Vivos Therapeutics, Inc. (VVOS) Earnings Call Transcript & Summary

Good day, everyone, and welcome to the Vivos Therapeutics Second Quarter 2026 Conference Call. [Operator Instructions] This conference call is being recorded, and a replay of today's call will be available on the Investor Relations section of Vivos website and will remain posted there for the next 30 days. I would now like to hand the conference over to Brad Amman, Principal Accounting Officer and former CFO for introductions and the reading of the safe harbor statement. Please go ahead.

Thank you, Ludy. Hello, everyone, and welcome to our conference call. A copy of our earnings press release is available on the Investor Relations section of our website at www.vivos.com. With me on the call today is Kirk Huntsman, Vivos' Chairman and Chief Executive Officer; and Roman Franklin, Vivos' Chief Financial Officer and Principal Financial Officer. Today, we will review the financial results of the second quarter of 2026 as well as more recent developments and Vivos' plans for the rest of the year 2026 and beyond. Following these formal remarks, we will be happy to take questions. I would also like to remind everyone that today's call will contain certain forward-looking statements from our management made within the meaning of Section 27A of the Securities Act of 1933 as amended and Section 21E of the Securities and Exchange Act of 1934 as amended, concerning future events. Words such as aim, may, could, should, projects, expects, intends, plans, believes, anticipates, hopes, estimates, goal and variations of such words and similar expressions are intended to identify forward-looking statements. These statements involve significant known and unknown risks and are based upon a number of assumptions and estimates, which are inherently subject to significant risks, uncertainties and contingencies, many of which are beyond the company's control. Actual results, including, without limitation, the results of Vivos' growth strategies, operational plans, including sales, marketing, distribution, medical sleep provider, acquisition and integration, research and development, regulatory initiatives, cost savings plans and plans to generate revenue as well as future potential results of operations or operating metrics such as the potential for Vivos to achieve future positive cash flows or profitability and other matters to be addressed by Vivos' management in this conference call may differ materially and adversely from those expressed or implied by such forward-looking statements. Factors that could cause actual results to differ materially include, but are not limited to, the risk factors described in other disclosures contained in Vivos' filings with the Securities and Exchange Commission, including the risk factors and other disclosures in our Form 10-K for the year ended December 31, 2025, and our other filings with the SEC including our second quarter 10-Q filed with the SEC today, all of which are, or will be accessible on the Investor Relations section of the Vivos website as well as the SEC's website. Except to the extent required by law, Vivos assumes no obligation to update statements as circumstances change. Finally, please be aware that the U.S. Food and Drug Administration has given certain specific Vivos appliances 510(k) clearance to treat mild to severe OSA in adults. With the FDA clearance of certain Vivos products for severe OSA in November of 2023, treatment of patients with severe OSA with these specific appliances is no longer needed to be performed off-label at the clinical discretion of the treating doctor and is now an integral part of the Vivos treatment protocol. Treatment of OSA of any severity or any other condition with any other of Vivos FDA-cleared devices remains at the clinical discretion of the treating doctor. For further information on our results for the 3-month period ended June 30, 2026, please see our earnings release, which was distributed earlier today and our quarterly report on Form 10-Q, which is available on the SEC filings portion of the Investor Relations section of our website. In the second quarter of 2026, Vivos completed its fourth full quarter of activity followed by our June 30 -- following our June 10 acquisition of -- in 2025 of the Sleep Center of Nevada, demonstrating that the pivot in our sales, marketing and distribution model has taken hold. Revenue increased by approximately $1.3 million or 35% to $5.2 million for the 3 months ended June 30, 2026, compared to $3.8 million for the 3 months ended June 30, 2025. The increase in total revenue during the second quarter of 2026 was impacted by an increase of $1.9 million in service revenue and a decrease of $0.5 million in