Electromed, Inc. (ELMD) Q4 2026 Earnings Report, Transcript and Summary

Greetings, and welcome to the Electromed Fiscal Q4 2026 Earnings Call. [Operator Instructions] As a reminder, this conference is being recorded. I would now like to turn the conference over to Mike Cavanaugh, Investor Relations. Thank you, Mike. You may begin.

Good afternoon, and thank you for joining the Electromed earnings call. Earlier today, Electromed Inc. released financial results for the fourth quarter of fiscal 2026. The press release is currently available on the company's website at www.smartvest.com. Before we get started, I would like to remind everyone that some of the statements that management will make on this call are considered forward-looking statements, including statements about the company's future operating and financial results and plans. Such statements are subject to risks and uncertainties that could cause actual performance or achievements to be materially different from those projected. Any such statements represent management's expectations as of today's date. You should not place any undue reliance on those forward-looking statements, and the company does not undertake any obligation to update or revise forward-looking statements, whether because of new information, future events or otherwise. Please refer to the company's SEC filings for further guidance on this matter. Joining me on the call today are Jim Cunniff, Electromed's President and Chief Executive Officer; and Brad Nagel, Chief Financial Officer. As on previous calls, Jim will provide operational highlights from the quarter. Brad will then review the financials, and we will close with a question-and-answer session. With that, I will now turn the call over to Jim Cunniff, President and Chief Executive Officer of Electromed.

