DocGo announces 2026 revenue guidance of $280M to $300M, driven by strong demand and strategic acquisition of SteadyMD

OPERATOR - (00:00:00)

Are included in our earnings release on the current report on Form 8K. That includes our earnings release, which is posted on our website go.com as well as filed with the SEC. The information contained in this call is accurate as of only the date discussed. Investors should not assume that statements will remain relevant and operative at a later time. We undertake no obligation to update any information discussed in this call to reflect events or circumstances after the date of this call or to reflect new information or the occurrence of unanticipated events except as to the extent required by law. At this time, it is now my pleasure to turn the call over to Mr. Lee Beanstalk, CEO of DocGo. Lee,

Lee Beanstalk - Chief Executive Officer - (00:00:39)

Please go ahead thank you Mike and thank you all for joining us today. 2025 has been an important year of transition for DocGo and I would like to start our call by sharing four key headlines from the quarter before sharing more specifics about our performance. First, we experienced record volumes across all of our base business offerings in the quarter. Our strategy to build a robust evergreen healthcare business is coming to fruition. Second, we continue to have a strong balance sheet with cash we intend to use to fund our growth and capitalize on the opportunities in front of us. Third, we are extremely excited about our acquisition of SteadyMD and how their 50 state virtual care network and over 500 advanced practice providers will allow us to scale more efficiently. And fourth, today we announced 2026 guidance of 280 to 300 million in revenue and a full year 2026 adjusted EBITDA loss of 15 to 25 million, with the majority of this adjusted EBITDA loss expected to be realized in the first half of the year. Our 2026 revenue guidance represents 12 to 20% year over year base business growth. Any potential acquisitions or new contract wins would be incremental to that amount and we would provide updates on 2026 guidance as needed. At the top end of our revenue guidance range for 2026, we would expect to exit the year on an adjusted EBITDA positive run rate. We have a bold vision of building a company that brings the capabilities of a doctor's office into a patient's living room. I am excited about our investment to build these capabilities, which I believe is a small price to pay for the promise of something that has transformational potential both for our company and our industry. Before I cover the individual business verticals, I want to emphasize that each of our service lines, with the exception of our caregap closure and primary care offerings, is adjusted EBITDA positive on a contribution basis. I think it's important to highlight this because their value can be masked by the impact of corporate overhead costs at our current scale and the investment we are making in the capabilities I just referenced. Now I'll touch on our Medical transportation and Payer Provider Mobile Health Verticals Our flagship medical transportation business achieved record volumes in Q3 driven by numerous long term contracts. With strong visibility and an enviable roster of customers including Jefferson Health, Mount Sinai, New York City Health and Hospitals, hca, tristar, the NHS in the UK and others. We expect this business will generate more than 200 million of revenue in 2025, making this a strong foundational asset. As we add additional scale and ramp staffing in in this segment over the next two to three years, we anticipate that we can further improve the adjusted EBITDA contribution margin to approximately 12%. We continue to see incredibly strong demand for our services with opportunities to grow revenue within our existing customer base. Several of our large health system customers use our Total Transportation solution which includes our proprietary software, dedicated ambulances, EMS crews and staff to manage their transfer center operations. Our EPIC Integrated technology platform creates efficiency, transparency and provides a single source of truth for transportation management across vendors. In this capacity we often have the ability to select whether to assign a trip to one of our ambulances or select a different transportation vendor if we don't have an available unit staffed to run the trip. We estimate that over the last 12 months we have assigned over 26,000 trips to other companies, many of which could have been run by our fleet if we had available service level capacity. We have accelerated our talent acquisition efforts and are looking to hire hundreds of additional EMS staff as soon as it is practical to create the capacity and better capitalize on this embedded demand from our current customers. We expect that these targeted additional hires will enable us to capture millions of dollars of additional top line revenue on our existing contracts in 2026. In summary, our transportation business serves a vital market need, is profitable on a standalone basis and is a valuable foundational asset. Moving on, I would like to cover our payer and provider vertical which is expected to generate approximately 50 million of revenue in 2025, which includes a contribution of approximately 5 million from the SteadyMD acquisition in mid October and is expected to grow to 85 million next year. This vertical includes services such as Caregap closure, primary and preventive care, telehealth, remote patient monitoring, mobile phlebotomy and other payer and provider services. One of our core offerings in this vertical is our remote patient monitoring business which has made considerable progress over the last year. Remote patient monitoring is operating at an annual run rate of approximately 15 million with a greater than 10% adjusted EBITDA contribution margin, which is expected to continue trending higher in 2026. We've signed 13 new contracts or expansions this year on the back of strong demand and have eight additional proposals submitted or in contracting. We are excited to keep developing this capability in a space that typically commands high multiples. An area of our payer and provider vertical that is taking longer than anticipated to ramp but still holds great promise for us is our primary care services. We had originally budgeted approximately 5 to 10 million of revenue from primary