetics effective March 23. Dan is a proven leader with more than 30 years in medical devices, and he knows how to build and scale commercial health care businesses. Having spent time with Dan through the search process, I am confident he is the right person to lead the company into the next chapter. And I'm looking forward to working with him to ensure a smooth transition.

Now turning to our performance. A little over a year ago, we closed the Greenbrook acquisition and set out to build a vertically integrated mental health company with the technology, the clinical infrastructure and the scale to fundamentally change how patients access treatment for mental health conditions. I'm proud to say that in our first full year as a combined company, we've done exactly that. We delivered a strong fourth quarter results with adjusted pro forma revenue growth of 23%, driven by our strongest capital shipment quarter of the year and continued momentum across our Greenbrook clinic network. We also achieved a key milestone of positive operating cash flow in the fourth quarter, driven by revenue growth, operational discipline and the cash collection improvements that we have been implementing throughout the year.

Starting with the update on Greenbrook. Over the course of 2025, we executed against our growth initiatives, and the results speak for themselves. Full year clinic revenue grew 28% on an adjusted pro forma basis. Our regional account manager program is building awareness among referring providers and helping more patients find relief from their depression in our clinics. In the fourth quarter, our referring provider network added 430 new providers, a 25% increase year-over-year, contributing to over 1,300 new referrals added across 2025.

This growth was supported by significantly higher field engagement with our regional teams completing more than 47,000 physician outreach activities during the year. These efforts drove over 2,300 patient referrals in Q4, representing a 46% increase over the prior-year period. Our automated patient transfer process, educational tools, scheduling QR codes and coordinated intake team engage patients while they are still at the primary care doctor's office. These capabilities are improving referral-to-treatment conversion while reducing friction for both the provider and the patient across the Greenbrook network.

We are nearly complete with our SPRAVATO rollout with 84 clinics now providing the treatment. Throughout 2025, we optimized our billing practices based on the economics of buy and bill versus administer and observe. And we have taken a disciplined approach to deploying the right billing model by state, by payer and by clinic. Our efforts across both SPRAVATO and CMS continue to drive strong results with total treatment volume up 18% year-over-year in the fourth quarter.

On the operational side, we continue to drive standardization across the network, focused on getting patients into treatment faster and simplifying their experience at our clinics. We deployed tablet kiosks across all locations, streamlining check-in and making it simple for a patient to remit their patient responsibility payments at the time of the visit. We are also piloting a patient portal that allows patients to complete intake forms and submit insurance information before their appointment with the goal of offering an all-digital intake pathway in the future.

We are starting to leverage AI in our benefits investigation process with initial application helping us file claims faster and more accurately, increasing first-pass acceptance rates while reducing labor. Collectively, these efforts are enabling our team to care for more patients daily while improving our cash conversion.

Turning to our NeuroStar business and the BMP program. On the system side, we had a strong finish to the year, shipping 49 systems in the quarter at an average selling price above our target for the fourth consecutive quarter. That tells us customers continue to see the value in NeuroStar and the support that comes with it. As we have discussed throughout the year, we made a deliberate decision to realign our capital team towards higher volume, higher growth accounts that could add NeuroStar TMS into their practices quickly, meaning that they have the staff available to incorporate TMS into their practice, are credentialed with insurance payers and therefore, can get up and running, treating patients faster.

With that focus on TMS-ready accounts, we are seeing the benefits in system ASP, a reduction in resources needed to go from purchase to treatment of the first patient and in the quality of accounts we are adding to the network. We believe this positions our NeuroStar business well heading into 2026, and I'll discuss more about that shortly.

On a pro forma basis, treatment session revenue increased 6% in Q4 on a strong treatment utilization growth of 11%. Our Better Me Provider program had over 420 active sites at the end of 2025, with nearly 100 additional sites working towards qualification. Since inception, the program has connected more than 66,000 patients interested in NeuroStar TMS with one of our Better Me Providers. BMP sites continue to deliver significantly higher patient volumes and faster response times than nonparticipating sites, and we have observed that treatment session utilization is increasing at these sites, indicating strong patient flow and demand for existing equipment.

We also continue to see growing recognition of NeuroStar TMS as a treatment option for adolescents. During the quarter, TRICARE West expanded coverage for TMS therapy to include adolescents aged 15 and older diagnosed with depression, and the coverage is effective across 26 states. That's a meaningful development for military families and further validates the expanding insurance landscape for adolescent TMS treatment.

Moving on to our Provider Connection program, which we launched last April. The program has gained real traction. Our field team has held over 400 educational meetings, resulting in more than 210 new referral sites by year-end. We have also seen strong engagement through the direct-to-provider campaigns and the inside sales outreach efforts. This program takes what we have learned at Greenbrook about educating primary care physicians on the benefits of NeuroStar TMS and applying it across our entire NeuroStar customer base, and it is becoming a meaningful part of how we help patients find and access care with NeuroStar providers.

We are also leveraging our Greenbrook infrastructure to offer new services to our NeuroStar customers. Through our intake center, we are now providing benefits investigations and patient management support to partners like Transformations Care Network and Elite DNA. Our benefits investigation model delivers financial clarity to patients within 24 hours, helping practices accelerate patient decision-making. And our patient management program guides patients from initial interest through to treatment, ensuring seamless engagement at every step. These programs are already driving new patient starts at our partner sites and represent a scalable model that we can extend across our national enterprise accounts.

Stepping back, I want to put this year into context. When we announced the Greenbrook acquisition, we laid out a thesis that combining NeuroStar's technology platform and training programs with the Greenbrook's national care delivery network, we would expand patient access, accelerate growth and create a path to profitability. One year in, that thesis is playing out. We grew revenue, we reached positive operating cash flow, we strengthened our balance sheet, and we built a platform that is now enabling opportunities that neither company could have pursued on its own.

I'll now turn it over to Steve to take you through the financial details, and then I'll come back to talk about what those opportunities look like heading into 2026.

Thank you, Keith, and good morning, everyone. Unless otherwise noted, all performance comparisons are being made for the fourth quarter of 2025 versus the fourth quarter of 2024.

Total revenue in the fourth quarter was $41.8 million, an increase of 86% compared to revenue of $22.5 million in the fourth quarter of 2024, primarily driven by the inclusion of Greenbrook operations following our acquisition in December 2024. On an adjusted pro forma basis, fourth quarter revenue increased 23% versus the prior year.

Total revenue from our NeuroStar business, inclusive of our system revenue as well as treatment session revenue was $18.3 million in the fourth quarter of 2025. On a pro forma basis, taking into account the impact of the intercompany revenue, this represents an increase of 9% versus the prior year.

