Assure Holdings Reports Fourth Quarter and Full Year 2021 Financial Results

Rhea-AI Summary

Assure Holdings Corp. (NASDAQ: IONM) reported significant growth in its financial results for 2021, with total revenue surging 730% to $29.2 million and managed cases increasing 76% to 17,436. The company achieved adjusted EBITDA of $1.1 million, a strong recovery from a loss of $14.4 million in 2020. General and administrative expenses rose to $14.8 million, reflecting investments in automation and acquisitions. Looking forward, Assure anticipates managing over 25,000 cases in 2022. The firm secured a 3-year agreement with Premier, enhancing its operational footprint.

Positive

• Total revenue rose 730% to $29.2 million in 2021.
• Managed cases increased by 76% to 17,436 in 2021.
• Achieved adjusted EBITDA of $1.1 million compared to a loss of $14.4 million in 2020.
• Secured a 3-year agreement with Premier to provide IONM services.
• Forecasting over 25,000 total managed cases for fiscal year 2022.

Negative

• General and administrative expenses increased to $14.8 million from $9.6 million.

Full Year 2021 Managed Case Volume Increased 76% to 17,436

Substantially Improved Adjusted EBITDA

DENVER, March 14, 2022 (GLOBE NEWSWIRE) -- Assure Holdings Corp. (the “Company” or “Assure”) (NASDAQ: IONM), a provider of intraoperative neuromonitoring (“IONM”) and remote neurology services, reported financial results for the fourth quarter and full year ended December 31, 2021.

Key Financial Metrics (in thousands of Dollars)	4Q'21		4Q'20		Full Year 2021		Full Year 2020
Revenue	$	9,659	$	5,964	$	29,192	$	3,524
Gross Profit		5,297		3,114		14,874		(4,388	)
Total operating expenses		5,013		4,392		17,001		11,815
Adjusted EBITDA		1,400		752		1,144		(14,397	)

*- See Explanation of Non-GAAP Financial Measures below for an explanation of Adjusted EBITDA and a reconciliation to GAAP financial measures

Key Operational Metrics	4Q'21	4Q'20	Full Year 2021	Full Year 2020
Remote Neurology Managed Cases	1,222	-	2,127	-
Total Managed Cases	5,485	3,057	17,436	9,914

 

Fourth Quarter 2021 Financial Summary vs. Fourth Quarter 2020

• Total revenue was $9.7 million versus $6.0 million
• Managed cases increased 79% to a quarterly record of 5,485 versus 3,057
• Net loss of ($0.3) million for both periods
• Adjusted EBITDA was $1.4 million versus $0.8 million
• Net loss per diluted share of ($0.03) versus ($0.04)
• General and administrative expenses were $4.5 million compared to $3.7 million, reflecting information technology investments in support of automation and data analytics as well as adding complementary talent to the management team
• The Company collected on accounts receivable generated from professional and technical services provided by Assure owned entities $4.2 million versus $3.7 million
• Total cash collected was $5.4 million versus $6.5 million

Full Year 2021 Financial Summary vs. Full Year 2020

• Total revenue was $29.2 million versus $3.5 million
• Managed cases increased 76% to an annual record of 17,436 versus 9,914
• Net loss of $(2.8) million compared to net loss of $(15.0) million
• Adjusted EBITDA was $1.1 million versus $(14.4) million
• Net loss per diluted share was $(0.24) compared to net loss of $(2.07) per diluted share
• General and administrative expenses were $14.8 million compared to $9.6 million reflecting professional fees associated with the Company’s financial transactions, Nasdaq listing and acquisitions, and increased head count in certain administrative functions to support Company growth
• The Company collected on accounts receivable generated from professional and technical services provided by Assure owned entities a record $14.3 million versus $13.8 million
• Total cash collected was $22.9 million compared to $23.9 million

