Assure Neuromonitoring | Investor Presentation
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Disclaimer

Our presentation includes “forward-looking statements” and “forward looking information” as those terms are used within applicable Canadian and United States securities law, that are subject to risks and uncertainties that may result in actual results differing from the statements we make. Certain information included or incorporated by reference in this presentation may contain forward-looking statements. This information may involve known and unknown risks, uncertainties, and other factors which may cause our actual results, performance, or achievements to be materially different from the future results, performance, or achievements expressed or implied by any forward-looking statements. Forward-looking statements, which involve assumptions and describe our future plans, strategies, and expectations, are generally identifiable by use of the words “may,” “will,” “should,” “expect,” “anticipate,” “estimate,” “believe,” “plan,” “intend” or “project” or the negative of these words or other variations on these words or comparable terminology. Certain risks underlying our assumptions are highlighted below; if risks materialize, or if assumptions prove otherwise to be untrue, our results will differ from those suggested by our forward- looking statements and our results and operations may be negatively affected.
Forward-looking statements in this presentation include statements regarding profitability, additional acquisitions, increasing revenue and adjusted EBITDA, continued growth of our business in line with historical growth rates, trends in our industry, financing plans, our anticipated needs for working capital and leveraging our capabilities. Actual events or results may differ materially from those discussed in forward-looking statements. There can be no assurance that the forward-looking statements currently contained in this report will in fact occur. The Company bases its forward-looking statements on information currently available to it. The Company disclaims any intent or obligations to update or revise publicly any forward-looking statements whether as a result of new information, estimates or options, future events or results or otherwise, unless required to do so by law. Forward-looking information reflects current expectations of management regarding future events and operating performance as of the date of this document. Such information involves significant risks and uncertainties, should not be read as guarantees of future performance or results, and will not necessarily be accurate indications of whether or not such results will be achieved. Prospective investors should not place undue reliance on forward- looking information and are cautioned that, except as available on www.SEDAR.com, any information included herein may not be accurate or complete and should not be relied upon. 

To the extent any forward-looking statements contain forecasts or financial outlooks, such information is being provided solely to enable the reader to assess Assure Holdings Corp.’s financial condition and its operational history and experience in the medical industry. Readers are cautioned that this information may not be appropriate for any other purpose, including investment decisions. No representation or warranty of any kind is or can be made with respect to the accuracy or completeness of, and no representation or warranty should be inferred from our projections or the assumptions underlying them.
This presentation does not constitute an offer of securities, and no offer or sale of securities will be conducted in any jurisdiction where such offer or sale is prohibited.
A number of factors could cause actual results to differ materially from the results discussed in forward- looking information, including, without limitation: our need for additional financing and our estimates regarding our capital requirements, future revenues and profitability; if our patient volume or cases do not grow as expected, or decreases, this could impact revenue and profitability; if we are unable to complete transactions with new physician practices, this could impact our future revenue growth and profitability; unfavorable economic conditions could have an adverse effect on our business; risks related to increased leverage resulting from incurring additional debt; the policies of health insurance carriers may affect the amount of revenue the Company receives; our ability to successfully market and sell our products and services; we may be subject to competition and technological risk which may impact the price and amount of services we can sell and the nature of services we can provide; regulatory changes that are unfavorable in the states where our operations are conducted or concentrated; our ability to comply and the cost of compliance with extensive existing regulation and any changes or amendments thereto; changes within the medical industry and third-party reimbursement policies and our estimates of associated timing and costs with the same; risks related to the Company’s reliance on third-party billing and collection companies to appropriately bill healthcare payers and to maximize reimbursement during the collections process; risks related to the Affordable Care Act (the “ACA”) or any replacement legislation in terms of patient volume and reimbursement and the corresponding effect on our business; changes in key United States federal or state laws, rules, and regulations; our ability to establish, maintain and defend intellectual property rights; risks related to United States antitrust regulations; risks related to record keeping and confidentiality by our affiliated physicians; our ability to recruit and retain qualified personnel and other resources to provide our services; 