care in 2025. We are seeing progress here and just received a substantial list from a major health plan to offer these services to 10,000 members which will launch in Q4 and ramp in early 2026. Also within our payer and provider vertical, our Caregap closure and transitions of care business more than quadrupled when we compare Q3 2025 to Q3 2024. While our investment in product development, training and technology to build our capabilities was substantial in 2025, we expect that rate of investment to decline considerably in 2026 which will help contribute to our goal of achieving profitability. As we work to drive our caregap and primary care business to profitability as soon as possible, I want to underscore why we are making this strategic investment to build these capabilities. Daco's ability to leverage a tech enabled clinical workforce to reach difficult populations with chronic conditions delivers meaningful value to our payer and provider customers. Our solutions help keep people healthier and in their homes and have the potential to significantly lower health systems costs. Considering the convergence of increasing costs, flat reimbursement levels, facility overcrowding and ongoing operational challenges facing healthcare today, we believe Daco's offering is positioned to drive substantial value and represents a significant opportunity for our company. While this payer and provider business takes considerable time to develop, we have made significant inroads over the last two years and we believe it has high growth potential. As I shared on our last earnings call, we are already working with two of the top 10 national payers and are in active discussions with both of these customers to expand those contracts. Additionally, we are in the process of contracting with two more of the top 10 national payers and have an additional 10 pending proposals in our business development pipeline. I wanted to illustrate the potential of these relationships by highlighting the growth trajectory of one of our major payer customers over time. In 2023. Our first year working with a major California health plan, we performed 789 total patient visits. In 2024, that number grew by nearly 65% to 1,293. In 2025, it is expected to grow another 250% and reach 4,500. And in 2026, it's expected to grow another 280% and reach over 17,000 visits based on existing plans. This same customer started with a single transition of care program, added caregap Closure, and has recently added longitudinal care services as well. In summary, it takes time for these relationships to ramp, but they can accelerate quickly as our customers appreciate the value we can deliver. As I mentioned, we also considerably expanded our capabilities with our acquisition of virtual care provider steadymd last month. We believe we got a very attractive deal for our shareholders with the way we structure this transaction and and the value it brings. For those of you who didn't have the opportunity to dial into our webcast last month, which is posted on our Investor relations website, SteadyMD offers a 50 state virtual clinician workforce, clinical operations and world class technology that powers real time matching between patient needs and clinical expertise. The company provides virtual care for top consumer healthcare and digital wellness brands including two Fortune 10 customers. Steadymd maintains a roster of over 500 clinicians, is expected to service over 3 million patients in 2025 and is projected to generate approximately 25 million in revenue this year. Steadymd's scaled network of virtual providers is expected to enable DocGo to achieve more efficient delivery of patient care by pairing DOCO's mobile health clinicians in the field with SteadyMD's clinical network or over time. We are enthusiastic about this acquisition for numerous reasons. First, it provides us with a 50 state virtual care footprint which significantly expands our clinical capacity and positions us to extend our offering to both payers and providers. Second, we have long believed that pairing our last mile clinical delivery capabilities with virtual care has the potential to unlock the power and potential of telehealth and creates an optimal end to end solution. We look forward to the potential synergies this creates and will look to both amplify our existing offerings and potentially launch new services next year. Lastly, we see strong opportunities for cross pollinization between the two exceptional customer bases that both DoCo and SteadMD have built and we look forward to exploring those as well. We continue to believe that doco has a unique ability to acquire traditional healthcare assets where we can overlay our technology, mobile health capabilities and extensive customer base to drive additional value. There are a wide variety of healthcare companies out there that see doco's last mile healthcare delivery capabilities as a missing piece, making us a very attractive partner and we plan to remain active on the MA front. In sum, 2025 has been a transitional year as we moved beyond emergency response contracts and increasingly focused on executing DocGo's evolution to a provider of long term integrated technology driven healthcare solutions that meet the needs of our customers today and tomorrow. I couldn't be more proud of the progress we are making as we are positioned for strong growth in each of our key verticals. We expect the investment in our early stage business lines to gradually abate over the course of 2026. We have made a strategic acquisition in Steadynd that expands our footprint, adds accretive capabilities and a roster of blue chip customers that we can continue building upon. Additionally, we continue to grow our pipeline of new business and look for potential acquisition opportunities both of which can help us gain critical mass, achieve profitability and create additional shareholder value in the coming years. Our future is bright and valuable. We have the right products and services to address critical needs in our health care industry, have built differentiated technology and capabilities and have business lines such as medical transportation and remote patient monitoring that are already firmly EBITDA positive and we have the balance sheet to see our vision of bringing the doctor's office to the living room a reality. At this time. I will hand it over to Norm to cover the financials. Norm, please go ahead.