Key 2021 Accomplishments

• Filed S-1 Resale Registration Statement which was deemed effective by the Securities and Exchange Commission on February 12, 2021
• Acquisitions of Sentry Neuromonitoring and Elevation, two Texas-based IONM service providers
• Launched remote neurology services, which utilize the patient volume Assure has already established through the managed cases performed by the Company’s technologists
• Secured $11 million credit facility with Centurion Financial Trust (“Centurion”) including funding of a second tranche increasing access to line of credit previously designated for M&A amended for growth capital
• Awarded a 3-year agreement to become the sole contracted provider of IONM services for Premier, Inc. (“Premier”), a group purchasing organization with a network of approximately 4,400 U.S. hospitals and 225,000 other providers
• Listing approved for Nasdaq Capital Markets (“NASDAQ”) under new ticker “IONM.”
• Expanded operational footprint into four new states: Kansas and Missouri (Sentry acquisition) and Nebraska and Nevada (organic growth)
• Closed $5.2 million private placement from institutional investors with management and board participation
• Record managed cases reported for full-year, fourth quarter and month of December 2021
  

See “Explanation of Non-GAAP Financial Measures” below for an explanation of Adjusted EBITDA and a reconciliation to GAAP financial measures

Management Commentary

“Assure clearly outlined its 2021 goals and I am pleased with what we accomplished, including listing on NASDAQ, launching our remote neurology business, strengthening our balance sheet through a new credit agreement and a private placement, completing two acquisitions and securing a three-year system-wide agreement with Premier to serve as the sole contracted supplier of intraoperative neuromonitoring for its network of hospitals and providers,” said John A. Farlinger, Assure’s executive chairman and CEO. “We expect to continue executing effectively in 2022 as we advance our key corporate objectives: scaling our platform through both organic growth and M&A, developing an in-network revenue stream, improving the performance of Assure’s billing and collection function and becoming a recognized clinical care leader in the IONM industry.”

“Among Assure’s most important growth drivers is remote neurology services. This enables the Company to reduce cost of delivery for the provision of IONM thereby driving higher profit on every case we perform and creating a new revenue stream. Importantly, Assure is simply servicing the patient volume we have already established through the managed cases our technologists perform, so the focus now is simply transitioning Assure patients onto our remote neurology platform.”

“Assure’s business is evolving as we transition to our next stage of growth. We are transforming from utilizing a one-to-one model as an operating room provider of the technical component of IONM to a Company primarily driven by delivering remote neurology services in a far more scalable one-to-many model through the professional component of IONM. Our strategy is to build a telehealth remote neurology services company with exceptional capabilities in IONM and numerous adjacent markets. Further, our investment in automation and analytics is strengthening our revenue cycle management function, and we have already reported record collections over a consecutive three-month period from December 2021 through February 2022.”

Assure will be filing its year-end financial statements and MD&A on Form 10-K with the SEC at www.sec.gov and the Company website.

Operational Guidance

In 2021, Assure’s 78 technologists managed 17,436 cases, supporting 258 surgeons across 150 hospitals and medical facilities. Comparatively, in 2020, Assure’s 59 technologists managed 9,914 cases, supporting 141 surgeons across 77 hospitals and medical facilities.

The Company is forecasting more than 25,000 total managed cases for fiscal year 2022, a record number of managed cases representing an increase of more than 40% compared with 2021 volume. The guidance reflects our forecasted impact of COVID-19, but not a substantial future disruption relating to the pandemic.

Conference Call

The Company will hold a conference call today, March 14, 2022, at 8:00 a.m. Eastern Time to discuss its fourth quarter and full year 2021 results.

The live webcast of the conference call and related presentation slides can be accessed at ir.assureneuromonitoring.com/news-events/ir-calendar. An audio-only option is available by following the dial-in instructions below. Investors who opt for audio-only will need to download the related slides at ir.assureneuromonitoring.com/company-information/presentations.

Date: Monday, March 14, 2022
Time: 8:00 a.m. Eastern Time (6:00 a.m. Mountain Time)
Toll-free dial-in number: 1-877-407-0792
International dial-in number: 1-201-689-8263
Conference ID: 13727565

Please call the conference telephone number 5-10 minutes prior to the start time. An operator will register your name and organization.