risks related to any affiliated physicians leaving our affiliated Provider Network Entities (“PNEs”); our ability to enforce non-competition and other restrictive covenants in our agreements; contracts with PNEs, or other customers may be terminated, or may not be renewed, by the counterparty; risks related to corporate practice of medicine and our ability to renew and maintain agreements our contractors; our ability to adequately forecast expansion and the Company’s management of anticipated growth; risks related to our dependence on complex information systems; our senior management has been key to our growth and we may be adversely affected if we are unable to retain them, conflicts of interest develop or we lose any key member of our senior management team; risks associated our dependence on third-party suppliers; changes in the industry and the economy may affect the Company’s business; risks related to the competitive nature of the medical industry; evolving practices and regulation of corporate governance and public disclosure may result in additional corporate expenses; adverse events relating to our product or services could result in risks relating to product liability, medical malpractice, other legal claims, insurance and other liabilities; various risks associated with legal, regulatory or investigative proceedings; risks associated with governmental or other investigations or inquiries into marketing and other business practices; we are subject to health and safety risks within our industry; our ability to successfully identify and complete future transactions and integrate our acquisitions; anti-takeover provisions create risks related to lost opportunities; we may not continue to attract PNEs and other licensed providers to provide our services resulting in slower than expected growth; risks associated with the trading of our common shares on a public marketplace which could result in changes to stock prices unrelated to our performance; risks related to the reduction in the reimbursement of our service procedure codes; changes in our effective income tax rates; risks related to our ability to retain and manage third-party service providers; risks related to the failure of our employees and third-party contractors to appropriately record or document services that they provide; risks that while the primary market for the Company’s common stock is the TSX Venture Exchange and the Company is a “reporting issuer” in Canada, the Company is a Nevada corporation and its principal business is located in the United States, subject to United States federal and state securities laws, there may be uncertainty regarding the application of the federal and state securities laws to the shares of common stock issued in connection with the qualifying transaction with Assure Holdings, Inc. on May 26, 2017; and risks related to criminal or civil sanctions in connection with failure to comply with privacy regulations regarding the use and disclosure of personal identifiable or other patient information.

COMPANY OVERVIEW

  • Assure is a best-in-class provider of outsourced intraoperative neurophysiological monitoring (IONM) and the only publicly traded pure-play IONM company
  • Complemented core business by 1Q’21 launch of telehealth offering for professional neurology services relating to IONM

11

state with operations

9,914

total number of 2020 procedures

191

surgeons we are working with

127

hospitals & medical facilities

80

technologists employed

97%

YoY surgeon retention rate
Assure Neuromonitoring | Investor Presentation
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Assure Neuromonitoring | Investor Presentation
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WHAT IS INTEROPERATIVE NEUROMONITORING (IONM)

WHAT?
The use of electrophysiological methods (EEG, EMG) to observe the functional integrity of neural structures during surgery
WHY?
Provides immediate feedback and warning to a surgeon before occurrence of neurological deficits or permanent injuries Has become standard of care in U.S.
  • American Society of Anesthesiologists recommendation
  • Integration of IONM into medical school curriculum

WHEN?

Spinal & neurosurgeries, vascular, ENT, orthopedic & other invasive surgeries.

  • ~1.4 million IONM procedures in the US in 2019
  • Growth in number of surgeries
  • Expanding geriatric population
  • Increasing prevalence of chronic diseases

HOW IONM
WORKS

TECHNOLOGIST
Highly trained Assure employee is matched with a surgeon and embedded in the operating room team; serves as a direct point of contact to communicate IONM information
TELENEUROLOGY
Telehealth provider serves as professional oversight, supporting the surgeon and technologist by communicating IONM information during the procedure

OPERATIONAL SCALE

While technologists (managing ~200 cases/year) are exclusively focused on monitoring the patient in the operating room, the telehealth provider (managing ~2,500 cases/year) monitors multiple procedures simultaneously.

