All right, we will get the show on the road here. three, two, one. Good morning, everyone, and welcome to NeuPath Health's fiscal 2025 earnings call. Today is March the twenty-sixth. The financial statements and MD&A have been filed and are available on the SEDAR+ website. Joseph Walewicz, NeuPath's Chief Executive Officer, Stephen Lemieux, NeuPath's President and incoming Chief Executive Officer, and Jeff Zygouras, NeuPath's Chief Financial Officer, will present the company's financial results and provide a business update, followed by a Q&A session. Investors are encouraged to submit their questions via the Q&A box, and we will address them at the end of the session. Please make your questions clear and succinct. Please also remember that certain statements made today may contain forward-looking statements that are subject to known and unknown risks, uncertainties and other factors.
Please refer to the MD&A and other continuous disclosure filings for updates which also are available on the SEDAR+ website. Gentlemen, you may proceed.
Good morning, and thank you, Martin. Thanks for the intro, and thanks once again for hosting our call. Before we dive into the year-end results, I just wanted to make a few quick comments. First, as I continue my role on NeuPath's board and pass the baton to Stephen Lemieux as our new incoming CEO, I just wanted to thank the entire NeuPath team for an incredible three and a half years. We have a clean balance sheet, we have strong organic growth and continued improved operations. I and the board are extremely confident in Stephen, Jeff, and the entire team's ability to build on our recent success, execute our growth strategy, and expand to new locations so that we may serve more patients who are desperately in need of our services.
With that, I'll pass it over to Stephen and Jeff so we can walk through the financials.
Perfect. No, thanks, Joe. Yeah, thanks, Martin, for hosting us. I'm gonna give a brief overview of NeuPath for anyone who is new to this story, and then we will walk through our quarter end and then open up for questions at the end of the call. As Martin mentioned, we will make some forward-looking statements, all of our risks are disclosed in our documents that were just filed on SEDAR+. Who is NeuPath? We are a company that provides healthcare for chronic pain. We have regulated healthcare facilities, these are different from what you would consider as like a walk-in clinic. Like, these are regulated by the government.
They're considered in Ontario like an Out-of-Hospital Premises, and all of our doctors have specialized skills and training and as well as a lot of the equipment we use here is all specialized for the procedures that we do. We have a strong organic growth profile, and you'll see that in our numbers as we come forward. We have a large patient backlog that we are trying to work through, and our biggest challenge to growth is really building on doctors' hours, and we will talk about that in the presentation as well. You'll see historically there's been a great trend growing positive cash flows on a year-over-year basis with the kudos to all the hard work that Jeff and Joe did in really turning this business around.
The services we offer. It's a broad spectrum. We do everything from injections. We've launched Arthrosamid this year as a private pay treatment for people with severe arthritis of the knee. We do Botox for migraines and then a variety of other nerve or joint blocks to help patients manage their pain. We do infusion therapy at some of our clinics as well to deal with ketamine and lidocaine. We also do everything from a variety of physical therapy. We do radiofrequency ablation in some of our fluoroscopy centers, and we use chiropractic massage. It's kind of a broad spectrum depending on where the patient is and what their pain needs are.
The majority of our business is central in Alberta and Ontario, so we've got clinics pretty much across Ontario, ranging from Windsor to Ottawa, with still great growth potential in this market. You can see from the chart there's a lot of untapped markets here that we're looking to expand into. As well in Alberta, we're located in Edmonton and Red Deer, and then we'll talk about our growth strategy later, but looking to expand into new markets in Alberta and into other provinces. On the financials, turn this over to Jeff to walk through our numbers. Then, Jeff.
Thank you very much, Stephen. Good morning, and thank you, Martin, for inviting us to be with you for today's webcast. Turning to our financials, revenue for 2025 reached CAD 87.2 million, which represents about a 20% increase over last year. One more point to add there. During the second quarter of 2025, we did announce there was a material one-time revenue item. If we exclude the impact of that revenue item, our year-over-year growth would have been roughly 17%. We're quite pleased with the strong continued growth in revenues. Next slide, please. As we move over to profitability, adjusted EBITDA grew to CAD 6 million for fiscal 2025, which is up 56% from last year.