U.S. NeuroStar system revenue was $4.4 million, an increase of 15% on a year-over-year pro forma basis, and we shipped 49 systems in the quarter. This compares favorably to our fourth quarter 2024 shipments of 46 units, and we continue to see strong system ASP in the quarter. U.S. treatment session revenue was $12.4 million. On a pro forma basis, treatment session revenue increased 6% compared to the prior-year quarter. The reported decline of 4% is primarily attributable to the absence of prior year Greenbrook intercompany purchases. Clinic revenue was $23.5 million for the 3 months ended December 31, 2025, a 37% increase on an adjusted pro forma basis, driven by growth in treatments across both NeuroStar TMS and SPRAVATO treatments.

Gross margin was 52% in the fourth quarter of 2025 compared to 66% in the prior-year quarter. The decrease was due to the inclusion of Greenbrook's clinic business, which operates at a lower margin. It's worth noting that Q4 gross margin was our highest quarterly margin of the year, reflecting the impact of our efficiency efforts within the Greenbrook clinics as well as favorable product mix.

Operating expenses during the quarter were $26.7 million, an increase of $0.4 million or approximately 1.4% compared to $26.4 million in the fourth quarter of 2024. The increase was primarily attributable to the inclusion of Greenbrook's general and administration expenses of $8.5 million, partially offset by a reduction of R&D expenses. During the quarter, we incurred approximately $2.2 million of noncash stock-based compensation expense.

Net loss for the quarter was $7.2 million or $0.10 per share as compared to a net loss of $12.7 million or $0.34 per share in the prior-year quarter. Fourth quarter 2025 EBITDA was negative $4.3 million as compared to negative $11 million in the prior year.

Moving to the balance sheet and cash flow. As of December 31, 2025, total cash was $34.1 million, consisting of cash and cash equivalents of $28.1 million and restricted cash of $6 million. This compares to total cash of $19.5 million as of December 31, 2024. Cash provided by operations in the fourth quarter was a positive $0.9 million, representing a continuation of the steady improvement we delivered throughout 2025.

To put this in context, our operating cash burn improved sequentially every quarter this year from negative $17 million in Q1 to positive $0.9 million in Q4. This progress reflects the compounding effect of our continued revenue growth, expense discipline, revenue cycle management improvements and operational efficiencies across the business.

In March 2026, we amended our debt agreement with Perceptive, which reduces our outstanding debt obligation and interest expense. Under the amendment, we made a onetime principal payment of $5 million to Perceptive along with adjustments to the existing covenants.

Now turning to guidance. For the full year 2026, we expect total revenue of between $160 million and $166 million, with the midpoint of that range representing greater than 9% growth versus 2025. We expect to see strong revenue performance in our clinic business with growth year-over-year in the double digits to mid-teens. For the NeuroStar business, we see increased momentum driving revenue growth year-over-year in the low to mid-single digits. For the first quarter of 2026, we project revenue of between $33 million and $35 million.

We expect full year gross margin to be between 47% and 49%. This reflects the impact of efficiency efforts within our clinic network as well as product mix associated with higher clinic revenue growth.

As we drive revenue growth, we remain highly focused on operating efficiency. We expect operating expenses of between $100 million and $105 million for the full year, inclusive of approximately $8.5 million of noncash stock-based compensation. This total includes investments and costs associated with efficiency efforts primarily in the first half of 2026. We expect to see the full benefit of these efforts by the end of the third quarter with operating expenses at an annualized run rate of less than $100 million by the fourth quarter of 2026.

For the full year 2026, we expect cash flow operations to be between negative $13 million and negative $17 million. This includes the necessary investments in efficiency, particularly in the first half of 2026 to continue our efforts to drive towards sustainable operating cash flow. Similar to last year, we expect our operating cash burn will be highest in the first quarter due to seasonality of both businesses, where we typically see our lowest patient volumes and lowest capital revenues. Additionally, the first quarter is when we see higher annual cash outlays, such as licenses and incentive compensation. Operating cash flow is projected to improve significantly beginning in the second quarter and then sequentially through the remainder of the year with operating cash flow being positive during the second half of the year.

I will now turn it back to Keith for his closing remarks.

Thank you, Steve. I would now like to spend a few minutes on multiple meaningful opportunities ahead of us in 2026. We have spent the last year proving that our integrated model works. We now have a national platform with over 420 BMP accounts and Greenbrook locations across 49 states, a proven playbook for launching therapies in clinic-based settings, deep relationships with primary care physicians and an infrastructure that gets stronger with every patient we treat.

As we move into 2026, we are focused on leveraging that platform to drive the next phase of growth through two key initiatives. First, we are expanding how we bring NeuroStar TMS systems to market. As we continue to analyze the TMS market, we have determined that different customers want to acquire access to our technology in different ways. We are piloting new models to meet these customers' needs, allowing them to utilize NeuroStar TMS in a way that works best for them. We are testing these approaches during the first quarter, and we'll provide updates throughout the year on their progress. We have expanded our capital sales team to help target and capture these opportunities.

Second, we will continue to see strong growth in demand for depression treatment at our Greenbrook clinics. We now know that a significant unmet need remains. There are approximately 4 million patients with treatment-resistant depression, or TRD, in the United States and individuals who have failed two or more antidepressants and have limited effective options.

NeuroStar TMS and SPRAVATO are both important therapies for many of these patients, but the vast majority of TRD population remains undertreated, and we believe new therapy options can help us reach more of these patients. That is why we're excited to continue to advance our collaboration with Compass Pathways on COMP360 psilocybin, a potentially transformational new treatment for TRD. We believe that this could represent one of the most meaningful developments in mental health treatments in decades. Compass has recently completed two Phase III studies, demonstrating highly statistically significant and clinically meaningful results, including durable improvement through at least 26 weeks after just one or two doses. Compass plans to submit an NDA with the potential for an FDA decision by year-end.

Our Greenbrook clinics are uniquely positioned to be the leader in offering new therapies like this. We already serve a large TRD population across our network, and we believe a new FDA-approved option has the potential to drive increased awareness and engagement from both patients and referring providers.

Through our experience integrating and scaling SPRAVATO across the Greenbrook network, we have built a proven playbook for launching REMS-compliant therapies, those requiring enhanced safety protocols and administration in the clinic-based settings. We have a national footprint, experienced staff and an operational infrastructure to support a launch. And because of the alignment with our existing SPRAVATO operations, we expect only limited incremental investment to support this new modality, if approved.

Through our existing collaboration with Compass, we are preparing to commercially offer this treatment upon an FDA approval. We have identified the initial centers for the rollout, and we are working closely with Compass to align launch plans and to support the establishment of favorable coverage policies with payers. We see this as a natural extension of what we have built, further expanding Greenbrook's care platform to deliver innovative treatments to patients who need the most.

