Exhibit 99.3
Greenbrook
TMS Inc.
MANAGEMENT’S DISCUSSION AND ANALYSIS OF
FINANCIAL CONDITION AND RESULTS OF OPERATIONS
For the three and nine-month periods ended September 30,
2022 and 2021
November 8, 2022
TABLE OF CONTENTS
| BASIS OF PRESENTATION |
3 |
| CAUTIONARY NOTE REGARDING NON-IFRS MEASURES AND INDUSTRY METRICS |
3 |
| CAUTIONARY NOTE REGARDING FORWARD-LOOKING INFORMATION |
5 |
| OVERVIEW |
5 |
| KEY HIGHLIGHTS AND RECENT DEVELOPMENTS |
6 |
| FACTORS AFFECTING OUR PERFORMANCE |
8 |
| COMPONENTS OF OUR RESULTS OF OPERATIONS |
9 |
| FACTORS AFFECTING THE COMPARABILITY OF OUR RESULTS |
12 |
| RESULTS OF OPERATIONS |
13 |
| Analysis of Results for Q3 2022 and YTD 2022 |
14 |
| EBITDA AND ADJUSTED EBITDA |
18 |
| RECONCILIATION OF NON-IFRS MEASURES |
18 |
| RECONCILIATION OF ACCOUNTS RECEIVABLE |
22 |
| QUARTERLY FINANCIAL INFORMATION |
22 |
| LIQUIDITY AND CAPITAL RESOURCES |
24 |
| INDEBTEDNESS |
25 |
| Off-Balance Sheet Arrangements |
27 |
| Related Party Transactions |
27 |
| Risks and Uncertainties |
28 |
| DISCLOSURE CONTROLS & PROCEDURES AND INTERNAL CONTROL OVER FINANCIAL REPORTING |
30 |
| Share Information |
31 |
| Critical Accounting Estimates |
31 |
| ADDITIONAL INFORMATION |
32 |
MANAGEMENT’S
DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The following Management’s
Discussion and Analysis (“MD&A”) provides information concerning the financial condition and results of operations
of Greenbrook TMS Inc. (the “Company”, “Greenbrook”, “us” or “we”).
This MD&A should be read in conjunction with our unaudited condensed interim consolidated financial statements for the three and nine-month
periods ended September 30, 2022 and 2021, including the related notes thereto, and our audited consolidated financial statements,
including the related notes thereto, for the fiscal years ended December 31, 2021, 2020 and 2019, and the related MD&A. The financial
information contained in this MD&A is derived from the financial statements prepared in accordance with International Financial Reporting
Standards (“IFRS”) as issued by the International Accounting Standards Board (“IASB”).
BASIS OF PRESENTATION
Our
unaudited condensed interim consolidated financial statements have been prepared in accordance with International Accounting Standard
(“IAS”) 34 – Interim Financial Reporting, as issued by the IASB. Our fiscal year is the 12-month period
ending December 31. The next fiscal year will occur in the 12-month period ending December 31, 2022.
All
references in this MD&A to “Q3 2022” are to our fiscal quarter for the three-month period ended September 30,
2022 and all references to “Q3 2021” are to our fiscal quarter for the three-month period ended September 30,
2021. All references in this MD&A to “Q2 2022” are to our fiscal quarter for the three- month period ended June 30,
2022, all references in this MD&A to “Q1 2022” are to our fiscal quarter for the three- month period ended March 31,
2022, all references in this MD&A to “Q1 2021” are to our fiscal quarter for the three-month period ended March 31,
2021 and all references to “Q4 2021” are to our fiscal quarter for the three-month period ended December 31, 2021.
All references in this MD&A to “YTD 2022” or “year-to-date 2022” are to the nine-month period
ended September 30, 2022 and all references to “YTD 2021” or “year-to-date 2021” are to the
nine-month period ended September 30, 2021. All references in this MD&A to “Fiscal 2021” are to our fiscal
year ended December 31, 2021 and all references in this MD&A to “Fiscal 2022” are to our fiscal year ending
December 31, 2022.
Amounts
stated in this MD&A are in United States dollars, unless otherwise indicated.
CAUTIONARY NOTE REGARDING NON-IFRS MEASURES AND INDUSTRY METRICS
This MD&A makes reference
to certain non-IFRS measures including certain metrics specific to the industry in which we operate. These measures are not recognized
measures under IFRS, do not have a standardized meaning prescribed by IFRS and, therefore, may not be comparable to similar measures presented
by other companies. Rather, these measures are provided as additional information to complement those IFRS measures by providing further
understanding of our results of operations from management’s perspective. Accordingly, these measures are not intended to represent,
and should not be considered as alternatives to, loss attributable to the common shareholders of Greenbrook or other performance measures
derived in accordance with IFRS as measures of operating performance or operating cash flows or as a measure of liquidity. In addition
to our results determined in accordance with IFRS, we use non-IFRS measures including, “EBITDA”, “Adjusted EBITDA”
and “Same-Region Sales Growth” (each as defined below). These non-IFRS measures and industry metrics are used to provide investors
with supplemental measures of our operating performance and thus highlight trends in our core business that may not otherwise be apparent
when relying solely on IFRS measures. We also believe that securities analysts, investors and other interested parties frequently use
non-IFRS measures and industry metrics in the evaluation of issuers. However, we caution you that “Adjusted EBITDA” and “Same-Region
Sales Growth” may be defined by us differently than by other companies. Our management also uses non-IFRS measures and industry
metrics to facilitate operating performance comparisons from period to period, to prepare annual operating budgets and forecasts and to
determine components of management compensation.
We define such non-IFRS measures
and industry metrics as follows:
“Adjusted EBITDA”
is a non-IFRS measure that is defined as net income (loss) before amortization, depreciation, interest expenses, interest income and income
taxes, adjusted for share-based compensation expenses (comprising share-based compensation and the re-valuation of equity-based conversion
instruments) and one-time expenses. We believe our Adjusted EBITDA metric is a meaningful financial metric as it measures the ability
of our current TMS Center (as defined below) operations to generate earnings while eliminating the impact of one-time expenses and share-based
compensation expenses, which do not have an impact on the operating performance of our existing TMS Center network. The IFRS measurement
most directly comparable to Adjusted EBITDA is loss attributable to common shareholders of Greenbrook. Beginning in Fiscal 2021, we no
longer adjust for center development costs because a key component of our growth strategy is to grow our business and revenues through
the development and building of additional TMS Centers and the expansion of the Spravato Program® (as defined below). We have retrospectively
calculated Adjusted EBITDA for Q3 2021 and YTD 2021 to reflect this change (see “Reconciliation of Non-IFRS Measures” below).
“EBITDA”
is a non-IFRS measure that is defined as net income (loss) before amortization, depreciation, interest expenses, interest income and income
taxes. The IFRS measurement most directly comparable to EBITDA is loss attributable to common shareholders of Greenbrook.
“Same-Region Sales
Growth” is a non-IFRS metric that we calculate as the percentage change in sales derived from our established management regions
in a certain financial period as compared to the sales from the same management regions in the same period of the prior year. This metric
reflects growth achieved through marketing and operational focus to increase volumes at existing TMS Centers as well as growth achieved
through the opening of additional TMS Centers within established management regions. For information regarding how we define our management
regions, see “Overview”. Our established management regions are defined as management regions containing open TMS Centers
all of which have performed billable TMS (as defined below) services for a period of at least one full year prior to the more recent period
of the two financial periods that are compared in calculating Same-Region Sales Growth. Within a management region we focus on increasing
patient volume in addition to assessing individual TMS Center locations on a standalone basis. As a result, we will from time to time
establish a TMS Center that may, over the short term, negatively impact the patient volume at another TMS Center, but which is expected
to add incremental patient volume to the management region as a whole in an economically beneficial manner. We believe Same-Region Sales
Growth is a useful metric to investors because it helps quantify our sales growth within regional management areas and the growth achieved
by adding TMS Center density within established management regions. Our Same-Region Sales Growth is unique to our financial management
strategy and may not be comparable to non-IFRS measures used by other companies.
See “Reconciliation
of Non-IFRS Measures” below for a quantitative reconciliation of the foregoing non-IFRS measures to their most directly comparable
measures calculated in accordance with IFRS.
CAUTIONARY NOTE REGARDING FORWARD-LOOKING INFORMATION
Some
of the information contained in this MD&A, including the Company’s expectations regarding the expansion of the Spravato®
(esketamine nasal spray) offering (the “Spravato® Program”) and our potential to enhance profit margins and diversify
total revenue, the impact of the Achieve TMS East/Central Acquisition (as defined below) on our business, the impact of the Success TMS
Acquisition (as defined below) and the Madryn Credit Facility (as defined below) on our business, our expansion opportunities, our expectations
regarding our liquidity and available financing, and our expectations of future results, performance, achievements, prospects or opportunities,
constitutes “forward-looking information” within the meaning of applicable securities laws in Canada and “forward-looking
statements” within the meaning of the United States Private Securities Litigation Reform Act of 1995. This information is based
on management’s reasonable assumptions and beliefs in light of the information currently available to us and is current as of the
date of this MD&A. Actual results and the timing of events may differ materially from those anticipated in the forward-looking information
contained in this MD&A as a result of various factors.
Particularly, information
regarding our expectations of future results, performance, achievements, prospects or opportunities or the markets in which we operate
is forward-looking information. In some cases, forward-looking information can be identified by the use of forward-looking terminology
such as “plans”, “targets”, “expects” or “does not expect”, “is expected”,
“an opportunity exists”, “budget”, “scheduled”, “estimates”, “outlook”, “forecasts”,
“projection”, “prospects”, “strategy”, “intends”, “anticipates”, “does
not anticipate”, “believes”, or variations of such words and phrases or statements that certain actions, events or results
“may”, “could”, “would”, “might”, “will”, “will be taken”, “occur”
or “be achieved”. In addition, any statements that refer to expectations, intentions, projections or other characterizations
of future events or circumstances contain forward-looking information. Statements containing forward-looking information are not facts
but instead represent management’s expectations, estimates and projections regarding future events or circumstances.
Many factors could cause our
actual results, level of activity, performance or achievements or future events or developments to differ materially from those expressed
or implied by the forward-looking statements, including, without limitation, macroeconomic factors such as inflation and recessionary
conditions, as well as the factors discussed in the “Risks and Uncertainties” section of this MD&A. Additional risks and
uncertainties are discussed in the Company’s materials filed with the Canadian securities regulatory authorities and the United
States Securities and Exchange Commission (the “SEC”) from time to time, including the Company’s Annual Report
on Form 20-F dated March 31, 2022 in respect of the fiscal year ended December 31, 2021 (the “Annual Report”).
These factors are not intended to represent a complete list of the factors that could affect us or our ability to achieve the anticipated
benefits from the Success TMS Acquisition and the Madryn Credit Facility; however, these factors should be considered carefully.
The purpose of the forward-looking
information is to provide the reader with a description of management’s current expectations regarding the Company’s financial
performance and may not be appropriate for other purposes; readers should not place undue reliance on forward-looking information contained
herein. To the extent any forward-looking information in this MD&A constitutes future-oriented financial information or financial
outlook, within the meaning of applicable securities laws, such information is being provided to demonstrate the potential of the Company
and readers are cautioned that this information may not be appropriate for any other purpose. Future-oriented financial information and
financial outlook, as with forward-looking information generally, are based on current assumptions and are subject to risks, uncertainties
and other factors. Furthermore, unless otherwise stated, the forward-looking statements contained in this MD&A are made as of the
date of this MD&A and we have no intention and undertake no obligation to update or revise any forward-looking statements, whether
as a result of new information, future events or otherwise, except as required by applicable securities law. The forward-looking statements
contained in this MD&A are expressly qualified by this cautionary statement.
OVERVIEW
We
are a leading provider of Transcranial Magnetic Stimulation (“TMS”) therapy in the United States for the treatment
of Major Depressive Disorder (“MDD”) and other mental health disorders. Our predecessor, TMS NeuroHealth Centers Inc.
(“TMS US”) was established in 2011 to take advantage of the opportunity created through the paradigm-shifting technology
of TMS, an FDA-cleared, non-invasive therapy for the treatment of MDD. In 2018, our TMS Centers began offering treatment for obsessive
compulsive disorder. Our business model takes advantage of the opportunity for a new, differentiated service channel for the delivery
of TMS – a patient-focused, centers-based service model to make treatment easily accessible to all patients while maintaining a
high standard of care.
After
opening our first center in 2011 in Tysons Corner in Northern Virginia, we have grown to control and operate a network of outpatient mental
health service centers that specialize in TMS treatment (each, a “TMS Center”) across the United States. We offer TMS
treatment facilities in convenient locations to provide easy access to patients and clinicians. As at September 30, 2022, the Company
owned and operated 183 TMS Centers in the Commonwealths of Massachusetts, Virginia and Pennsylvania and the States of Maryland, Delaware,
North Carolina, Missouri, Illinois, Ohio, Texas, Connecticut, Florida, South Carolina, Michigan, Alaska, Oregon, California, Iowa,
New Jersey, Nevada and Wisconsin.