Norm - (00:13:37)

Thank you Lee and good afternoon. Total revenue for the third quarter of 2025 was $70.8 million compared to $138.7 million in the third quarter of 2024. The year over year revenue decline was entirely due to the sunset of migrant related projects. Excluding revenue for migrant related programs, Revenue increased by 8% to $62.4 million in Q3 of 2025 from 58 million in Q3 of 2024. Medical Transportation Services revenue increased to $50.1 million in Q3 of 2025 from $48 million in transport revenues that we recorded in the third quarter of 2024. Revenues were driven higher by gains in nearly all of our US markets with some of the strongest growth in Texas and Tennessee. Mobile health revenue for the third quarter of 2025 was $20.7 million down from $90.7 million in the third quarter of last year driven by the wind down of migrant services. Included in this year's amount was approximately $8 million in migrant related revenues. Non migrant mobile health revenues increased by more than 20% year over year driven by increases in care gap closures, remote patient monitoring and mobile phlebotomy. Adjusted EBITDA for the third quarter of 2025 was a loss of $7.1 million compared to adjusted EBITDA of $17.9 million in the third quarter of 2024. The adjusted gross margin, which removes the impact of depreciation, amortization and several one off items and is the measure of margins that we track most closely, was 33% in the third quarter of 2025 compared to 36% in the third quarter of 2024. During the third quarter of 2025, adjusted gross margins for the Medical Transportation segment were 31.7% compared to 30.7% in Q3 of 2024 and the highest gross margins we've seen in this segment since Q1 of 2024. During the third quarter, our transportation business ran at the highest utilization rates that we've seen. Given these utilization rates, it will be critical for us to expand our field labor team which we would expect to lead to higher revenues and improved gross margins for transport in 2026. Mobile Health segment adjusted gross margin was 36.2% versus 38.8% in the third quarter of 2024, but up from adjusted gross margins of 32.5% in the second quarter of 2025. We expect to continue replacing migrant related revenues with relatively higher margin service lines such as remote patient monitoring and mobile phlebotomy. On both the cost of goods sold and an operating cost basis, we continue to make significant investments in our caregap closure business. We estimate that the adjusted gross margin for mobile health would have been above 40% in Q3 of 2025 excluding the care gap closure business. There were also some non recurring items that had a large impact on our GAAP results this quarter, so I'd like to briefly review them. Within the cost of goods sold area, we incurred increased insurance costs in the amount of approximately $5.2 million. These largely consisted of additional premium owed for workers compensation coverage back in 2022 and 2023 driven largely by an increased migrant program related employee base and the settlement of a large auto insurance claim for an incident in 2022 in the since discontinued California transport market. Also within the operating expense category, we incurred non cash charges due to the write down of various intangible assets and goodwill. These charges totaled $16.7 million in the quarter. During the third quarter we made further progress on strengthening our balance sheet by paying off the outstanding amounts under our line of credit removing $30 million in debt from our balance sheet, we continued to collect our older, larger invoices, which allowed us to generate approximately $1.7 million in operating cash flow for the quarter. Despite our operating losses through the first nine months of 2025, we have generated nearly $45 million in cash flow from operations. As of September 30, 2025, our total cash and cash equivalents, including restricted cash and investments, was $95.2 million, down from 107.3 million at the beginning of the year. However, having paid down the entire outstanding balance on our credit line during Q3, our cash position, our cash position net of debt is well above our