Cuộc họp công bố kết quả kinh doanh Quý 2 năm 2026 của GMR Solutions (GMRS): Tăng trưởng doanh thu và tái khẳng định dự báo

Điểm tin chính

• Doanh thu thuần quý 2/2026 tăng 3,3% so với cùng kỳ năm ngoái lên 1,49 tỷ USD, nhờ sản lượng vận chuyển bằng đường hàng không và cấp cứu đường bộ tăng, cùng với tăng trưởng trên cùng thị trường.
• EBITDA điều chỉnh giảm 11,8% xuống 284,5 triệu USD, với biên lợi nhuận đạt 19,1%. Mức so sánh này đã tính đến khoản giảm 74 triệu USD so với cùng kỳ năm ngoái do các điều chỉnh ước tính doanh thu thuận lợi giảm, chủ yếu liên quan đến các yêu cầu bồi thường cũ theo Đạo luật Không bất ngờ (No Surprises Act).
• Sản lượng vận chuyển bằng đường hàng không tăng 6,9% và vận chuyển cấp cứu đường bộ tăng 2,4%. Vận chuyển phi cấp cứu đường bộ giảm 3,0% do GMR chuyển hướng nguồn lực sang các dịch vụ chăm sóc mức độ cấp bách hơn.
• Chương trình Điều dưỡng Điều phối 911 (911 Nurse Navigation) đã xử lý gần 29.000 cuộc gọi, tăng 50% so với cùng kỳ năm ngoái. Đến cuối quý, chương trình đã bao phủ 29 cộng đồng và 19,7 triệu người.
• GMR tái khẳng định dự báo cả năm với doanh thu từ 5,89 tỷ USD đến 6,18 tỷ USD và EBITDA điều chỉnh từ 1,135 tỷ USD đến 1,195 tỷ USD.
• Tỷ lệ đòn bẩy ròng giảm xuống 3,5 lần từ mức 4,3 lần của một năm trước đó. Ban lãnh đạo kỳ vọng tỷ lệ này sẽ giảm xuống dưới 3,3 lần vào cuối năm và hướng tới mức 3,0 lần trước cuối năm 2027.

Dữ liệu tài chính cốt lõi

Khoản lỗ thuần chủ yếu phản ánh 142,3 triệu USD chi phí liên quan đến IPO và sự đóng góp thấp hơn từ các điều chỉnh ước tính thuận lợi đối với các yêu cầu bồi thường cũ theo Đạo luật Không bất ngờ.

Kết quả hoạt động kinh doanh

GMR đã hoàn thành gần 1,4 triệu lượt tiếp nhận bệnh nhân trong quý 2. Dịch vụ y tế đường bộ đã phục vụ hơn 1,3 triệu bệnh nhân, bao gồm hơn 1 triệu chuyến vận chuyển, gần 29.000 cuộc gọi Điều dưỡng Điều phối 911 và khoảng 280.000 lần can thiệp tại hiện trường không cần vận chuyển. Dịch vụ y tế đường hàng không đã phục vụ hơn 36.000 bệnh nhân.

Doanh thu trên cùng thị trường tăng 53,1 triệu USD, tương đương 3,8%, trong khi doanh thu từ thị trường mới đạt 21,3 triệu USD. GMR cũng ký kết các thỏa thuận mới mang lại hơn 43 triệu USD doanh thu hàng năm bổ sung.

Công ty đã mở hai hệ thống 911 mới tại các thị trường nơi công ty đã vận hành các dịch vụ hàng không. Công ty cũng bổ sung ba căn cứ hàng không, bao gồm hai căn cứ liền kề với các hoạt động hiện có và một căn cứ ở vùng mới.

Điều dưỡng Điều phối 911 tiếp tục là sáng kiến tăng trưởng trọng tâm. GMR đã bổ sung ba cộng đồng tương ứng với 1,3 triệu người được bao phủ trong quý và có kế hoạch triển khai thêm bốn cộng đồng trong thời gian còn lại của năm 2026. Ban lãnh đạo cho biết chương trình này đã điều hướng tới 20% cuộc gọi y tế 911 ở một số thị trường và đưa ra bằng chứng về việc cải thiện biên lợi nhuận khoảng 150 điểm cơ bản ở những nơi chương trình được triển khai.

Transport.net đã được cài đặt tại gần 3.000 điểm tiếp nhận thông tin an toàn công cộng, chiếm hơn 65% số địa điểm như vậy trên toàn quốc. GMR cho biết nền tảng này giúp cải thiện khả năng quan sát và minh bạch trong việc đặt xe, theo dõi và điều phối xe cấp cứu đường bộ lẫn đường hàng không.

Kế hoạch / Dự báo của ban lãnh đạo

GMR tái khẳng định triển vọng cả năm 2026:

Triển vọng này giả định đà tăng trưởng của giá cước và sản lượng vận chuyển tiếp tục được duy trì, cơ cấu bên thanh toán ổn định bao gồm việc hết hạn các khoản trợ cấp trên sàn giao dịch Đạo luật Chăm sóc Sức khỏe Hợp túi tiền (ACA), và các chi phí tiếp diễn liên quan đến xung đột kéo dài tại Iran.

Ban lãnh đạo kỳ vọng việc hết hạn trợ cấp sàn giao dịch sẽ tiếp tục là yếu tố bất lợi làm giảm doanh thu và EBITDA khoảng 15 triệu USD đến 16 triệu USD mỗi quý. Chi phí liên quan đến nhiên liệu dự kiến sẽ tiếp tục cao hơn 10 triệu USD mỗi quý so với giả định kế hoạch ban đầu của công ty, dựa trên đường cong giá dầu kỳ hạn trung bình khoảng 80 USD/thùng trong thời gian còn lại của năm.

Rủi ro và các yếu tố cần theo dõi

Quý này chỉ bao gồm khoảng 5 triệu USD từ các điều chỉnh ước tính thuận lợi liên quan đến Đạo luật Không bất ngờ, so với khoảng 79 triệu USD của một năm trước đó. Ban lãnh đạo kỳ vọng các thay đổi trong tương lai nói chung sẽ nằm trong khoảng từ 0, cộng hoặc trừ 5 triệu USD. Nửa cuối năm 2025 bao gồm các khoản lợi ích ngoài kỳ tương tự trị giá dưới 100 triệu USD một chút, tạo ra một mức so sánh cùng kỳ khó khăn khác cho thời gian còn lại của năm 2026.