Our regional model seeks to
develop leading positions in key regional markets, leveraging operational efficiencies by combining smaller local TMS treatment centers
that are strategically located within a single region for convenient patient and clinician access, with regional management infrastructure
in place to support center operations. Management regions typically cover a specific metropolitan area that meets a requisite base population
threshold. The management region is typically defined by a manageable geographic area in terms of size, which facilitates the use of regional
staff working across the various TMS Center locations within the management region, and which resides within a marketing capture area
that allows for efficiencies in advertising cost. Management regions often have similar economic characteristics and are not necessarily
defined by state lines, other geographic borders, or differentiating methods of services delivery, but rather are defined by a functional
management area.
In
Q1 2021, we commenced offering Spravato® (esketamine nasal spray) at select TMS Centers to treat adults with treatment-resistant
depression and depressive symptoms in adults with MDD with suicidal thoughts or actions. See “Key Highlights and Recent Developments—Spravato®
Program” below.
KEY HIGHLIGHTS AND RECENT DEVELOPMENTS
During Q3 2022, the Success
TMS Acquisition added significant operating scale and top-line growth to the business and allowed us to achieve record quarterly consolidated
revenue as well as our highest quarterly treatment volumes and consultations performed to date. During the quarter, management also continued
to focus on integration of the combined business and the execution of near-term operational synergies in an effort to accelerate the Company’s
timeline to profitability, including by reducing our TMS Center footprint by seven TMS Centers.
Driven predominantely by
the completion of the Success TMS Acquisition in Q3 2022 and the Achieve TMS East/Central Acquisition in Q4 2021, quarterly revenue
increased in Q3 2022 by 58% to $20.8 million as compared to $13.1 million in Q3 2021, while treatment volumes increased in Q3 2022
by 74% with 95,046 treatments performed during Q3 2022 as compared to 54,525 in Q3 2021. We also achieved a record high in quarterly
consultations performed which increased by 156% to 8,797 as compared to 3,437 in Q3 2021, which we believe will provide strong
momentum into the fourth quarter of Fiscal 2022.
Concurrent with the Success
TMS Acquisition, we also entered into the Madryn Credit Facility, effectively recapitalizing the combined business in an effort to move
toward EBITDA positive operations and accelerate our timeline to profitability. See “—Recapitalization Through Debt Financing”
below.
We anticipate that our record
highs in quarterly consultations and patient treatment starts and the continued roll-out of our Spravato® Program will be a catalyst
for accelerated future growth.
We believe that mental health
remains a key focus in the United States, and the unmet demand for treatment is at an all-time high. We believe our business fundamentals
remain sound and that our network of TMS Centers has the capacity to serve this unmet need.
Acquisition of Success TMS
On July 14, 2022, we,
through our wholly-owned U.S. subsidiary, TMS US, completed the acquisition of all of the issued and outstanding equity interests in Check
Five LLC, a Delaware limited liability company (doing business as “Success TMS”) (“Success TMS”) from its
parent company, Success Behavioral Holdings LLC (the “Success TMS Acquisition”) pursuant to a Membership Interest Purchase
Agreement dated as of May 15, 2022 (the “Purchase Agreement”) by and among the Company, Success TMS and its direct
and indirect owners, including Success Behavioral Holdings LLC, Theragroup LLC, The Bereke Trust U/T/A Dated 2/10/03, Batya Klein and
Benjamin Klein (collectively, the “Seller Parties”).
As consideration for the purchase
of Success TMS, the Seller Parties received, in the aggregate, 8,725,995 common shares of the Company (“Common Shares”),
and an additional 2,908,665 Common Shares have been held back and deposited with an escrow agent, to be released to Benjamin Klein or
the Company, as applicable, upon satisfaction of customary working capital and certain other adjustments, including to satisfy any indemnity
claims against the Seller Parties (such Common Shares issued as consideration to the Seller Parties, including the Common Shares deposited
in escrow, collectively, the “Consideration Shares”). The purchase price consideration was determined based on the
pro forma revenue contribution of the two companies and was fixed at an amount equal to approximately 40% of the total issued and outstanding
Common Shares on a post-acquisition basis and subject to adjustments, as described above.
The Seller Parties are subject
to a 12-month lock-up period in respect of the Consideration Shares. As contemplated by the Purchase Agreement, the Company also entered
into a registration rights agreement with the Seller Parties, dated as of July 14, 2022, which provides the Seller Parties with certain
customary registration rights in connection with the resale of the Consideration Shares, once the lock-up restrictions have expired.
As contemplated by the Purchase
Agreement, the Company also entered into an investor rights agreement with Benjamin Klein, dated as of July 14, 2022 (the “Investor
Rights Agreement”), which provides Benjamin Klein with a right to nominate a single representative to the board of directors
of the Company (the “Board”) for so long as the Seller Parties own at least 5% of the issued and outstanding Common
Shares, subject to certain conditions, including applicable securities laws and stock exchange requirements. In accordance with the terms
of the Investor Rights Agreement, Mr. Klein has been appointed to the Board as the board nominee, effective on July 14, 2022,
immediately following completion of the Success TMS Acquisition. Mr. Klein has also joined the Company as Chief Operating Officer.
Success TMS is one of the
largest providers of TMS therapy in the United States. Since founding its first TMS center in Florida in 2018, Success TMS has grown to
47 locations and has provided us with a new presence in additional states, which also represents new management regions, in Illinois,
New Jersey, Nevada and Pennsylvania, which we believe will serve as a foundation for future growth within these regions (see “Cautionary
Note Regarding Forward-Looking Information”).
Recapitalization Through Debt Financing
On July 14, 2022, the
Company entered into a credit agreement (the “Madryn Credit Agreement”) for a $75 million secured credit facility (the
“Madryn Credit Facility”) with Madryn Asset Management, LP (“Madryn”) and its affiliated entities.
The Madryn Credit Facility
provides the Company with a $55 million term loan (the “Term Loan”), which was funded on closing. In addition, the
Madryn Credit Facility permits the Company to incur up to an additional $20 million in a single draw at any time on or prior to December 31,
2024 for purposes of funding future mergers and acquisition activity. All amounts borrowed under the Madryn Credit Facility will bear
interest at a rate equal to the three-month LIBOR rate plus 9.0%, subject to a minimum three-month LIBOR floor of 1.5%. The Madryn Credit
Facility matures over 63 months and provides for four years of interest-only payments. The terms of the Madryn Credit Facility require
us to satisfy various affirmative and negative covenants including consolidated minimum revenue and minimum liquidity covenants that become
effective September 30, 2022 and July 14, 2022, respectively. See “Indebtedness” for further details.
On July 14, 2022, the
Company used approximately $15.4 million of the proceeds from the Madryn Credit Facility to repay in full the outstanding balance owing
under the Oxford Credit Facility (as defined below) and terminated the Oxford Credit Facility. Concurrently, the Company used approximately
$15.1 million of the proceeds from the Madryn Credit Facility to repay various loans previously held by Success TMS in connection with
the Success TMS Acquisition.
Spravato®
Program
The roll-out of our Spravato®
Program at select TMS Centers continued through Q3 2022, building on our long-term business plan of utilizing our TMS Centers as platforms
for the delivery of innovative treatments to patients suffering from MDD and other mental health disorders. We have managed to leverage
excess capacity in certain of our TMS Centers through the Spravato® Program which has effectively enhanced profit margins in these
TMS Centers. As at September 30, 2022, we have expanded our offering of Spravato® to an additional 10 TMS Centers, bringing our
total to 35 TMS Centers offering Spravato®.
FACTORS AFFECTING OUR PERFORMANCE
We
believe that our performance and future success depend on a number of factors that present significant opportunities for us. These factors
are also subject to a number of inherent risks and challenges, some of which are discussed below. See also the “Risks and
Uncertainties” section of this MD&A.
Number of TMS Centers
We believe we have a meaningful
opportunity to grow the number of our TMS Centers in the United States through organic in-region growth, establishing new regions and
potential future acquisitions. The opening and success of new TMS Centers is subject to numerous factors, including our ability to locate
the appropriate space, finance the operations, build relationships with clinicians, negotiate suitable lease terms and local payor arrangements,
and other factors, some of which are beyond our control. At the same time, we have selectively closed certain TMS Centers to maximize
our profitability, which may temporarily reduce our number of active TMS Centers from quarter to quarter as we continue to aim for overall
expansion of the business.
Competition
The market for TMS is becoming
increasingly competitive. We compete principally on the basis of our reputation and brand, the location of our centers, the quality of
our TMS and other mental health services and the reputation of our partner clinicians. In the markets in which we are operating, or anticipate
operating in the future, competition predominantly consists of individual clinicians that have a TMS device, an FDA-regulated medical
device specifically manufactured to transmit the magnetic pulses required to stimulate the cortical areas in the brain to effectively
treat MDD and other mental health disorders (a “TMS Device”), in their office and who can offer TMS therapy directly
to their patients. We also face competition from a limited number of multi-location psychiatric practices or behavioral health groups
that offer TMS therapy as part of their overall practice, as well as a few other specialist TMS providers. As we expand our mental health
products and services to include Spravato®, we also face competition from mental health practitioners that
provide similar offerings. We also face indirect competition from pharmaceutical and other companies that develop competitive products,
such as anti-depressant medications, with certain competitive advantages such as widespread market acceptance, ease of patient use and
well-established reimbursement. Our commercial opportunity could be reduced or eliminated if these competitors develop and commercialize
anti-depressant medications or other treatments that are safer or more effective than TMS or Spravato®. At any time, these and other
potential market entrants may develop treatment alternatives that may render our products uncompetitive or less competitive.
We are also subject to competition
from providers of invasive neuromodulation therapies such as electroconvulsive therapy and vagus nerve stimulation.
Capital Management
Our
objective is to maintain a capital structure that supports our long-term growth strategy, maintain creditor and customer confidence, and
maximize shareholder value. We have historically raised capital from equity offerings, often with the support of our existing shareholders,
and from our credit facilities. Our primary uses of capital are to finance operations, finance new center start-up costs, increase non-cash
working capital and capital expenditures. We may also use capital to finance potential acquisitions. As a result of these activities,
we may require additional financing in the future, and we will be required to remain in compliance with our debt covenants. See the “Liquidity
and Capital Resources” and “Risks and Uncertainties” sections of this MD&A.
Industry and Reimbursement Trends
Our revenue is impacted by
changes to United States healthcare laws, our clinical partners’ and contractors’ healthcare costs, the ability to secure
favorable pricing structures with device manufacturers and payors’ reimbursement criteria and associated rates. In addition, the
geographic distribution of our TMS Centers can impact our revenues per treatment because reimbursement rates vary from state to state.
Technology
Our revenues are affected
by the availability of, and reimbursement for, new TMS indications, new technology or other novel treatment modalities (including Spravato®)
and our ability to incorporate the new technology into our TMS Centers.
Segments
We evaluate our business and
report our results based on organizational units used by management to monitor performance and make operating decisions on the basis of
one operating and reportable segment: Outpatient Mental Health Service Centers. We currently measure this reportable operating segment’s
performance based on total revenues and entity-wide regional operating income (loss).
COMPONENTS OF OUR RESULTS OF OPERATIONS
Total Revenue
Total revenue consists of
service revenue attributable to the performance of treatments. In circumstances where the net patient fees have not yet been received,
the amount of revenue recognized is estimated based on an expected value approach. Due to the nature of the industry and complexity of
our revenue arrangements, where price lists are subject to the discretion of payors, variable consideration exists that may result in
price concessions and constraints to the transaction price for the services rendered.
In estimating this variable
consideration, we consider various factors including, but not limited to, the following:
| · | commercial payors and the administrators of federally-funded healthcare programs exercise discretion over
pricing and may establish a base fee schedule (which is subject to change prior to final settlement) or negotiate a specific reimbursement
rate with an individual provider; |
| · | average of previous net service fees received by the applicable payor and fees received by other patients
for similar services; |
| · | management’s best estimate, leveraging industry knowledge and expectations of third-party payors’
fee schedules; |
| · | factors that would influence the contractual rate and the related benefit coverage, such as obtaining
pre-authorization of services and determining whether the procedure is medically necessary; |
| · | probability of failure in obtaining timely proper provider credentialing (including re-credentialling)
and documentation, in order to bill various payors which may result in enhanced price concessions; and |
| · | variation in coverage for similar services among various payors and various payor benefit plans. |
We update the estimated transaction
price (including updating our assessment of whether an estimate of variable consideration is constrained) to represent faithfully the
circumstances present at the end of the reporting period and the changes in circumstances during the reporting period in which such variances
become known.