PAYMENT
Assure bills, collects and keeps 100% of the technical bill; for the professional bill, Assure has begun transitioning teleneurology services in-house to capture a larger proportion of revenue and margin
Assure Neuromonitoring | Investor Presentation
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Assure Neuromonitoring | Investor Presentation
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2021 CORPORATE OBJECTIVES

Expand Scale

  • Number of procedures expected to increase 70%+ in 2021. This will be driven by both organic growth and M&A. Replace comment at bottom of slide with: Assure reached its objective to become a Nasdaq-traded company September 2021.
  • Pursue M&A opportunities in a highly fragmented industry
  • Build out neurologist telemedicine platform
  • Seek facility wide outsourcing agreements

In-Network Agreements

  • Use data and analytics to evangelize the value Assure and IONM provides to payors
  • By end of 2021, bring ~50% of commercial volume into contractual rates with payors
  • Goal by end of 2022 is to directly or indirectly contract with virtually all major payors in each of our markets

Cash Collections

  • Generate positive cash flow for the year in 2021
  • Continue automation and integration of revenue cycle management process that was formerly entirely manual
  • Expand improvements that generated a record ~$24m of total cash collected in 2020 vs. ~$16m in 2019

Clinical Leadership

  • Further leverage our competitive advantages in quality of service to increase visibility and standing within IONM industry and among payors, hospitals and surgeons
  • Become a market leader in IONM clinical research, continue investing in technologist training & development

Registration statement on Form S-1 declared effective and Assure is seeking to uplist to a major U.S. exchange in 2021.

Assure Neuromonitoring | Investor Presentation
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Assure Neuromonitoring | Investor Presentation
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HOW ASSURE SOLVES PROBLEMS FOR ITS STAKEHOLDERS

IONM
INDUSTRY TRENDS

IONM regarded as standard of care for decades

  • Saves healthcare system money
  • Improves patient outcomes

Recognition for reduced surgical complications

  • Increasingly applied to new surgical settings

Demographic tailwinds driving an increase in number

  • 20% growth in U.S. population aged 65+ from 2018-20262
  • Increasing prevalence of chronic disorders

Highly fragmented and chronically undercapitalized industry

  • IONM ripe for industry consolidation including substantial M&A opportunity

1) Allied Market Research, August 2018

2) US Census Bureau

Outsourced U.S. IONM market ~$880M, growing at a ~10.1% CAGR to ~$1.1B by 20221

Insourced U.S. IONM market another ~$850M as roughly half of these services provided by hospital and ambulatory surgery centers

  • Insourced providers increasingly seeking to outsource IONM to improve quality and reduce their costs
Assure Neuromonitoring | Investor Presentation
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Assure Neuromonitoring | Investor Presentation
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INTEROPERATIVE NEUROMONITORING
COMPETITIVE LANDSCAPE

Assure is a physician relationship driven organization providing the highest level of patient care in the industry

ASSURE'S COMPETITIVE ADVANTAGES
VS. INDUSTRY PEERS

Digital Transformation
Assure’s use of analytics, including data warehousing and AI tools strengthens revenue cycle management, operational and financial performance and Company’s ability to support negotiations of new in-network agreements

Integrated Offering
Controlling both aspects of the IONM offering (operating room technologist + telehealth neurology) make ongoing operations more profitable and facilitate new business wins as a low-cost, high-quality provider

High Velocity Collections
Automated internal billing team + in-network agreements have added predictability and transparency to cash flows that industry peers heavily dependent on 3rd party billing providers and overwhelmingly out-of-network are unable to match

Deep Clinical Expertise
Substantial resources devoted to ongoing technologist training to ensure value-add to surgeons, fellowship program developing new talent, and clinical research, thereby increasing standing among payors, hospitals, physicians and in industry

Track Record of Successful M&A
Demonstrated ability to acquire and integrate peers with strong clinical reputations that add meaningful procedure scale at favorable terms; Plugging them into platform leverages strength in revenue cycle management and provision of teleneurology services

Untapped Teleneurology Upside
Expertise in IONM teleneurology will facilitate Assure’s penetration into adjacent markets that require similar expertise and telehealth capabilities including EEG, stroke, epilepsy and sleep studies, among others