Beyond treatment-resistant depression, we are also excited about the broader promise of psychedelic-class treatments which have the potential to help patients suffering from PTSD, generalized anxiety disorder and other serious conditions. We want Greenbrook to be the platform that can serve all these patients and our track record of launching and scaling treatments across a national clinic network gives us confidence that we can deliver on that vision. We are excited to share more as we get closer to the potential launch in 2027.

Before we open for questions, I want to take a moment to reflect on my time at Neuronetics. When I joined over 5 years ago, we were a single-product company with a bold vision. Today, we are a vertically integrated mental health platform with a national clinic network, a growing base of committed NeuroStar providers and a pipeline of potential new treatment modalities on the horizon.

None of that happens without this team. The people at Neuronetics and across the Greenbrook clinics show up every day with a commitment to patients. I'm proud of what we have built together, and I'm proud of the difference we are making in the lives of patients and providers across the country. I leave this company in a position of strength and in very capable hands with Dan. I believe the best is truly ahead for Neuronetics.

With that, I'd like to turn the call over to the operator for questions.

[Operator Instructions] And our first question is going to come from Bill Plovanic with Canaccord.

So first of all, Keith, congratulations on your retirement, on a significant transformation of the business. I think this was $50-ish million in revenues when you took over 5 years ago and just adding Greenbrook and the scale and finally hitting that target of cash flow positive, it's definitely a hard-fought battle, but won, and congratulations.

Thanks, Bill. I appreciate it.

I have three questions, one of them is simple. So just one, I'm going to start with the tough one. Just any granularity color you can provide on the CID in Florida and Michigan and what they're -- what documents are really asking for? And is this related to Greenbrook?

Bill, that is an investigation that is ongoing at the moment. What we can say about it is that it is -- we are providing all of the information to the U.S. Attorney Office and the Middle District of Florida. They've requested documentation for billing practices prior to the acquisition -- our acquisition of Greenbrook, and we're cooperating fully with them.

Okay. And then just secondly, on the SPRAVATO, thanks for the update. On the COMP360, just if you could give us any feeling for difference in time the patients have to be in the facility post-treatment or delivery of medication? And then any difference in the profitability? Like is this going to be shorter and more profitable or the patient hangs out longer and it's less profitable per hour, per minute, whatever way you -- metric you look at? How do we think about that as that rolls out?

Bill, we have asked Cory Anderson, who is our Chief Technology Officer and running the Greenbrook side of the business to join us today. So I'm going to let him answer that question for you.

Thank you for the question. So COMP360 is administered in supervised doses within the clinic setting. So there's not a daily or recurring protocol. And unlike these daily medications, the treatment effect appears to be durable after just one or two administrations. So if it's approved, COMP360 would be administered under a REMS protocol requiring certified health care settings, trained staff and patient monitoring, very similar to what we're currently doing with SPRAVATO.

And then post...

Yes, Bill, this is Steve. Just to add, you asked about the economics. I mean we're working closely with Compass to look at reimbursement and understand that as we get closer to launch. So more to come on that piece, but I would view it similar to how we've looked at SPRAVATO A&O and SPRAVATO B&B. If the reimbursement is there, it's a great business, but we're not going to take on business that isn't going to be profitable at the end of the day. But I think Compass is working hard, and we're working hand-in-hand with them to make sure we've got adequate reimbursement to make this a profitable business.

Great. And then last question, Steve, is you ended the year with $34.1 million, $6 million was restricted. Now you paid down $5 million to Perceptive. Did that $5 million come out of the restricted stock or the nonrestricted stock? And how do you feel about the cash position given the projected Q1 cash burn?

Yes. So it does not come out of the restricted piece. So on -- if you look at the end of 2025, we had $34 million. So if you take that $5 million off, it would be pro forma cash balance of $29 million. If you look at the midpoint of our operating cash flow guidance, we would still have, call it, $14 million to $15 million of cash at year-end. Obviously, some of that being restricted. But that's a cash balance that we've been comfortable with, especially as we're focused on efficiency, reducing overall expenses and profitability, especially in the second half of this year.

I think the other benefit of paying that down is just we get interest expense reduction from that. We're probably spending -- we're probably going to pay this close to $600,000 annually just for that $5 million paydown. And it just kind of optimizes that overall debt balance that we have out there. So net-net, we're comfortable with where we sit, and I think it continues kind of reducing that operating cash flow burn by taking out some interest.

And our next question is going to come from Adam Maeder with Piper Sandler.

Keith, wishing you all the best in the next chapter. A couple of questions for me. I guess I wanted to start on the guidance front and just double-click on the 7% to 11% top line guidance for the overall business. If I heard correctly, double digits to mid-teens growth for the clinic, low to mid-single-digit growth for stand-alone. Can you just help us understand within the clinic, how much is coming from SPRAVATO? And then on the NeuroStar or stand-alone side of things, volume versus capital? And then I had a couple of follow-ups.

Yes. Thanks, Adam. I'll give a little bit of commentary on that. On the clinic side, we expect majority of the growth to come from the volume side of it. Although in Q1, in particular, we will have a lot of SPRAVATO growth due to B&B. So as you recall, we really didn't have buy-and-bill volume in 2024, and it was actually pretty limited in Q1 of this past year. In fact, we kind of stabilized more in Q2 of last year at about one out of every seven SPRAVATO treatments being buy-and-bill. But prior to that, in Q1, it was still very, very limited. So I think what you'll see on the growth is Q1 driven by that SPRAVATO B&B impact. Once we get into Q2, it's annualizing.

And from that point forward, really, it's about just volume growth overall. SPRAVATO growth, I think, will be -- volume growth will be higher than TMS in general, but we haven't broken out that growth rate. Maybe just to give you a flavor, SPRAVATO was probably 30% of our treatments at the start of 2025. It was about 35% by year-end 2025. I would expect to see kind of that pattern continue of SPRAVATO representing kind of more of that treatment volume on a -- as we go quarter-over-quarter basis throughout 2026. It's just a significant growth.

I think the thing to remember about SPRAVATO in particular, once you start a patient and they respond, they stay on maintenance therapy long term, whereas with TMS, it's a course of 36 treatments, they're done and they'll come back only if they need to. So it's a little different cadence of how those patients build over time. But SPRAVATO, certainly, we have that continuing maintenance therapy that patients stay on long term.

On the NeuroStar side, we'll give a little bit of color there. Keith mentioned that we do have additional capital reps. So we've been generally at around 40 capital shipments a quarter, a little less in Q1, a little higher in Q4. We would expect that to increase to as much as 45 or more as their impact is felt over time. So I think it will take a little bit of time for those reps to get up and running. And then the guidance we gave really is because our treatment section is just the biggest segment of the business, we would expect kind of growth there to largely match the overall guidance of what we gave for the NeuroStar side of the business.