Adjusted EBITDA as a percentage of revenues was 6.8% in 2025 versus 5.2% in the prior year. If we exclude the margin impact of that one-time payment in Q2, adjusted EBITDA would have been approximately 6.3% of revenues. Turning now to the balance sheet. We've had a significant improvement in our net debt over the year. At December 31, cash was CAD 4.5 million, and debt was CAD 6.2 million, which leaves us with net debt balance of approximately CAD 1.7 million and represents about 0.3 times of our adjusted EBITDA. Our strong cash balance and the access to additional borrowing capacity from the National Bank financing that we completed earlier in 2025 leave us with the flexibility to continue investing in growth initiatives, both technology and transactions, while maintaining financial discipline.
Overall, we're very pleased with the results to date and continue to believe we are well-positioned for growth and value creation into the future. Back over to you.
Thanks, Jeff. I'm gonna spend a few minutes talking about capacity utilization. In our documents that were released this morning, we're changing the way we look at capacity utilization and the metric that we're using to assess it. I just wanna give a little bit of color on this. Historically, we had a capacity utilization that was more focused on physician utilization. The challenge we had internally is it didn't really give a good realistic indicator of what our growth constraints or potential was. Under that measure, we were at an 82% capacity in 2025, compared to 75% in 2024. The new metric is gonna look at utilizing physical capacity. This is our ability to fill available patient spots with patients coming into the clinics, assuming our clinics only operate 40 hours per week.
Under this metric, we've got our physical capacity utilization was 51% last year compared to 48% the year before. What's good with this tool is it shows you the amount of significant growth there is organically that we have the potential in the business, but we also have the ability to increase hours, which we can add evenings, which we do in some of our clinics. We also have the ability to add weekends, which we do in some of our clinics that are busy. This is a good tool for us as well 'cause what it does is it allows us to determine what medical facilities need either expansion into adjacent units, which we have done this year at a few of our locations.
It helps hone and target our recruiting efforts to clinics that have available patient spots where we can bring a doctor in, and with the patient wait list, fill a business practice for them and improve capacity. It also helps us focus marketing efforts on area where we may need to bring more patients in as we offer new services such as fluoroscopy or arthroscopy this year. Internally, we believe this measure will really help everyone understand the potential there is to continue to grow this business as we look towards the future. On our growth strategy, this is really how we're gonna execute to fill that capacity utilization. On the organic side, it's really about growing available physician hours.
where we've been working hard on recruiting new physicians in, we've had two start already this year. We've got three more starting in second quarter and a number of active discussions to bring new physicians into the business in the second half of this year. Another metric we have is the physicians that are currently on our roster, it's getting them to add time. An example I can give you here is we had a doctor start with us in one of our clinics a year ago. He worked in the hospital, wanted to try out what NeuPath can offer. He gave us a day a week, and then approached us again last year and was happy with what he's got, happy with how his business is going. He's added a second day.
Now we're basically double the output from that physician. We're able to see more patients, and it helps fill that capacity utilization. With Sandy on board as our CIO, there's really a good focus on utilizing technology now. The key one here we're really driving in our clinics is the use of AI Scribe. This is allowing physicians to record patient visits, dictate their notes, and it really saves them a lot of time on the charting process, which gives them more time back that they can use to see patients. We've also had a focus on improving medical facility efficiency. What's the right patient flow, making sure we've got the nurses, and really focusing on how we can make each operation work more efficient.
We'll continue to look at building new locations in new markets, and we're gonna continue to expand our service offerings. As I mentioned earlier, we launched Arthrosamid this year. That's now available in Alberta and majority of our clinics in Ontario. On the inorganic side, we are looking at acquiring medical facilities. We're talking to locations in new provinces such as BC and in new markets in Ontario and Alberta. We're also looking at expanding to adjacent markets. If there's other areas where our model would work, where they can utilize our equipment, our fluoroscopy, and there's a big overlap between what we do and what they do, such as, like, orthopedics, which is similar to our Red Deer operation or even into diagnostic imaging. There's a lot of opportunity there.