Việc hết hạn trợ cấp sàn giao dịch ACA đã khiến một số bệnh nhân chuyển từ bảo hiểm thương mại sang tự chi trả. Ban lãnh đạo cho biết tác động địa lý là khác nhau, với một số bệnh nhân chuyển sang các chương trình thương mại khác và công ty đang tiếp tục đánh giá các phản ứng về giá hợp đồng tiềm năng.

Giá nhiên liệu cao hơn cũng đang ảnh hưởng đến hoạt động của tàu bay, chi phí đi lại của nhân viên, vận chuyển và phụ phí từ nhà cung cấp. Việc giao tàu bay từ một nhà cung cấp đã bị trễ vài tháng, đẩy một số đợt bổ sung theo kế hoạch từ năm 2026 sang năm 2027, mặc dù ban lãnh đạo mô tả sự chậm trễ này là không đáng kể về lâu dài.

Nội dung nổi bật từ phiên Hỏi & Đáp với chuyên gia phân tích

• Đạo luật Không bất ngờ và IDR: Ban lãnh đạo cho biết điều chỉnh ước tính thấp hơn trong quý 2 phản ánh khả năng dự báo doanh thu được cải thiện chứ không phải do hoạt động cốt lõi yếu đi. Phí IDR thấp hơn theo các quy định mới nhất có thể mang lại lợi ích hàng năm khoảng 1 triệu USD đến 2 triệu USD.
• Ký kết hợp đồng với bên thanh toán: GMR ưu tiên các hợp đồng trong mạng lưới với mức chiết khấu khiêm tốn so với phán quyết IDR vì chúng giúp cải thiện việc thu hồi tiền mặt, xử lý yêu cầu bồi thường và tỷ lệ từ chối. Tỷ lệ trong mạng lưới và tỷ lệ hoàn trả đã biết của dịch vụ hàng không kết thúc quý 2 ở mức khoảng 69%.
• Thu hút sản lượng vận chuyển hàng không: Thời tiết tốt hơn ở các khu vực trọng điểm đã hỗ trợ tỷ lệ thu hút cao hơn. GMR cũng đang đầu tư vào tàu bay có khả năng bay theo quy tắc bay bằng thiết bị (IFR), nhân sự và Transport.net để nâng cao tính sẵn sàng và tỷ lệ đáp ứng.
• Mở rộng chương trình Điều dưỡng Điều phối 911: Ban lãnh đạo nhận thấy ba kênh tăng trưởng: mở rộng trong phạm vi hoạt động hiện tại của GMR, các sáng kiến y tế nông thôn và các hợp đồng đô thị lớn. Công ty hiện đang phục vụ 19,7 triệu người được bao phủ và xem 100 triệu người là mục tiêu tiềm năng trong 5 năm.
• Phân bổ vốn: GMR có danh mục gồm khoảng 15 mục tiêu thâu tóm với quy mô khác nhau, nhưng ban lãnh đạo cho biết sẽ xem xét kỹ lưỡng các thương vụ so với lợi ích của việc tiếp tục giảm đòn bẩy và giành được các hợp đồng tự thân.
• Các sáng kiến tối ưu hiệu quả: Công ty đang điều chỉnh việc phân bổ lao động phù hợp với sản lượng và theo đuổi 40 đến 50 sáng kiến liên quan đến AI trong toàn bộ hoạt động và chức năng hậu cần (back-office), dưới sự quản trị tập trung vào lĩnh vực y tế.

Toàn văn biên bản cuộc họp báo cáo kết quả kinh doanh

Toàn văn cuộc gọi công bố kết quả kinh doanh

Phần trình bày của ban lãnh đạo

Operator

Hello everyone, thank you for joining us and welcome to GMR Solutions' Q2 2026 earnings call. After today's prepared remarks, we will host a question-and-answer session. [Operator Instructions] I would now like to turn the conference over to [ Krister Sorensen ], Vice President of Investor Relations. [ Krister ], please go ahead.

Krister Sorensen

Good morning and welcome to the GMR Solutions Q2 2026 Earnings Conference Call. Joining me today are Nick Loporcaro, our Board Chair and CEO; Ted Van Horne, our President and COO; and Brian Tierney, our Executive Vice President and CFO. Before we begin, note that during this call, we may make forward-looking statements, and actual results may differ materially from those statements because of various risks and uncertainties, including those described in our most recent earnings report posted on our investor relations website and in the risk factors section in our IPO prospectus. Today's remarks also include certain non-GAAP financial measures, including adjusted EBITDA, in our earnings release and earnings presentation that is available on our website at investors.globalmedicalresponse.com. Unless otherwise noted, references to the quarter will be for the second quarter of 2026. I will now turn the call over to Nick.

Nicola Loporcaro

Thanks, [ Krister ], and thank you all for joining us today. We are excited to report strong financial and operational results in the second quarter of 2026 that are in line with our expectations. We provide a high-level overview of the quarter. GMR completed nearly 1.4 million patient encounters during the second quarter. We provided ground medical services to over 1.3 million patients, which includes more than 1 million transports, along with 29,000 calls to our 911 Nurse Navigation offering. And the remaining approximately 280,000 ground patient encounters consisted of interventions on scene that did not result in a transport. During the quarter, we provided air medical services to over 36,000 patients.

Q2 revenue was $1.49 billion, which represents 3.3% year-over-year growth. Adjusted EBITDA of $285 million decreased 11.8% year-over-year, with an adjusted EBITDA margin of 19.1%. As mentioned previously, prior year results benefited from favorable revenue estimate adjustments associated with the No Surprises Act-related collections on claims from earlier dates of service. Aside from this comparability impact, you will see that the business delivered strong underlying revenue and operating performance during the quarter that Brian will expand on later in the call. Our strong performance was driven by continued same-market revenue growth, revenue from cross-selling and new markets, disciplined cost management, continued optimization of our clinical and operational platforms, and an unwavering focus on service to our communities by keeping care at the center of what we do. Today marks our second earnings call since the successful completion of our IPO 3 months ago, which was an incredible accomplishment that could not have been possible without the dedication of our frontline and support staff as we refocused our energy on our core competency of emergency care over the past few years. Before Ted and Brian discuss the quarter in more detail, I want to step back and reiterate why we believe GMR is best positioned as a front of the frontline healthcare provider.