Thank you, Mike, and thank you all for joining us today. I'm pleased to report on another record quarter for Electromed. Q4 marks our 15th consecutive quarter of year-over-year revenue and profit growth, a track record that reflects the durability of our direct-to-patient model and the growing recognition of SmartVest within the bronchiectasis community. Net revenue for the fourth quarter was a record $19.4 million, up 12% versus the fourth quarter of last year. We again delivered operating leverage in the quarter. Operating income was $3.8 million in Q4, representing 26% year-over-year growth. Earnings per share was also a quarterly record at $0.39 per share on a fully diluted basis. Growth in the quarter was led by our core home care channel, which grew 15% and our distributor channel, which grew 2%, both reflecting consistent demand for our SmartVest. Hospital revenue declined 29% in the quarter. As we've discussed on prior calls, hospital orders have a longer sales cycle and are inherently less predictable than our other channels. We are bullish on our hospital as a gateway to the home, and we'll continue to invest in this area of our business. We ended the quarter with 64 direct sales representatives, an increase of 6 reps versus the third quarter. This increase reflects hiring ahead of our planned territory expansions in fiscal 2027, and we're pleased with the caliber of talent we've been able to bring on to the team. We continue to expand our sales force deliberately, and I continue to be impressed with the revenue growth the team has delivered. As many of you know, the largest strategic opportunity for Electromed is within the underserved bronchiectasis market. Today, approximately 1 million patients in the United States are diagnosed with bronchiectasis, yet only about 16% are currently benefiting from high-frequency chest wall oscillation therapy. That leaves approximately 800,000 patients who have been diagnosed with bronchiectasis that could benefit from SmartVest but have not been prescribed therapy. We also estimate that more than 4 million additional individuals may have undiagnosed bronchiectasis which underscores the market opportunity and necessity for further patient and provider education. To address this, we initiated our triple down on bronchiectasis campaign last year to raise awareness of our therapy to highlight the integral part airway clearance plays in the treatment of bronchiectasis. The campaign is built around our 3-part treatment approach. Number one, clear airways first with SmartVest to remove the mucus that fuels future infections; second, treat the infection with antibiotics; and third, reduce inflammation. Together, these 3 steps are designed to break the cycle of chronic infection, persistent inflammation and airway damage that drives progressive lung disease and decline in quality of life for these patients. This year, we've expanded this campaign with a new initiative we're calling Treat Smart from the start, which is designed to help clinicians identify patients whose current airway clearance therapy isn't working and determine whether it's time to reassess treatment. Beyond these campaigns, our clinical team remained active raising awareness among providers this quarter. We presented at 2 regional respiratory conferences reaching a combined audience of more than 200 clinicians. Additionally, we conducted 3 peer-to-peer webinars this quarter, each with at least 100 clinicians in attendance and attended several national conferences. On the research side, we completed a manuscript, which was accepted for publication in the September issue of the COPD Foundation Journal. Using data from the NTM Bronchiectasis Research Registry, the study found that 58% of qualified patients were not prescribed HFCWO therapy despite meeting all the clinical criteria needed for insurance coverage. That's a meaningful gap we are addressing by engaging physicians who diagnose high volumes of bronchiectasis patients but are not yet prescribing HFCWO therapy. Separately, the BE NTM Association launched a new educational website for physicians and patients, including a quick guide on airway clearance. We're proud to be a sponsor of their airway clearance resource library helping close the void in patient and provider education. I've talked previously about our smart order e-prescribe solution, which is changing how prescribing clinics submit orders more efficiently to our fulfillment team. Of note, the Centers for Medicare and Medicaid Services finalized its rule on administrative simplification, adopting new standards for health care claims attachment transactions and electronic signatures. In practice, this means covered entities will need to modernize how they process orders and phase out faxes by May of 2028. Our e-prescribed solution already meets CMS' requirements for electronic signatures and order processing, which positions us well as the industry moves away from faxes. In the fourth quarter, more than 45% of the orders we received came through Smart Order and those orders shipped on average 5 days faster than orders submitted by fax. Expanding payer coverage remains one of our core strategies because it's what ultimately gives patients in need access to SmartVest. We ended the year with 87% of covered lives in the United States under contract. This is a tremendous accomplishment by our market access team, which ended the year by having executed 40 new payer contracts and expanded our network by more than 6 million covered lives. I'm also proud that Electromed's products are manufactured here in the United States. Given the supply chain disruptions we've seen across the industry, we believe our U.S.-based operations are competitive advantage. 99% of our net revenue is generated domestically and that concentration gives us confidence in our ability to maintain our strong track record of on-time delivery and our mid-70% or better gross margins. I also want to recognize the Electromed team, which continues to operate at a high level. Recently, the Minneapolis St. Paul Business Journal named Electromed the eighth fastest-growing public company in Minnesota, and we were named a top workplace in Minnesota this year by the Star Tribune. In fiscal 2026, 45% of our new hires came through employee referrals. Our employees are engaged and want to bring others like them on to the team. We believe engaged employees lead to engaged customers, and that virtuous cycle is a big part of how we built this business. Before I turn the call over to Brad, I'd like to take a moment to address an important leadership transition that we also announced today. After considerable thought and discussion with our Board, I have decided to retire as Chief Executive Officer of Electromed with expected timing in April 2027. My decision is accompanied by a thoughtful succession planning process led by our Board, and I believe the timing will be right for the company and for me personally. I'm extremely proud of what our team has accomplished over the past 3 years. We've built a strong business, established a clear strategy for growth and most importantly, developed a talented leadership team that gives me tremendous confidence in the company's future. Between now and my retirement, my focus will remain exactly where it's been on executing our strategy, delivering against our commitments to shareholders and ensuring a smooth transition of leadership. I have never been more confident in the strength of the organization or in its opportunities. I'm grateful to our employees, customers, shareholders and Board for the opportunity to lead this company, and I look forward to continuing to work with the team over the coming months. With that, Brad, over to you.