Third-party payors include
federal and state agencies (under the Medicare programs), managed care health plans and commercial insurance companies. Variable consideration
also exists in the form of settlements with these third-party payors as a result of retroactive adjustments due to audits and reviews.
We apply constraint to the transaction price, such that net revenues are recorded only to the extent that it is probable that a significant
reversal in the amount of the cumulative revenue recognized will not occur in the future.
Entity-Wide Regional Operating Income (Loss) and Direct Center
and Regional Costs
Regional operating income
presents regional operating income on an entity-wide basis and is calculated as total revenue less direct center and regional costs. Direct
center and regional costs consist of direct center and patient care costs, regional employee compensation, regional marketing expenses,
and depreciation. These costs encapsulate all costs (other than incentive compensation such as share-based compensation granted to senior
regional employees) associated with the center and regional management infrastructure, including the cost of the delivery of treatments
to patients and the cost of our regional patient acquisition strategy.
Center Development Costs
Center development costs represent
direct expenses associated with developing new TMS Centers, including small furnishings and fittings, wiring and electrical and, in some
cases, the cost of minor space alterations.
Corporate Employee Compensation
Corporate employee compensation
represents compensation incurred to manage the centralized business infrastructure of the Company, including annual base salary, annual
cash bonuses and other non-equity incentives.
Corporate Marketing Expenses
Corporate marketing expenses
represent costs incurred that impact the Company on an overall basis including investments in website functionality and brand management
activities.
Other Corporate, General and Administrative Expenses
Other corporate, general and
administrative expenses represent expenses related to the corporate infrastructure required to support our ongoing business including
insurance costs, professional and legal costs and costs incurred related to our corporate offices.
Share-Based Compensation
Share-based compensation represents
stock options, restricted share units and performance share units granted as consideration in exchange for employee and similar services
to align personnel performance with the Company’s long-term goals.
Amortization
Amortization relates to
the reduction in useful life of the Company’s intangible assets that were realized as part of the Achieve TMS West
Acquisition, the Achieve TMS East/Central Acquisition (each as defined below) and the Success TMS Acquisition.
Interest
Interest expense relates to
interest incurred on loans and lease liabilities. Interest income relates to income realized as a result of investing excess funds into
investment accounts.
Loss on Extinguishment of Loan
Loss on extinguishment of
loan represents costs related to the extinguishment of the Oxford Credit Facility, as well as the extinguishment of a loan previously
held by Success TMS.
Forgiveness of Loan Payable
Forgiveness of loan payable
represents a one-time gain due to the forgiveness by the U.S. Small Business Administration of the PPP Loan (as defined below) previously
made to the Company under the United States Paycheck Protection Program (the “PPP”).
Adjusted EBITDA
Adjusted
EBITDA is a non-IFRS measure that deducts from EBITDA share-based compensation expenses and expenses that represent one-time costs incurred
for purposes of enhancing the performance of the business and to achieve our TMS Center growth. See “Cautionary Note Regarding Non-IFRS
Measures and Industry Metrics” above. Beginning in Fiscal 2021, we no longer adjust for center development costs because a key component
of our growth strategy is to grow our business and revenues through the development and building of additional TMS Centers and
the expansion of the Spravato Program®. We have retrospectively calculated Adjusted EBITDA for Q3 2021 and YTD 2021 to reflect this
change (see “Reconciliation of Non-IFRS Measures” below).
FACTORS AFFECTING THE COMPARABILITY OF OUR RESULTS
Acquisition of Achieve TMS West
On
September 26, 2019, we, through our wholly-owned subsidiary, TMS US, completed the acquisition of all of the issued and outstanding
membership interests of each of Achieve TMS Centers, LLC and Achieve TMS Alaska, LLC (collectively, “Achieve TMS West”)
for a purchase price of $10.8 million (excluding Achieve TMS West’s cash and subject to working capital adjustments), of which $2.6
million of the purchase price was satisfied through the issuance of an aggregate of 286,348 Common Shares to the vendors and the remainder
was settled in cash, less deferred and contingent consideration of $1.3 million (the “Achieve TMS West Acquisition”).
A
portion of the purchase price payable in respect of the Achieve TMS West Acquisition was subject to an earn-out based on the earnings
before interest, tax, depreciation and amortization achieved by Achieve TMS West during the twelve-month period following the September 26,
2019 closing date of the Achieve TMS West Acquisition (the “Earn-Out”). The Earn-Out was confirmed to be $10.3 million,
of which $3.1 million was settled through the issuance of an aggregate of 0.2 million Common Shares to the vendors on March 26, 2021.
Of the remaining $7.2 million of Earn-Out consideration payable, $2.8 million was paid in cash on March 26, 2021. Certain vendors
agreed to defer $4.4 million of the cash Earn-Out consideration due to them until June 30, 2021 in exchange for additional cash consideration
in the aggregate amount of $0.3 million, which payment was made in full concurrently with the deferred cash payment on June 28, 2021.
Acquisition of Achieve TMS East/Central
On
October 1, 2021, we completed the acquisition of Achieve TMS East, LLC (“Achieve TMS East”) and Achieve TMS Central,
LLC (“Achieve TMS Central”, and together with Achieve TMS East, “Achieve TMS East/Central”). The
aggregate purchase price for Achieve TMS East/Central was $7.9 million, excluding Achieve TMS East/Central’s cash and subject to
customary working capital adjustments. In addition, contingent consideration for the acquisition of Achieve TMS East/Central (the “Achieve
TMS East/Central Acquisition”) was subject to a capped earn-out of up to an additional $2.5 million based on the financial performance
of Achieve TMS East during the twelve-month period following completion of the Achieve TMS East/Central Acquisition, payable following
the calculation period. As at September 30, 2022, we estimated the fair value of the purchase price payable in respect of the earn-out
to be nil.
Acquisition of Success TMS
On July 14, 2022, we
completed the Success TMS Acquisition. See “Key Highlights and Recent Developments—Acquisition of Success TMS” above.
Regional Development Activity
Our regional model seeks to
develop leading positions in key markets, and to leverage operational efficiencies by combining smaller local treatment centers within
a region under a single shared regional management infrastructure. Part of our core strategy is to continue to develop new TMS Centers
within our existing regions as well as in new management regions, in each case, organically or through acquisitions of existing centers
or businesses, which may affect comparability of results.
Seasonality
Typically, we experience seasonal
factors in the first quarter of each fiscal year that result in reduced revenues in those quarters as compared to the other three quarters
of the year. These seasonal factors include cold weather and the reset of deductibles during the first part of the year. We also typically
experience a slowdown in new patient starts during the third quarter of each fiscal year as a result of summer holidays.
RESULTS OF OPERATIONS
Summary Financial Information
The
following table summarizes our results of operations for the periods indicated. The selected consolidated financial information
set out below has been derived from our unaudited condensed interim consolidated financial statements, and should be read in conjunction
with those financial statements and the related notes thereto.
| (US$) |
|
Q3 2022
(unaudited) |
|
|
Q3 2021
(unaudited) |
|
|
YTD 2022
(unaudited) |
|
|
YTD 2021
(unaudited) |
|
| Total revenue |
|
|
20,752,105 |
|
|
|
13,130,245 |
|
|
|
48,027,560 |
|
|
|
38,150,632 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Direct center and patient care costs |
|
|
10,207,404 |
|
|
|
6,911,058 |
|
|
|
25,193,562 |
|
|
|
20,125,081 |
|
| Regional employee compensation |
|
|
5,081,645 |
|
|
|
3,115,709 |
|
|
|
11,918,622 |
|
|
|
9,170,971 |
|
| Regional marketing expenses |
|
|
3,176,159 |
|
|
|
1,481,272 |
|
|
|
6,581,059 |
|
|
|
4,867,188 |
|
| Depreciation |
|
|
3,136,369 |
|
|
|
1,373,149 |
|
|
|
6,292,913 |
|
|
|
4,309,114 |
|
| Total direct center and regional costs |
|
|
21,601,577 |
|
|
|
12,881,188 |
|
|
|
49,986,156 |
|
|
|
38,472,354 |
|
| Regional operating (loss) income |
|
|
(849,472 |
) |
|
|
249,057 |
|
|
|
(1,958,596 |
) |
|
|
(321,722 |
) |
| Center development costs |
|
|
215,954 |
|
|
|
203,929 |
|
|
|
562,108 |
|
|
|
667,336 |
|
| Corporate employee compensation |
|
|
5,156,259 |
|
|
|
3,514,477 |
|
|
|
12,211,803 |
|
|
|
10,071,740 |
|
| Corporate marketing expenses |
|
|
169,653 |
|
|
|
125,306 |
|
|
|
394,223 |
|
|
|
468,139 |
|
| Other corporate, general and administrative expenses |
|
|
4,303,486 |
|
|
|
1,506,181 |
|
|
|
7,759,607 |
|
|
|
5,145,650 |
|
| Share-based compensation |
|
|
2,762 |
|
|
|
221,679 |
|
|
|
315,966 |
|
|
|
631,011 |
|
| Amortization |
|
|
570,648 |
|
|
|
115,834 |
|
|
|
985,648 |
|
|
|
347,500 |
|
| Interest expense |
|
|
3,183,165 |
|
|
|
1,145,337 |
|
|
|
5,633,165 |
|
|
|
3,507,436 |
|
| Loss on extinguishment of loans |
|
|
2,331,917 |
|
|
|
– |
|
|
|
2,331,917 |
|
|
|
– |
|
| Interest income |
|
|
– |
|
|
|
(3,067 |
) |
|
|
(12,230 |
) |
|
|
(5,260 |
) |
| Forgiveness of loans payable |
|
|
– |
|
|
|
(3,128,596 |
) |
|
|
– |
|
|
|
(3,128,596 |
) |
| Loss before income taxes |
|
|
(16,783,316 |
) |
|
|
(3,452,023 |
) |
|
|
(32,140,803 |
) |
|
|
(18,026,678 |
) |
| Income tax expense |
|
|
– |
|
|
|
– |
|
|
|
– |
|
|
|
– |
|
| Loss for the period and comprehensive loss |
|
|
(16,783,316 |
) |
|
|
(3,452,023 |
) |
|
|
(32,140,803 |
) |
|
|
(18,026,678 |
) |
| Income (loss) attributable to non-controlling interest |
|
|
(421,890 |
) |
|
|
65,227 |
|
|
|
(593,545 |
) |
|
|
(107,049 |
) |
| Loss attributable to the common shareholders of Greenbrook |
|
|
(16,361,426 |
) |
|
|
(3,517,250 |
) |
|
|
(31,547,258 |
) |
|
|
(17,919,629 |
) |
| Net loss per share (basic and diluted) |
|
|
(0.59 |
) |
|
|
(0.22 |
) |
|
|
(1.49 |
) |
|
|
(1.23 |
) |
Selected Financial Position Data
The
following table provides selected financial position data as at the dates indicated:
| | |
As at September 30, | | |
As at December 31, | |
| (US$) | |
2022
(unaudited) | | |
2021
(unaudited) | | |
2021 | |
| Cash and restricted cash | |
| 11,148,819 | | |
| 26,058,288 | | |
| 11,949,679 | |
| Current assets (excluding cash) | |
| 17,637,031 | | |
| 12,929,590 | | |
| 12,909,746 | |
| Total assets | |
| 143,940,344 | | |
| 77,462,975 | | |
| 72,643,693 | |
| Current liabilities | |
| 38,252,188 | | |
| 17,349,680 | | |
| 18,525,723 | |
| Non-current liabilities | |
| 106,011,466 | | |
| 36,873,838 | | |
| 37,528,638 | |
| Total liabilities | |
| 144,263,654 | | |
| 54,223,518 | | |
| 56,054,361 | |
| Non-controlling interests | |
| (2,127,559 | ) | |
| (823,724 | ) | |
| (738,105 | ) |
| Total shareholders’ (deficit) equity | |
| (323,310 | ) | |
| 23,239,457 | | |
| 16,589,332 | |
Selected Operating Data
The
following table provides selected operating data as at the dates indicated:
| | |
As at September 30, | | |
As at December 31, | |
| (unaudited) | |
2022 | | |
2021 | | |
2021 | |
| Number of active TMS Centers(1) | |
| 183 | | |
| 127 | | |
| 147 | |
| Number of TMS Centers-in-development(2) | |
| 1 | | |
| 4 | | |
| 2 | |
| Total TMS Centers | |
| 184 | | |
| 131 | | |
| 149 | |
| Number of management regions | |
| 18 | | |
| 13 | | |
| 15 | |
| Number of TMS Devices installed | |
| 338 | | |
| 214 | | |
| 234 | |
| Number of regional personnel | |
| 501 | | |
| 350 | | |
| 386 | |
| Number of shared-services / corporate personnel(3) | |
| 143 | | |
| 58 | | |
| 44 | |
| Number of TMS providers(4) | |
| 208 | | |
| 126 | | |
| 135 | |
| Number of consultations performed(5) | |
| 16,616 | | |
| 10,561 | | |
| 14,108 | |
| Number of patient starts(5) | |
| 6,474 | | |
| 4,762 | | |
| 6,429 | |
| Number of treatments performed(5) | |
| 216,151 | | |
| 164,870 | | |
| 226,286 | |
| Average revenue per treatment(5) | |
$ | 222 | | |
$ | 231 | | |
$ | 231 | |
Notes:
| (1) | Active TMS Centers represent TMS Centers that have performed billable TMS and other mental health services
during the applicable period. |
| (2) | TMS Centers-in-development represents TMS Centers that have committed to a space lease agreement and the
development process is substantially complete. |
| (3) | Shared-services / corporate personnel is disclosed on a full-time equivalent basis. The Company utilizes
part-time staff and consultants as a means of managing costs. |
| (4) | Represents clinician partners that are involved in the provision of TMS therapy and other mental health
services from our TMS Centers. |
| (5) | Figure calculated for the applicable year or period ended. |
Analysis of Results for
Q3 2022 and YTD 2022
The following section provides
an overview of our financial performance during Q3 2022 compared to Q3 2021 and during YTD 2022 compared to YTD 2021.