As the largest provider of emergency medical services, we serve 5.5 million patients annually, covering markets that represent over 60% of the U.S. population with 1 or more of our solutions. Our more than 24,000 highly trained clinicians and fleet of ambulances and aircraft are rapidly deployed to navigate and provide essential out-of-hospital care for patients when they need us most. Our model is differentiated because it is integrated. We bring together clinical capabilities through air, ground, technology, and care navigation assets in a way that allows us to serve communities, health systems, payers, federal and state agencies, and patients across a broad range of settings. In addition to emergent care, we provide non-emergent care, medical response, and disaster response. We have also maintained a long-standing role as the prime EMS contractor for FEMA, supporting national emergency and disaster response needs. The opportunity in front of us is built around 4 ideas.

Saving and serving lives through clinical excellence. Second, growth across existing and new markets. Third, differentiation through our integrated platform and innovative solutions. And fourth, maintaining sustainable margins through disciplined, operating execution. We operate within a $35 billion total addressable market that includes private providers like us, municipal-run EMS systems, and volunteer programs. The U.S. population is growing as well as aging, and chronic disease prevalence continues to rise. Many rural healthcare facilities face closure or a reduction in service capabilities.

All of this drives an increase in demand for EMS. As the primary provider and connection point to healthcare facilities and the only nationally integrated air and ground ambulance provider across 46 states and Washington, D.C., we believe GMR is best positioned to capture this demand. This positioning gives us a greater access to growth through adjacent markets, cross-selling within existing markets, and through disciplined M&A. And we never stop scrutinizing our existing business to ensure we continue to grow and provide sustainable care to our communities. As the national leader of EMS, this puts us in an exceptional position to be the innovators of the practice and raise the tide for the entire industry. At GMR, we have several systems and solutions, including 911 Nurse Navigation, our Concierge platform, and our online ordering system, Transport.net, that enhance efficiencies across our organization, resulting in the most appropriate care for patients. Our 911 Nurse Navigation connects lower callers with skilled nurses who can guide them to more appropriate sites of care when an ambulance transport is not clinically necessary.

Concierge helps health systems better coordinate discharge and non-emergent transport needs, improve hospital throughput, and create a clear reimbursement framework. Transport.net reduces the effort in requesting, tracking, and dispatching both air and ground ambulance resources. Together, these solutions strengthen our offering, improve resource utilization, enhance patient outcomes, and create a reinforcing flywheel. Our national scale creates clinical data, that data informs innovation, our tools support contract wins, and those wins further reinforce our national scale. Each of these innovations help take the friction out of a traditionally run EMS system and ultimately provide better patient care, more efficient operations, and better hospital throughput while delivering savings to payers in turn. Our scale also enables a large EMS database, currently over 80 million records, that allows us to pair with hospital outcome data to drive system improvements and protocols. This data-driven effort resulted in GMR receiving ESO's Best Use of EMS Data to Improve Outcomes Award at ESO's WAVE Conference in April this year, which is a national gathering for fire, EMS, and hospital professionals. Our performance continues to be driven by the same key ideas. First, saving and serving lives through clinical excellence. Our advanced clinical protocols and rigorous training standards remain the foundation of everything we do, ensuring the highest quality of care in every patient encounter. Second, on growth, we continue to expand in existing markets, enter adjacent and new markets, cross-sell our solutions, and evaluate disciplined M&A opportunities. Third, on differentiation, our integrated air and ground model, supported by innovative technology, allows us to reduce friction in traditional EMS systems and deliver care more efficiently. Fourth, on margins, we continue to scrutinize the markets and contracts in which we operate, emphasizing work that is strategically aligned and economically sustainable.

On the reimbursement front, we applaud the recent introduction of the Reimbursing Emergency Services for Critical Urgent Events or RESCUE Act of 2026 in the U.S. House of Representatives. This bipartisan legislation provides a necessary solution to modernize the Medicare payment structure so emergency medical services are treated similarly to other healthcare providers with payments based on real cost data. Under this approach, Medicare's payment rates will be more transparent, financially responsible, and cost-based, helping to close the financial gap between reimbursement and the cost of services for EMS providers. Achieving this milestone is another example of the recognition we are garnering with lawmakers and the payer community with respect to the necessary services we provide. Ted will now provide more detail on how our initiatives are unfolding operationally. I will now turn it over to Brian, who will provide more detail on the financials.

Edward Van Horne

Thanks, Nick. GMR's operational focus remains clear. Grow our core emergent services, participate in non-emergent services where they make fiscal and strategic sense, and realize efficiency through innovative offerings such as 911 Nurse Navigation, Concierge, and Transport.net. These capabilities give us ways to pair clinical care with better operational decision-making and stronger partnerships across communities and health systems. These reflect a broader principle behind our model. We coordinate care across modalities and geographies as an integrated service. Rather than providing services on a standalone basis, even patients rarely fit neatly into a single mode of care. Care coordination allows us to better match resources to acuity, improve visibility for our partners, and support more efficient operations.

In weather-constrained air markets, for example, the ability to deploy clinical resources across the ground platform reflects the practical value of integration. 911 Nurse Navigation continues to be 1 of our most important examples of innovation in the EMS model. The program connects lower-acuity 911 callers with skilled nurses who can assess the patient's needs and guide them to appropriate care setting or transport modality. This is better for patients, better for crews, better for hospital systems facing emergency department overcrowding, a lower-cost option for payers, and better for communities seeking a more sustainable EMS model. In the second quarter, we navigated nearly 29,000 calls through this program, up 50% year-over-year. In the quarter, we started servicing 3 new communities representing 1.3 million covered lives, bringing our total to 29 communities representing 19.7 million covered lives. And we plan to implement 4 more communities over the remainder of the year. We've seen up to 20% of 911 medical calls diverted to nurse navigation with qualitative benefits, including better alignment of resources to acuity, improved resource utilization, client stickiness, and higher satisfaction for both patients and crews.