That's great color. Appreciate that, Steve. And for the follow-up, I actually wanted to ask about Q1 guidance and Street was a little bit higher than where you've guided to for the first quarter, maybe some mismodeling on our part. But can you just talk about the trends in the business quarter-to-date? And are you seeing anything that has maybe deviated from past trends? And just -- yes, I would love some incremental color for kind of the first couple of months of the year.

Yes. I'll give a couple of comments there. Certainly, one is we're still just over a year into the Greenbrook acquisition. A big piece of kind of what we've come to understand is just there's just seasonality in the business itself. And we find kind of, call it, latter half of November and December, we just see new starts come down on the clinic side of the business. That's just holiday impact. So that kind of works its way through the first part of Q1 here. So we tend to have a little bit of that negative seasonality impacting us in Q1. I think if you look, it's not it's not uncommon for us to see a huge swing between Q1 and Q4 between the overall level of revenue. And so clinic seasonality is a big piece of that.

I would say seasonality also impacts us on the NeuroStar side of the business, especially when you think about capital. So capital is just always lighter in Q1 versus Q4. That has to do with just how capital budgets are planned in clinics and at our customers. So generally, they're kind of using it in Q4 and using less of it in Q1. So I don't -- depending on how you look at that, those are two big seasonality impacts.

I think the other thing that's really been an impact here, especially over the last, call it, 2 months, we certainly had some weather impacts, which affects the impact of patients being able to get in the clinic. We're going to have some of that every winter, but that's obviously something we have to manage as well as we think about January, February, March and some of the storms we've had. So that bleeds into the seasonality that we generally see as we go from Q1, which, again, we've said is kind of always our lowest revenue quarter of the year to end of Q4, which is generally the highest.

And our final question is going to come from Danny Stauder with Citizens.

Just first off, Keith, congratulations on a great run. It's been great working with you. So extending my congrats and just reiterating everyone else's comments.

I guess, first, on the Compass collaboration, that's really positive news. I know we've talked a bit about this new wave of therapeutics and the potential role Neuronetics could play here. But I was hoping you could give us any more color on this agreement specifically. It sounds like you'll be the preferred provider, but is there any exclusivity involved at this point? And if not, could there be in the future?

Cory?

Yes. Thanks for the question. So Greenbrook has been working with Compass over the past 3 years, and we have continued to advance that COMP collaboration to begin or help them with their preparations for commercial launch. And we anticipate through the course of this year, we will have continued discussions about our preparations as an organization to launch the therapy.

As you probably are aware, our CMO, Dr. Geoff Grammer, participated in a Compass-hosted webinar in January. And we have laid out our operating plans to be prepared for the launch next year. As to the point of exclusivity, Compass has about seven of these strategic collaborations to help them prepare for commercial readiness and Greenbrook is one of them.

Great. Appreciate it. And just following up on that, staying with Compass. It sounds like there shouldn't be too much more of a lift, but -- beyond having to update some of your workflow maybe. Are there any other updates you need to make such as personnel or anything visible to your clinics? And really just trying to get more of an appreciation of how seamlessly this could integrate into the current infrastructure you have.

Yes. So we -- as you are aware, we operate about 84 SPRAVATO clinics under this REMS framework across the country. And I think our infrastructure and experience in running these SPRAVATO clinics provides three key advantages for Greenbrook.

First, our staff, our clinical staff is experienced in both administering and monitoring these patients under treatment. Second, we have a significant infrastructure and investment in the back-office support of benefits investigations, prior authorizations and ultimately helping patients access care. And then third, we have a deep network of referring providers, psychiatrists, primary care doctors and others that refer their patients to Greenbrook for these treatments. And so I think the infrastructure is largely there, and we will be able to provide COMP360 treatments within the clinics and with the staff already in place at Greenbrook.

Appreciate that. Just one final one for me on the SPRAVATO rollout. It sounds like you are nearly complete with all the 89 sites. But I just wanted to ask on the utilization of SPRAVATO for these newer converted clinics. How quickly has this ramp in once it's available? Is it weeks, months, quarters? Just trying to get a sense of some of these utilization trends.

We look at our utilization, our marketing and our conversion rates on a daily basis. We are able to identify where we need to add SPRAVATO and where we don't. So in the five locations that are remaining, it's -- we are building up that marketing presence there to be able to hit the ground running. So we are very comfortable with each one of our locations generating SPRAVATO at the proper level and with the proper billing process, either buy and bill or administer and observe.

And I would now like to turn the call back over to Keith for closing remarks.

Thank you, operator. Thank you all for your interest in Neuronetics. I really appreciate your support over the last 5.5 years while I've been here. It has been a pleasure working with our three analysts and all of the investors. So I look forward to hearing the updates on the Q1 call and getting you updated at that point. So thank you all.

This concludes today's conference call. Thank you for participating, and you may now disconnect.

Good day, and thank you for standing by. Welcome to the Neuronetics Third Quarter 2025 Earnings Conference Call. [Operator Instructions] Please be advised that today's conference is being recorded.

I would now like to hand the conference over to your first speaker today, Mark Klausner, Investor Relations. Please go ahead.

Good morning, and thank you for joining us for the Neuronetics Third Quarter 2025 Conference Call. Joining me on today's call are Neuronetics’ President and Chief Executive Officer, Keith Sullivan; and Steven Pfanstiel, Neuronetics’ Chief Financial Officer.

Before I begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements covered under the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements related to our business, strategy, financial and revenue guidance, the Greenbrook integration and other operational issues and metrics. Actual results can differ materially from those stated or implied by these forward-looking statements due to risks and uncertainties associated with the company's business.

For a discussion of risks and uncertainties associated with the Neuronetics business, I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's quarterly report on Form 10-Q, which was filed premarket today. The company disclaims any obligation to update any forward-looking statements made during the course of this call, except as required by law.

During the call, we'll also discuss certain information on a non-GAAP basis, including EBITDA. Management believes that non-GAAP financial information taken in conjunction with U.S. GAAP financial measures provide useful information for both management and investors by excluding certain noncash and other expenses that are not indicative of trends in our operating results. Management uses non-GAAP financial measures to compare our performance relative to forecast and strategic plans to benchmark our performance externally against competitors and for certain compensation decisions. Reconciliations between U.S. GAAP and non-GAAP results are presented in the tables accompanying our press release, which can be viewed on our website.

With that, it's my pleasure to turn the call over to Neuronetics' President and Chief Executive Officer, Keith Sullivan.

Thanks, Mark. Good morning, and thank you for joining us today. I'll begin by providing an overview of the third quarter performance and key operational updates. Steve Pfanstiel will then review our financial results, and I will conclude with some comments before turning to Q&A.