Thank you, Jim. I've enjoyed our partnership and your leadership of the Electromed team over the past few years, and I look forward to continuing to work with you until your retirement. Turning to our financial results. All amounts I'm about to review are for the 12 months ended June 30, 2026, which I will refer to as fiscal 2026 and compared to the 12 months ended June 30, 2025, or fiscal 2025, unless otherwise noted. Net revenues for Q4 grew 11.6% to $19.4 million, bringing net revenues for our full fiscal year 2026 to a record $73.8 million or 15.3% growth from $64 million last year. Annual revenues in our direct home care market increased year-over-year by 16.3% to $66.6 million from $57.3 million in the prior year. The increase in revenue was due to an increase in direct sales representatives, increased sales representative productivity and higher net revenues per approval. The annualized home care revenue per weighted average direct sales representative in fiscal year 2026 was $1,145,000, exceeding Electromed's target range of $1 million to $1,100,000 per rep. With our strong performance in fiscal 2026 and continued efficiency expected in fiscal 2027, we're increasing our target range for fiscal year 2027 home care revenue per rep to a range of $1,050,000 to $1,150,000 as we balance the record sales rep productivity we saw in fiscal 2026 with the sales team expansion plans for fiscal 2027. Revenue in our non-home care business grew 6.7% to $7.2 million in fiscal 2026. The increase was primarily due to increased distributor and hospital revenue, which grew 12.7% and 9.6%, respectively. Gross profit increased to $57.9 million or 78.5% of net revenues from $50 million or 78.1% of net revenues in fiscal 2025. The increase in gross profit and gross margin was primarily due to increased revenue and higher net revenue per device. Selling, general and administrative or SG&A expenses were $42.7 million, representing an increase of $3.4 million or 8.7% from $39.3 million. The increase was primarily due to increased salaries and incentive compensation related to the higher average number of personnel in the sales, sales support, marketing and reimbursement teams to process more patient referrals. Operating income this year was $13.9 million or 18.8% of net revenues compared to $9.7 million or 15.1% of net revenues last year. The growth of 43.7% in operating income reflects the leverage benefit of mid-teen growth in net revenues and gross profit, balanced with the disciplined investment into the business' operating expenses, which grew about 9%. When putting these full year results together, we're excited to have delivered a record year with pretax income of $14.4 million, net income of $11.3 million and full year EPS of $1.30 per diluted share. As of June 30, 2026, Electromed had $20.5 million in cash, $29.8 million in accounts receivable and no debt, achieving a working capital of $45.1 million and total shareholders' equity of $54 million. The cash balance reflects an increase of $5.2 million for the year ended June 30, 2026, compared to a decrease in cash of $0.8 million in the same period in the prior year. The increase in cash for the 12 months ended June 30, 2026, was driven primarily by positive operating cash flow of $9.7 million, partially offset by repurchases of Electromed common stock totaling $3.9 million. I'll close by saying that Jim and I are very encouraged by the commitment and energy of the Electromed team as we continue bringing our innovative SmartVest technology to patient populations that remain significantly underserved. It's rewarding to see how that dedication to the patients and physicians we serve has translated into strong financial performance throughout fiscal 2026, creating meaningful value for Electromed and our shareholders. As we look forward into fiscal 2027, we continue to see opportunity to leverage the investments we've made to drive both our mission and our financial commitments forward, delivering double-digit top line growth, expanded operating leverage and strong operating cash flow in the new year. Operator, please open the call to questions.

[Operator Instructions] Our first question comes from the line of Kyle Bauser with Titan Partners.

But first, Jim, congrats on your retirement next year, we wish you all the best.

Thank you, Kyle. I appreciate that.

Yes. Glad to see there's some time to make the transition. So thanks for the update there. And maybe for my first question, obviously, another really strong quarter of operating leverage, and you talked a little bit about it. But maybe you could just discuss a bit about your expectations for continued leverage in fiscal '27. And any expectations to kind of add more reps in territories as well?