For example, during the Spokane wildfires, GMR's 911 Nurse Navigation Program quickly partnered with local emergency response and healthcare teams to connect displaced residents with appropriate care. Within hours, nurse navigators were helping patients access urgent care, telehealth, and community resources, reducing unnecessary emergency department visits while ensuring timely support. This effort demonstrates how 911 Nurse Navigation can rapidly adapt during crisis to improve patient access and support healthcare system capacity. We expect to continue expanding 911 Nurse Navigation in existing 911 markets and using the system as a differentiator in new municipal and health system partnerships. Concierge supports the non-emergent side of the model by partnering with health systems to coordinate appropriate transports under a clear reimbursement structure. This creates a more predictable framework for service that can otherwise be low reimbursing or operationally inefficient. It also supports hospital throughput by helping discharge processes move more efficiently and by reducing friction in scheduled transport workflows.

Transport.net reduces friction in the process of requesting, tracking, and dispatching air and ground ambulance resources. Increasing visibility and simplifying handoffs among access points, health systems, and dispatch teams, the platform enhances the value of our integrated network. We are installed in nearly 3,000 public safety answering points, or PSAPs, across the country, representing over 65% of all PSAPs nationwide. This software reduces dispatch friction, improves visibility, and strengthens partner relationships. For example, in Fredericksburg, Texas, Gillespie County Dispatch serves both the police department and sheriff's office. This is a very busy system. They were an early adopter of the Transport.net ordering technology and now process 100% of their air transport requests through the platform.

Thanks to its ease of use, reliability, and aircraft tracking capabilities, they save valuable minutes on every request, allowing them to focus on other emergencies instead of spending significant time on the phone. Turning to growth, we remain positive about our ability to win new business opportunities in core emergency medical services and expanded municipal ambulance contracting through 911 Nurse Navigation. Our growth strategy is multi-pronged: grow same-market revenue, expand in existing markets and enter new markets, cross-sell our integrated offering, and evaluate disciplined acquisitions where they are financially accretive and strategically aligned. Same-market revenue increased $53.1 million, or 3.8% year-over-year. Market revenue in the quarter was $21.3 million. For new market starts in the quarter, we opened 2 new 911 systems in markets where we already had air operations advancing our integrated market strategy. We also opened 3 new air bases, 2 adjacent to existing operations, expanding our footprint, and 1 in a new region with future growth potential. Also in the quarter, we executed new agreements totaling over $43 million in incremental annualized revenue.

We continue engaging with states and other stakeholders on rural healthcare access and EMS models, including opportunities tied to state-led rural health transformation initiatives under the Rural Healthcare Transformation Fund with our 911 React platform. 911 React provides rural areas with the connection point to care that is desperately needed in these healthcare deserts. While we believe we are the best positioned to help solve rural health issues, we also believe we are the best to provide urban system rescue. Over the Fourth of July weekend, as part of our response capabilities, the State of New York requested 50 ambulances and 110 personnel for the City of New York to supplement the FDNY during what is typically the busiest weekend of the year for local EMS. GMR teams responded to over 2,200 emergency calls throughout all 5 boroughs. This short deployment is just another example of GMR's ability to be the safety net for EMS across the country. Under our event medical operations, we covered 7 of the 11 stadiums hosting FIFA World Cup games, as well as provided coverage for several of the team's practice facilities. We treated over 3,000 patients across the U.S., including about 300 transports and 1 full cardiac arrest resuscitation. I will now turn it over to Brian.

Brian Tierney

Thanks, Ted. In the second quarter of 2026, GMR reported net revenue of $1.49 billion, a 3.3% increase year-over-year. Compared to the same quarter in 2025, Q2 air volumes were up 6.9% due to strong request demand coupled with improved capture rate. Emergent ground transports increased 2.4% driven by strong same-store demand, while non-emergent ground transports decreased 3.0%, reflecting our deliberate strategy of redirecting our resources towards higher acuity responses. As a result, during the quarter, total patient encounters associated with our focus areas of emergent transports and nurse navigation grew 3.7%, while lower reimbursement patient encounters associated with non-emergent wheelchair and non-transports decreased. On margin, our operating discipline remains centered on contract profitability, labor productivity, resource utilization, rate adequacy, and operational efficiency. Following the strategic review process that began in 2022, we have continued to focus the portfolio on core operations and better-performing services, including reviewing, renegotiating, and, where appropriate, exiting contracts that did not meet the return thresholds or strategic requirements.

We also continue to benefit from efficiency initiatives in billing, collections, staffing, fleet utilization, and shared services. Long-term, we believe margin sustainability will be supported by integrated operations, payer relationships, disciplined contract structures, and continued refinement of the independent dispute resolution and other reimbursement processes. Net transport revenue per ambulance transport, or NRT, increased 1.4% compared to the prior year quarter. Revenue performance was driven by a positive mix shift from non-emergent to emergent transports and strong underlying NRT improvement on a like-for-like basis. This was partially offset by an approximate $16 million payer mix shift impact from the expiration of the Affordable Care Act exchange subsidies as patients shifted out of commercial insurance and into self-pay, which was in line with our expectations and was included in our prior guidance. Additionally, the current quarter did not benefit from the same level of favorable changes in revenue estimates recognized in the prior year period, which were largely associated with collections on No Surprises Act claims from earlier dates of service. During the second quarter, changes in estimates predominantly related to No Surprises Act claims were approximately $74 million lower than the prior year period. This creates a meaningful variance in the year-over-year comparison in net revenue per transport, total revenue, and adjusted EBITDA, which was $284.5 million, down 11.8% from the prior year.