net position as of the beginning of this year. Our balance sheet is now debt free. For the first time since late 2023, our accounts receivable continued to decrease, particularly for migrant related receivables. At quarter end, we had approximately $37 million in accounts receivable from the various migrant programs, which represented a little more than a third of our total company AR. This compares to $54 million in migrant program related AR at the end of Q2, 120 million at the end of Q1, and $150 million at the end of 2024, which at the time represented approximately 71% of the company total. We've now collected about 96% of all of our migrant related receivables from the inception of those programs until today, and we remain confident that we will collect all remaining outstanding amounts. Now that we've improved our cash balance and paid off our credit line debt, we are well positioned to carry the company through this ongoing transitionary period. Over these final seven weeks or so of 2025, we will focus intently on collecting the remainder of the migrant related receivables. Assuming that these amounts are collected during the fourth quarter, we would expect our cash balances at year end to be higher than they were at the end of Q3. After adjusting for the steady MD acquisition, we expect to exit 2026 at about $65 million of cash, which we expect will be the low point, subject of course, to buybacks or any additional acquisitions. Finally, as we head here into the home stretch of 2025, we'd like to discuss our outlook for for the full year and offer a preliminary view on 2026. For full year 2025, we now expect revenues in the range of 315 million to 320 million. Of that amount, about 68 million to 70 million relates to migrant projects, so the base revenue should come in at about $250 million. For adjusted EBITDA, we see the full year 2025 loss in the range of 25 million to 28 million. For 2026, we see revenues in the range of 280 to 300 million, which would represent a 12% to 20% growth over 2025 based revenues. We anticipate a full year adjusted EBITDA loss of somewhere between 15 million and 25 million. However, at the top end of this revenue guidance range for 2026, we would expect to exit the year on an adjusted EBITDA positive run rate on a sequential basis. Looking at 2026, we expect revenues to increase and for the EBITDA performance to improve over each of the four quarters of the year. At this point, I'd like to turn the call back over to the operator for questions and answers. Operator, please proceed.

OPERATOR - (00:20:22)

Thank you, ladies and gentlemen. We'll now begin the question and answer session. Should you have a question, please press the star followed by the one. On your touchtone phone you will hear a prompt that your hand has been raised. Should you wish to decline from the polling process, please press the star followed by the two. If you are using a speakerphone, please lift the handset before pressing any keys. One moment please for your first question. And your first question comes from Peter Chickering from Scotiabank. Please go ahead.

Peter Chickering - Equity Analyst - (00:20:50)

Hey, good afternoon guys and thanks for taking my question. Looking at the implied margins for the fourth quarter look to be sort of, I think it looks like negative 13%. Can you help bridge US versus margins? We saw in the third quarter of down 10%. How much came from the Steady MD acquisition services? CoreOps just bridging the 3Q to 4Q margins.

Norm - (00:21:12)

So there wasn't anything in Q3 on Steady MD. Steady MD showed up in October. So you're going to get most of the quarter steady MD. We think that number should be somewhere around $5 million in a little bit more than $5 million in revenue for the quarter and I would say slightly EBITDA negative for that period. So it really shouldn't have a material impact. It's going to have an impact on the margin percentage, but otherwise it's not going to have much of an impact. We will have lower. We will have basically no revenue from or very small revenue number from the migrant related revenues. So that's also going to have an impact on the margin a little bit.