At the end of the day, we think there's significant growth potential here in the business. We're really doing a great job, as Jeff mentioned, with the 20% growth executing on the organic growth strategy, and we're gonna continue to drive forward with this throughout 2026. On our capitalization, we have a very clean capital structure now, so 56 million shares outstanding, 62 on a fully diluted basis. The only dilutive instruments are stock options and restricted share units, and there's no warrants left in the business. It's a tight capital structure, so the board and management's around 11% ownership. We've got about 20% in institutional ownership. That does include both the board and institutional includes about 8% that's owned by Bloom Burton.
We're continuing to use our NCIB, so to date from the launch of that program, we've purchased back 1.1 million shares, and management continues to buy when we have purchasing opportunities available to us. Yeah, just to wrap up, we are a private provider of public health. We're operating a growing network of medical facilities focused on the treatment of chronic and musculoskeletal pain. This is a large growing market, like, well, though we're one of the largest, we've only got a lot of room to expand. We don't dominate any of the markets that we're in. There's lots of organic and inorganic opportunities here, and the fact that we're regulated is a barrier to entry, so it gives us a significant advantage and some economies of scale as we grow our business.
We've with Joe at the helm and Jeff, we've gone through an amazing turnaround, which has really given us a solid foundation. With where our leverage is with our partner, National Bank, we've got a lot of opportunity and a lot of financial resources to go out and execute on the growth strategy without having to go back to the capital markets to raise capital. With that, I'll turn it back to you, Martin.
Thank you very much. As a reminder, please enter your questions into the Q&A box. We already have received several questions, and we thank you for that. I will begin to read the first out here. Could you please provide color on the mix of services provided in Q4, arthro, fluoroscopy or other therapies, and what you see as the largest opportunity for gross margin expansion across your service suite?
Sure. Our Arthrosamid we launched last year, so that's a growing product. It continues to grow. It's still a small part of our service mix, but it's a growing part. The large opportunity is in the fluoroscopy business. In Alberta, fluoroscopy is about 30%-40% of our business, so we have room to grow there. As we've expanded and renovated facilities, if you think of the Ontario marketplace, we've got fluoroscopy in two of our medical clinics. We're adding it to a third that we're just recently renovating, and there's a few more that we're looking to add it into, but fluoroscopy is the biggest growth opportunity. Fluoroscopy is using image-guided procedures to target different treatments that different specialists can use in our business.
that's the biggest opportunity from a service mix for margin expansion.
Thank you. You mentioned in the press release that you expect margin improvement in 2026. Is this gross margin or EBITDA margin? To what extent and what would the drivers of that be?
It'll be EBITDA margin, and that'll come from a variety of places. One, that's as we continue to execute our growth strategy, and we've got new doctors coming on, which is gonna leverage our corporate resources to drive more EBITDA margin there. We're continuing to work with Sandy, who's our CIO, on really understanding the doctor's processes and with AI Scribe and different tools, how we can make our clinics more efficient. Then continue to focus on, like, the service model and how we can make the patient experience when they come in to when they leave, how we can make that flow easier, quicker, and more efficient as well. Those are the three key drivers to continue to drive that EBITDA margin.
Can you pro-
Bring any M&A. That's right. Yeah. That's right.
Can you provide any revenue growth expectations for 2026?
We've been giving guidance that we expect to grow kind of that 8%-12% range, excluding that one-time item, and we still believe that's the right target for 2026. That's right.
How much of your share repurchases offset the option dilution?
It's more than like offsetting right now. Like, if you look at fully diluted, like the fully diluted amount actually went down at Q4 versus where it was at Q3 of last year just from our share repurchases. That's right.
All right. Can you please discuss in more detail what you are looking at in regards to M&A activity in terms of size and valuation?