Aside from this comparability impact, the business continued to demonstrate strong underlying revenue and operating performance during the quarter. Turning to expenses, total operating expense increased 19.4% to $1.43 billion in the quarter compared to $1.20 billion for the same period in 2025. Employee wages, benefits, and taxes increased by 24.5% to $925 million. The increase year-over-year was primarily driven by increased stock compensation expense of $129.6 million related to the vesting of stock units associated with the execution of the IPO. The remaining increase was primarily driven by improved staffing and normal wage adjustments to attract and retain talent. The average base unit wage increase during the quarter was 3.3%. Maintenance, fuel, and other direct expenses increased by 21.1% to $136.4 million.

The increase was primarily driven by fuel unit costs associated with the Iran conflict and the timing of aircraft maintenance events. We also saw higher-than-normal inflationary costs impact lines that have a direct correlation with the suppliers' underlying fuel costs, including travel and shipping costs. Other operating expenses were generally in line with expectations. As reported, we recognized a net loss of $28.3 million in the quarter compared to net income of $80.8 million in the prior year period. The year-over-year change was primarily driven by $142.3 million of expenses associated with our IPO, as well as the lowered changes in estimates already mentioned related to No Surprises Act claims on older dates of service. Shifting to CapEx, cash flows, and liquidity. Cash used for CapEx and aircraft financing was 6.3% of revenue for the second quarter of 2026, compared to 4.5% of revenue for the second quarter of 2025. The increase was primarily due to the timing of CapEx purchases in both years, as well as our decision to pull forward certain purchases that were planned for later in the year to capture available price discounts.

GMR finished the second quarter with $420.0 million in cash and cash equivalents, and undrawn ABL with $696 million of cash borrowing capacity after letters of credit. Our free cash flow was approximately $15 million. Net leverage finished the quarter at 3.5x, down from 4.3x at the end of 2Q last year. We expect strong cash flows to drive this below 3.3x by year-end and have line of sight to 3.0x before the end of the year in 2027. Shortly after the IPO, Moody's and S&P upgraded our credit ratings from B2 to B1, and B to B+, respectively, triggering a 25-basis-point interest rate step down on our term loan facility. Moving on to guidance, we are reiterating our full year earnings guidance. We continue to expect revenue in the range of $5.89 billion to $6.18 billion.

Our adjusted EBITDA in the range of $1.135 billion to $1.195 billion and total cash used for CapEx and aircraft financing between 5.1% and 5.3% of total revenue. Our guidance assumes continued momentum in transport rates and volumes, a stable payer mix that already reflects the elimination of the ACA exchange subsidies, and the ongoing impact of the prolonged Iran conflict. We had strong demand for and grew our core emergent services. We collected more for those services. Unit wage costs were moderate. We have ample liquidity enabling further deleveraging. And now I will turn it over to the operator to open for any questions.

Operator

We will now begin the question-and-answer session. [Operator Instructions] Your first question comes from the line of Scott Fidel with Goldman Sachs. Please go ahead.

Phần hỏi đáp

Scott Fidel

First question, just was hoping to get maybe a little bit more context to the extent you can provide it just around the IDR dynamics and appreciate the flagging the year-over-year change. Maybe if you could just sort of push that maybe in the context of sort of more of like year-to-date and the first quarter, did you have, I don't recall similar dynamics, but it seems like that was more of a meaningful number in the second quarter of last year. And I think you mentioned having maybe some sort of prior year sort of sweeps and collecting some of those funds and just maybe more broadly just talk about the trends with IDR in terms of how basically the revenues that you're generating from that to the extent you can have been trending year-to-date.

Brian Tierney

Hey Scott, thank you. This is Brian. Yes, last year in the second quarter we had about $79 million worth of change in estimate related to the No Surprises Act stuff. This year was about 5. So that drives that $74 million delta. What that really says is, we've been able to really dial in the estimates. This is all related, the stuff in '25 is really related to stuff much earlier. So feel really good about where our ability to predict the revenue here. Now there's still some older stuff hanging out there.

We will continue to try to go get that really old stuff, but feel that, you know, we're going to be more in this 0 plus or minus 5 range here as we go forward.

Scott Fidel

Okay, got it. And then just for my follow-up question, maybe if you could walk us through just the payer mix dynamics in terms of fully bridging to the year-over-year changes and certainly heard the call out around the impact on the exchanges and would imagine that that certainly had a meaningful amount of it. So should we think about the sort of the lower commercial payer mix year-over-year being largely a function of both the impact from the lower exchange revenue and then combined with the lower IDR revenues that you already recognize, would that largely comprise it? Or just curious if there's anything else that we should be aware of? And then how you're thinking about, you know, payer mix sort of trends within your guidance into the back half of the year. Thanks.

Nicola Loporcaro

Hey Scott, it's Nick. Let me tackle a higher level and then Brian can get in a little more granular. So, you know, when we had our last call, we had said we saw little, if any, impact first quarter. We started seeing some impact in the second quarter in the ACA and I recall mentioning we'd seen that in our own benefits, we had more employees taking on our employer benefit plan. We suspected there that these were folks that were on the exchanges looking for other alternatives. I also mentioned, you know, whether you're on the Gold Plan or the Bronze Plan doesn't make a difference for our types of interventions that we get paid. So we did see some impact in second quarter that Brian can expand on and mention obviously in our call here. So, you know, thinking we still need to better understand it.

Where are these folks? Are they all going to self-pay? Are they all going to different commercial? And we're seeing evidence of that. The other key thing we're learning, and I think it showed up, at least in what I've read on some of the hospital readouts recently, geographically, it's different as well. We have parts of the country where, yes, we'll see more go to self-pay. Other parts of the country that we're finding them now in commercial plans, which is actually an upside for us. So still, you know, thinking about all of this, studying it, learning more and anticipate we'll learn more even this quarter. We'll hand it over to Brian to get a little more granular and tackle some of the numbers around your question.

Brian Tierney

Yes, but it's the short answer. Your question is yes, it's the exchange impact and the No Surprises Act year-over-year comp that really drive the payer mix shift. To expand a little bit more on what Nick said, we're seeing it exactly where we thought we would see it. It's the big exchange providers, the Molinas, the Centenes, few of the bigger Blues that are in the exchange programs. We've seen the decrease in their volumes in the states that they were heavy in. And so it's really, since April, we've seen a very consistent mix shift relative to what we had expected.

And so that we've got that in our guidance as we go forward. We had it in our guidance before, it's still in our guidance.