Peter Chickering - Equity Analyst - (00:21:52)

Okay. And then for 2026 EBITDA guidance, you know, the implied margins there for next year are negative 10% yet we're exiting fourth quarter at sort of negative 13% margin. Can you sort of walk us through kind of, you know, how that improves throughout the year? And what should we be modeling in the first half of your EBITDA versus the back half of your ebitda?

Norm - (00:22:13)

Yeah, sure. So there are a couple of areas where we think we'll do a little bit better in terms of our model. First of all on a gross margin percentage. So it's interesting to Note that the Q3 adjusted gross margin as we walk through worked out to about 33%. That's higher than what we did in Q1 or Q2 of this year. And we think that it's something of a proxy for where we go in the next few quarters going forward. There are some projects that we have, especially on the transport side, that we think will raise the gross margin a little bit, but realistically those will probably have more of an impact in the second, third and fourth quarter of next year than here in the fourth quarter of 2025 with the first quarter of 2026. So there's a little bit of room over there as well. And then on the operating expense side, so we continue to work hard at trying to reduce our sga. And as we were able to take a couple of million dollars out per quarter in sga, that should also have an impact towards the back half of next year. And then, and then there's a scale. So our expectation, Peter, is that whatever we see in terms of revenue in Q1 will be the low point of 2026. It'll go up and it'll go up. Then the way we model it out into Q2, into Q3, into Q4, and consequently the EBITDA loss or profitability will improve every quarter as we go Q1, 2, 3 and Q4. So we think that that's going to have the impact. So going to your second question, as far as the breakdown, I would say the bulk of the expectation for a negative EBITDA number is going to come in that in the first half of the year. It's clearly going to be skewed towards the first half of the year in terms of those losses. And then you get a much smaller loss in the third quarter and maybe even perhaps we think a positive number in the fourth quarter.

Peter Chickering - Equity Analyst - (00:23:46)

Okay, and the last question for me, looking at our 2026 revenue guidance, how much do you assume for migrants for next year and how should we be modeling transport versus mobile health next year? Thanks.

Lee Beanstalk - Chief Executive Officer - (00:24:01)

Absolutely. Peter, this is Lee. So in terms of migrant related revenues for 2026. We don't expect any migrant related revenues for 2026, so that number will be zero for next year. In terms of the breakdown for the guide, it's important to note that the guide really is current guidance is based on the baseline of the business as we see it today. Any new contract wins or MA would be in addition to the number we're sharing tonight. The breakdown is about 2/3 transport, 1/3 mobile health. That's essentially the way to look at it. Great.

Peter Chickering - Equity Analyst - (00:24:36)

Thanks so much.

Lee Beanstalk - Chief Executive Officer - (00:24:37)

Of course.

OPERATOR - (00:24:39)

Thank you. And your next question comes from Sarah James from Cantor. Please go ahead. Thank you.

Sarah James - Equity Analyst - (00:24:47)

I wanted to dig a little bit more into the payer provider revenue growth. So you guys obviously have a very strong pipeline there. Sounds like when you step up from 50 million in 25 to 85 million in 26, am I right in annualizing the steady MD impact to be 15 million of that and then you'd have 20 million from organic growth and then what kind of deal closure assumptions does that include for the pipeline that you talked about with possibly expanding your existing two national payers or adding in two others?

Lee Beanstalk - Chief Executive Officer - (00:25:23)

Absolutely. Sarah, thanks for the question. So first off, the $85 million for payer and provider for next year includes about 25 million from the Steady MD acquisition. That's the run rate the business is on. Of course we announced that acquisition a few weeks ago, so we're in the process of integrating it. So we have a $25 million of the 85 million as a steady MD contribution for next year and the remaining would be the 60 million from our current payer and provider baseline business. To answer your question specifically, I'm glad you asked it, it does not include any deal closures or additional M and A or contribution from our pipeline. We're looking at the contracts we currently have today. We're looking at the geographies we currently operate in today, the list of patients that have been provided to us so far and our current customer set and basing our guidance for next year off of that, both for payer and provider and the transportation portions of the business.