Assure Neuromonitoring | Investor Presentation
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Assure Neuromonitoring | Investor Presentation
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DEEP PIPELINE OF GEOGRAPHIC EXPANSION OPPORTUNITIES

  • Expansion into three new states in 2021
  • Extending reach within existing states
  • Numerous M&A opportunities
  • Extending medical device distributor network that has already facilitated expansion into new states
  • Pathway to become premier provider of IONM services for entire facilities
    • Recently awarded systemwide contract to provide IONM services for Premier, Inc., a leading U.S. GPO that includes 4,400 hospitals and 225,000 providers
Assure Neuromonitoring | Investor Presentation
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Assure Neuromonitoring | Investor Presentation
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SUBSTANTIAL INCREASE IN MANAGED CASES

  • Historically, acceleration in total procedures primarily driven by organic growth
  • Despite the COVID-19 pandemic, Assure increased total procedures 54% in 2020
  • Case volume expected to grow to 17,000 cases 2021, including a combination of organic sources and pro-rated impact of the Sentry Neuromonitoring acquisition
  • Current forecast does not incorporate any potential M&A activity that could occur in 2H’21
    other M&A activity
Assure Neuromonitoring | Investor Presentation
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Assure Neuromonitoring | Investor Presentation
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EMERGING TELEMEDICINE OFFERING

Off-site professional neurology services driving emerging telehealth offering1

  • Makes existing operations more valuable by facilitating the capture of additional revenue and margin
  • Adds organic growth and acquisition targets to funnel
  • Controlling of quality of services is a key consideration for
    payors negotiating in-network agreements
  • Strengthens offering as we position to sell directly to hospitals

Reinforces competencies around telehealth, medical data and analytics

  • Enables Assure to offer hospitals, surgeons and insurance payors a more robust and differentiated offering

Substantial market opportunity for teleneurology in IONM with strong potential to serve as a platform for additional and adjacent neurology services

Assure Teleneurology Timeline

SENTRYNEURO ACQUISITION

VALUABLE ASSET

  • Joint Commission certified IONM provider
  • Primarily serves Greater Houston; operational footprint extends within Texas and also includes Kansas and Missouri
  • Sentry performed more than 5,500 IONM procedures in 2020, increasing Assure’s scale in terms of number of procedures by ~50%
  • Generated ~$5m of incremental cash receipts

APPEALING TRANSACTION TERMS

  • $3.5m purchase price ($1.225m in cash and $2.275m in Assure common stock
SIGNIFICANT UPSIDE
Substantial opportunity to:
  • Maximize Sentry’s surgeon relationships to win new business
  • Leverage scale to negotiate new in network agreements with payors
  • Improve Sentry’s future revenue and cash flow on a per procedure basis
Assure Neuromonitoring | Investor Presentation
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FACTORS SUPPORTING IMPROVING
TOP-LINE RESULTS

INCREASING CASE COUNTS & COLLECTIONS

  • In-house revenue cycle management leads to faster and greater cash collections
  • Repeatable surgeon business drives more revenue and increased margins

REVENUE ACCRUAL RATES ADJUSTMENT

  • Properly reflects downward pressure felt across entire IONM industry
  • Linked to recently negotiated in network agreement rates and expected future in-network agreement rates

RECOVERY OF WRITE DOWNS

  • Working toward a resolution of dispute with Louisiana insurer
  • Assure re-billed all reserved 2018 claims
    and anticipates ultimately recovering a meaningful share of these receivables

IN-NETWORK REVENUE CONTRACTS

  • Over 30% of commercial insurance volume is currently supported by in network agreements
  • Seeking to drive ~50% of overall commercial volume into contractual rates with payors by end of 2021

Assure previously relied on a 3rd party billing company which it terminated in late 2019 for: not pursuing claims, waiting months to initiate claims and not following up with insurers As a result, in 2020 Assure reserved a disproportionate number of claims that aged 2+ years.