product revenue to our VIPs. The increase in product revenue is attributable to a decrease in appliance sales of $1.1 million as a result of our strategic pivot away from VIPs to sleep centers, which is reported as treatment revenue under service revenue offset by a decrease of $0.5 million in discounts offered. The increase in service revenue is attributable to $1.5 million in sleep testing services, primarily generated from SCN and an increase of $800,000 in revenue generated from Vivos treatment to patients launched at 2 SCN locations, offset by a decrease of $100,000 in VIP enrollment revenue and $100,000 from sponsorship, seminar and other service revenue. For the 6 months ended June 30, revenue increased by $3.5 million or 51% to $10.3 million compared to $6.8 million for the 6 months ended last year. The increase in total revenue during the period was impacted by an increase of $4.4 million in service revenue and a decrease of $900,000 in product revenue. The decrease in product revenue is attributable to a decrease in appliance sales to VIPs of $2.1 million, again, due to our strategic pivot, offset by a decrease of $200,000 in discounts offered. The increase in service revenue is attributable to $3.5 million of sleep testing services, primarily generated from SCN and an increase of $1.4 million of revenue generated from Vivos treatment to patients launched it to SCN locations, offset by a decrease of $300,000 in VIP enrollment revenue. For the 3 months ended June 30, 2026, we sold 5,180 oral appliance arches for a total of approximately $1.4 million, a 28% decrease in revenue from the 3 months ended June 30, 2025. We when we sold 4,116 oral appliance arches for a total of $1.9 million. The decrease is directly attributable to a higher volume mix of preformed appliance sales, which are lower revenue-generating products when compared to Vivos care appliances. For the 6 months ended June 30, 2026, we sold 10,484 oral appliance arches for a total of $2.8 million, a 24% decrease in revenue from the 6 months ended June 30 with last year when we sold 7,852 arches for a total of $3.7 million. The decrease is directly attributable to higher volume mix of the preformed appliance sales, which are lower revenue-generating products compared to our care devices, as I mentioned earlier. Cost of sales increased $0.5 million or 29% to $2.2 million for the 3 months ended June 30 compared to $1.7 million for the same period in 2025. This was primarily attributable to higher costs associated with diagnostic services and patient therapy, including the addition of staff at the Vivos treatment centers. For the 6 months ended June 30, 2026, cost of sales increased $1.1 million or 33% to $4.3 million compared to $3.2 million for the 6 months ended June 30, 2025. This was primarily related to the higher costs associated with diagnostic services, patient therapy, including additional staff at the Vivos treatment centers. For the 3 months ended June 30, 2026, gross profit increased by $800,000 to $3 million. This increase was attributable to the increase in revenue of $1.3 million and an increase of cost of sales of $0.5 million. Gross margin increased to 57% for the 3 months ended June 30, 2026 compared to for the 3 months ended June 30, 2025, due to the increase in both revenue and cost of sales. For the 6 months ended June 30, 2026, gross profit increased by $2.4 million to $6 million. This increase was attributable to the increase in revenue of $3.5 million and an increase in cost of sales of $1.1 million. Gross margin increased to 58% for the 6 months ended June 30 of this year compared to 53% for the 6 months ended last year due to the increase in revenue and smaller increase in cost of sales. General and administrative expenses increased $700,000 or 11% to approximately $7.1 million through the 3 months ended June 30, 2026, as compared to $6.4 million for the 3 months ended June 30, 2025. The primary cause of this increase was $600,000 in salary and wages related to the acquisition of SCN and the opening of Vivos treatment centers and $300,000 in higher rent expense, offset by a reduction of $200,000 in bad debt and allowances. For the 6 months ended this year, general and administrative expenses increased $4.8 million or 42% to $6.1 million as compared to $11.3 million for the 6 months ended last year. The primary driver of this increase related to the costs associated with acquiring and integrating SCN and establishing the Vivos treatment centers, including an increase in salaries and related compensation of $3 million for additional -- hiring additional staff and an increase of $900,000 for professional fees and an increase in rent of $600,000 and other costs of $300,000. Sales and