In the third quarter, we built real momentum as we work through the integration and optimization of our combined operations. We are finding opportunities to improve efficiencies, take advantage of our scale and streamline operations to capture the full value of the combined businesses. Our recently announced partnership with Elite DNA is a great example of this, which I'll provide more details on later in the call.

Total revenue was $37.3 million, up 11% on a pro forma basis compared to prior year quarter. This growth was primarily driven by strong performance at our Greenbrook clinics, which generated $21.8 million in revenue, up 25% on an adjusted pro forma basis compared to the prior year quarter. Our integration efforts are delivering high treatment volumes across the NeuroStar TMS and SPRAVATO patients.

Within the NeuroStar business, we had a solid quarter for system sales with 40 systems shipped, an average selling price above our target for the third quarter in a row. That tells us customers see real value in our technology and support. Importantly, total NeuroStar treatment session utilization in the third quarter grew 11% versus the prior year on a pro forma basis.

Beyond our revenue performance, we made significant strides on our path to cash flow positivity. That progress comes from careful expense management and better cash collections.

Now turning to an update on our achievements during the third quarter. First, our Greenbrook growth strategy delivered strong results and continues to be a significant opportunity moving forward. Contributing to the growth is our regional account manager or RAM program. The optimization of the RAMs continues to produce results. As part of the initiative to build awareness among referring physicians, we executed a targeted outreach campaign during the third quarter. We quickly scheduled over 350 physician meetings for our RAM team, most of which took place in the third quarter, with the remainder in the fourth quarter.

These educational sessions are already building awareness and driving results. To build on this momentum, we have dedicated 2 full-time intake team members to this effort, equipping them with educational materials that will make it simple for the physicians to refer patients to Greenbrook clinics. We have also seen notable enhancement in patient conversion rates through the coordination of automated patient transfer process, QR codes and the Greenbrook intake team. This process engages patients while they are still at the referring physician's office, which significantly increases the likelihood that they will follow through with the treatment in a Greenbrook clinic. In the third quarter alone, patients referred through the RAMs totaled more than 2,200.

Our SPRAVATO rollout remains on track with 84 of the 89 SPRAVATO-eligible clinics now offering the therapy, and we are on pace for a full rollout by year-end. As we scale the program, we learned a lot about the economics of billing methods of Buy & Bill versus administer and observe across our network, mainly that reimbursement varies by contract, by state and by clinic. Based on these insights, we have expanded Buy & Bill where the economics are favorable. And this quarter, we added this billing method in Connecticut, Texas, Missouri, California and Virginia. We can now use the best model for each patient and location, allowing us to drive increased sequential SPRAVATO treatment session volume while delivering stronger margins.

Turning to our second focused area, our Better Me Provider Program. This remains a key growth driver. We now have nearly 425 active BMP sites with another 100 sites working towards qualification. The numbers prove this works. BMP sites respond to patients faster and are more knowledgeable about NeuroStar TMS, resulting in them treating significantly more patients per quarter than the non-BMP practices. Our NeuroStar Provider Connection program keeps building momentum. As I mentioned last quarter, this program takes what is working at Greenbrook and applies it to our NeuroStar customers. Through this initiative, our practice development managers are building awareness of NeuroStar TMS within primary care settings, where 69% of patients with depression are currently being treated.

Since we launched this program in April, we have hosted over 300 primary care physician meetings, educating approximately 3,000 providers on NeuroStar TMS and the results it can deliver for their patients. The impact has been significant. Many of these doctors did not know about NeuroStar TMS and are now excited to have a new option for patients who have not responded to antidepressants. We do not just educate them about NeuroStar TMS, we help connect them with the NeuroStar provider in their area. Many of the primary care physicians we talk to prefer to send patients to the BMP sites because of their commitment to patient responsiveness and education.

The feedback I have heard from our customers validates this approach. For example, Dr. Ken Pages, who operates a private practice in Tampa, Florida, told us that the NeuroStar Provider Connection Program has been the most valuable resource we have offered to help grow his practice. He explained that having our representative personally visit local psychiatrists, therapists and primary care office to share information about NeuroStar TMS has been a home run for his business. Dr. Pages noted that for providers who have never heard of NeuroStar TMS, it is a great introduction. And for those who have referred to him in the past, it serves as a helpful reminder to keep their treatment option in mind for patients who could benefit from it. In addition to our outbound cold  calling team, we have also launched a direct-to-provider ad campaign that has generated significant interest from PCPs who have requested a meeting with our local NeuroStar practice development manager.

Now turning to our third strategic priority, operational excellence and cash optimization. We made real progress here this quarter. Since closing the Greenbrook acquisition, we have been improving efficiency across the network and several initiatives are driving results. For example, our self-check-in kiosks. As of mid-November, the kiosks are live in over 30 centers. More locations are coming online each week, and we are on track for a full network rollout by mid-November. Adoption has been exceptional. Nearly every patient uses the kiosk for check-in and payment. The impact was immediate. Sites saw an increase in collection in the first week after installation.

We have integrated the kiosks with our EMR system, so paperwork gets completed right on the kiosk. Check-in is faster. Front desk bottlenecks are reduced, and this enables our staff to focus more on direct patient care. The feedback has been positive. These tools led our technicians and intake coordinators to care for more patients daily without adding headcount. We also plan to leverage AI and digital forms in the intake process. These tools will reduce the traditional 45-minute consultation call by enabling patients to enter personal health information on their own time from home, reducing the friction and improving the patient experience while freeing up resources.

While technology is enabling efficiency, we are also taking a hard look at our organizational structure. Last quarter, I mentioned that we had brought in a consultant to review operations across the Greenbrook network. That review found opportunities to eliminate overlapping responsibilities and reduce management layers. Many of these changes are being implemented. For example, we have moved staff from our intake team to our provider connection group to support growth initiatives without additional headcount. We have identified several other opportunities that will be implemented in the fourth quarter.

Revenue cycle management has been a major priority, and we are seeing real gains. We have accelerated collection timing compared to earlier quarters. We are also shifting more patient payments to time of service through the kiosks, which speed up cash collections. For the first time, we collected more cash in the quarter than we booked as revenue in the quarter. That is real proof that the improvements we have made are working. While we have made progress, we are not done. The entire executive team is dedicated to further improvements.

Beyond these 3 priorities, we also focused on expanding treatment access and advancing our clinical evidence. We recently submitted a filing to the FDA, which would broaden the eligible patient population. I'm also pleased to share that as of October 1, New York State Medicaid began covering NeuroStar TMS therapy for adults with major depressive disorder, expanding access to over 5 million members statewide. Together, these regulatory and reimbursement advancements show growing recognition of NeuroStar TMS as an effective treatment option and reflect our commitment to making sure patients who need NeuroStar therapy can access it.