Total Revenue
Consolidated
revenue increased to $20.8 million in Q3 2022, a 58% increase compared to Q3 2021 (Q3 2021: $13.1 million), and $48.0 million in
YTD 2022, a 26% increase compared to YTD 2021 (YTD 2021: $38.2 million). This increase was predominately due to the additional active
TMS Centers acquired in connection with both the Achieve TMS East/Central Acquisition and the Success TMS Acquisition which were completed
in Q4 2021 and Q3 2022, respectively.
New
patient starts increased to 2,848 in Q3 2022, an 87% increase compared to Q3 2021 (Q3 2021: 1,520), and increased to 6,474 in YTD 2022,
a 36% increase compared to YTD 2021 (YTD 2021: 4,762). Treatment volumes in Q3 2022 were 95,046, a 74% increase compared to Q3 2021 (Q3
2021: 54,525), and were 216,151 in YTD 2022, a 31% increase compared to YTD 2021 (YTD 2021: 164,870). Consultations performed were 8,797
in Q3 2022, a 156% increase compared to Q3 2021 (Q3 2021: 3,437), and were 16,616 in YTD 2022, a 57% increase compared to YTD 2021 (YTD
2021: 10,561). The increase in new patient starts, treatment volumes and consultations performed were predominantly due to operating
183 active TMS Centers as at September 30, 2022 as compared to 127 active TMS Centers as at September 30, 2021, which increase
was driven primarily by the Achieve TMS East/Central Acquisition and the Success TMS Acquisition that were completed in Q4 2021 and Q3
2022, respectively.
Same-Region
Sales Growth was 17.1% in Q3 2022 as compared to 9.4% in Q3 2021, as a result of growth in our mature regions. Same-Region
Sales Growth was 6.9% in YTD 2022 as compared to 14.9% in YTD 2021. The decrease in Same-Region Sales Growth during YTD 2022 as
compared to YTD 2021 was predominately due to a tight labor market, coupled with high inflation, that caused a disruption in
operations primarily during the first half of Fiscal 2022. See “Cautionary Note Regarding Non-IFRS Measures and Industry
Metrics” above and “—Reconciliation of Non-IFRS Measures” below.
Average
revenue per treatment decreased by 10% to $218 in Q3 2022 as compared to Q3 2021 (Q3 2021: $241) and decreased by 4% to $222 in
YTD 2022 as compared to YTD 2021 (YTD 2021: $231). This decrease was primarily attributable to the geographical distribution of revenue.
Accounts Receivable
Accounts
receivable increased by $3.5 million to $14.4 million as at the end of Q3 2022 (Q3 2021: $10.9 million) and increased by $3.4 million
as compared to the end of Q4 2021 (Q4 2021: $11.0 million). This increase was primarily due to the existing accounts receivable acquired by the Company as part of the Success TMS Acquisition.
We also continue to collect
on services rendered in excess of 24 months from the date such services were rendered.
Direct Center and Regional Costs
Direct
center and regional costs increased by 68% to $21.6 million during Q3 2022 as compared to Q3 2021 (Q3 2021: $12.9 million) and by 30%
to $50.0 million during YTD 2022 as compared to YTD 2021 (YTD 2021: $38.5 million). Direct center and regional costs were comparatively
high due to operating 183 active TMS Centers as at September 30, 2022 as compared to 127 active TMS Centers as at September 30,
2021.
Management also continued
to focus on integration of the combined business and the execution of near-term operational synergies subsequent to the Success TMS Acquisition. We believe we will be able to continue to execute on further near-term operational synergies
to accelerate the Company’s timeline to profitability (see “Cautionary Note Regarding Forward-Looking Information”).
Entity-Wide Regional Operating (Loss) Income
Entity-wide
regional operating loss was $0.8 million during Q3 2022 as compared to an entity-wide regional operating income of $0.2 million in Q3
2021. Entity-wide regional operating loss increased by 509% to $2.0 million during YTD 2022 as compared to YTD 2021 (YTD 2021:
$0.3 million). These changes were primarily due to the increase in direct center and regional costs, partially offset by the increase
in revenue as described above.
Center Development Costs
Center
development costs remained consistent at $0.2 million during Q3 2022 (Q3 2021: $0.2 million) and decreased by 16% to $0.6 million
during YTD 2022 (YTD 2021: $0.7 million). The decrease in center development costs in YTD 2022 as compared to YTD 2021 was a result of
a decrease in the number of TMS Centers developed during YTD 2022 as compared to YTD 2021, partially offset by the minimal incremental
costs associated with establishing the Spravato® Program at select additional TMS Centers during the period.
Corporate Employee Compensation
Corporate
employee compensation incurred to manage the centralized business infrastructure of the Company increased by 47% to $5.2 million
during Q3 2022 (Q3 2021: $3.5 million) and increased by 21% to $12.2 million during YTD 2022 (YTD 2021: $10.1 million). The increase in
corporate employee compensation in Q3 2022 and YTD 2022 is predominately due to the Success TMS Acquisition and the re-valuation of deferred and performance share units as a result of fluctuations in the Company’s share price.
Corporate Marketing Expenses
Corporate
marketing expenses increased by 35% to $0.2 million during Q3 2022 as compared to Q3 2021 (Q3 2021: $0.1 million) and decreased
by 16% to $0.4 million during YTD 2022 as compared to YTD 2021 (YTD 2021: $0.5 million). These changes were primarily a result of the
timing of discretionary spending which includes $0.1 million in corporate marketing expenses relating to the Success TMS Acquisition during
Q3 2022.
Other Corporate, General and Administrative Expenses
Other
corporate, general and administrative expenses increased by 186% to $4.3 million during Q3 2022 as compared to Q3 2021 (Q3 2021:
$1.5 million) and by 51% to $7.8 million during YTD 2022 as compared to YTD 2021 (YTD 2021: $5.1 million). These increases were predominantly
due to an increase in one-time professional and legal fees related to the Success TMS Acquisition, the re-valuation of the Conversion
Instruments (as defined below) in connection with the Madryn Credit Facility as well as Success TMS integration and related expenses (see
“Adjusted EBITDA and One-Time Expenses” below).
Following completion of the
Success TMS Acquisition, management also continued to focus on integration of the combined business and the execution of near-term operational
synergies. We believe we will be able to continue to execute on further near-term operational synergies to accelerate the Company’s timeline
to profitability (see “Cautionary Note Regarding Forward-Looking Information”).
Share-Based Compensation
Share-based
compensation decreased by 99% to $0.002 million during Q3 2022 as compared to Q3 2021 (Q3 2021: $0.2 million) and decreased by
50% to $0.3 million during YTD 2022 as compared to YTD 2021 (YTD 2021: $0.6 million). The decrease was predominantly due to the timing
and fair value of stock options granted to key personnel to ensure retention and long-term alignment with the goals of the Company.
Amortization
Amortization
increased by 393% to $0.6 million during Q3 2022 as compared to Q3 2021 (Q3 2021: $0.1 million) and increased by 184% to $1.0 million
during YTD 2022 as compared to YTD 2021 (YTD 2021: $0.3 million). These changes were primarily a result of the intangible assets acquired
by the Company in connection with the Achieve TMS East/Central Acquisition and the Success TMS Acquisition.
Interest
Interest
expense increased by 178% to $3.2 million during Q3 2022 as compared to Q3 2021 (Q3 2021: $1.1 million) and increased by 61% to
$5.6 million during YTD 2022 as compared to YTD 2021 (YTD 2021: $3.5 million). The increase in interest expense in Q3 2022 and YTD 2022
as compared to Q3 2021 and YTD 2021 was primarily due to the addition of new lease liabilities in connection with the Success TMS Acquisition
and the execution of our regional growth strategy as well as interest expense incurred in connection with the Madryn Credit Facility.
Interest income was nil during
Q3 2022 (Q3 2021: $0.003 million) and $0.01 million during YTD 2022 (YTD 2021: $0.005 million). The increases were primarily a result
of a decrease in the amount of excess funds invested during Q3 2022 and YTD 2022 as compared to Q3 2021 and YTD 2021, respectively.
Loss on Extinguishment of Loans
Loss
on extinguishment of loans was $2.3 million during Q3 2022 and YTD 2022 as compared to nil in Q3 2021 and YTD 2021, due to the
extinguishment of the Oxford Credit Facility, as well as the extinguishment of a loan previously held by Success TMS.
Forgiveness of Loans Payable
Forgiveness
of loans payable decreased to nil during Q3 2022 and YTD 2022 as compared to $3.1 million in each of Q3 2021 and YTD 2021. The forgiveness
of loan payable represents a one-time gain due to the forgiveness by the U.S. Small Business Administration of the PPP Loan which occurred
in Q3 2021.
Loss for the Period and Comprehensive Loss
and Loss for the Period Attributable to the Common Shareholders of Greenbrook
The loss for the period and
comprehensive loss increased by 386% to $16.8 million during Q3 2022 as compared to Q3 2021 (Q3 2021: $3.5 million) and increased by 78%
to $32.1 million during YTD 2022 as compared to YTD 2021 (YTD 2021: $18.0 million). These increases were predominately due to increases
in entity-wide regional operating loss, corporate employee compensation and other corporate general and administrative expenses as a result
of incurring duplicative and one-time costs of the combined business subsequent to the Success TMS Acquisition arising from operational
synergies not yet executed, interest expense and loss on extinguishment of loans (see “ —Direct Center and Regional Costs”, “ —Entity-Wide Regional Operating (Loss) Income” , “ —Corporate
Employee Compensation”, “ —Other Corporate, General and Administrative Expenses”, “ —Interest”, and “
—Loss on Extinguishment of Loans” above).
The loss attributable to the
common shareholders of Greenbrook increased by 365% to $16.4 million during Q3 2022 as compared to Q3 2021 (Q3 2021: $3.5 million). The
loss attributable to the common shareholders of Greenbrook increased by 76% to $31.5 million during YTD 2022 as compared to YTD 2021 (YTD
2021: $17.9 million). This increase was predominantly due to the factors described above impacting net losses.
Adjusted EBITDA and One-Time Expenses
The
Adjusted EBITDA loss position increased by 24% to $3.8 million during Q3 2022 as compared to Q3 2021 (Q3 2021: $3.1 million) and by 15%
to $11.9 million during YTD 2022 as compared to YTD 2021 (YTD 2021: $10.3 million). The increase in the Adjusted EBITDA loss position
is due to the increase in the loss attributable to the common shareholders of Greenbrook as a result of incurring duplicative costs of
the combined business subsequent to the Success TMS Acquisition arising from operational synergies not yet executed and changes in one-time
costs incurred during Q3 2022 and YTD 2022 as compared to Q3 2021 and YTD 2021. See “—Loss for the Period and Comprehensive
Loss and Loss for the Period Attributable to the Common Shareholders of Greenbrook” above and “—Reconciliation of Non-IFRS
Measures” below.