Nicola Loporcaro

You know, for we'll keep said, we're going to make sure everybody ultimately land consistent here across the common aid make here, you teams as we figure out that we do have some levers to back to the counties. We programs. We can reopen up some of those contracts on pricing. So there are some levers. We haven't flipped them yet because we want to better understand where the impact is.

Operator

Your next question comes from the line of Elizabeth Anderson with Evercore ISI. Please go ahead.

Elizabeth Anderson

I have lots of conceptual questions and maybe 1 numbers cleanup question. If you talk about the improved capture rate as 1 of the nice improvements in the quarter, can you talk a little bit more about that? I know obviously the weather is better in the second quarter than the first quarter, but is that sort of what you're referring to, or is there something more underlying than that that also helped improve the capture rate?

Nicola Loporcaro

Elizabeth and I'll have Ted expand on this. This is Nick. You know, there's a lot of levers here that we're looking at. Some of it's technology, some of it's, you know, recruiting of pilots and medical staff, making sure we have people in the right places, studying trends. You heard Ted mentioned Transport.net and how that drives 1, making sure we understand the demand, where it is, and that we're readily available to capture it. Obviously, weather and even with weather, we've talked about further investments in IFR, which, you know, mitigate some of the weather impacts. But I'll ask Ted to maybe provide a little bit more color around this and the initiatives we're having on the air side.

Edward Van Horne

Yes, and that quarter specific in Q2, the way the weather was impacting the good parts, different parts of geographies for us too. So where we see higher capture rates in certain parts of America, and that's where we're seeing a lot of the weather improvements and we saw the capture rates improve with that also. That was a big chunk of the reason why. And we are going to continue to make all the improvements and investments, this IFR, different types of aircraft. We've been bringing them in from 1 of the vendors specifically at a pretty good click right now. So we're excited about that. We do see the results every time we bring in the IFR aircraft.

Elizabeth Anderson

Great. And my number is a cleanup question, just to make sure that we're modeling your go-forward correctly. One, I heard you say sort of a continuation of high oil price expectations. Is it currently sort of that current rates continue for the rest of the year? So that's the first part of it. And then secondly, obviously the World Cup doesn't happen every year. So the specific World Cup part of the revenue, just to make sure that we're not, you know, comping you off of it for next year.

Brian Tierney

I'll take the second part first. The World Cup was a couple of million dollars, a very low revenue piece, you know, and not all of that flows through to earnings. So it's a very, very small piece. The oil prices on a go-forward basis, we use the forward curve. The average for the rest of the year is about $80 a barrel, a little bit higher in August and September, a little bit lower in November. I think the market is assuming at least for the rest of the year, there's continued Iran conflict with potential for, you know, a little bit relief at the end. We've baked that in going forward.

That's $10-plus million a quarter of incremental fuel relative to what we had initially. Initially we would have done if we were setting a budget or something before the year began. All of that's baked in.

Operator

Your next question comes from the line of Benjamin Rossi with JP Morgan. Please go ahead.

Benjamin Rossi

Just as a follow-up on the IDR comments, by my math during the first half of the year, you've left about $110 million in out-of-period benefits from IDR last year. When we think about the back half of the year, if you were to receive no IDR benefits during 3Q and 4Q, what would this out-of-period comp dynamic look like? Is it fair to think of this step down during the second and a half of the year being similar in magnitude as the first half? Just curious on what that contribution looked like last year during the second half compared to the first half.

Brian Tierney

Yes, thanks, Ben. Yes, the number is about the same. It's just under $100 million was in that second half of the year last year.

Benjamin Rossi

Got it. Okay. I guess just as a follow-up question, the press release, you mentioned some new business wins. Can you just elaborate on those opportunities and how you're thinking about potential contributions from these wins in the back half of the year? Thanks.

Edward Van Horne

We don't get into specifics per contract, but overall the 911 wins both on the ground and air adjacent markets. I think as I mentioned where we had opportunities and air bases and expanding footprint for us when we can operationalize the next town over, the next county over, we get such great operational synergies with it. And then when we link in our transportation, we're actually building in more aircraft into that web for the 911 centers as they're using it. So that's been a big piece of the Q2 on the air side. The ground side was 2 new 911 wins in New Castle, communities that we already had the air. So it was great that we were able to bring in the ground operations, create that integrated market. So those were in the southeast and they're excited because that's we see a lot of that opportunity continue for the rest of the year these small mid-sized communities across the U.S.

Benjamin Rossi

Great. Thanks for the additional details.

Operator

Your next question comes from the line of AJ Rice with UBS. Please go ahead.

Albert Rice

First, maybe just to pursue a little more on your roll out of your 911 Nurse Navigation. How much of your footprint does that address today? And is there an ultimate target of how much of your footprint you can get to and what limiting factor on rolling that out is?

Nicola Loporcaro

AJ, it's Nick. Again, I'll start at a high level and ask Ted to offer up some more details if I miss anything here. So, you know, we're probably 29 communities today of coverage representing just shy of 20 million covered lives. And I think you'll recall, and we talked about in our presentations, we have approximately 200 million lives in the geographies that we serve. So that's the potential. I think as the CEO and pushing the team, as you look at our sort of a 5-year plan, could we potentially get the 100 million covered lives? I think that's realistic. I think we have plans in place. Now, what does that mean for the impact of the business? You know, you've all challenged us before on what is NurseNav and its worth.

It allows us to run our business better. It allows us to win more business because of the value. And just real interesting, actually, in a session we had yesterday, we have evidence of where we put in NurseNav, and Brian can speak to the numbers here, on 150-basis-point lift on just margin improvement in the markets we put it in. But what's even more interesting, what we're learning, when we have nurse navigation combined with like a treat, no transport, we're actually making better reimbursement on that versus a basic life support transport. And that's the dynamic that's important. And the reason you'll continue to talk about NurseNav, the push of it and the proliferation and how it positions us in the markets where we're deploying. Ted, I don't know if you'd offer up any other detail on that.