To wrap up, our third quarter results demonstrate solid execution across our priorities. The Greenbrook integration keeps beating our expectations. The BMP program is scaling effectively, and our operational improvements are producing progress towards cash flow positivity. I am confident in our team's ability to execute and in the value we are creating for both patients and shareholders.

I'd like to turn the call over to our CFO, Steve Pfanstiel, for a financial update.

Thanks, Keith, and good morning, everyone. Unless otherwise noted, all performance comparisons are being made for the third quarter of 2025 versus the third quarter of 2024.

Total revenue in the third quarter of 2025 was $37.3 million, an increase of 101% compared to the revenue of $18.5 million in the third quarter of 2024. The increase is primarily driven by the inclusion of Greenbrook operations following our acquisition in December 2024. On an adjusted pro forma basis, which includes adjusting for both the impact of the Greenbrook acquisition and site closures, third quarter revenue in 2025 increased by 11% versus the prior year.

Total revenue from our NeuroStar business, which includes our system revenue as well as our treatment session revenue was $15.5 million in the third quarter of 2025. On a pro forma basis, taking into account the impact of the intercompany revenue, this represents a decrease of 4% versus the prior year. The change was primarily driven by the previously announced realignment of our capital team to focus on strategic higher growth accounts and a change in customer purchasing patterns for treatment sessions in 2025 versus 2024.

U.S. NeuroStar System revenue was $3.5 million in the third quarter of 2025 and included shipment of a total of 40 systems. The third quarter also represented our third consecutive quarter of system ASP greater than our target, demonstrating the value of our system and its features.

U.S. treatment session revenue was $10.5 million in the third quarter of 2025. As Keith mentioned, third quarter NeuroStar treatment session utilization increased 11% versus the prior year and treatment session purchases in the third quarter were closely aligned with utilization. The decrease in third quarter treatment session revenue versus the prior year is largely due to the impact of a change in customer purchasing patterns, which led to increased customer inventory levels during 2024.

U.S. clinic revenue was $21.8 million for the 3 months ended September 30, 2025, a 25% adjusted pro forma increase, driven by growth in treatment sessions across both NeuroStar TMS and SPRAVATO patients. SPRAVATO volumes were up sequentially in the third quarter versus the second quarter, while we also shifted to a higher percentage of administer and observed compared to Buy & Bill. This reflects our strategy of optimizing our SPRAVATO offering to drive the strongest profitability, which we evaluate on a by-state, payer and clinic basis.

Gross margin was 45.9% compared to 75.6% in the prior year quarter. This change in gross margin was primarily a result of the inclusion of Greenbrook's clinic business, which operates at a lower margin. Operating expenses during the quarter were $24.4 million, an increase of $2.7 million or 12% compared to $21.7 million in the third quarter of 2024. The increase was primarily attributable to the inclusion of Greenbrook.

During the quarter, we incurred approximately $1.4 million of noncash stock-based compensation expense. Net loss for the quarter was $9.4 million or $0.13 per share as compared to a net loss of $13.3 million or $0.44 per share in the prior year quarter. Third quarter 2025 EBITDA was negative $6.4 million as compared to negative $11.6 million in the prior year.

Turning to the balance sheet. As of September 30, 2025, total cash was $34.5 million, consisting of cash and cash equivalents of $28 million and restricted cash of $6.5 million. As previously communicated in our August earnings call, we became eligible and received an additional $10 million of funding under our existing debt agreement with Perceptive Advisors. We became eligible for those funds as a result of achieving required revenue conditions under the Tranche 2 funds. We remain eligible for an additional $5 million of funds under the Tranche 2 funds. Additionally, within the third quarter, a total of 2.3 million shares were sold through the company's at-the-market facility, contributing net proceeds of $8 million. The addition of these funds strengthens our cash position, providing us with strategic financial flexibility for the future.

Turning to cash flow. I am very pleased with our progress this quarter. Our cash used in operations for the third quarter was $0.8 million, which represents our second consecutive quarter of substantial improvement. To put this in perspective, our operating cash burn has decreased from $17 million in Q1 to $3.5 million in Q2 and now just $0.8 million in Q3. This steady sequential improvement validates the operational initiatives we have implemented. The progress reflects multiple factors coming together. Revenue cycle management improvements are accelerating the timing of current collections as well as ensuring collection of longer age receivables. Additionally, expense discipline is paying off and operational efficiencies across Greenbrook and Neuronetics are taking hold.

Now turning to guidance. For the fourth quarter, we expect net revenue of between $40 million to $43 million. For the full year 2025, we now expect total revenue of between $147 million and $150 million compared to previous guidance of $149 million and $155 million. The change in guidance is primarily driven by our expectations around SPRAVATO Buy & Bill usage. As we have learned more about the state and payer reimbursement dynamics, we have adjusted our SPRAVATO offering to include the Buy & Bill option only where reimbursement makes financial sense to do so.

For gross margin, we now expect our full year to be between 47% and 49% versus our prior guidance of approximately 48% to 50%. The change is driven by a shift in the overall mix of the business. We continue to project operating expenses of between $100 million and $105 million for the full year. We continue to target positive cash flow from operations in the fourth quarter of 2025 with a projected range of between $2 million of positive and $2 million of negative operating cash flow. We further project year-end 2025 total cash, consisting of cash, cash equivalents and restricted cash to be in the range of $32 million and $36 million.

I will now turn it back to Keith for his closing remarks.

Thank you, Steve. Looking ahead, we are focused on driving growth across the business while being smart stewards of capital and cash collections. Before I end, I want to highlight 2 exciting near-term opportunities within the NeuroStar business. As outlined in last year's Q3 earnings call, one of the key benefits of the Greenbrook transaction is that our scale allows us to provide broader service offerings to all of our customers. By leveraging our central intake center operation, we can help manage patient calls and education more efficiently, potentially increasing conversion rates and reducing the administrative burden required to meet the demands of NeuroStar TMS.

Late in the third quarter, we finalized a 3-year agreement to be the sole provider of TMS systems within Elite DNA Behavioral Health, one of Florida's largest and fastest-growing mental health networks, which has over 30 clinics. As part of this agreement, through a new wholly-owned subsidiary, we would utilize the intake center to pilot a fee-for-service offering to Elite DNA, which would include processing patient PHQ-10 responses as well as conducting and scheduling consultations and preassessments.

In another important partnership, we deepened our relationship with Transformations Care Network, which operates 72 clinics in the Northeastern United States. Through our service offerings, we can accelerate time to treatment for patients by leveraging the Greenbrook Intake Center's expertise in performing benefits investigations. These partnerships will expand NeuroStar's footprint and will bring advanced NeuroStar TMS access to thousands of patients through a scalable, systemized model of care.