Well, as I think Brad said it well, we're expecting this year to be not necessarily a repeat of last fiscal year, but we're certainly projecting that we will be able to deliver double-digit top line growth and operating leverage. And that's been the mantra that we've been beating the drum on for the last 3 years, and we've been able to deliver on that. So yes, we're confident we'll be able to do that. We have added sales reps, which we're excited about. So as you heard in the prepared remarks, we really ended the year with 64 direct sales reps. A lot of those actually came in, in June of the last fiscal year. But the good news is they were to help fill the void for territory expansions that we have for this fiscal year. So we're kind of hitting the ground running. That includes actually 2 hospital account liaisons. These are folks that we're actually doing a pilot with in a couple of key markets to see if we can capture some of those patients that are in the hospital that then get transitioned to the home and get those referrals. In addition to that, we also have 3 additional territories that we're looking to fill. So our touch wood, our expectation is to have 67 territories filled this year, including 2 hospital account liaisons. Brad had also mentioned in his comments that we have raised our guidance on the revenue per rep for this year, albeit it's below where we ended up last year. And that's mainly because, as you know, Kyle, some of these reps are going to take some time to ramp up and become productive for us. But yes, we're really bullish on the business and the new talent that we're bringing on to the team.

Got it. Appreciate that. And maybe for my follow-up, obviously, the cash balance continues to grow amid very strong share price. Any thoughts on your capital allocation strategy and how you're thinking about deploying cash going forward?

Thanks for the question, Kyle. Yes, the strategy remains the same. We continue to think in terms of priorities with our cash. First, just derisking the business. Second, investing back into the business. And as Jim mentioned, we are adding quite a few sales reps as we come into 2027 and want to support them, not just the headcount, but also with sort of the right marketing support, the right investment into R&D, continuing to reinvest into the business to the extent that we can and still show leveraged growth across the P&L. Beyond that, as we have in the past, we'll continue to look for ways to add shareholder value. Our key method of operation on that has been through share repurchases, which we've done over the past couple of years. So opportunistically, when we have the option to, we'll continue to find ways to create that shareholder value.

Our next question comes from the line of Arailym Kanatkyzy with Freedom Broker.

Before I get to my questions, congratulations on the announcement. 3 years and 15 straight quarters is a good place to hand off from. So I want to say thanks for taking my question.

Thank you for the kind words.

So first question is about R&D. Spend was up meaningfully year-over-year in percentage terms. So it's still a small name for the P&L. Can you give us a sense of what that dollar is actually going forward or going forward to? Is it iteration on the Clearway generator? Is it the connectivity and data side of things like smart nodes? Or is it work on something adjacent to the current platform?

That's a great question. And to your point, it's actually on a really small base, our R&D investment. We are a single product company. And so when you take a look at our R&D spend, it's really bifurcated for sustaining engineering. So we're always looking at upgrading the technology that we have today. That's one element to it. And so we're investing in that. The other side of it is innovation. And I think I've mentioned this on previous calls in the past. One of the areas that we believe needs a little bit more innovation on our side. There's really 2 areas, one of which is connectivity and we're working on that right now, as you had mentioned. And then the second piece of it is really just expanding our vest line. And so to do that predominantly on the smaller sizes of our vest, that's really where a big focal point of our R&D team is, is to enhance that and expand it.

Great. And I also have a related question. So acquisition shows up in the deck as one of the 3 main pillars of the growth strategy. I want to know the detail behind it. When you talk about inorganic opportunities, what problem are you trying to solve? Is it adding a second product to the reps are already carrying? Or is it acquiring a capability like monitoring data? Or is it about diversification?

Yes, it could be all of the above. No, I think those are great questions. So we're always looking at -- we are a single product company. It would be great if we could add another leg to the stool for our sales reps, add something to their bag that complements the call point that they focus on and enhances the customer relationship. And we are constantly on the lookout if there's a 1 plus 1 equals 3, we're interested in it. We just haven't found it yet. And to your question, we're not pigeonholing ourselves into one inorganic opportunity. If it makes sense for our sales rep and it complements what they're doing, that's something that we're very much open to. Conversely, we've got a terrific reimbursement team and contracting engine. And in the home care space, that's a very valuable asset. And so that's another area where we could see leveraging that capability through an acquisition and bringing somebody on board who may have a technology that fits this space, but they don't have that same type of capability.