Sarah James - Equity Analyst - (00:26:17)

Great. And can you help us understand what does it look like when you expand the payer provider contracts going from transition of care to care gap closure to longitudinal what are the orders of magnitude of revenue that that could impact or the way it could change your margin profile for that segment?

Lee Beanstalk - Chief Executive Officer - (00:26:37)

Absolutely. So as you mentioned Sarah, mostly our parent provider contracts typically start with either caregap closure services where they the payers provide us with a list of patients that have open Care gaps, they haven't been seen. This could be diabetic retinal exams, bone density scans, annual wellness visits, vaccinations. And then we go and engage those patients, we meet them where they are and we help close out those care gaps. And these are chronically ill patients. They're typically patients that are costing the health plans a lot of money. And so the health plans are heavily incentivized to make sure that they're reaching these patients. And if they don't, their quality scores for their plan are negatively impacted. And then of course, patients end up landing in the hospital. That costs the payers lots of money. So they're providing us with lists of patients. These are the patients that have open gaps in care and we're going to see them. So they either start with care gap closure or transitional care management. And so as a patient is being discharged from the hospital, they've already been hospitalized or they visited the emergency room, they're leaving the hospital. We work with them to make sure that their transition of care to the next setting could be their home, could be another facility. We make sure that they're, their discharge plan is well taken care of and that we're redressing the incision sites, titrating meds, making sure we're checking their vitals, that their transition of care is well taken care of and they don't end up back in the hospital. That's where our services typically start with the payers. What we're also finding is a lot of these patients need primary care services and preventative care. And so as I mentioned, we're in the process of, of expanding the relationships we have into primary care and preventative care, more longitudinal care. So instead of going to serve a caregap closure visit or transitional care, we're providing the long term care and the preventative care and the primary care for that patient. And that's typically step two in that process. And then you can see scenarios where we enroll those patients in remote patient monitoring, as I mentioned. And so really enveloping the patient in, in the care they need, meeting them where they are, closing care gaps to start, and then making sure they have the proper primary and preventative care. That's how the progression of those contracts typically take. And then the lists get larger, the patient needs get bigger and more varied. And then we're there to sort of expand into those payer contracts as they see really the impact of our work and how better off their patients are with our services. I know we've shared and I want to share one more piece here, which is with a lot of the health plans we work with. One example we gave, which I gave in the prepared remarks, we've helped reduce their ED readmission rate by over 50% for the patients in that transitional care management program. So the payers are seeing real benefit and they're continuing to give us more and more work. And so that's what we're basing our guidance on, is contracts we currently have and the ability to expand with our current customer set. Any new additions from the pipeline or M and A or any significant contract wins would be in addition to the guidance we're giving tonight.

Sarah James - Equity Analyst - (00:29:38)

Thank you very much.

Lee Beanstalk - Chief Executive Officer - (00:29:39)

Absolutely.

OPERATOR - (00:29:41)

Thank you. And your next question comes from Ryan McDonald from Needham. Please go ahead.

Ryan McDonald - Equity Analyst - (00:29:48)

Hi. Thanks for taking my questions. Maybe just start on the transportation side. So it's great to hear about the heightened levels of utilization and sort of that being a signal for or incremental investment to scale the team. But how do you balance sort of supply demand in terms of what you're seeing so that as you continue to scale the team that you have enough demand to sort of utilize those teams in an optimal way so it's not becoming sort of margin dilutive. Thanks.

Lee Beanstalk - Chief Executive Officer - (00:30:19)

Absolutely. Ryan. Thanks for the question. So I thought it was important for us to mention how many trips we're currently outsourcing or handing off to other vendors. And so we looked at that number over the last 12 months. It's added up to about 26,000 trips. So that's really the number we're using as sort of the embedded demand we have in the contracts we have and how much staff and supply we need in order to meet that demand. And that's really the number we're working off of. Of course, new contract wins, we'd have to hire more, but that's the number we're working off of. And we've been able to quantify those, those trips in all of our markets and then the corresponding level of staff that we would need in order to satisfy those trips and not outsource them. And so that's what we're basing our entire hiring plan around. If you add Those up, those 26,000 trips across all of our markets, it looks like we have to hire about another 7 to 800 staff. Now I'll tell you, we've made progress on that over the past number of weeks here, but we're continuing to ramp that up pretty intensively. Right now we have big work streams going within the company to make sure that we're Both retaining the great staff we have and attracting new team members to join so that we can scale those efforts. But it's really based off of the number of trips that we're already outsourcing from the embedded demand we have from our contracts.