Before we open up the call for questions, I would like to comment on the announcement today that I intend to retire from Neuronetics on June 30, 2026. I'm extremely proud of what we have accomplished in the 5-plus years with the company. These accomplishments include the acquisition of Greenbrook TMS, which has vertically integrated the company's value chain and the advancements of the NeuroStar TMS technology and the millions of treatments we have performed that have saved so many lives.

Our performance in the third quarter, combined with the strength of our balance sheet has us entering the fourth quarter and 2026 with tremendous momentum and has the company well positioned for long-term growth. I am confident in the company's ability to execute on our priorities and create meaningful value for both our patients and our shareholders. I look forward to participating in the search for my successor and to working closely with the new CEO once on board to ensure a seamless transition.

With that, I'd like to turn the call over to the operator for questions.

[Operator Instructions] Our first question comes from the line of William Plovanic of Canaccord Genuity.

Just to kick it off, I was wondering, definitely, you're seeing solid growth on pro forma in the Greenbrook sites and maybe less so in the former NeuroStar sites. I'm just kind of curious what's really driving those dynamics?

Yes, Bill, thanks for the question. I think on the Greenbrook side, certainly, we've given out kind of our clinic activity and looking at that quarter-over-quarter, you could see that's up nearly 28% year-over-year. I think that is leaning into SPRAVATO, inclusive of the Buy & Bill offering, although we're being very smart about how we optimize that. But also, we continue to see growth on the TMS segment as well. So I think in general, we've got the right clinics to be driving that growth. We're very focused on having a nice extra growth driver in SPRAVATO, especially with B&B. But we just see kind of continued strong growth in Greenbrook driving along.

On the NeuroStar side of the business, I think the big thing to remember is we look at kind of, hey, what are the actual treatment utilization. So how many times of our systems being used year-over-year. What we're seeing is that's more than double digit year-over-year compared to Q3 a year ago. I think the change and why we're not seeing that happen translate to revenue growth is that this year, we're seeing those treatment session usage match the purchases. That makes sense. It means our customers are keeping a pretty steady level of treatment session inventory. This is different from 2024, where we saw customers strategically increasing inventory levels. Some of that was their own purchasing processes. There were some marketing, other incentives that drove a little bit of that. But particularly in Q3 of last year, we were still dealing with the impact of the Change Healthcare cyber events, which caused a lot of our customers to shift orders from Q2 into Q3.

So in fact, while we're up utilization 11% year-over-year, that's more than offset by the fact that our customers in Q3 of last year bought 13% more than they utilized in Q3. So that's 11 days they increased inventory just in Q3 of last year. So that headwind is really kind of what's driving, I would say, the lack of translation of that utilization increase to the revenue side. I think the positive note is for us is as we enter 2026, we expect it will be with normalized inventory levels, and we wouldn't expect this kind of headwind to reoccur as we get into '26. We'll have normal kind of comparator periods.

Perfect. Okay. And then just on the gross margin dynamics, it's really been different, the reality or the outcomes versus what the expectations were at the time of the Greenbrook merger. And I'm just trying to figure out kind of what changed different than expected? And are there any onetime headwinds kind of hitting things today? How should we think about this?

Yes. I'll start with the general comment there. When I look at the margin, I really view it as we're kind of a mix of kind of a higher margin and a lower-margin business. If you look at the NeuroStar margins prior to the acquisition, go look Q3 year-to-date, you'd see that our GP margin was just under 75%, right in that mid-70% range. That cost structure for the NeuroStar business largely remains the same today. There's been no significant change there. So really, what's happened is we mixed in this Greenbrook acquisition with the clinic business, we know that's operating at a lower margin.

So the big piece in my mind is, okay, as you bring these together, it's understanding that revenue mix and how much are you growing on the NeuroStar side relative to Greenbrook. So trying to bring that together, it's somewhat a math, but really the big picture is what is that revenue mix that's going to drive ultimately that gross profit margin.

Now with that said, in the quarter, if I compare, say, Q3 to Q2, we saw a slight decline of about 70 basis points in our overall margin. I would say between Q2 and Q3, these were smaller items, really not significant long-term drivers. We had capital sales that were a little bit higher percent of the NeuroStar sales. We were still optimizing Buy & Bill in Q3. We had some carryover of patients where we know it's just not as advantageous from a reimbursement standpoint.

And we had some revenue in Q3 from our Compass collaboration that we had revenue in Q2 that didn't repeat in Q3. If you just excluded that kind of episodic Compass revenue, that would account for 60 of the 70 basis point change we saw between Q2 and Q3. If I think long term, what I'm probably most excited about on the Greenbrook side is we see the opportunity to optimize SPRAVATO, making sure we stick with A&O where that makes financial sense and then expanding B&B where the reimbursement allows us to do that. With the volumes we're seeing, we have some pretty significant leverage that we'll see in the 95 clinics. And that is our focus, getting those 95 clinics as efficient as possible, where we'll be able to leverage provider fees, which are a big part of that cost of goods. But also we're leaning into some of the automation and other things that I think are going to help us continue to drive high patient growth and high treatments, but also do that very cost effectively where we're not having to add cost and in some cases, hopefully reduce costs.

And then lastly, as I think about some of the operational efficiencies you announced that you're finding even a year later after the deal, I was wondering if you can quantify that for us. Is this another $2 million, another $5 million in cost savings? Because I mean you're so close to that cash flow positive, I mean it's a pretty important cost savings. So I'm just trying to wonder if you could quantify that for us. And Keith, I know you'll be around a couple more quarters, so I'm not saying goodbye yet.

Thanks, Bill.

Yes, Bill, I don't think we've specified kind of the total full impact that we can have. We are leaning into, like I said, on a few places where we have -- automation is going to help us. I think the challenge here in the short term, maybe in the next quarter or 2 is there are some places where I think investment is going to make sense short term that's going to drive long-term efficiency here.

So the clinic kiosks are one we've talked about that was cost to implement in Q3 and Q4, but that's going to make us more efficient from a scheduling collection standpoint. There's also additional automation we can do. We've just started leaning into patient text alerts. I know that's been around for a little while, but we're adding that into our arsenal as well.

So there's going to be investments in Q4 and probably even into Q1 that I think will offset some of those gains. Obviously, we guided -- kept the guidance the same on OpEx. But I do view it as long term, there's still a significant opportunity for cost reduction. And I think we'll provide more detail on that as we get towards next year.

Our next question comes from the line of Adam Maeder of Piper Sandler.

This is Kyle Winborne on for Adam. Maybe just to try a little bit more on the treatment session revenue in the quarter. Even when you add back kind of the $2.2 million that was attributable to Greenbrook, it was still down year-over-year. And I understand some of the commentary there, maybe it's a little bit of a comp issue year-over-year with the inventory dynamic.