Edward Van Horne

For us, the NurseNav really is 3 distinct growth channels. One is our existing footprint, which you mentioned, and we can continue to spread that out in multiple ways over the course of each year. You know, we're going to keep growing those out. The second channel is the Rural Health Transformation Fund and the new bids there as we're proposing that across the U.S. And the third channel is the big Metro models, right? We're working the nurse navigation in with the very large municipal city bids. Those take a little bit longer on the sales cycle, obviously, because they're very big municipalities, but when we have a great, sales team is working very closely with each 1 of those cities as they walk through that, you know, those proposals. So, you know, that's how we see those 3 distinct cycles. Each 1 has got a lot of room in it and we're excited because we've just opened up the second center in Phoenix.

So we've got a lot of capacity and room to grow. We've thought Phoenix, both Phoenix and here in the Dallas area, being able to get the nurses. And so we continue to grow that, the actual nurses taking the call. So we're ready for it on the technology side, space side, and continue to grow it.

Albert Rice

Okay, thanks. Maybe the follow-up. You mentioned on the prepared remarks, you'd be at 3.3x leverage by the end of the year, 3.0x by the end of next year. Is sort of 3.0x a steady state that you're comfortable with? And then if it is, it sounds like there are some potential deals out there. Can you categorize what you're seeing, what kind of things you might be interested in doing, and how – what kind of valuations are they going to be potentially immediately accretive to you if you can do some things?

Nicola Loporcaro

So AJ, I'm going to start backwards with your question. We had hoped and anticipated post the IPO, we would have some arbitrage opportunities. Admittedly, with where we're trading and where the market is evaluating things, I think that's created a bit of conservatism around the pipeline. We do have a healthy pipeline. We've probably got about 15 targets from some small mid-size to some larges. And ultimately, and I lean on Brian and the team here on, how do we best leverage our capital? To go now to the front end of your question, are we better focusing on de-levering for the time being? We're going to be, you know, we're going to scrutinize the M&A opportunities. There's a couple of opportunities in adjacent markets where we have to ask ourselves the question, can we just win the business? Is it quicker to buy it? You know, we've mentioned to you guys in the past, we're going to look at a market that has strong ground presence.

Do we buy an air asset there? So that's how we're looking at it. I think, as you said in the prepared remarks, you know, this is a conversation Brian and I and the teams have often is where are the opportunities now? Are we, we constantly look at our current rates, is de-levering combined with some of that in our best interest? So there'll be more news coming along those lines in probably pretty short order.

Albert Rice

Okay, thanks.

Operator

Your next question comes from the line of Joanna Gajuk with Bank of America. Please go ahead.

Unknown Analyst

So actually have a 2-part question on the IDR process. First about the final regulation that came out, a call for lower fee per claim going to an arbitration, but there's some other changes in there. So just curious, how do you expect the threat, if at all, to impact your IDR process and your experience there? And the second part, we heard from the health plan industry lobby groups. They've been very vocal. They clearly call for some changes to the IDR process together. They complain about the number of claims, the rates that providers get awarded. So what are your thoughts about potential changes to the IDR process?

Nicola Loporcaro

Joanna, let me hit the second part of your question. I'm going to hand it over to Brian. On the second part, we understand the health plans are pushing back on the volume. Our belief is a lot of that has less to do with us on the EMS side of the business and more on what they're getting from other provider groups. That's our assessment of a lot of that. As Brian has mentioned in the past, and he can provide an update, we continue to bring some of the larger plans in network. We have great collaboration with them and we see that continuing.

Now, honestly, we have our own concerns on how the plans behave on some of them and some pushback and have been winning some of those arguments as well. But I'll hand it over to Brian to tackle the first part of your question.

Brian Tierney

Yes, let me just hit quickly on the second part as well. We continue to have really good conversations with a number of large payers to get them in network. You've also got some large payers that really have no interest in getting to a reasonable rate and term environment. And so that group, we will continue to have to beat them in IDR. I'd rather have them all in network. But it takes 2 to get to there. On the first part, I think we appreciated the ruling or new rules from the government on how the IDR process will work.

I think it really cleaned up a little bit, didn't have really much impact to us from an overall perspective. We do appreciate the lower fees, that's a slight tailwind for us, in the very, very low millions of dollars range of $1 million, $2 million for on an annual basis. So nothing material, but we think, you know, the administration coming out and kind of reaffirming the current process was very helpful. It would take Congress to reopen the process to do something different. So until that happens, if that happens, we'll just continue to work to get everybody in network. And if not, we will continue to work to beat them in IDR.

Unknown Analyst

Thank you. And if I might, just a follow-up on the commentary around the subsidy expiration impact in the quarter. So, should we assume a similar amount, you know, per quarter going forward? Sort of, you know, $60 million. And just to clarify, that was the EBITDA type headwind you referred to?

Brian Tierney

Yes, it's both revenue and EBITDA. And that's, yes, that's what's in our guidance going forward is about that $15 million, $16 million a quarter.

Operator

Your next question comes from the line of Andrew Mok with Barclays. Please go ahead.

Andrew Mok

I think air bases increased pretty meaningfully in the quarter. I think it's up 10 or so. Do I have that right? So what drove that level of accelerated expansion? And was that all planned or is that a result of newer unexpected wins? And just how should we think about the pace of air base expansion for the balance of the year?

Brian Tierney

Yes, I know. I think we were up 3 or 4 bases in the quarter. And as we go forward, we do have a lot of questions. We do have a large number of aircraft coming really over the next couple of years. We will, we've got a number of them. I don't know the exact count. It's in the high single digits for the remainder of the year. It's actually down a little bit from what we would have projected at the beginning of the year.

We've got 1 of our aircraft suppliers is just a little bit late with some of their deliveries. So we're seeing a few aircraft push out of '26 and into '27 than by a couple of months. It's not material or meaningful, and it'll all catch up in the long term, but yes.

Edward Van Horne

We're not at 10, but we do have good air base growth going forward. To your question about plan, these aircrafts that Brian's mentioning are all tied to contracts as well. So they are planned. As they come in, they'll be deployed.

Andrew Mok

Got it. Okay. And then just a follow-up on the IDR side. Can you share where your in-network race stand today and just the progress you've been able to make with this IDR backdrop developing more negatively against the insurers?