Ryan McDonald - Equity Analyst - (00:31:38)

Helpful color there. Thanks, Lee. And then maybe as a follow up. Obviously great to hear about the continued scaling and growth in the remote patient monitoring business. You know, 13 contracts this year, eight more proposals. Can you just talk about what some of the core areas and point sort of care areas that you're focused in with remote. And really the genesis of the question is a bit is, you know, obviously the recent news about United rolling back, you know, rpm, except for I think chronic heart failure and hypertension during pregnancy. Just kind of curious what you're hearing in the market of, you know, does that sort of create a knock on effect at all for other payers in the market? Thanks.

Lee Beanstalk - Chief Executive Officer - (00:32:19)

Yeah, Ryan, I'm so glad you mentioned that. So actually our core offering on remote patient monitoring is really in the cardiology space. So you mentioned chronic heart failure and other insurance companies rolling back coverage to address cardiology and heart disease. That's actually would bode well for us. We have a deep expertise in cardiology and implantable cardiac devices like loop recorders, pacemakers and so forth. So that's really our specialty and that's the area where we're investing in. So that's the focus of remote patient monitoring efforts is these devices that are transmitting data, particularly for heart failure and other cardiology related chronic conditions. We have been expanding since from that into other specialties like diabetes and others. But the core focus of our group right now is in cardiology.

Ryan McDonald - Equity Analyst - (00:33:16)

Awesome. Appreciate all the color there, Lee.

Lee Beanstalk - Chief Executive Officer - (00:33:18)

Of course.

OPERATOR - (00:33:20)

Thank you. And your next question comes from David Larson from btig. Please go ahead.

Jenny Shen - (00:33:28)

Hi, this is Jenny Shen on for David. Thanks for taking my question. First. I just wanted to ask about your current view, the hospital and hospital spending environment as a whole. We've spoken to some hospital executives who've said some of the uncertainty in the market, including around things like ACA and Medicaid, have caused them to be more cautious with their budgets and they're expecting there could be pressure on volumes. And have you had or heard any of that sentiment with your customers so far? But it looks like volumes are strong. Just any thoughts on hospital customer sentiment on spending? Thank you.

Lee Beanstalk - Chief Executive Officer - (00:34:14)

Absolutely. Jenny, it's great to hear from you and it's a great question. So look, I think it's still early to tell what really the impacts will be from any new legislation. But you can certainly see an area where perhaps there's more Americans that are underinsured or uninsured and they end up in high hospitals, emergency rooms and really straining capacity. And then of course, perhaps those hospitals won't be able to recoup reimbursement from underinsured or uninsured patients. So it's definitely a concern. We spend a lot of time with hospital executives and I speak to hospital system cos very regularly and I think our core focus is on how we can save them money and be more efficient. That's really always been our focus. We feel like we can help them manage their patient flow, make sure patients are not staying an extra night in the hospital. They don't need to because they couldn't get the medical transportation coordinated. We help with that. Our platform specifically is designed for that. And so we feel like we've gotten receptivity from hospital systems very recently to that. And then of course, on the payer and provider side, our whole goal again, whether it be with hospital systems or payers, is we want to help lower their costs and their utilization. So that transitional care management program I described, when a patient is getting discharged, that is a critical moment in patient engagement. They're leaving the hospital and so we're there bedside often scheduling a follow up appointment, making sure that we're going to go and see them, perhaps in their home to make sure they're discharge planning is being taken care of. That is very valuable and that will help patients stay out of the hospital and that helps hospitals because hospitals get penalized if patients bounce back within a 30 day window. And so we're helping keep patients from doing that and it helps the payers because again, patients are most costly when they're in the hospital. So again, we really are excited by what we're building here. We think it is very timely, we think it's incredibly strategic to the healthcare ecosystem and really it's all designed on trying to save the system money, the hospital's money and the payers money and that what we think will be successful with that.