The conference call will be broadcast live and available for replay here.

A replay of the conference call will be available after 11:00 a.m. Eastern Time on the same day through March 28, 2022.

Toll-free replay number: 1-844-512-2921
International replay number: 1-412-317-6671
Replay ID: 13727565

Explanation of Non-GAAP Financial Measures

This press release includes certain measures which have not been prepared in accordance with Generally Accepted Accounting Principals (“GAAP”) such as Adjusted EBITDA. We define EBITDA as net income/(loss) before interest expense, provision for income taxes, depreciation and amortization. We calculate Adjusted EBITDA as EBITDA further adjusted to exclude the effects of the following items: share-based compensation, gain on payroll protection program loan and gain on extinguishment of acquisition debt. We exclude share-based compensation because this represents a non-cash charge and our mix of cash and share-based compensation may differ from other companies, which effects the comparability of results of operations and liquidity. We exclude gain on payroll protection program loan and gain on extinguishment of acquisition debt because these are non-recurring items, and we believe their inclusion is not representative of operating performance. Adjusted EBITDA is not an earnings measure recognized by GAAP and does not have a standardized meaning prescribed by GAAP. Management believes that Adjusted EBITDA is an appropriate measure in evaluating the Company’s operating performance. Management uses Adjusted EBITDA to evaluate our ongoing operations and for internal planning and forecasting purposes. Management believes that non-GAAP financial information, when taken collectively, may be helpful to investors because it provides consistency and comparability with past financial performance. Readers are cautioned that Adjusted EBITDA should not be construed as an alternative to net income (as determined under GAAP), as an indicator of financial performance or to cash flow from operating activities (as determined under GAAP) or as a measure of liquidity and cash flow. Investors are cautioned that there are material limitations associated with the use of non-GAAP financial measures as an analytical tool. Other companies, including companies in our industry, may calculate similarly titled non-GAAP measures differently or may use other measures to evaluate their performance, all of which could reduce the usefulness of our non-GAAP financial measures as tools for comparison. We attempt to compensate for these limitations by providing specific information regarding the GAAP items excluded from these non-GAAP financial measures.

Investors are encouraged to review the related GAAP financial measures and the reconciliation of these non-GAAP financial measures to their most directly comparable GAAP financial measures presented below and not rely on any single financial measure to evaluate our business.

Key Performance Metrics

This announcement contains key performance metrics that management of the Company utilizes to determine operational performance from period to period. These metrics include managed cases and remote neurology managed cases. We define managed cases as all technical cases Assure performs and any cases where the professional bill is from a 100% owned Assure entity and excludes cases when a global bill is presented and we calculate it based on bills presented during the relevant measurement period. We define remote neurology managed cases as a subset of managed cases where Assure’s remote neurology platform is utilized and billed. Management believes that managed cases and remote neurology managed cases are important measures of the Company’s operational performance because they are a consistent measurement to evaluate patient revenue streams.

About Assure Holdings

Assure Holdings Corp. is a best-in-class provider of outsourced intraoperative neuromonitoring and remote neurology services. The Company delivers a turnkey suite of clinical and operational services to support surgeons and medical facilities during invasive procedures that place the nervous system at risk including neurosurgery, spine, cardiovascular, orthopedic and ear, nose and throat surgeries. Assure employs highly trained technologists that provide a direct point of contact in the operating room. Physicians employed through Assure subsidiaries simultaneously monitor the functional integrity of patients’ neural structures throughout the procedure communicating in real-time with the surgeon and technologist. Accredited by The Joint Commission, Assure’s mission is to provide exceptional surgical care and a positive patient experience. For more information, visit the company’s website at www.assureneuromonitoring.com.