EBITDA AND ADJUSTED EBITDA
The table below presents our
EBITDA and Adjusted EBITDA for the periods indicated:
| (US$) | |
Q3 2022
(unaudited) | | |
Q3 2021(1)
(unaudited) | | |
YTD 2022
(unaudited) | | |
YTD 2021(1)
(unaudited) | |
| EBITDA | |
| (9,471,244 | ) | |
| (885,997 | ) | |
| (18,647,762 | ) | |
| (9,760,839 | ) |
| Adjusted EBITDA | |
| (3,832,751 | ) | |
| (3,097,211 | ) | |
| (11,858,706 | ) | |
| (10,280,194 | ) |
Note:
| (1) | Beginning in Fiscal 2021, we no longer adjust for center development costs in our presentation of Adjusted
EBITDA because a key component of our growth strategy is to grow our business and revenue through the development and building of additional
TMS Centers and the expansion of the Spravato Program®. We have retrospectively calculated Adjusted EBITDA for Q3 2021 and YTD 2021
to reflect this change. |
For
a definition of EBITDA and Adjusted EBITDA, see “Cautionary Note Regarding Non-IFRS Measures and Industry Metrics” above.
For quantitative reconciliations of EBITDA and Adjusted EBITDA to loss attributable to the common shareholders of Greenbrook, see
“Reconciliation of Non-IFRS Measures” immediately below.
RECONCILIATION OF NON-IFRS MEASURES
The table below illustrates
a reconciliation of loss attributable to the common shareholders of Greenbrook to EBITDA and Adjusted EBITDA for the periods presented:
| (US$) | |
Q3 2022
(unaudited) | | |
Q3 2021(1)
(unaudited) | | |
YTD 2022
(unaudited) | | |
YTD 2021(1)
(unaudited) | |
| Loss attributable to the common shareholders of Greenbrook | |
| (16,361,426 | ) | |
| (3,517,250 | ) | |
| (31,547,258 | ) | |
| (17,919,629 | ) |
| Add the impact of: | |
| | | |
| | | |
| | | |
| | |
| Interest expense | |
| 3,183,165 | | |
| 1,145,337 | | |
| 5,633,165 | | |
| 3,507,436 | |
| Amortization | |
| 570,648 | | |
| 115,834 | | |
| 985,648 | | |
| 347,500 | |
| Depreciation | |
| 3,136,369 | | |
| 1,373,149 | | |
| 6,292,913 | | |
| 4,309,114 | |
| Less the impact of: | |
| | | |
| | | |
| | | |
| | |
| Interest income | |
| – | | |
| (3,067 | ) | |
| (12,230 | ) | |
| (5,260 | ) |
| EBITDA | |
| (9,471,244 | ) | |
| (885,997 | ) | |
| (18,647,762 | ) | |
| (9,760,839 | ) |
| Add the impact of: | |
| | | |
| | | |
| | | |
| | |
| Share-based compensation | |
| 1,933,280 | | |
| 221,679 | | |
| 2,246,484 | | |
| 631,011 | |
| Add the impact of: | |
| | | |
| | | |
| | | |
| | |
| Deferral payment expense in relation to Achieve TMS West cash Earn-Out consideration owed | |
| – | | |
| – | | |
| – | | |
| 300,000 | |
| Nasdaq listing related professional and legal fees | |
| – | | |
| – | | |
| – | | |
| 451,105 | |
| Forgiveness of loans payable | |
| – | | |
| (3,128,596 | ) | |
| – | | |
| (3,128,596 | ) |
| Loss on extinguishment of loan(2) | |
| 2,331,917 | | |
| – | | |
| 2,331,917 | | |
| – | |
| Withdrawn Public Offering related professional and legal fees(3) | |
| – | | |
| 273,561 | | |
| – | | |
| 804,983 | |
| Achieve TMS East/Central Acquisition related professional and legal fees | |
| – | | |
| 422,142 | | |
| – | | |
| 422,142 | |
| Success TMS Acquisition related professional and legal fees | |
| 530,130 | | |
| – | | |
| 1,265,225 | | |
| – | |
| Madryn Credit Facility related professional and legal fees | |
| (102,264 | ) | |
| – | | |
| – | | |
| – | |
| Success TMS related integration and related expenses | |
| 945,430 | | |
| – | | |
| 945,430 | | |
| – | |
| Adjusted EBITDA | |
| (3,832,751 | ) | |
| (3,097,211 | ) | |
| (11,858,706 | ) | |
| (10,280,194 | ) |
Notes:
| (1) | Beginning in Fiscal 2021, we no longer adjust for center development costs in our presentation of Adjusted
EBITDA because a key component of our growth strategy is to grow our business and revenue through the development and building of additional
TMS Centers and the expansion of the Spravato Program®. We have retrospectively calculated Adjusted EBITDA for Q3 2021 and YTD 2021
to reflect this change. |
| (2) | Loss on extinguishment of loan relates to
the extinguishment of the Oxford Credit Facility, as well as the extinguishment of a loan previously held by Success TMS. Due to their
nature, these are considered one-time costs and, accordingly, have been excluded from Adjusted EBITDA. |
| (3) | On June 25, 2021, the Company elected to withdraw its previously announced public offering of Common
Shares in light of market conditions (the “Withdrawn Public Offering”). Due to their nature, professional and legal
fees associated with the Withdrawn Public Offering are also considered one-time costs and, accordingly, have been excluded from Adjusted
EBITDA. |
Quarterly Adjusted EBITDA Reconciliation
The table below illustrates
a reconciliation of loss attributable to the common shareholders of Greenbrook to EBITDA and Adjusted EBITDA for the eight most recently
completed fiscal quarters:
(unaudited)
(US$) | |
Q3 2022 | | |
Q2 2022 | | |
Q1 2022 | | |
Q4 2021(1) | | |
Q3 2021(1) | | |
Q2 2021(1) | | |
Q1 2021(1) | | |
Q4 2020(1) | |
| Loss attributable to the common shareholders of Greenbrook | |
| (16,361,426 | ) | |
| (7,347,849 | ) | |
| (7,837,983 | ) | |
| (6,831,859 | ) | |
| (3,517,250 | ) | |
| (6,775,825 | ) | |
| (7,626,554 | ) | |
| (8,391,630 | ) |
| Add the impact of: | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
| Interest Expense | |
| 3,183,165 | | |
| 1,220,689 | | |
| 1,229,311 | | |
| 1,254,007 | | |
| 1,145,337 | | |
| 1,334,187 | | |
| 1,027,912 | | |
| 745,579 | |
| Amortization | |
| 570,648 | | |
| 207,500 | | |
| 207,500 | | |
| 207,500 | | |
| 115,834 | | |
| 115,833 | | |
| 115,833 | | |
| 115,834 | |
| Depreciation | |
| 3,136,369 | | |
| 1,586,560 | | |
| 1,569,984 | | |
| 1,529,892 | | |
| 1,373,149 | | |
| 1,461,631 | | |
| 1,474,334 | | |
| 1,454,680 | |
| Less the impact of: | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
| Interest income | |
| – | | |
| (9,943 | ) | |
| (2,287 | ) | |
| (9,429 | ) | |
| (3,067 | ) | |
| (11 | ) | |
| (2,182 | ) | |
| (2,572 | ) |
| EBITDA | |
| (9,471,244 | ) | |
| (4,343,043 | ) | |
| (4,833,475 | ) | |
| (3,849,889 | ) | |
| (885,997 | ) | |
| (3,864,185 | ) | |
| (5,010,657 | ) | |
| (6,078,109 | ) |
| Add the impact of: | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
| Share-based compensation | |
| 1,933,280 | | |
| 63,882 | | |
| 249,322 | | |
| 248,428 | | |
| 221,679 | | |
| 203,362 | | |
| 205,970 | | |
| 135,476 | |
| Add the impact of: | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
| Deferral payment expense in relation to Achieve TMS West cash Earn-Out consideration owed | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | | |
| 300,000 | | |
| – | |
| Earn-out consideration | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | | |
| 1,024,429 | |
| Nasdaq listing related professional and legal fees | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | | |
| 240,761 | | |
| 210,344 | | |
| 600,485 | |
| Equity Financing related professional and legal fees | |
| – | | |
| – | | |
| – | | |
| 273,561 | | |
| – | | |
| 531,422 | | |
| – | | |
| – | |
| Forgiveness of loans payable | |
| – | | |
| – | | |
| – | | |
| – | | |
| (3,128,596 | ) | |
| – | | |
| – | | |
| – | |
| Loss on extinguishment of loan(2) | |
| 2,331,917 | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | |
| Withdrawn Public Offering related professional and legal fees(3) | |
| – | | |
| – | | |
| – | | |
| (273,561 | ) | |
| 273,561 | | |
| – | | |
| – | | |
| – | |
| Internal controls assessment professional and legal fees | |
| – | | |
| – | | |
| – | | |
| 31,840 | | |
| – | | |
| – | | |
| – | | |
| – | |
| Achieve TMS East/Central Acquisition related professional and legal fees | |
| – | | |
| – | | |
| – | | |
| 3,864 | | |
| 422,142 | | |
| – | | |
| – | | |
| – | |
| Success TMS Acquisition related professional and legal fees | |
| 530,130 | | |
| 643,247 | | |
| 91,848 | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | |
| Madryn Credit Facility related professional and legal fees | |
| (102,264 | ) | |
| 102,264 | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | |
| Success TMS related integration and related expenses | |
| 945,430 | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | | |
| – | |
| Adjusted EBITDA | |
| (3,832,751 | ) | |
| (3,533,650 | ) | |
| (4,492,305 | ) | |
| (3,565,757 | ) | |
| (3,097,211 | ) | |
| (2,888,640 | ) | |
| (4,294,343 | ) | |
| (4,317,719 | ) |
Notes:
| (1) | Beginning
in Fiscal 2021, we no longer adjust for center development costs in our presentation of Adjusted
EBITDA because a key component of our growth strategy is to grow our business and revenue
through the development and building of additional TMS Centers and the expansion of the Spravato
Program®. We have retrospectively calculated Adjusted EBITDA for Q4 2020 through Q4 2021,
inclusive, to reflect this change. |
| (2) | Loss
on extinguishment of loan relates to the extinguishment of the Oxford Credit Facility, as
well as the extinguishment of a loan previously held by Success TMS. Due to their nature,
these are considered one-time costs and, accordingly, have been excluded from Adjusted EBITDA. |
| (3) | On
June 25, 2021, the Company elected to withdraw its previously announced public offering
of Common Shares in light of market conditions. Due to their nature, professional and legal
fees associated with the Withdrawn Public Offering are also considered one-time costs and,
accordingly, have been excluded from Adjusted EBITDA. |
We
believe that Adjusted EBITDA provides a meaningful financial metric to investors as it measures the ability of our current TMS Center
operations to generate earnings while eliminating the impact of one-time expenses and share-based compensation expenses, none of which
have an impact on the operating performance of our existing TMS Center network. One-time expenses include professional and legal fees
associated with our Nasdaq listing, the Success TMS Acquisition, the Madryn Credit Facility and the Achieve TMS East/Central Acquisition, Success TMS integration and related
expenses, the costs related to the loss on extinguishment of loans and forgiveness of loans payable as well as the deferred payment
costs with respect to the Earn-Out consideration in connection with the Achieve TMS West Acquisition.
In addition, we present Same-Region
Sales Growth, which is a non-IFRS measure that we calculate as the percentage change in sales derived from our established management
regions in a certain financial period as compared to the sales from the same management regions in the corresponding period of the prior
year. As a result, when we calculate Same-Region Sales Growth for a particular comparative period (e.g., Q3 2022 vs Q3 2021), the total
amount of same-region sales revenue for the comparative period in the prior year (e.g., for Q3 2021) may differ compared to the total
amount of same-region sales revenue that we had calculated in the comparative period, e.g., in the event that certain management regions
that had been excluded in the comparative period are considered established management regions in the current period. This is necessary
in order for us to present a more meaningful percentage of sales growth as it ensures that the same management regions are being included
in both periods for each calculation of Same-Region Sales Growth. Other than for purposes of the reconciliation tables below, we do not
present same-region sales revenue as an independent non-IFRS measure because the management regions that are included may vary from period-to-period.
We refer you to our revenues as reported under IFRS and as discussed elsewhere in this MD&A for a discussion and analysis of our revenues
on a consolidated basis. However, we believe Same-Region Sales Growth is a useful metric to investors because it helps quantify our sales
growth (as a percentage change) within established management areas that are relevant for the comparative period and, accordingly, enables
us to present the growth achieved by adding TMS Center density within these established management regions by taking into account sales
attributable to recently acquired management regions or regions that we do not consider to be “established” or “mature”,
i.e., those in which none of the TMS Centers have performed billable TMS services for a period of at least one full year prior to the
more recent period of the two financial periods that are compared in calculating Same-Region Sales Growth. Our Same-Region Sales Growth
is unique to our financial management strategy and may not be comparable to non-IFRS measures used by other companies.