Brian Tierney

Yes, so yes, we get higher rates through the IDR process than we are willing to take in-network. I'd rather have them in-network and we'll take a discount because the whole process is easier. The cash is faster. With the right partners you can get better terms so you've got your claims flow through the process a lot easier. Again, I'd rather have them in network at a little bit of a discount relative to what we're winning in IDR and the contracts that we're signing, you know, they are just below our IDR rates.

Nicola Loporcaro

We've gotten, we continue to make progress with, with those groups. Andrew, the other thing, there's 2 reasons on, you know, the obvious on why we don't want to mention the rate is for competitive reasons. The other thing is, you know, I think we've walked through this before as well. What we find is when we're bringing folks in network, we see a drop in medical necessity denials and we see a drop in the DSO. So there's a lot of other aspects. So the rate difference, I think we more than make up for as we bring them in network. So we kind of hesitate on putting that out there because, honestly, I think it's a much better deal to bring them in-network, even though the sticker price looks a little different, we more than make up for it.

Andrew Mok

Right. And maybe I should phrase it better. I was looking for the rates themselves, just kind of what percentage of your contracts are in network today? What progress have you made and where do you see that going?

Nicola Loporcaro

Hovering around the 70%. I think if we drill down, we're like at 69%, but I keep waiting for Brian to tell me the next big 1 that's just about to be signed.

Brian Tierney

I bet a number in the hopper. And remember, this is just an air conversation, right? All of the ground in network, out of network is not there, not the same concept. So that 69% is where we landed the second quarter for in-network and known reimbursement.

Operator

Your next question comes from the line of Craig Hettenbach with Morgan Stanley. Please go ahead.

Craig Hettenbach

But the implied second half guidance, can you just touch on kind of volume expectations, ground and air, like any noticeable changes in the market that you're seeing relative to first half?

Edward Van Horne

Yes, I mean, we're for us how we are expecting to roll out our new base growth for second half is what we're still projecting and what you kind of see in the guidance. So we've worked through that. So we've got not only our new bases, but then any of the starts. So that's all projected. We do still see and always manage in and what weather impacts are happening, some of the fire activity that happens across the U.S., obviously from an air standpoint, sometimes cause some weather behavior, believe it or not, and ability to fly out West. So we're watching all that through the course of the year, but what you see on the forecast and how we plan that out is on the base expectations of aircraft coming in and the base starts that we've got working in.

Craig Hettenbach

Got it. And then just to follow up with Brian, you talked about just some operating efficiencies. Can you just touch on some of the key drivers there and maybe expand on ways you're using technology to help expand margins over time?

Brian Tierney

Yes, well, I think from an operation deficiencies, we continue to match our labor to our volume. And so, you know, in markets where we've got stronger volume, right, it's not always a 1 for 1 that you've got to add incremental labor costs. We can do that. But then also is as the if we've got a market where maybe the volume is down a little bit, the operations do a really good job of trying to manage the staff to that level. Yes, we're always looking for efficiencies across the back office. We've got 40 or 50 different AI-related initiatives, some of them bigger, some of them smaller, that just help drive the efficiencies that we should get out of our system. We should be better today than we were yesterday and a little better tomorrow than we are today. A little bit of incremental improvement all the time, ultimately adds up. We've got folks that are always focused on making sure we're spending the right amounts out of our procurement teams and so on.

So it's really a culture and a focus for us just to make sure that we're being as efficient as we can.

Nicola Loporcaro

Yes, and I would add to the 2 things. One, we often talk about our scale. And 1 of the things that we've gotten really good at and still more room to get better at is how do we get better alignment across the whole organization? I often quote my friend Pareto, you know, the 80% that's similar across our platform, we're getting really good at leveraging best practices, better alignment, standardization across the platform with leaving that 20% of the local flavor and intervention that we need to. So we're seeing a lot of that on the operations side. Just to lean on the AI implementations, 1, we have an AI governance committee we're very sensitive to in healthcare, but not to sound too cliche, our North Star remains and our effort remains patient care. And how do we continue to optimize the time that our providers spend with hands-on patient? That's always our focus, going into any deployment of technology innovation. And we really believe if we do that right, we'll see the efficiencies as well in the system as we're providing better care.

Operator

Your next question comes from the line of Daniel Grosslight with Citi. Please go ahead.

Unknown Analyst

Hey, this is Luis for Daniel. Guidance does contemplate steps on the EBITDA margins in the back end of the year relative to 2Q. And I know that you're rolling out some ground 911 contracts, which should benefit an NRT. So my question is, what is driving the margin compression in the back end?

Brian Tierney

Thanks, Daniel. I think a little bit if you're comparing first half to second half. I think as we mentioned in the first quarter, we really didn't see the exchange impact that we saw really start in the second quarter that will continue through the rest of the year. Probably another driver of that is really just the whole Iran conflict-related costs fuels really until the latter part of really seen that, you know, $10-plus million a quarter really run through, you know, the P&L and then we've seen quite call it Iran conflict-related costs pop up across the P&L in small ways. Our airfare for moving crews around is up. Shipping costs, fuel costs. All of those are just add a little bit more to the back half of the year. I got a new 1 yesterday, fuel surcharges on office supply delivery. So making sure that we're minimizing the deliveries.

It's that kind of thing that I think will impact the back half of the year, but feel good about our guidance and the range that we've got out there.

Operator

We have reached the end of the Q&A session. I would now like to turn the call back to Nick Loporcaro for closing remarks. Please go ahead.

Nicola Loporcaro

Thank you again for joining our call today. The second quarter reinforces our confidence in GMR's strategy and execution. Underlying performance was strong, our mix continues to shift toward higher-yielding services, nurse navigation is scaling, and our liquidity position remains strong. We are proud of the role GMR plays across the EMS system from major events to disaster response to everyday care in the communities we serve. None of this would be possible without our exceptional frontline clinicians, pilots, mechanics, dispatchers, support personnel, and regional leaders. They keep care at the center every day, and I want to thank them for their commitment to patients, partners, and communities. Thank you for your continued support, and have a wonderful day.

Operator

This concludes today's call. Thank you for attending. You may now disconnect.