Norm - (00:36:27)

Yeah, Jenny, what I would add to that is that I can say anecdotally that in the last six months or a year, we've had conversations with hospital systems that, you know, we've been in the ambulance business for quite some time, but there are some big hospital systems we've spoken to that we had not really spoken to prior to, let's say the last six or 12 months, who are now thinking about precisely that outsourcing the management of the flow of patients into and out of their facilities. Something that they had always done on their own. It's always been a pain point to them and now they really have to think about being more efficient and getting it off their plate. So we're having, we have opportunities that I don't think even existed a couple of years ago.

Jenny Shen - (00:37:01)

That sounds great. And then for a quick follow up, have you seen any impact from the government shutdown? Has that impacted any municipality decision making at all? Thank you.

Lee Beanstalk - Chief Executive Officer - (00:37:15)

Absolutely. So we've shared over the past several earnings calls. We've actually emphasized less our work in the population, government space. So we've really been focused on the hospital systems, the payers, the providers, steady and D's now customer set. It's going to get more and more of our attention, time and resources and so that's really where our big focus is. And again I think honestly it's very early to tell any impact from some of this legislation or policy changes. We don't see it yet and frankly a lot of the policy changes kick in later on down the road next year, the year after. So we're really heads down. We think our value prop speaks to whatever environment the healthcare system or policy may, may be, whatever's situation the healthcare system may be in or whatever policy that there may be in effect. Because again we're there to help save the system money, save hospital systems money, help CMS save money, help our insurance partners save money. And that's really our goal and we think that'll be germane and relevant no matter what going forward here.

Jenny Shen - (00:38:25)

That's great. Thank you.

OPERATOR - (00:38:29)

Thank you. And your last question comes from Mike Latimore from Northwind Capital. Please go ahead.

Aditya - (00:38:39)

Hi, this is Aditya. On behalf of Mike Lattimore, could you give some color on how are the bookings in the third quarter and how much did they grow sequentially for which, for which business? Like overall, I mean we saw, we saw sequential growth in almost all of our businesses in transport we would see let's say in the US and you know we look at it in terms of the number of trips that we carried. So we saw like a mid single digit sequential growth in trip count which you know, for a quarter over quarter number. That's very, very good. We're happy with that. Obviously our payer and provider business lines all show some growth during the quarter. I think every one of those business lines showed a higher revenue number for Q3 than for Q4. So in fact when we look towards 2026, if we would simply take the Q3 results and annualize them. That would already put us in pretty good shape as far as the guidance that we gave. So we definitely saw a pickup in volumes. I think we mentioned in the release or elsewhere that we. We did see record volumes. Now, granted, it wasn't blowing away our previous records, but we did see higher volumes across all of those business lines in Q3 than we had ever seen. Got it. And how much cash do you expect to have at the end of the year? So just using the end of Q3 as a baseline, we had $95 million in when you take cash, and the restricted cash as well, or 73 million. If you just look at the unrestricted cash, we would expect that number to go up net by a few million dollars. Assuming that as we expect, we will collect on the remainder of the large migrant related invoices that are out there. That would be enough to cover any kind of operating loss. And we should be able to squeeze out some operating cash flow on that, on that basis. So we would expect that the number will go up a little bit by the end of Q4. As we've shared, we think that that number from there starts to go down at the end of Q1, at the end of Q2 before picking up in the back half of the year. But we feel that we would exit 2026 at a number that's about 65 million or higher. All right, got it. Thank you. Of course.

OPERATOR - (00:41:03)

Thank you. And there are no further questions at this time. I would now like to turn the call back after Mr. Lee Beanstalk. Please continue.

Lee Beanstalk - Chief Executive Officer - (00:41:11)

Thank you. And thank you all for joining us today. Be well.

OPERATOR - (00:41:18)

Ladies and gentlemen, this concludes your conference call for today. We thank you very much for your participation. You may now disconnect. Have a great day.