The tables below illustrate
a reconciliation of total revenue to Same-Region Sales Growth for the periods presented:
Q3 2022 SAME-REGION SALES GROWTH
| (unaudited) (US$) | |
Q3 2022 | | |
Q3 2021 | |
| Revenue | |
| 20,752,105 | | |
| 13,130,245 | |
| Less the impact of regions not yet mature(1): | |
| | | |
| | |
| Massachusetts | |
| (829,727 | ) | |
| – | |
| Iowa | |
| (212,711 | ) | |
| – | |
| Illinois | |
| (750,088 | ) | |
| – | |
| Nevada | |
| (397,307 | ) | |
| – | |
| New Jersey | |
| (2,001,305 | ) | |
| – | |
| Pennsylvania | |
| (1,181,777 | ) | |
| – | |
| Same-Region Sales Revenue | |
| 15,379,190 | | |
| 13,130,245 | |
| Same-Region Sales Growth | |
| 17.1 | % | |
| | |
Note:
| (1) | These regions were acquired as part of the Achieve TMS East/Central Acquisition on October 1, 2021
or the Success TMS Acquisition on July 14, 2022 and therefore were not present in Q3 2021. As TMS Centers in these regions have not
performed billable TMS services, subsequent to being acquired, for a period of at least one full year prior to September 30, 2022,
they have been excluded from the calculation. |
YTD 2022 SAME-REGION SALES GROWTH
| (unaudited) (US$) | |
YTD 2022 | | |
YTD 2021 | |
| Revenue | |
| 48,027,560 | | |
| 38,150,632 | |
| Less the impact of regions not yet mature(1): | |
| | | |
| | |
| Massachusetts | |
| (2,480,481 | ) | |
| – | |
| Iowa | |
| (440,156 | ) | |
| – | |
| Illinois | |
| (750,088 | ) | |
| – | |
| Nevada | |
| (397,307 | ) | |
| – | |
| New Jersey | |
| (2,001,305 | ) | |
| – | |
| Pennsylvania | |
| (1,181,777 | ) | |
| – | |
| Same-Region Sales Revenue | |
| 40,776,446 | | |
| 38,150,632 | |
| Same-Region Sales Growth | |
| 6.9 | % | |
| | |
Note:
| (1) | These regions were acquired as part of the Achieve TMS East/Central Acquisition on October 1, 2021
and the Success TMS Acquisition on July 14, 2022 and therefore were not present in YTD 2021. As TMS Centers in these regions have
not performed billable TMS services, subsequent to being acquired, for a period of at least one full year prior to September 30,
2022, they have been excluded from the calculation. |
Q3 2021 SAME-REGION SALES GROWTH
For purposes of calculating Q3 2021 Same-Region
Sales Growth, there were no management regions excluded in either Q3 2021 or Q3 2020, and accordingly, same-region sales revenue is equal
to revenue for both periods:
| (unaudited) (US$) | |
Q3 2021 | | |
Q3 2020 | |
| Revenue | |
| 13,130,245 | | |
| 12,006,570 | |
| Same-Region Sales Revenue | |
| 13,130,245 | | |
| 12,006,570 | |
| Same-Region Sales Growth | |
| 9.4 | % | |
| | |
YTD 2021 SAME-REGION SALES GROWTH
For purposes of calculating YTD 2021 Same-Region
Sales Growth, there were no management regions excluded in either YTD 2021 or YTD 2020, and accordingly, same-region sales revenue is
equal to revenue for both periods:
| (unaudited) (US$) | |
YTD 2021 | | |
YTD 2020 | |
| Revenue | |
| 38,150,632 | | |
| 33,215,627 | |
| Same-Region Sales Revenue | |
| 38,150,632 | | |
| 33,215,627 | |
| Same-Region Sales Growth | |
| 14.9 | % | |
| | |
RECONCILIATION OF ACCOUNTS RECEIVABLE
A quantitative reconciliation
of accounts receivable in respect of the three and nine-month periods ended September 30, 2022 and 2021, and the year ended December 31,
2021 is provided below, which includes a quantification of the adjustment to variable consideration estimate resulting from the additional
price concessions which were deemed necessary:
| (US$) | |
Q3 2022
(unaudited) | | |
Q3 2021
(unaudited) | | |
YTD 2022
(unaudited) | | |
YTD 2021
(unaudited) | | |
Fiscal 2021
(unaudited) | |
| Opening accounts receivable balance as at the period opening date | |
| 9,805,095 | | |
| 10,793,064 | | |
| 10,997,389 | | |
| 10,708,062 | | |
| 10,708,062 | |
| Accounts receivable acquired as part of the Success TMS Acquisition | |
| 3,522,315 | | |
| – | | |
| 3,522,315 | | |
| – | | |
| – | |
| Revenue recognized based on expected value | |
| 22,531,797 | | |
| 13,357,580 | | |
| 52,179,553 | | |
| 40,773,063 | | |
| 55,716,778 | |
| Adjustment to variable consideration estimate | |
| (1,779,692 | ) | |
| (227,335 | ) | |
| (4,151,993 | ) | |
| (2,622,431 | ) | |
| (3,518,694 | ) |
| Payments received | |
| (19,677,712 | ) | |
| (12,979,281 | ) | |
| (48,145,461 | ) | |
| (37,914,666 | ) | |
| (51,908,757 | ) |
| Ending accounts receivable balance at the period end date | |
$ | 14,401,803 | | |
$ | 10,944,028 | | |
$ | 14,401,803 | | |
$ | 10,944,028 | | |
$ | 10,997,389 | |
QUARTERLY FINANCIAL INFORMATION
Selected Quarterly Financial Information
The following table summarizes
the results of our operations for the eight most recently completed fiscal quarters:
(unaudited)
(US$) | |
Q3 2022 | | |
Q2 2022 | | |
Q1 2022 | | |
Q4 2021 | | |
Q3 2021 | | |
Q2 2021 | | |
Q1 2021 | | |
Q4 2020 | |
| Revenue | |
| 20,752,105 | | |
| 14,210,309 | | |
| 13,065,146 | | |
| 14,047,452 | | |
| 13,130,245 | | |
| 13,707,212 | | |
| 11,313,175 | | |
| 9,913,552 | |
| Regional operating income (loss) | |
| (849,472 | ) | |
| (71,075 | ) | |
| (1,038,049 | ) | |
| 43,741 | | |
| 249,057 | | |
| 921,339 | | |
| (1,492,118 | ) | |
| (2,050,168 | ) |
| Net loss attributable to common shareholders of Greenbrook | |
| (16,361,426 | ) | |
| (7,347,849 | ) | |
| (7,837,983 | ) | |
| (6,831,859 | ) | |
| (3,517,250 | ) | |
| (6,775,825 | ) | |
| (7,626,554 | ) | |
| (8,391,630 | ) |
| Adjusted EBITDA(1) | |
| (3,832,751 | ) | |
| (3,533,650 | ) | |
| (4,492,305 | ) | |
| (3,565,757 | ) | |
| (3,097,211 | ) | |
| (2,888,640 | ) | |
| (4,294,343 | ) | |
| (4,317,719 | ) |
| Net loss per share – Basic(2) | |
| (0.59 | ) | |
| (0.41 | ) | |
| (0.44 | ) | |
| (0.34 | ) | |
| (0.22 | ) | |
| (0.48 | ) | |
| (0.56 | ) | |
| (0.60 | ) |
| Net loss per share – Diluted(2) | |
| (0.59 | ) | |
| (0.41 | ) | |
| (0.44 | ) | |
| (0.34 | ) | |
| (0.22 | ) | |
| (0.48 | ) | |
| (0.56 | ) | |
| (0.60 | ) |
Note:
| (1) | Adjusted
EBITDA is a non-IFRS measure. See “Cautionary Note Regarding Non-IFRS Measures and
Industry Metrics” and “Reconciliation of Non-IFRS Measures - Quarterly Adjusted
EBITDA Reconciliation” above. Beginning in Fiscal 2021, we no longer adjust for center
development costs in our presentation of Adjusted EBITDA because a key component of our growth
strategy is to grow our business and revenue through the development and building of additional
TMS Centers and the expansion of the Spravato Program®. We have retrospectively calculated
Adjusted EBITDA for Q4 2020 through Q4 2021, inclusive, to reflect this change. |
| (2) | The
Company has retrospectively presented the number of Common Shares and net loss per share
calculations reflecting the number of Common Shares following the consolidation of our Common
Shares on the basis of one post-consolidation Common
Share for every five pre-consolidation Common Shares, which was implemented by the Company
effective February 1, 2021. |
Selected Quarterly Operating Data
The following table provides
selected operating data for the periods indicated:
| (unaudited) | |
Q3
2022 | | |
Q2
2022 | | |
Q1
2022 | | |
Q4
2021 | | |
Q3
2021 | | |
Q2
2021 | | |
Q1
2021 | | |
Q4
2020 | |
| Number
of active TMS Centers(1) | |
| 183 | | |
| 144 | | |
| 146 | | |
| 147 | | |
| 127 | | |
| 122 | | |
| 119 | | |
| 116 | |
| Number
of TMS Centers-in-development(2) | |
| 1 | | |
| – | | |
| 2 | | |
| 2 | | |
| 4 | | |
| 7 | | |
| 9 | | |
| 9 | |
| Total
TMS Centers | |
| 184 | | |
| 144 | | |
| 148 | | |
| 149 | | |
| 131 | | |
| 129 | | |
| 128 | | |
| 125 | |
| Number
of management regions | |
| 18 | | |
| 15 | | |
| 15 | | |
| 15 | | |
| 13 | | |
| 13 | | |
| 13 | | |
| 13 | |
| Number
of TMS Devices installed | |
| 338 | | |
| 234 | | |
| 234 | | |
| 234 | | |
| 214 | | |
| 209 | | |
| 201 | | |
| 198 | |
| Number
of regional personnel | |
| 501 | | |
| 328 | | |
| 340 | | |
| 386 | | |
| 350 | | |
| 343 | | |
| 317 | | |
| 305 | |
| Number
of shared-services / corporate personnel(3) | |
| 143 | | |
| 66 | | |
| 68 | | |
| 44 | | |
| 58 | | |
| 51 | | |
| 49 | | |
| 49 | |
| Number
of TMS providers(4) | |
| 208 | | |
| 164 | | |
| 161 | | |
| 135 | | |
| 126 | | |
| 124 | | |
| 116 | | |
| 117 | |
| Number
of consultations performed(5) | |
| 8,797 | | |
| 4,318 | | |
| 3,501 | | |
| 3,547 | | |
| 3,437 | | |
| 3,533 | | |
| 3,591 | | |
| 3,587 | |
| Number
of patient starts(5) | |
| 2,848 | | |
| 1,809 | | |
| 1,817 | | |
| 1,667 | | |
| 1,520 | | |
| 1,659 | | |
| 1,583 | | |
| 1,428 | |
| Number
of treatments performed(5) | |
| 95,046 | | |
| 62,038 | | |
| 59,067 | | |
| 61,416 | | |
| 54,525 | | |
| 58,219 | | |
| 52,126 | | |
| 54,408 | |
| Average
revenue per treatment(5) | |
$ | 218 | | |
$ | 229 | | |
$ | 221 | | |
$ | 229 | | |
$ | 241 | | |
$ | 235 | | |
$ | 217 | | |
$ | 182 | |
Notes:
| (1) | Active TMS Centers represent TMS Centers that have performed billable TMS and other mental health services
during the applicable period. |
| (2) | TMS Centers-in-development represents TMS Centers that have committed to a space lease agreement and the
development process is substantially complete. |
| (3) | Shared-services / corporate personnel is disclosed on a full-time equivalent basis. The Company utilizes
part-time staff and consultants as a means of managing costs. |
| (4) | Represents clinician partners that are involved in the provision of TMS therapy and other mental health
services from our TMS Centers. |
| (5) | Figures calculated for the applicable period ended. |
Analysis of Quarterly Results
New
patient starts were 2,848 in Q3 2022, representing a 57% quarter-over-quarter increase as compared to Q2 2022 (Q2 2022: 1,809). Treatment
volumes were 95,046 in Q3 2022, representing a 53% quarter-over-quarter increase as compared to Q2 2022 (Q2 2022: 62,038). Consultations
also reached a record quarterly high of 8,797 in Q3 2022, representing a 104% quarter-over-quarter increase as compared to Q2 2022 (Q2
2022: 4,318). These increases were predominantly due to the completion of the Success TMS Acquisition in Q3 2022 (see “Factors
Affecting the Comparability of Our Results—Acquisition of Success TMS” above).
We
achieved quarterly consolidated revenue of $20.8 million in Q3 2022, representing a 46% quarter-over-quarter increase as compared to Q2
2022 (Q2 2022: $14.2 million). Average revenue per treatment was $218 in Q3 2022, representing a decrease of 5% as compared to Q2 2022
(Q2 2022: $229). The increase in consolidated revenue was attributable to an increase in quarterly treatments performed in Q3 2022 as
compared to Q2 2022, predominately as a result of the completion of the Success TMS Acquisition in Q3 2022 (see “Factors
Affecting the Comparability of Our Results—Acquisition of Success TMS” above), partially offset by a decrease in reimbursement
rates due to a change in the geographical distribution of revenue.
