Ladies and gentlemen, thank you for standing by, and welcome to the Neuronetics, Inc. Reports Fourth Quarter 2025 Financial and Operating Results. At this time, participants are in a listen-only mode. After the speakers' presentation, there will be a question-and-answer session. To ask a question during this session, you will need to press 11 on your telephone. You will then hear an automated message confirming your hand is raised. To withdraw your question, please press star 11 again. Please be advised that today's conference is being recorded. I would now like to turn the conference over to Mark R. Klausner. Sir, please go ahead.

Good morning, and thank you for joining us for the Neuronetics, Inc. Fourth Quarter 2025 Conference Call. Joining me on today's call are Neuronetics, Inc.'s President and Chief Executive Officer, Keith J. Sullivan, and Steven E. Pfanstiel, Neuronetics, Inc.'s 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, Inc.'s 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 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 non-cash 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 is my pleasure to turn the call over to Neuronetics, Inc.'s President and Chief Executive Officer, Keith J. Sullivan.

Thanks, Mark. Good morning, everyone, and thank you for joining us today. Before I get into our results, I am pleased to announce that the Board has appointed Dan Reavers as our next President and Chief Executive Officer of Neuronetics, Inc., 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 am 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 am proud to say that in our first full year as a combined company, we have done exactly that. We delivered 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 the 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…

Thank you, Keith. Good morning, everyone. Unless otherwise noted, all performance comparisons are being made for 2025 versus 2024. Total revenue in the fourth quarter was $41.8 million, an increase of 86% compared to revenue of $22.5 million in 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 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 three months ended 12/31/2025, 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 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 is 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…

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 will 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 have limited effective options. NeuroStar TMS and SPRAVATO are both important therapies for many of these patients, but the vast majority of the TRD population remains undertreated, and we believe new therapy options can help us reach more of these patients. That is why we are excited to continue to advance our collaboration with COMPASS Pathways on COMP360…

Thank you. To withdraw your question, please press 11 again. We will now open for questions. Our first question is from William John Plovanic with Canaccord. Your line is now open.

Hey, great. Thanks. Good morning, and thanks for taking my question. So first of all, Keith, congratulations on your retirement, on significant transformation of a business. I think this was $50-ish million in revenues when you took over five years ago, and just adding Greenbrook and the scale and finally hitting that targeted cash flow positive, you know, it is definitely a hard-fought battle, but one, and congratulations. I have three questions. One of them is simple. So just, you know, one, I am going to start with the tough one. Just any granularity, color you can provide on the CID in Florida and this Michigan and what documents they 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 we are providing all of the information to the U.S. Attorney's Office in the Middle District of Florida. They have requested documentation for billing practices prior to the acquisition of our acquisition of Greenbrook, and we are cooperating fully with them.

Okay. Thank you. And then just secondly, on this SPRAVATO, thanks for the update. You know, 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, you know, any difference in the profitability. Like, is it going to be shorter and more profitable, or the patient hangs out longer and it is 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 Corey Anderson, who is our Chief Technology Officer and running the Greenbrook side of the business, to join us today. So I am going to let him answer that question for you.

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

Yeah, Bill, this is Steve. Just to add, you asked about the economics. We are 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 have looked at SPRAVATO A and O and SPRAVATO B and B. You know, if the reimbursement is there, it is a great business, but we are not going to take on business that is not going to be profitable at the end of the day. I think COMPASS is working hard, and we are working hand in hand with them to make sure we have got adequate reimbursement to make this a profitable business.

Great. And then last question, Steve, is you ended the year with $34.1 million, $6.0 million was restricted. Now you paid down $5.0 million to Perceptive. Did that $5.0 million come out of the restricted or the non-restricted? And how do you feel about the cash position given the projected Q1 cash burn?

Yeah. So it does not come out of the restricted piece. So if you looked at 2025, we had $34 million. If you take that $5 million off, it would be a 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 is a cash balance that we have been comfortable with, especially as we are 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 we get interest expense reduction from that. We are probably going to save close to $600,000 annually just for that $5 million paydown, and it just optimizes that overall debt balance that we have out there. So net-net, we are comfortable with where we sit, and I think it continues reducing that operating cash flow burden by taking out some interest.

Great. Thanks for taking my questions.

Thank you. Our next question is from Adam Maeder with Piper Sandler. Your line is open.

Hi. Good morning, Keith and Steve. And, Keith, wishing you all the best in the next chapter. A couple of questions from 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 standalone. Can you just help us understand within the clinic how much is coming from SPRAVATO, and then on the NeuroStar or standalone side of things, volume versus capital? And then I had a couple of follow-ups.