marketing expenses decreased $100,000 to $200,000 for the 3 months ended June 30 of this year compared to $300,000 for the 3 months ended June 30, 2025. This is attributable and significant part to our focus on reducing costs. Sales and marketing expense decreased $200,000 to $400,000 for the 6 months ended June 30, 2026, compared to $600,000 for the 6 months ended June 30, 2025. This decrease was primarily driven by our decrease in sales and marketing campaigns, lower commissions paid to our employees, digital media services and reduction in use of marketing supplies due to our pivot. Depreciation and amortization expense increased $200,000 for the 3 months ended June 30, 2026, and depreciation and amortization expense increased $0.5 million to $1 million for the 6 months ended June 30, 2026. Depreciation and amortization increased due to assets being placed into service during the period. Other expense increased $900,000 for the quarter and $2 million year-to-date due to additional interest expense on a note during the 3 and 6 months ended June 30, 2026. This was offset by an increase in other income of $300,000 during the 3 and 6 months ended June 30, 2026 related to the valuation change in an earn-out related to the acquisition of SCN. The financial statements have been prepared in conformity with GAAP, which contemplate a continuation of the company as a going concern. We have incurred losses since inception, including $5.5 million and $5 million for the 3 months ended June 30, 2026 and 2025, respectively, and $13.3 million and $8.9 million for the 6 months ended June 30, 2026 and 2025, respectively, resulting in an accumulated deficit of $138 million as of June 30, 2026. Net cash used in operating activities amounted to approximately $9.2 million and $7.3 million for the 6 months ended June 30, 2026 and 2025, respectively. As of June 30, 2026, we had total liabilities of approximately $28.1 million. As of June 30, 2026, we had approximately $1.8 million in cash and cash equivalents, which will not be sufficient to fund operations and strategic objectives over the next 12 months from the date of issuance of these financial statements. Without additional financing, these factors raise substantial doubt regarding the company's ability to continue as a going concern. We have implemented cost savings measures in our legacy business that have reduced cash in operations. During the first 6 months of 2025, many onetime costs related to the acquisition of SCN were recognized and were not reoccurring in 2026. As such, we have funded our operations through equity raises in the period ending June 30, 2026 and fiscal year ended December 31, 2025. We were required to obtain additional financing to satisfy our cash needs, including funding the SCN acquisition and increasing our stockholders' equity for NASDAQ compliance purposes as we seek to increase revenue with a view toward ultimately achieving positive cash flow from operations. During the 6 months ended June 30, 2026, the company sold an aggregate of 694,564 ATM shares at an average price of $0.69 per share through the ATM sales agreement, resulting in proceeds of approximately $0.5 million net of commissions. Under the ATM offering, $2.3 million remain available for future sales as of June 30, 2026. However, the company is not obligated to make any sales under this program. Given that our stockholders' equity at December 31, 2025 and June 30, 2026, was less than $2.5 million. We are presently not in compliance with NASDAQ Stock Market minimum stockholders' equity requirement. We are seeking to regain compliance by raising new funding in the form of equity and reducing our costs. However, we will be faced with delisting proceedings which will distract management and cost resources to remedy if we don't get remedy the $2.5 million stockholder equity requirement. In summary, we're seeing significant increases in revenue, reflecting the acquisition of SCN, which has now contributed a full year of operations to our results and partnerships with 2 additional groups as well as related treatment revenue from providing patients with OSA treatment options, all of which is extremely encouraging. We are also seeing higher costs associated with diagnostic services and patient therapy, including addition of staff at the Vivos treatment centers. We believe the strategic move to acquire SCN to establish other affiliate alliances sets the stage for stronger performance in the upcoming quarters. For more detailed information, I refer you to our earnings release and our in our full Form 10-Q filed earlier today. And with that, I'll hand the call over to our Chairman and CEO, Kirk Huntsman, to discuss the progress we have made to date on SCN and Vivos.