We
experienced an increase in entity-wide regional operating loss of $0.8 million in Q3 2022 (Q2 2022: $0.1 million), primarily as
a result of incurring duplicative costs of the combined business subsequent to the Success TMS Acquisition arising from additional operational
synergies not yet executed, offset by an increase in revenue in Q3 2022 as compared to Q2 2022. We believe we will be able to continue to execute on further near-term operational synergies to accelerate the Company’s
timeline to profitability (see “Cautionary Note Regarding Forward-Looking Information”).
The
loss attributable to the common shareholders of Greenbrook was $16.4 million in Q3 2022, representing a 123% quarter-over-quarter
increase as compared to Q2 2022 (Q2 2022: $7.3 million), primarily as a result of incurring duplicative costs of the combined business
subsequent to the Success TMS Acquisition arising from additional operational synergies not yet executed, offset by an increase in revenue
in Q3 2022 as compared to Q2 2022.
We believe that we will be
able to achieve further near-term operational synergies resulting from the Success TMS Acquisition in an effort to accelerate the Company’s
timeline to profitability (see “Cautionary Note Regarding Forward-Looking Information”).
LIQUIDITY AND CAPITAL RESOURCES
Overview
Since inception, we have financed
our operations primarily from equity offerings, credit facilities and revenue generated from our TMS Centers. Our primary uses of capital
are to finance operations, finance new TMS Center development costs, increase non-cash working capital and fund investments in our centralized
business infrastructure. We have also used capital to finance acquisitions and may continue to do so in the future. Our objectives when
managing capital are to ensure that we will continue to have enough liquidity to provide services to our customers and provide returns
to our shareholders. Cash is held primarily in U.S. dollars.
As
part of our annual budgeting process, we evaluate our estimated annual cash requirements to fund planned expansion activities and working
capital requirements of existing operations. Based on this budget, historical cash flow analysis and considering our anticipated cash
flows from regional operations and our holdings of cash, as of the date of this MD&A, we believe that we have sufficient capital to
meet our future operating expenses, capital expenditures and future debt service requirements for at least the next 12 months. However,
our ability to fund operating expenses, capital expenditures and future debt service requirements will depend on, among other things,
our ability to source external funding, our future operating performance, which will be affected by the velocity of our regional development
strategy, our ability to meet our debt covenants, and general economic, financial and other factors, including factors beyond our control
such as inflation and recessionary conditions. See “Cautionary Note Regarding Forward-Looking Information”, “Risks and
Uncertainties” and “Factors Affecting our Performance” in this MD&A.
Analysis of Cash Flows for YTD 2022
The following table presents
our cash flows for each of the periods presented:
| (US$) | |
YTD 2022 | | |
YTD 2021 | |
| Net cash generated from (used in) operating activities | |
| (9,970,212 | ) | |
| (11,803,430 | ) |
| Net cash generated from financing activities | |
| 9,200,124 | | |
| 27,482,846 | |
| Net cash generated from (used in) investing activities | |
| 219,228 | | |
| (9,477,870 | ) |
| Increase (decrease) in cash | |
| (550,860 | ) | |
| 6,201,546 | |
Cash Flows used in Operating Activities
For YTD 2022, cash flows used
in operating activities (which includes the full cost of developing new TMS Centers) totaled $10.0 million, as compared to $11.8 million
in YTD 2021. The decrease in cash flows used in operating activities is primarily attributable to changes in non-cash working capital
resulting from the timing of payments, offset by increased collection activity and increased losses (see “Loss for the Period and
Comprehensive Loss and Loss for the Period Attributable to the Common Shareholders of Greenbrook” above).
Cash Flows generated from Financing Activities
For YTD 2022, cash flows generated
from financing activities amounted to $9.2 million as compared to $27.5 million generated in YTD 2021. This change is primarily driven
by the net bank loans advanced in relation to the Madryn Credit Facility in YTD 2022 as compared to the net proceeds of $23.5 million
and $13.2 million on the issuance of Common Shares in connection with securities offerings that were completed during YTD 2021, in addition
to an increase in lease liability interest expense and lease payments in YTD 2022 as compared to YTD 2021.
Cash Flows generated from (used in) Investing
Activities
For
YTD 2022, cash flows generated from investing activities totaled $0.2 million as compared to cash flows used in investing activities
of $9.5 million in YTD 2021, which primarily relates to the release of the deferred consideration held in an escrow account upon satisfying
all escrow conditions and the Earn-Out consideration in relation to the Achieve TMS West Acquisition in YTD 2021 which did not recur in
YTD 2022. See “Factors Affecting the Comparability of our Results—Acquisition of Achieve TMS West” above.
INDEBTEDNESS
Madryn Credit Facility
On
July 14, 2022, the Company entered into a credit agreement for a $75 million secured credit facility with Madryn and its affiliated
entities. The Madryn Credit Facility provides the Company with a $55 million term loan (the “Term Loan”), which was
funded on closing. In addition, the Madryn Credit Facility permits the Company to draw up to an additional $20 million in a single draw
at any time on or prior to December 31, 2024 for purposes of funding future mergers and acquisition activity. All amounts borrowed
under the Madryn Credit Facility will bear interest at a rate equal to the three-month LIBOR rate plus 9.0%, subject to a minimum three-month
LIBOR floor of 1.5%. The Madryn Credit Facility matures over 63 months and provides for four years of interest-only payments. The Company
has granted general security over all assets of the Company in connection with the performance and prompt payment of all obligations of
the Madryn Credit Facility.
The terms of the Madryn Credit
Agreement require the Company to satisfy various affirmative and negative covenants and to meet certain financial tests, including but
not limited to, financial covenants that require the Company to (i) generate consolidated revenues for each 12-month period (on a
pro forma basis giving effect to the Success TMS Acquisition), measured quarterly (commencing with the 12 months ending on September 30,
2022), in amounts that (A) for the first, second and third measurement periods, are in line with the historical trailing performance
of the Company and Success TMS (taken together as a combined company) but substitute one, two and three quarters, respectively, of historical
combined revenues with a portion of the projected combined revenues for those quarters; and (B) for measurement periods thereafter,
represent a percentage of the Company’s projected consolidated revenues for such periods, assuming modest growth over time, and
is capped at the minimum revenue requirement for the 12 months ending on June 30, 2027, and (ii) maintain minimum liquidity
of $3.0 million. In addition, the Madryn Credit Agreement contains affirmative and negative covenants that limit, among other things,
the Company’s ability to incur additional indebtedness outside of what is permitted under the Madryn Credit Agreement, create certain
liens on assets, declare dividends and engage in certain types of transactions. As of September 30, 2022, we are in compliance with
these covenants; however, we can provide no assurance that we will remain in compliance in the future. See “Risks and Uncertainties”.
The Madryn Credit Agreement also includes customary events of default, including payment and covenant breaches, bankruptcy events and
the occurrence of a change of control.
In accordance with the terms
of the Madryn Credit Agreement, Greenbrook has issued conversion instruments (each, a “Conversion Instrument”) to Madryn
and certain of its affiliated entities that provide the holders thereof with the option to convert up to $5 million of the outstanding
principal amount of the Term Loan into Common Shares at a price per share equal to $1.90 (representing a 15% premium to the 30-day volume
weighted average trading price of the Common Shares as of the closing date of the transaction), subject to customary anti-dilution adjustments
and approval of the TSX prior to each such issuance.
Uses of Madryn Credit Facility in Q3 2022
On
July 14, 2022, the Company used approximately $15.4 million of the proceeds from the Madryn Credit Facility to repay in full the
outstanding balance owing under the Oxford Credit Facility (as defined below), as well as prepayment fees and legal fees incurred, and
terminated the Oxford Credit Facility. Concurrently, the Company used approximately $15.1 million of the proceeds from the Madryn
Credit Facility to repay various loans previously held by Success TMS. The Company subsequently used $2.9 million to normalize vendor
payment aging resulting from cash management practices prior to strengthening our balance sheet and made a $2.3 million cash investment
due to a lag in working capital from the continued development of Success TMS center locations. After financing fees and closing costs
of $3.1 million, the remaining balance of the proceeds in respect of the Madryn Credit Facility totaled $16.2 million.
Oxford Credit Facility
On December 31, 2020,
the Company entered into a credit and security agreement (the “Oxford Credit Agreement”) in respect of a $30 million
credit facility (“Oxford Credit Facility”) with Oxford Finance LLC (the “Lender”).
As consideration for providing
the Oxford Credit Facility, we issued 51,307 common share purchase warrants (the “Lender Warrants”), each exercisable
for one Common Share at an exercise price of C$11.20 per Common Share, to the Lender. To date, none of the Lender Warrants have been exercised.
The Lender Warrants will expire on December 31, 2025.
In
connection with entering into the Madryn Credit Facility on July 14, 2022, the Company repaid in full the outstanding balance owing
under the Oxford Credit Facility and terminated the Oxford Credit Agreement. See “—Madryn Credit Facility” above.
Other Indebtedness
During
the year ended December 31, 2018, the Company assumed loans from four separate banking institutions that were previously extended
for the purchase of TMS Devices to non-controlling interest holder partners. The TMS Device loans were assumed as part of partnerships
with local physicians, behavioral health groups or other strategic investors, which own minority interests in certain TMS Center subsidiaries.
These TMS Device loans bear an average interest rate of 10% with average monthly blended interest and capital payments of $1,575 and mature
or have matured, as applicable, during the years ended or ending December 31, 2019 to December 31, 2023, as the case may be.
There are no covenants associated with these loans. The loans related to one of the banking institutions were repaid during the fiscal
year ended December 31, 2019 (“Fiscal 2019”).
During Fiscal 2019, the Company
assumed loans from two separate banking institutions that were previously extended for the purchase of TMS Devices to non-controlling
interest holder partners. These TMS Device loans were assumed as part of partnerships with local physicians, behavioral health groups
or other investors, which own minority interests in certain TMS Center subsidiaries. These TMS Device loans bear an average interest rate
of 13% with average monthly blended interest and capital payments of $1,756 and matured during Fiscal 2021. There are no covenants associated
with these loans. The loans were repaid during Fiscal 2021.
During the period ended September 30,
2022, the Company assumed loans as part of the Success TMS Acquisition from three separate financing companies for the purchase of TMS
Devices. These TMS Device loans bear an average interest rate of 9.3% with average monthly blended interest and capital payments of $1,556
and mature during the years ending December 31, 2023 to December 31, 2025. There are no covenants associated with these loans.
During
YTD 2022, the Company repaid TMS Device loans totalling $0.1 million (YTD 2021: $0.05 million).
During YTD 2022, the Company
assumed two promissory notes totaling $0.2 million, bearing interest of 5% per annum with a maturity date of December 31, 2025. In
addition, on July 14, 2022, in connection with the Success TMS Acquisition the Company assumed the obligation of Success TMS to repay
a promissory note to Benjamin Klein, who is a significant shareholder, officer and director of the Company. This promissory note totals
$2.1 million bears interest at a rate of 10% per annum and matures on May 1, 2024. The carrying value of these three promissory notes
(collectively, the “Promissory Notes” and each, a “Promissory Note”) as at September 30, 2022
was $2.4 million (December 31, 2021 – nil). During YTD 2022, the Company paid $0.03 million towards these Promissory Notes
(YTD 2021: nil).
Tabular Disclosure of Contractual Obligations
The following table summarizes
our significant contractual obligations as of September 30, 2022:
| (unaudited) | |
Total | | |
Less than 1
year | | |
1 – 3 years | | |
3 – 5 years | | |
More than 5
years | |
| Loans Payable(1) | |
| 92,246,456 | | |
| 5,952,592 | | |
| 13,560,814 | | |
| 72,733,050 | | |
| – | |
| Rental Leases(2) | |
| 51,544,254 | | |
| 7,593,654 | | |
| 13,827,073 | | |
| 12,365,884 | | |
| 17,757,643 | |
| Device Leases(3) | |
| 37,264,226 | | |
| 9,402,224 | | |
| 16,064,118 | | |
| 8,325,247 | | |
| 3,472,637 | |
| Total | |
| 181,054,936 | | |
| 22,948,470 | | |
| 43,452,005 | | |
| 93,424,181 | | |
| 21,230,280 | |
Notes:
| (1) | Loans payable relate to undiscounted cash flows for loans, including the Madryn Credit Facility, TMS Device
loans, and the Promissory Notes as at September 30, 2022, inclusive of principal and interest. We expect to satisfy our loans payable
with cash from operations. |
| (2) | Rental leases relate to the undiscounted cash flows of all future payments for all rental agreements.
We expect to satisfy these obligations with cash from operations. |
| (3) | Device leases relate to the undiscounted cash flows of all future payments for all device agreements.