Assure Neuromonitoring | Investor Presentation
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Assure Neuromonitoring | Investor Presentation
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Assure Neuromonitoring | Investor Presentation
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BALANCE SHEET AND CASH FLOW SUPPORTS GROWTH OBJECTIVES

CAPITALIZATION
Strengthened financial position:

  • $11m credit facility secured with Centurion (Jun ’21)
  • $10.5m private placement with Special Situations Funds and Manchester Management as lead investors (Dec ‘20)
  • Received $1.7m SBA second draw loan; $1.2m SBA loan from CARES Act forgiven
  • $3.4m in non-brokered convertible debenture offerings

CASH FLOW

  • Total cash collections was $23.9m in FY’20 vs.
    $15.9m in FY’19
BALANCE SHEET
JVs with less than a 50% ownership stake are not consolidated, reported in “Equity method investments”:
  • ~$15mm of receivables are off balance sheet and
    relate to minority interest
* Related to convertible debt and private placement issuances
** Will not be issued to the former COO of the Company, but may subsequently be sold by Assure to fund amounts due to the Company from the former COO and to fund income tax withholdings

Seasoned MANAGEMENT TEAM

JOHN PRICE
CFO

  • Various senior executive roles in accounting and finance over 25 years
  • Deeply experienced in compliance, financial reporting as well as mergers & acquisitions

STEPHANIE KROUSE
VP, TECHNOLOGIST MANAGER

  • More than 10 years of IONM experience
  • Leader in industry organizations including ABRET Neurodiagnostic Credentialing and Accreditation

JOHN A. FARLINGER
CPA CA EXECUTIVE CHAIRMAN & CEO

  • 25+ years of technology, operations and capital markets experience
  • Former Chair and CEO of Urban Communications, CEO of Titan Communications and Adzilla
  • Drove multiple corporate exits

ALEX RASMUSSEN
EXEC VP, OPERATIONS

  • Previously served as ops leader for UMB Financial overseeing 350 associates
  • Substantial experience in productivity optimization and customer relations

SEAN BLOSSER
VP, REVENUE CYCLE MGMT.

  • Served as a financial leader at publicly traded and private equity portfolio healthcare organizations
  • Was responsible for $780M in annual revenue and 400 person staff at Option Care Health

PRESTON PARSONS FOUNDER & DIRECTOR

  • Founded, operated and grew various neuromonitoring companies since 2014
  • Former NFL quarterback

Paul Webster
VP, Managed Care

  • 20+ years of experience in out of network billing including as VP, Payor Strategy at Air Methods
  • Strong background in healthcare, regulation, negotiating in network agreements and M&A activity

JEROD POWELL
CHIEF INFORMATION OFFICER

  • 20+ years of experience in cloud computing, digital transformation and process optimization
  • Expertise in data warehousing, cyber security and artificial intelligence

Assure Neuromonitoring | Investor Presentation
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Assure Neuromonitoring | Investor Presentation
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ACCOMPLISHED BOARD OF DIRECTORS

JOHN A. FARLINGER
CPA CA (CHAIR)

  • 25+ years of technology, operations and capital markets experience
  • Former Chair and CEO of Urban Communications, CEO of Titan Communications and Adzilla
  • Drove multiple corporate exits

STEVEN SUMMER

  • Over four decades of management experience in health care
  • Served as president and CEO of the Colorado Hospital Association and before that the West Virginia Hospital Association

ACCOMPLISHED BOARD OF DIRECTORS

MARTIN BURIAN,
CPA CA

  • CPA and Chartered Business Valuator with over 25 years of investment banking experience
  • A director of multiple publicly traded companies

PRESTON PARSONS

  • Founded, operated and grew various neuromonitoring companies since 2014
  • Former NFL quarterback

DR. CHRISTOPHER
RUMANA

  • 20+ years of experience as a board certified neurosurgeon
  • Currently a board member of the Tallahassee Memorial Hospital

JOHN FLOOD

  • 35+ years of capital markets, operations, business building and governance experience
  • Co-founded and served as chairman and managing partner of Craig-Hallum Capital Group

CONTACT US

ASSURE HOLDINGS

COMPANY CONTACT

INVESTOR RELATIONS

Assure Neuromonitoring | Investor Presentation
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