Forward-Looking Statements

This news release may contain “forward-looking statements” within the meaning of applicable securities laws. Forward-looking statements may generally be identified by the use of the words "anticipates," "expects," "intends," "plans," "should," "could," "would," "may," "will," "believes," "estimates," "potential," "target," or "continue" and variations or similar expressions. Forward-looking statements include, but are not limited to, management’s expectation of continued improvement in revenue and profitability, continued increases in managed cases and market share, execution of management key objectives of scaling Assure’s platform through both organic growth and M&A, development of an in-network revenue stream, improving the performance of Assure’s billing and collections function and becoming a recognized clinical care leader in the IONM industry, the planned roll out of Assure’s remote neurology services and the potential to scale Assure’s remote neurology offering. These statements are based upon the current expectations and beliefs of management and are subject to certain risks and uncertainties that could cause actual results to differ materially from those described in the forward-looking statements. These risks include risks regarding our patient volume or cases not growing as expected, or decreasing, which could impact revenue and profitability; unfavorable economic conditions could have an adverse effect on our business; risks related to increased leverage resulting from incurring additional debt; the policies of health insurance carriers may affect the amount of revenue we receive; our ability to successfully market and sell our products and services; we may be subject to competition and technological risk which may impact the price and amount of services we can sell and the nature of services we can provide; regulatory changes that are unfavorable in the states where our operations are conducted or concentrated; our ability to comply and the cost of compliance with extensive existing regulation and any changes or amendments thereto; changes within the medical industry and third-party reimbursement policies and our estimates of associated timing and costs with the same; our ability to adequately forecast expansion and the Company’s management of anticipated growth; and risks and uncertainties discussed in our most recent annual and quarterly reports filed with the United States Securities and Exchange Commission, including our annual report on Form 10-K filed on March 14, 2022, and with the Canadian securities regulators and available on the Company’s profiles on EDGAR at www.sec.gov and SEDAR at www.sedar.com, which risks and uncertainties are incorporated herein by reference. Readers are cautioned not to place undue reliance on forward-looking statements. Except as required by law, Assure does not intend, and undertakes no obligation, to update any forward-looking statements to reflect, in particular, new information or future events.

Contact

Scott Kozak, Investor and Media Relations
Assure Holdings Corp.
1-720-287-3093
Scott.Kozak@assureiom.com

SCHEDULE A
ASSURE HOLDINGS CORP.
CONSOLIDATED BALANCE SHEETS
(in thousands of Dollars)
		December 31,				December 31,
		2021				2020
ASSETS
Current assets
Cash		$	4,020			$	4,386
Accounts receivable, net			27,810				14,965
Income tax receivable			136				150
Other current assets			151				618
Due from MSAs			5,886				4,856
Total current assets			38,003				24,975
Equity method investments			525				608
Fixed assets			85				356
Operating lease right of use asset			956				124
Finance lease right of use asset			743				608
Intangibles, net			3,649				4,115
Goodwill			4,448				2,857
Total assets		$	48,409			$	33,643
LIABILITIES AND SHAREHOLDERS’ EQUITY
LIABILITIES
Current liabilities
Accounts payable and accrued liabilities		$	2,194			$	2,871
Current portion of debt			515				4,100
Current portion of lease liability			702				521
Current portion of acquisition liability			306				—
Other current liabilities			—				96
Total current liabilities			3,717				7,588
Lease liability, net of current portion			1,482				772
Debt, net of current portion			13,169				2,251
Acquisition liability			459				—
Acquisition share issuance liability			—				540
Fair value of stock option liability			25				16
Performance share issuance liability			—				2,668
Deferred tax liability, net			601				599
Total liabilities			19,453				14,434
SHAREHOLDERS’ EQUITY
Common stock			13				11
Additional paid-in capital			43,387				30,886
Accumulated deficit			(14,444	)			(11,688	)
Total shareholders’ equity			28,956				19,209
Total liabilities and shareholders’ equity		$	48,409			$	33,643