Yeah, thanks, Adam. I will give a little bit of commentary on that. On the clinic side, we expect the 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 BNB. So as you recall, we really did not 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 limited. So I think what you will see on the growth is Q1 driven by that SPRAVATO BNB impact. Once we get into Q2, it is annualizing, and from that point forward, really, it is about just volume growth overall. SPRAVATO growth, I think, will be volume growth that will be higher than in TMS in general, but we have not broken out that growth rate. Maybe just to give you a flavor, SPRAVATO was probably 30% of our treatment at the start of 2025. It was about 35% by year end 2025. I would expect to see that pattern continue of SPRAVATO representing more of that treatment volume on a quarter-over-quarter basis throughout 2026. It is just a significant growth. I think the thing to remember about SPRAVATO in particular is once you start a patient and they respond, they stay on maintenance therapy long term, whereas with TMS, it is a course of 36 treatments, they are done, and they will come back only if they need to. So it is a little different cadence of how those patients build over time, but SPRAVATO certainly has that continuing maintenance therapy that patients stay on long term. On the NeuroStar side, to give a little bit of color there, Keith mentioned that we do have additional capital reps. We have 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, because our treatment session is just the biggest segment of the business, we would expect growth there to largely match the overall guidance of what we gave for the NeuroStar side of the business.

That is great color. Appreciate that, Steve. And for the follow-up, I actually wanted to ask about Q1 guidance. The Street was a little bit higher than where you have 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? I would just love some incremental color for the first couple of months of the year.

Thanks. I will give a couple of comments there. Certainly, one is we are still just over a year into the Greenbrook acquisition. A big piece of what we have come to understand is that there is seasonality in the business itself, and we find in November and December we see new starts come down on the clinic side of the business. That is just holiday impact. So that kind of works its way through the first part of Q1 here. We tend to have a little bit of that negative seasonality impacting us in Q1. If you look at the overall level of revenue, clinic seasonality is meaningful. It is not uncommon for us to see a huge swing between Q1 and Q4. That 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. Capital is always lighter in Q1 versus Q4. That has to do with how capital budgets are planned in clinics and at our customers. Generally, they are using it in Q4 and using less of it in Q1. Depending on how you look at that, those are two big seasonality impacts. I think the other thing that has really been an impact here, especially over the last couple of months, we have had some weather impacts, which affects patients being able to get in the clinic. We are going to have some of that every winter, but that is obviously something we have to manage as we think about January, February, March, and some of the storms we have had. So that bleeds into the seasonality that we generally see as we go from Q1, which, again, is always our lowest revenue quarter of the year, to Q4, which is generally the highest.

That is helpful. Thanks. I will jump back in the queue.

Thank you. Our final question is from Daniel Walker Stauder with Citizens. Your line is now open.

Yeah, great. Thanks for the questions. Just first off, Keith, congratulations on a great run. It has been great working with you. So I am sending my congrats and just reiterating everyone else's comments. I guess, first, on the COMPASS collaboration, you know, that is really positive news, and I know we have talked a bit about this new wave of therapeutics and the potential role Neuronetics, Inc. could play here, but I was hoping you could give us any more color on this agreement specifically. It sounds like you will be the preferred provider, but is there any exclusivity involved at this point? And if not, could there be in the future? Thanks.

Yeah, thanks for the question. So, you know, Greenbrook has been working with COMPASS over the past three years, and we have continued to advance that collaboration to help them with their preparations for commercial launch. 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 are probably aware, our CMO, Dr. Jeff 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, you know, it sounds like there should not be too much more of a lift, but, you know, beyond having to update some of your workflow maybe, are there any other updates you need to make, such as personnel or anything physical to your clinics? I am really just trying to get more of an appreciation of how seamlessly this could integrate into the current infrastructure you have. Thank you.

Yeah. So, 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 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 third, we have a deep network of referring providers, psychiatrists, primary care doctors, and others that refer their patients to Greenbrook for these treatments. 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 from 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 ramped once it is available? Is it weeks, months, quarters? Just trying to get a sense of some of these utilization trends. Thank you.

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 do not. So in the five locations that are remaining, we are building up that marketing presence there to be able to hit the ground running. 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.

Great. Appreciate it, guys. Thank you.

Thank you. 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, Inc. I really appreciate your support over the last five and a half years while I have been here. It has been a pleasure working with our three analysts and all of the investors. I look forward to hearing the updates on the Q1 call and getting you updated at that point. Thank you all.

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