Just curious maybe like what gives you confidence going forward that there's enough resources to kind of drive success in both this business and the Greenbrook business, just kind of to alleviate any worries that like there's a little bit of cannibalization going on there. Just any additional color would be helpful kind of as we think about the treatment session business going forward.

Yes, absolutely. I think the key piece, and we've added 2 slides to our investor presentation deck towards the back, but we are showing kind of quarterly trends on utilization for the NeuroStar system. And I mentioned that earlier. That's the key to me, are our systems being used more and more for specific treatment sessions, that utilization piece, the fact that we see it at around 11% year-over-year, and we expect to continue to see that type of growth, that gives me just a lot of confidence that we have momentum in this business, and it really is a comp issue that we're dealing with from last year. Otherwise, I wasn't seeing double-digit increases year-over-year, maybe I feel different.

It's actually the same on the Greenbrook side. If you look, the clinic visits year-over-year are up almost 28% from Q3 a year ago. Again, that's an incredible momentum we have in the business, not just for SPRAVATO but TMS as well, continuing to grow. Those to me are the kind of the leading signals to say, hey, do I have a healthy business? Do I feel good about, hey, driving to increased revenue growth on the NeuroStar side, but maintaining a high revenue growth on the Greenbrook side. Those are the trends we look at, and that's the type of thing that gives us comfort that we're executing. We're still finding ways to take cost out but continue to drive top line growth.

This is Keith. I also think a good indicator for us is what we're seeing on both the RAM referral side and the provider connection. Both of those are gaining traction within the primary care network, and we are seeing a large number of providers who are interested in sending their patients to either a Greenbrook clinic through the RAM program or through provider connection. So I think we have seen that when a provider refers a patient in, they show up at a much higher rate than a patient that we get off of our marketing. So it's very encouraging to see the adoption on both sides.

Super helpful color. And then maybe, I guess, last one for me on guidance, the $40 million to $43 million for Q4. I was curious if you could kind of just unpack the different businesses there. Just since this was a little bit below where we were and where the Street was for Q4, just would be helpful to kind of hear how you're thinking about the business trends for these different businesses looking out to the year-end.

Yes, happy to share a little bit more color. Obviously, we guided to $40 million to $43 million for the fourth quarter, which translates to $147 million to $150 million for the full year. This really reflects, I think, just a couple of items. The biggest piece is really the impact of the SPRAVATO mix between A&O and B&B. We continue to see strong total SPRAVATO growth, but that mix between A&O and B&B is something we have to monitor. In the third quarter, A&O represented about 86% of our SPRAVATO volume. That was up 300 basis points from where we were in Q2. So obviously -- and that's a big revenue driver. In fact, if we had held our percentage of A&O flat from Q2 to Q3, our Q3 revenue would have been $38 million. So that's about a $0.75 million impact of shifting to a higher amount of A&O.

We know A&O provides less revenue on a per patient basis. But with A&O, we don't have to cover the cost of the drug, handling the drug, inventory. And as we said, there's just times where B&B just doesn't make financial sense, we don't get the right margin return. So this $147 million to $150 million really reflects that shift of strategy to making sure we optimize that B&B offering. That's something we spent a lot of time on this past quarter, as Keith mentioned, the additional geographies that we're going to launch B&B here or just starting to launch in Q4. We wanted to be very deliberate and take our time on that. I was actually proud in Q3 of how quickly we were able to pivot and shift the percentage of A&O higher, moving in those regions where we just weren't getting the right return on B&B. We moved that very quickly, much more quickly than actually I would have thought.

So our updated guidance is really, I think, primarily driven by this assumption of how we see the A&O and B&B mix evolving for the SPRAVATO business. Other than that, I don't think there's a lot of impact from what we've been seeing on the NeuroStar side of the business. Q4 is generally a good growth driver on the NeuroStar side of the business. We do have a little bit of summer seasonality as you look at the month of July and into August. But there's also some positive capital seasonality we see here in Q4, just things lined up for people to do heavier purchases at year-end. So hopefully, that gives you a little color on the trends as we think about the fourth quarter and the full year.

Our next question comes from the line of Daniel Stauder at Citizens.

First question I have was just on operating expense. It looks like you're making good progress on the G&A line, but I wanted to ask how we should be thinking about the sales and marketing spend, both as we contemplate fourth quarter and 2026. So from our understanding, the provider connection program should be a more efficient use of your marketing dollar, but just wanted to ask your broader thoughts on this spend and any strategy you have going forward.

Yes, Danny, I think on the OpEx, obviously, we kept that guidance flat to $100 million and $105 million. We don't break out the selling and marketing relative to the other. That would put our Q4 spend between [ 23% and 28% ] kind of for total OpEx there. I think we're going to continue to drive the cost efficiencies across the board. And those are in selling and marketing in addition to our other G&A pieces.

In terms of Q4, I think I'd go back to what I said earlier is there's places where we're going to make investments in patient alerts, other technologies. We're doing some, I think, some great things doing more targeted marketing in several regions for the Greenbrook side of the business that I think could pay off. So for me, it's really a balance of there's some key investments we want to make that are going to drive long-term efficiency, but also things that are going to drive long-term top line growth.

So I think as we get into '26, like I said, we'll give a little more color on some of the other efficiencies and cost reductions and where we see OpEx heading. But my commitment here is to make sure that we have great cost control. We're investing where it makes complete sense. But we still know that there are a ton of opportunities here for efficiencies via cost reduction. I just want to be really smart about how we evolve and make sure we put the right investments in place. So as we're reducing costs, we are not sacrificing top line growth.

Okay. Appreciate that. And just one follow-up for me. I wanted to ask on the adolescent indication. I think last quarter, you mentioned you saw an uptick in patient starts here and saw some pretty good trends. But I don't think you gave too much color on it today. So I was just curious on what you're seeing there in the third quarter and what we should expect in the rest of '25 and into '26. And also wanted to ask with this indication in mind, are you seeing more of a benefit from the provider connection program for these patients?

Thanks, Danny. This is Keith. So on the adolescent front, we are seeing an uptick every single quarter, and a lot of it is starting to come from the provider connection network where these primary care physicians really had no idea that there was another alternative for their younger patients with depression. So I don't think we're breaking out exactly how many patients that is, but it is good growth with it. We also mentioned on the call that we have another submission into the FDA that I think will also be meaningful as soon as we hear back from them.

This concludes the question-and-answer session. I would now like to turn it back to Keith Sullivan for closing remarks.

Thank you for your interest in Neuronetics, and we look forward to updating you in the next quarterly call. Thank you.

Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.