I am really excited for the results.

Thank you so much.

Our next question comes from the line of Ben Haynor with Lake Street Capital Markets.

First off for me, just thinking about payer mix as we get into fiscal 2027, it looks like you had commercial go down a couple of few hundred basis points over the course of fiscal '26. Some of that is probably comps, Medicare and Medicare Advantage up a little bit. How should we think about that tracking? Is it just kind of bounce around? Is there any underlying trends that make things go towards one or the other?

Yes. No, first off, thanks for the question, Ben, and thanks for being on the call. As you know, when we're going into a clinic and talking to a physician, we're not identifying who the payer type is that the patient has. What we're really looking for is are there patients that could benefit from using our technology. And so from that, it's kind of a black box for us. We really don't find out what type of insurance that patient has until we've gotten a prescription. And so typically and historically, the split has been pretty even between Medicare and commercial pay. I think the good news and one of the things we want to highlight is the fact that over the course of the last fiscal year, we've added 6 million additional covered lives. So in the past, we might have gotten a prescription. We may have been out of network, and we can't fulfill that because the patient doesn't want to be burdened with a large out-of-pocket expense. And so by continuing to add payer coverage, it just helps our ability to serve our patients and our ability to no longer be out of network.

Okay. So there's not necessarily a clear trend except for perhaps demographics?

No. I mean I think the reality is what's the stat? I think there's about 10,000 people per day who turn 65. And so the trend is more towards Medicare. But again, when we look historically over the last 3 years, the Medicare to commercial pay split has been pretty much 50-50.

Sure. That makes sense. And then secondly for me on the CHEST guidelines, I believe those got published not all that long ago, listing HFCWO kind of across the board, I believe. What does that do for your reps when they're detailing [indiscernible]? Can you give us a sense of how that helps folks out?

Yes. I think the good news is there's never been care guidelines in the United States on how to treat bronchiectasis patients. And the guidelines truthfully, they're going to be published later on this quarter. And so we're excited about that. It's been on the horizon for a long time, Ben, as you know. And it's not as definitive as we would like. There's not really an algorithm for treatment of bronchiectasis patients. Really what the guidelines point to is what are some of the different things that a provider can use to take care of bronchiectasis patients. And included in that is airway clearance, no surprise. And as you even heard on my remarks, these patients, they have a chronic irreversible condition. They have fluid that's building up in their lungs, and they need something to remove that mucus, which is the fuel for future infections. And so we're kind of the first point of attack. The other thing I would just point you to is, and this is exciting is that in conjunction with the CHEST guidelines, the bronchiectasis and NTM Foundation have actually just introduced new BE care pathway. And I think that's going to be a little bit better for health care providers to understand what tools they have in their toolbox to treat bronchiectasis patients. So it's good news for the industry in general, and it's good news for us because airway clearance is included in both of those guidelines.

Congrats on the retirement going on top.

Yes, appreciate it Ben. Thank you so much.

There are no further questions at this time. I'd like to turn the floor back over to Jim Cunniff for closing comments.

Yes. Thank you, operator. And before we close the call, I just want to leave you with some key takeaways from this past quarter. First, this was our 15th consecutive quarter of year-over-year revenue and profit growth with record revenue and record diluted earnings per share. It's our goal to deliver continued growth and profitability. In line with this goal, we're investing ahead of demand such as adding to our sales force. The bronchiectasis opportunity remains substantial and our Treat Smart from the Start campaign, together with our clinical, educational and payer initiatives are all designed to help us reach more patients responsibly. Our financial foundation is strong. We have a debt-free balance sheet and strong cash generation, which enable us to keep investing in profitable growth. As always, I want to thank you for joining us today. If you have questions or would like to schedule a call with the Electromed team after today's report, please reach our Investor Relations partners at ICR Healthcare. Operator, please close the call.

This concludes today's teleconference. You may disconnect your lines at this time. Thank you for your participation.