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Equity Research Profiles |
Assure Holdings Corp. ARHH / Other
OTC / $0.76 October 22, 2020 |
Business Overview |
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Assure Holdings Corp. (the Company)
is a leading turnkey outsource provider of intraoperative neurophysiological
monitoring (IONM) and professional neurologist oversight services. The
use of electrophysiological methods (EEG, EMG) to observe the functional
integrity of neural structures during surgery provides immediate feedback and
warning to surgeons before they cause neurological deficits or permanent
injuries. |
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The Company has a turnkey
suite of services. It employs its own technologists and uses its own
monitoring equipment (a 32-channel Cadwell Cascade
Pro), handles scheduling and setup, and bills for the technical services it
provides. Assure is JCAHO Joint Commission accredited. |
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Procedures presently
targeted by IONM include spinal and neurosurgeries, vascular, ENT, orthopedic
and other invasive surgeries. Management is actively looking to identify new
surgical specialties. |
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The Company has exclusive
partnerships with surgeons in Colorado, Louisiana, Texas, Pennsylvania, Utah,
Michigan, and South Carolina, and it is aggressively increasing the number of
physician and hospital partners in those markets. |
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A major long-term goal is to
boost the number of in-network provider agreements. The first such agreement,
Aetna in the State of Michigan, was completed in third-quarter 2019. |
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The number of procedures is rising very rapidly, rising
91% in 2019 to 5,813 vs. 3,043 in 2018. The number of procedures excluded the
February 2020 acquisition of Neuro-Pro Monitoring, serving the Dallas Ft.
Worth metroplex. Neuro-Pro performed 2,551 procedures in 2019 and was cash
flow positive. |
2020 Focus |
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A key goal is to grow the
number of surgeon partners by leveraging existing surgeon relationships,
connections with surgical equipment distributors, and the relationships of
its BoD members. Targeted acquisitions might also
play a role. |
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The Company has a clear path
to enter new geographic markets, having recently obtained approval to expand
into Georgia, Nevada, Arizona, and Oklahoma. |
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With its rapidly rising
scale, the Company plans to rapidly boost its in-network contracts with
insurance providers. |
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Days sales outstanding (DSO) runs high,
particularly for out-of-network procedures, but the Company recently brought
its billing and collections in house to reduce DSO, cut collection expenses,
and improve its relationship with insurers. |
Management and BoD Members |
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The backgrounds of the
management and directors are outlined on the Assure website and the investor
deck. John A. Farlinger, CPA CA, is Executive Chairman and CEO. He has 25+
years of experience in technology, operations, and finance. The overall
management team backrounds include neurophysiology,
management of fast-growing microcap companies, out-of-network billing,
in-network contracting, and M&A. |
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The four BoD members
have a broad range of relevant experience, including healthcare, commercial
banking, and investment banking. |
Financials |
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Income Statement (6 months through 06/30/20 vs. 06/30/19) |
|
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Revenue: (6,403,000) vs. 14,433,000 Operating income (loss): (14,101,000)
vs. 6,833,000 Net income (loss): (13,560,000)
vs. 5,772,000 Earnings (loss) per diluted common share: (0.39) vs.
0.13 |
|
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Balance Sheet (06/30/20) |
|
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Cash & equivalents: 273,000 Accounts receivable, net: 15,117,000 Total current assets: 18,987,000 Equity method investments: 856,000 Other assets: 8,206,000 Total assets: 28,049,000 Accounts payable & accrued liabilities: 2,521,000 Other current liabilities: 7,513,000 Total current
liabilities: 9,534,000 Provision for
performance share issuance: 16,011,000 Other
liabilities: 4,827,000 Shareholders
equity (deficit): (2,323,000) Number of
common shares outstanding (12/31/19): 34,795,313 |
|
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The Company completed the
acquisition of Neuro-Pro Monitoring in February 2020. Consideration included
$530,000 on February 14, $1,200,000 to be paid on March 31, monthly payments
of $328,462 during each of the 13 months through April 2021, and a final cash
payment of $1,700,000 on May 31, 2021. In 2019, Neuro-Pro generated
approximately $6 million in cash from revenue and $3 million in net income,
with approximately 80% of the Neuro-Pro procedures being paid for by
commercial insurance companies. Approximately 23% of the Neuro-Pro procedures
for 2019 will be included in the Assure financial statements for 2019, as
these cases were performed after the acquisition agreement was announced on
November 1, 2019. |
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Two executives (Messrs. Parsons and Willer) received
a performance share grant of 6,000,000 shares as a condition of the reverse
takeover in 2016. The Company met the conditions for such grant in 2017 and
has recorded a liability of approximately $16 million for the value of the
shares to be issued while the agreements are modified, and the cash collected
threshold achieved. Mr. Parsons has decided that once his 5,000,000
performance shares have been issued to distribute a meaningful portion of
those shares to other members of the management team and key personnel. |
Valuation Considerations |
The market for IONM is sizable and growing, and the Company is gaining
market share. The overall IONM market is estimated to grow to $1.9B in 2022
(Allied Market Research, August 2018). |
|
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Management expects the expanding scale of the Company to facilitate
acceleration of in-network contracts with insurance companies. |
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The February 2020 acquisition of Neuro-Pro brings important
relationships with prestigious spine surgeons in the Dallas Ft. Worth area
and could unlock additional business opportunities in Texas. |
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The Assure cash collection cycles are protracted, primarily reflecting
the out-of-network billing to private insurance payers. Claims that have aged
to 24 months are reserved but not written off until they age to 36 months. A
new in-house billing department is focused on reducing DSO and collection
costs and strengthening relationships with insurers. |
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The impact
from COVID-19 remains an uncertainty. In addition, the Company website and Consolidated
Financial Statements for the years ended 2018 and 2017 (unqualified) detail various
risks and other matters, and these are hereby incorporated by reference. |
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Executive offices: 4600
South Ulster Street, Suite 1225, Denver, CO 80237; 720.287.3093 |
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Company contact: John
Farlinger, Executive Chairman & CEO; John.Farlinger@assureiom.com; 604.763.7565 |
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Investor contact: Scott Kozak, Director of Investor
& Media Relations; Scott.Kozak@assureiom.com; 720.287.3093 |
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