Sure. From a size, we're looking at. It's a range from small single clinics that are in strategic new markets to larger ones. It'll be anywhere in a revenue basis from probably I'd say CAD 1 million-CAD 7 million range for some new markets. There are some larger ones we're looking at as well, but they're further off. On a valuation perspective, we're anywhere in the range of four to six times EBITDA. Really depends on if there's specialized equipment, specialists, or it's a strategic market that we're trying to get into. You'd see that on the higher end of the scale. If it's existing markets or just adding in areas that we're already in, but it's a good business opportunity for us to offer new services, you'd see that probably at the lower end of the scale. That's right.
All right. What is the reimbursement risk? Say, the government dramatically cuts the reimbursement rate for a handful of your treatments.
That's always a risk we have in all the markets we're in. We continually, like, try to diversify that from offering new services, bringing in new specialists. It's different with chronic pain 'cause it's like everyone's a little bit different. There's not like one or two procedures that drive the majority of our revenue. It's very spread out across the whole service piece we have. There may be a little bit of choppiness, but the doctors continue to evolve their practice. Like, if you look at a lot of the bill codes we were using five or six years ago for procedures, like some of those aren't even being used anymore as the treatments evolve or therapies evolve.
All right. For capacity utilization, you've changed how you're representing that now. Will you be showing both metrics in the future as they represent different aspects of the business, one showing how efficiently the doctors are being used, and secondly, how efficiently, I guess, the facilities are being used?
We're gonna only show the capacity one going forward, as we think that's a better measure of what we've achieved on our growth strategy and where the potential opportunity is. As you're seeing with the physician utilization, like with the focus we've had on the operations and the tools, like we are getting that to where like physician schedules are pretty much fully utilized, so which helps on our recruiting side for us 'cause doctors know they can come in, be busy, and fill a book of business. It may be a measure we'll talk to you from time to time, but not one that we're gonna regularly report on anymore.
Can you please talk about your backlog, and is there any limitations on what the demand is from the patient side, or is limiting growth more on how many doctor hours you can provide per week?
Yeah, the limitation's more on the doctor side. Like we've got like in the GTA, for example, like we can typically get patients into a facility in two to four weeks, depending on the type of treatment they need. If you look at some of our busier centers, like just like Edmonton or Ottawa, like they're on pretty close to full year plus wait lists, and that's just a matter of bringing more doctors into those areas to start working through the patient backlog. Some of them, like if you look at Alberta, where there's more image-guided, like the wait list could be shorter for some procedures, but longer for ones that require the specialized, like fluoroscopy equipment or specialized treatments that maybe only a few doctors would provide. It is really a physician bottleneck there.
you don't have doctors sitting in the coffee room drinking coffee, waiting for patients.
No.
to show up?
No, not at all. I try it out.
All right. What are you doing to attract new doctors?
We're doing a combination of things. We work with multiple recruiters to target the Canadian market, the U.S. market and like the European market. That's one tool we use. The other one is just the service we provide. For the doctors that we have, we have about like 100 doctors that are on our current roster in our network. The best way to grow our network is by having those doctors add days or even refer their friends to us. Some of those doctors I mentioned that are starting are referrals from doctors that are already in our network that like the services that we can provide.
Just to add to that, we also have an academic affiliation, so University of Alberta students rotate through our clinic there. We get to catch some of the grads on occasion, and we're expanding that to other locations, so we're working with other academic institutions to kinda get more people rotating through. You know, we're also going to the medical conferences. You know, we hadn't in the past, but now we're attending some of the sessions where the specialists are going so they can see where we're at, you know, and know what this is. 'Cause I think the biggest challenge is awareness, right?
We are the largest in pain, but you know, we're still, you know, there's still a relatively low-level awareness among specialists, so we're trying to make sure we raise that.
All right. Thank you. Can you talk about other initiatives you're doing to increase doctor efficiency or patient throughput at the clinic level?
Like the two big ones is really utilizing technology. We talked about AI a bit. We're piloting it in some of our facilities, like digital check-ins, so they could saves time for patients waiting for someone at a front desk. And then we've put last year, we have like clinic managers that run the clinic, so they can really focus on like even like what rooms get used, making sure there's a good patient flow. Like a doctor's going from like room one to room two, not from like room one to room ten. It's more efficient in how the doctors work.