Thanks, Brad. Good afternoon, everyone, and thank you for joining us. I'd like to thank Brad Amman in particular, today for his time here at Vivos and his service at this company over the course of less 6 or 7 years. Brad, has been a key part of our management team and we're going to miss him. I want to spend a few minutes, if I may, today, talking about the operational progress we're making within Sleep Centers of Nevada, something we refer to as SCN and also discuss several related strategic initiatives, because I think it's important for you to understand how these pieces fit together and what they could mean for Vivos over time. When we first acquired SCN a little over a year ago, we saw an opportunity that went far beyond adding another source of revenue. We saw the potential to build a broader clinical platform around a growing patient population to provide more services to those patients, to add recurring sources of revenue, expand our capacity and when clinically appropriate, create additional pathways into the Vivos care model. In the second quarter, we saw that strategy beginning to take shape. As SCN patient volume continues to grow, we have seen more opportunities to generate revenue both within SCN itself, where most of the diagnostic services are rendered and also at our strategically located sleep and airway medicine centers, what we typically refer to as our SAMC centers where most of the actual treatment takes place. That connection is important. At SCN, medical doctors and nurse practitioners conduct a variety of diagnostic tests and patient consultations and then refer patients out for treatment where medically necessary. At SAMC, SCN and other independent physician-referred patients with sleep and breathing disorders are provided a full and complete range of treatment options, from CPAP to lasers to oral appliances and other adjunctive treatments, including Vivos' proprietary rehabilitation and restorative care devices cleared by the FDA to treat all levels of obstructive sleep apnea severity, including severe OSA. Thus, SCN is far more than just a business that simply sits next to Vivos and SAMC. To ensure optimal clinical outcomes for patients, these 2 independent groups must fully communicate and support one another. This synergy closes a significant gap in traditional care models throughout sleep medicine today, where there is a significant patient fallout rate due to the roadblocks encountered by patients as they navigate multiple providers and services. I would now like to discuss the clinical and service initiatives to enhance patient care and revenue growth here at Vivos. To further drive top line revenue growth over the course of the second quarter, Vivos management has launched or expanded several key initiatives across multiple markets. These initiatives include: One, one of the most important clinical issues that we're actively pursuing is remote patient monitoring of patients on CPAP. Based on the preliminary data currently available to us, we estimate an addressable population of approximately 16,000 existing CPAP patients from SCN's legacy CPAP patient population. Under our current eligibility and enrollment estimates based on industry standard adoption metrics obtained from our current -- our contract service providers, we estimate that approximately 5,000 to 7,500 of those patients could be candidates for enrollment over the next 6 to 12 months, subject to clinical appropriateness, patient consent, coverage and enrollment. Based on extensive discussions and negotiations with our service provider, we estimate net revenue per patient per night to come in at between $40 and $50 each. That gives us a sizable existing patient platform population from which to build a strong recurring revenue program. To be sure, we are still early in this process, and the pace of adoption will depend on enrollment, reimbursement, implementation and our ability to execute. But this is exactly the type of opportunity we want to develop within Sleep Centers of Nevada, a recurring revenue service built around a patient population that is already there. Second, separately, we are targeting a phased launch of a wholly owned DME-based CPAP program in early fourth quarter of this year. Based on preliminary vendor discussions and our current planning assumptions, if the program reaches the level of scale we are contemplating, we estimate it could generate between 150 -- approximately $150,000 to $250,000 per month in contribution margin. Actual results will depend on successful implementation, patient volumes, reimbursement, vendor economics and operating execution. If we execute well, this has the potential to add yet another recurring revenue stream to our operations at Sleep Center of Nevada. Third, we continue to execute and implement our insomnia/EEG testing and treatment program at Sleep Center of Nevada. Patient encounters, patient tests administered and revenue generated from this program are all growing rapidly, with plenty of upside opportunities remaining. Fourth, we have also expanded and opened our new state-of-the-art Henderson, Nevada sleep testing and treatment facility, which has effectively more than doubled our production capacity there in Henderson to well over $10 million annually. That expansion gives both Sleep Center of Nevada and SAMC, additional capacity and infrastructure as patient volumes grow. It's a practical but important piece of this strategy. If we are successful in generating more demand, we also have to be able to serve it. Henderson and its expansion -- expanded facility gives us additional room to do just that and to support more services as the platform continues to develop. Any treatment decision, of course, remains with the independent clinicians that work at these facilities. When clinically appropriate, their evaluations may include consideration of Vivos treatment options, consistent with its applicable indications. So there are 2 potential benefits. EEG could grow as a stand-alone service within each of these SAMC centers and Sleep Center of Nevada, and that can create another clinically appropriate entry point into the broader Vivos care model as those patients begin to receive treatment. Another initiative we discussed publicly is our contemplated collaboration and partnership opportunities with large cardiology groups in both Arizona and Florida. We continue to actively pursue those options and expect to finalize our negotiations with both groups