We expect to satisfy these obligations with cash from operations. |
Off-Balance Sheet Arrangements
The Company has not engaged
in any off-balance sheet financing transactions.
Related Party Transactions
Greybrook Capital Inc.
During Q3 2022 and YTD 2022,
the Company recognized $0.004 million in other corporate, general and administrative expenses (Q3 2021: 0.03 million, YTD 2021:
$0.1 million). As at September 30, 2022, nil was included in accounts payable and accrued liabilities related to payables for Greybrook
Capital Inc.
Benjamin Klein
During Q3 2022 and YTD 2022,
the Company recognized $0.01 million in other corporate, general and administrative expenses (Q3 2021
and YTD 2021: nil). As at September 30, 2022, $0.04 million was included in accounts payable and accrued liabilities related to payables for
Benjamin Klein and entities he owns.
On July 14, 2022, in
connection with the Success TMS Acquisition, the Company assumed the obligation of Success TMS to repay one Promissory Note to Benjamin
Klein, who is a significant shareholder, officer and director of the Company. The Promissory Note totals $2.1 million and bears interest
at a rate of 10% per annum and matures on May 1, 2024. The carrying value of this Promissory Note as at September 30, 2022 was
$2.1 million (December 31, 2021 – nil). During YTD 2022, the Company paid $0.03 million towards this Promissory Note (YTD 2021:
nil).
Other Agreements with Related Parties
We
have also entered into certain customary investor rights and registration rights agreements with certain of our shareholders who have
a nominee appointed to our Board. For additional information on these related party agreements, please refer to the Annual Report, which
is available on SEDAR at www.sedar.com and on EDGAR at www.sec.gov. See also “Key Highlights and Recent Developments—Acquisition
of Success TMS” above.
Risks and Uncertainties
We are exposed to a variety
of financial risks in the normal course of our business, including currency, interest rate, credit, and liquidity risks, as well as macroeconomic
factors such as inflation and recessionary conditions. Our overall risk management program and business practices seek to minimize any
potential adverse effects on our consolidated financial performance. Risk management is carried out under practices approved by the Board.
This includes identifying, evaluating and hedging financial risks based on requirements of our organization. Our Board provides guidance
for overall risk management, covering many areas of risk including interest rate risk, credit risk, liquidity risk and currency risk.
For
a detailed description of risk factors associated with the Company, refer to the “Risk Factors” section of the Annual Report,
which is available on SEDAR at www.sedar.com and on EDGAR at www.sec.gov, as well as the risk factors described
below.
Macroeconomic Risk
Macroeconomic conditions may
adversely affect our business. Demand for our services may be impacted by weak economic conditions, inflation, stagflation, recession,
equity market volatility or other negative economic factors in the United States. Inflation has the potential to adversely affect our
liquidity, business, financial condition and results of operations by increasing our overall cost structure. The existence of inflation
in the economy has resulted in, and may continue to result in, higher interest rates and capital costs, supply shortages, increased costs
of labor, components, manufacturing and shipping, as well as weakening exchange rates and other similar effects. Accordingly, inflation
may have a negative impact on our future results of operations, which may be materially adverse. Further, as recessionary conditions develop,
our suppliers and other third-party partners may suffer their own financial and economic challenges and as a result they may demand pricing
accommodations, delay payment, or become insolvent, which could harm our ability to meet our patients’ demands or collect revenue
or otherwise could harm our business. Similarly, disruptions in financial and/or credit markets may impact our ability to manage normal
commercial relationships with our patients, suppliers and creditors and might cause us to not be able to continue to access preferred
sources of liquidity when we would like, and our borrowing costs could increase. These adverse macroeconomic conditions may also negatively
impact patient spending ability, which in turn may negatively impact our revenues. Thus, if general macroeconomic conditions deteriorate,
our business and financial results could be materially and adversely affected.
Credit Risk
Credit risk arises from the
potential that a counterparty will fail to perform its obligations. We are exposed to credit risk from patients and third-party payors
including federal and state agencies (under the Medicare programs), managed care health plans and commercial insurance companies. Our
exposure to credit risk is mitigated in large part by the fact that the majority of our accounts receivable balances are receivable from
large, creditworthy medical insurance companies and government-backed health plans.
Based on the Company’s
industry, none of the accounts receivable is considered “past due”. Furthermore, the payors have the ability and intent to
pay, but price lists for the Company’s services are subject to the discretion of payors. As such, the timing of collections is not
linked to increased credit risk. The Company continues to collect on services rendered in excess of 24 months from the date such services
were rendered.
Liquidity Risk
Liquidity
risk is the risk that we may encounter difficulty in raising funds to meet our financial commitments or can only do so at an excessive
cost. We aim to ensure there is sufficient liquidity to meet our short-term business requirements, taking into account our anticipated
cash flows from operations, our holdings of cash and our ability to raise capital from existing or new investors and/or lenders.
We have historically been able to obtain financing from supportive shareholders and other sources when required; however, we can provide
no assurance that such shareholders will continue to provide similar financing in the future.
Debt Compliance Risk
The terms of the Madryn Credit
Agreement require the Company to satisfy various affirmative and negative covenants and to meet certain financial tests, including but
not limited to, financial covenants that require the Company to (i) generate consolidated revenues for each 12-month period (on a
pro forma basis giving effect to the Success TMS Acquisition), measured quarterly (commencing with the 12 months ending on September 30,
2022), in amounts that (A) for the first, second and third measurement periods, are in line with the historical trailing performance
of the Company and Success TMS (taken together as a combined company) but substitute one, two and three quarters, respectively, of historical
combined revenues with a portion of the projected combined revenues for those quarters; and (B) for measurement periods thereafter,
represent a percentage of the Company’s projected consolidated revenues for such periods, assuming modest growth over time, and
is capped at the minimum revenue requirement for the 12 months ending on June 30, 2027, and (ii) maintain minimum liquidity
of US$3.0 million. We can provide no assurance that we will be able to meet the revenue targets that require us to remain in compliance
with the foregoing covenant.
In addition, the Madryn Credit
Agreement contains affirmative and negative covenants that limit, among other things, the Company’s ability to incur additional
indebtedness outside of what is permitted under the Madryn Credit Agreement, create certain liens on assets, declare dividends and engage
in certain types of transactions. As of September 30, 2022, we are in compliance with these covenants; however, we can provide no
assurance that we will remain in compliance in the future. A failure by us to comply with the covenants specified in the Madryn Credit
Agreement could result in an event of default under the agreement, which would give Madryn the right to terminate their commitments to
provide additional loans under the Madryn Credit Facility and to declare all borrowings outstanding, together with accrued and unpaid
interest and fees, to be immediately due and payable. If the debt under the Madryn Credit Agreement were to be accelerated, we may not
have sufficient cash or be able to borrow sufficient funds to refinance the debt or sell sufficient assets to repay the debt, which could
materially and adversely affect our business, financial condition and results of operations.
Currency Risk
Currency risk is the risk
to our earnings that arises from fluctuations in foreign exchange rates and the degree of volatility of those rates. We have minimal exposure
to currency risk as substantially all of our revenue, expenses, assets and liabilities are denominated in U.S. dollars. We pay certain
vendors and payroll costs in Canadian dollars from time to time, but due to the limited size and nature of these payments they do not
expose us to significant currency risk.
Interest Rate Risk
Interest
rate risk is the risk that the fair value of future cash flows of a financial instrument will fluctuate because of changes in market interest
rates. We are exposed to changes in interest rates on our cash and long-term debt.
For
additional information, see Note 18 of our unaudited condensed interim consolidated financial statements as of September 30,
2022 and for the three and nine months ended September 30, 2022 and 2021 for a qualitative and quantitative discussion of our exposure
to these market risks.
DISCLOSURE
CONTROLS & PROCEDURES AND INTERNAL CONTROL OVER FINANCIAL REPORTING
Disclosure Controls & Procedures
Management is responsible
for establishing and maintaining a system of disclosure controls and procedures to provide reasonable assurance that all material information
relating to the Company is gathered and reported to senior management, including the Chief Executive Officer (“CEO”)
and the Chief Financial Officer (“CFO”), on a timely basis so that appropriate decisions can be made regarding public
disclosure.
There has been no change in
the Company’s disclosure controls and procedures that occurred during the three and nine months ended September 30, 2022 that
has materially affected, or is reasonably likely to materially affect, the Company’s disclosure controls and procedures.
Internal Controls Over Financial Reporting
Management is also responsible
for establishing and maintaining adequate internal controls over financial reporting (“ICFR”) which is a process designed
to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial reports for external
purposes in accordance with IFRS. In designing such controls, it should be recognized that, due to inherent limitations, any controls,
no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives and may not
prevent or detect misstatements. Additionally, management is required to use judgment in evaluating controls and procedures.
There has been no change in
the Company’s ICFR that occurred during the three and nine months ended September 30, 2022 that has materially affected, or
is reasonably likely to materially affect, the Company’s ICFR.
Share Information
The
Company is authorized to issue an unlimited number of Common Shares and an unlimited number of preferred shares, issuable in series.
As of September 30, 2022, there were 29,436,545 Common Shares (which includes 2,908,665 Common Shares held in escrow in connection
with the Success TMS Acquisition) and nil preferred shares issued and outstanding. In addition, there were 796,334 stock options and 51,307
Lender Warrants, each representing a right to acquire one Common Share, issued and outstanding. ; and the Conversion Instruments issued
to Madryn and certain of its affiliates permit such holders to exchange such Conversion Instruments for up to an aggregate of 2,631,579
Common Shares. As of the date hereof, assuming exercise and exchange of all outstanding options, Lender Warrants and Conversion Instruments,
there would be 32,915,765 Common Shares issued and outstanding on a fully-diluted basis.
Critical Accounting Estimates
There have been no changes
to the Company’s critical accounting estimates and judgements since the fiscal year ended December 31, 2021, except as noted
below.
Going Concern:
We have experienced losses
since inception and has negative cash flow from operating activities of $10.0 million for the nine months ended September 30, 2022
(nine months ended September 30, 2021 – negative cash flow from operating activities of $11.8 million).
On December 31, 2020,
the Company entered into the Oxford Credit Facility. On July 14, 2022, the Company entered the Madryn Credit Facility. Approximately
$15.4 million of the proceeds from the Madryn Credit Facility was used to repay in full the outstanding balance owing under the Oxford Credit Facility and the Company terminated the Oxford Credit Facility effective July 14, 2022. As a result, the Company is no longer required to be in compliance with the financial covenants under the Oxford Credit Agreement
on a go-forward basis. Concurrently,
the Company used approximately $15.1 million of the proceeds from the Madryn Credit Facility to repay various loans previously held by
Success TMS.
Upon closing of the Madryn
Credit Facility, the Company drew a $55 million term loan under the Madryn Credit Facility. In addition, the Madryn Credit Facility permits
the Company to draw up to an additional $20 million in a single draw at any time on or prior to December 31, 2024 for purposes of
funding future mergers and acquisition activity. The terms of the Madryn Credit Facility require the Company to satisfy various financial
covenants including a minimum liquidity and minimum consolidated revenue amounts that become effective on July 14, 2022 and September 30,
2022, respectively. A failure to comply with these covenants, or failure to obtain a waiver for any non-compliance, would result in an
event of default under the Madryn Credit Facility and would allow Madryn to accelerate repayment of the debt, which could materially and
adversely affect the business, results of operations and financial condition of the Company. As at September 30, 2022, the Company
is in compliance with the various financial covenants required under the Madryn Credit Facility.
Although the Company believes
it will become cash flow positive in the future, the timing of this is uncertain. The Company has historically been able to obtain financing
from supportive shareholders and other sources when required as evidenced by the Company securing the Madryn Credit Facility on July 14,
2022.
The condensed interim consolidated
financial statements do not reflect adjustments that would be necessary if the going concern assumptions were not appropriate. If the
going concern basis was not appropriate for the condensed interim consolidated financial statements, then adjustments would be necessary
to the carrying value of assets and liabilities, the reported expenses, and the condensed interim consolidated statements of financial
position classification used, and these adjustments may be material.
Changes
in Significant Accounting Policies
The IASB has issued the following
amendment to the existing standard that will become effective for periods beginning on or after January 1, 2023:
| · | IAS 12, Income Taxes - Deferred Tax related to Assets and Liabilities arising from a Single Transaction,
narrowing the scope for exemption when recognizing deferred taxes. |
The Company is currently assessing
the impact of the pronouncement and does not expect the amendment to the existing standard to have any material impact on the Company’s
consolidated financial statements.
ADDITIONAL INFORMATION
Additional
information relating to the Company, including the Annual Report, is available on SEDAR at www.sedar.com and on EDGAR at www.sec.gov.
The Company’s Common Shares are listed for trading on the Nasdaq under the symbol “GBNH” and on the TSX under the symbol
“GTMS”.