We're also looking at like with the nurses and our other medical professionals, like is there more work that they can do to help free up time for doctors in like even in some of the, like looking at some consults. It does vary from province to province, but that's another piece that we're really trying to look at, while like really utilize the skills of all of our medical professionals across the business.
All right. Is there an insufficient supply of doctors who specialize in pain treatment, or do many of those doctors work in hospitals or universities and do not want to work in a clinical setting?
There's definitely a supply shortage of doctors. Like, when we have doctors work for us, no one works exclusively for NeuPath. A lot of our doctors will start one day a week, and then they'll add days as they get comfortable with the business. We do have some that work five days a week. I'd say the average is probably closer to three. A lot of our doctors will work with us. They'll still do hospital shifts. Some just like they'll do surgeries. It is a mix. Like, when we went through.
Like last year with some of our doctors that approached us about adding days, it's like as they get through their year, they're looking at their hospital schedules for the year after. They're pulling a day away from a hospital, giving a day to us. But they do work in other s-sections. It's really just, it's showing them the ability they can do. Like the one advantage we have is they can come into us, we manage their schedules, the billing, all the back office, so they're just really focused on practicing medicine, and we can, one, fill their day, and if they need the specialist equipment, we've shown with the even fluoroscopy, right?
As we get new doctors in, it's like we'll invest and we'll bring those machines in and we'll provide you with what you need to provide your treatment versus waiting for some of those equipment to become available in a hospital setting. We've got, with the foundation we have now, that ability to invest in that growth capital to bring in whatever technology we need to attract those doctors. We're starting to see that come through and then doctors that joined us last year in the pipeline of doctors we have that we're in discussions with for joining us this year.
Are doctors paid per patient treatment or paid by the hour or a monthly salary?
The way they're paid is they bill OHIP for their procedures. If it's through the government system or through Alberta, they get a percent of their billings. It's all based on the treatments that they perform and the care that the patients need.
then follow on with that. They get a percentage of that. The other percentage, NeuPath keeps to cover the overhead and profits and so forth.
Yeah. We use our percentage like paying for the facilities, the medical staff, medical supplies, and then all the back office work that we provide for doctors and then for our profits at NeuPath.
As a lot of it is largely fixed cost base. If you can get an extra procedure out of a doctor on a shift or that, a lot of that then falls to the bottom line because the rent has been paid and the power and the nurse is already on shift and so forth, correct?
That's correct, yes.
All right. How robust is your M&A pipeline, and what is the likelihood of doing an acquisition or opening a greenfield site in 2026?
Yeah. We do have a good pipeline. I'd say there's a very high likelihood we will open new locations in 2026. We'll definitely do some M&A. It's whether like it'd be like a late 2026 or in early 2027 timeframe. It depends. It's a little bit different with trying to 'cause you're negotiating with doctors, so it's working around their availability. We'll definitely open some new facilities this year.
You've reduced your leverage on your balance sheet significantly over the last years, and it's quite low right now. You are buying back shares. With an M&A, how much leverage would you be willing to take on or what would be a sort of an appropriate amount of leverage for your type of business?
We're comfortable going up to about 2.5 times for the right opportunity. That's like when Jeff mentioned, like we've got a lot of capacity there being at like around 0.3. From that bandwidth, 2.5 would be kind of the top end that we would look at.
That's 2.5x EBITDA?
Correct. Yes. Yeah. Mm-hmm.
All right. That is the last of our questions from the audience. Are there any other comments you would like to make before wrapping up?
Yeah, I'll just close out. Like, just to Joe's point, like thanking again the team on a great year for 2025 and then, like, to Joe, like it's been like I came back to the company last year in the president role. It's been a great almost a year now working closely with Joe, getting to know the business. As Joe continues in his board role, like just appreciate the mentorship and looking forward to that as we work together to keep growing this great company that we have at NeuPath.
Thank you very much. This concludes the earnings call today. Thank you.
Great. Thank you.
Thanks, Martin.