in the near future. We expect each of those affiliations to add significantly to our current revenue streams being worked in Colorado, Nevada and Michigan. Moreover, we expect to extend essentially the same operating model across additional affiliation opportunities that we are pursuing across the country. Based on the operating plan we previously announced, an initial fully staffed sleep optimization team could serve roughly 250 patients per month and under the assumptions underlying that plan, generate more than $6 million in annual revenue with contribution margins approaching 40% to 50% once fully developed. We have previously -- Number 6, we have previously announced our successful launch of a pediatric OSA testing and treatment program across all current markets. Today, I'm pleased to announce significant progress in this program with hundreds of children now receiving treatment and experiencing life-changing effects therefrom. We believe this program is still in its early stages and that there is significant and material upside to enroll and service many more children as we continue to expand this program and successfully execute. Keep in mind that there is an estimated 10,000 -- excuse me, 10 million children across the United States who suffer from sleep and breathing disorders such as obstructive sleep apnea. Seventh, finally, we continue to refine and fully develop our current opportunities at Sleep Center of Nevada. After considerable work with providers and staff, we are already experiencing a significant uptick in the total referral volume from SCN to SAMC. Just since the end of the second quarter, we have been seeing 3 to 4x as many patients being referred by SCN physicians and nurse practitioners over to SAMC for treatment. We expect to see production from these referrals begin to impact our financial results in the third quarter. Of course, the realization of these opportunities remain subject to definitive agreements, regulatory requirements, staffing, payer contracting, facility readiness, staff execution and other operating prerequisites. However, our deep experience in operating multi-site professional practices across multiple states as well as our deep experience in Nevada with SCN gives us a clear competitive advantage as we move forward. Keep in mind that we are still early on in these initiatives, and these results are still evolving within our operating model. Actual performance will depend on successful implementation and execution. But the opportunity is straightforward. The combined effect of these clinical and operational initiatives could be and is expected to be material and significant in the weeks, months and quarters ahead. So as we step back and look broadly at these initiatives together and their cumulative effect on our business, I think the strategy for us to achieve positive cash flow and profitability becomes much clearer. More patients from physician referrals gives us more opportunities to provide enhanced and recurring services. More production capacity from our facilities expansion, our providers and our new collaboration affiliations allow us to serve more patients at higher service levels and more patient and provider relationships can create, and we expect will create additional clinically appropriate ways to introduce patients into the core Vivos business ecosystem. That is the model we are building. Based on our current assumptions and subject to successful implementation and scaling, patient enrollment and conversion, reimbursement, vendor economics, available capacity and operating execution, we see a clear path for Vivos' growth initiatives to become cash flow positive near the end of 2026 or in early 2027, and generate significant positive EBITDA for the company in its fiscal 2027. That potential does not depend on just 1 program working perfectly. It reflects the combined opportunity we see across patient volume growth, remote patient monitoring, CPAP services, expanded capacities, EEG and our collaborations with cardiology groups in both Florida and Arizona. Now there's still a lot of work to do. We have to launch these programs well. We have to enroll the right patients. We have to manage reimbursement and capacities. We have to prove the economics as we go. But that's what this team is focused on. We intend to measure what works, invest beyond programs that perform and be disciplined about how we scale them. And then that brings me back to what I think is most important about our reports here today. The infrastructure that we are building here at Vivos is designed to reinforce the core business, not simply operate alongside of it. We expect to see -- continue to see more patients with more capacity for generating revenue off of those patients with more recurring touch points and recurring revenue streams and more clinically appropriate pathways into treatment for those patients. As we execute, we believe we can create a substantially stronger foundation for future growth across Vivos. I'd like to close by saying that we continue to see a bright future for this company, irrespective of what's happened in -- to our stock price in the market, we still believe that this company has a tremendous future. We believe that our technology is -- continues to lead the world in terms of its ability to resolve the conditions of obstructive sleep apnea in both children and adults. And we continue to believe that opportunities to deploy this technology will continue to arise across various platforms. As we do that, this company will emerge as an industry leader, and we believe that it will continue to set the pace for the future of an entire industry of advanced sleep medicine. And with that, I will close my remarks. Thank you for your time and attention today. And operator, we'll take a few questions from those who are in attendance today.

[Operator Instructions] And your first question comes from the line of Yi Chen with H.C. Wainright.

This is Katie on for Yi. Quick follow-up on the call. The release -- and you guys have described the cardiology partnership in Florida and Arizona as approaching finalization. What kind of capital does each 1 require? And if you can give us a target quarter that would be reasonable as we expect revenue to begin?

So we would expect that each of those will require CapEx of between $800,000 and $1 million. And we would see them beginning to generate revenue in the first part of -- the first quarter to second quarter of 2027.