ASSURE HOLDINGS CORP.
CONSOLIDATED STATEMENTS OF OPERATIONS
(in thousands of Dollars, except per share amounts)
(unaudited)
	Three Months Ended December 31,								Year Ended December 31,
	2021				2020				2021				2020
Revenue
Technical services	$	1,799			$	3,691			$	13,527			$	1,347
Professional services		8,193				(252	)			12,330				(3,172	)
Other		(333	)			2,525				3,335				5,349
Total revenue		9,659				5,964				29,192				3,524
Cost of revenues		4,362				2,850				14,318				7,912
Gross margin		5,297				3,114				14,874				(4,388	)
Operating expenses
General and administrative		4,530				3,739				14,805				9,592
Sales and marketing		334				408				1,082				1,209
Depreciation and amortization		149				245				1,114				1,014
Total operating expenses		5,013				4,392				17,001				11,815
Loss from operations		284				(1,278	)			(2,127	)			(16,203	)
Other income (expenses)
Income (loss) from equity method investments		89				255				225				(1,194	)
Gain on Paycheck Protection Program loan forgiveness		—				1,211				—				1,211
Gain on extinguishment of acquisition debt		—				188				—				188
Other income (expense), net		(17	)			39				(46	)			89
Accretion expense		(170	)			(163	)			(556	)			(782	)
Interest expense, net		(581	)			(366	)			(1,081	)			(530	)
Total other expense		(679	)			1,164				(1,458	)			(1,018	)
Loss before income taxes		(395	)			(114	)			(3,585	)			(17,221	)
Income tax benefit		86				(211	)			829				2,185
Net loss	$	(309	)		$	(325	)		$	(2,756	)		$	(15,036	)
Loss per share
Basic	$	(0.03	)		$	(0.04	)		$	(0.24	)		$	(2.07	)
Diluted	$	(0.03	)		$	(0.04	)		$	(0.24	)		$	(2.07	)
Weighted average number of shares used in per share calculation – basic		12,329,033				7,246,625				11,725,422				7,246,625
Weighted average number of shares used in per share calculation – diluted		12,329,033				7,246,625				11,725,422				7,246,625

ASSURE HOLDINGS CORP.
RECONCILIATION OF NON-GAAP ADJUSTED EBITDA TO NET LOSS
(in thousands of Dollars)
(unaudited)
		Three Months Ended December 31,								Year Ended December 31,
			2021		2020						2021		2020
EBITDA
Net Income (loss)		$	(309	)		$	(325	)		$	(2,756	)		$	(15,036	)
Interest expense			581				366				1,081				530
Accretion expense			170				163				556				782
Income tax			(86	)			211				(829	)			(2,185	)
Depreciation and amortization			149				245				1,114				1,014
EBITDA			505				660				(834	)			(14,895	)
Stock-based compensation			888				92				1,913				548
Director fees - paid in common shares			23				—				56				—
Provision for option liability			(16	)			—				9				(50	)
Adjusted EBITDA		$	1,400			$	752			$	1,144			$	(14,397	)

	ASSURE HOLDINGS CORP.
	TOTAL MANAGED CASES
		2021	2020
	1Q	2,794	2,087
	2Q	4,257	1,991
	3Q	4,996	2,685
	4Q	5,485	3,057
	Full Year	17,436	9,914

FAQ

What were Assure Holdings' revenue results for 2021?

Assure Holdings reported total revenue of $29.2 million for 2021, up 730% from the prior year.

How many managed cases did Assure Holdings report in 2021?

Assure managed 17,436 cases in 2021, a 76% increase compared to 9,914 cases in 2020.

What is the adjusted EBITDA for Assure Holdings in 2021?

The adjusted EBITDA for Assure Holdings in 2021 was $1.1 million, a significant improvement from a loss of $14.4 million in 2020.

What growth does Assure Holdings forecast for 2022?

Assure Holdings forecasts managing over 25,000 total cases in fiscal year 2022, representing a growth of over 40% compared to 2021.

What agreement did Assure Holdings secure with Premier?

Assure Holdings secured a 3-year agreement with Premier to become the sole contracted provider of IONM services for its network.