GMRS

• Strategic Positioning & Core Strategy

  • GMR is the largest U.S. integrated air and ground EMS provider, operating across 46 states and Washington D.C., serving 5.5 million patients annually and covering 60% of the U.S. population, operating in a $35 billion total addressable market.
  • The company's four core strategic priorities are: saving lives through clinical excellence, growth across existing and new markets, differentiation via an integrated innovative platform, and maintaining sustainable margins through disciplined execution.
  • Long-term demand growth is driven by an aging, growing U.S. population, rising chronic disease prevalence, and rural healthcare facility closures increasing need for outsourced EMS services.

• Innovative Platform & Service Expansion

  • 911 Nurse Navigation: This program diverts lower-acuity 911 callers to appropriate non-ambulance care settings, improving resource utilization, reducing hospital overcrowding, and lowering costs for payers. In Q2 2026, the program handled nearly 29,000 calls, up 50% year-over-year, expanding to 29 communities covering 19.7 million covered lives (up 3 new communities with 1.3 million covered lives in the quarter). The program delivers up to 150 basis points of margin improvement in markets where it is deployed, with 20% of 911 calls diverted in high-adoption areas. Four additional community deployments are planned for the remainder of 2026.
  • Concierge: This non-emergent service coordinates patient discharge and scheduled transports for health systems, improving hospital throughput and creating stable reimbursement for low-margin non-emergent work.
  • Transport.net: This digital ordering and dispatch platform is installed at nearly 3,000 public safety answering points (65% of all U.S. PSAPs), reducing dispatch friction, improving visibility, and cutting response time for air and ground requests.

• Operational Growth & Execution

  • Same-market revenue grew 3.8% year-over-year ($53.1 million) in Q2, with new market revenue totaling $21.3 million. The company secured $43 million in incremental annualized revenue from new agreements in the quarter.
  • Opened two new 911 ground systems in markets with existing air operations (advancing integrated market strategy) and three new air bases (two adjacent to existing operations, one in a new region for future growth).
  • Demonstrated national surge capacity: Supplemented FDNY with 50 ambulances and 110 personnel over the 2026 4th of July weekend, responding to over 2,200 calls, and provided medical coverage for 7 of 11 FIFA World Cup 2026 host stadiums, treating over 3,000 patients.

• Management reaffirmed all full-year 2026 guidance, maintaining prior ranges with no upward or downward revision
  • Full-year 2026 revenue is expected between $5.89 billion and $6.18 billion
  • Full-year 2026 adjusted EBITDA is expected between $1.135 billion and $1.195 billion
  • Total cash used for CapEx and aircraft financing is expected to be between 5.1% and 5.3% of total revenue
• Guidance already incorporates expected impacts from the expiration of Affordable Care Act exchange subsidies (the $16 million quarterly payer mix headwind is baked into full-year projections), sustained higher fuel costs related to the ongoing Iran conflict, and current volume and rate momentum
• Net leverage is expected to fall below 3.5x (reported at 3.5x at end-Q2 2026, down from 4.3x at end-Q2 2025) to below 3.3x by the end of 2026, with a target of 3.0x by the end of 2027

GMR Solutions reports two core service segments: air medical services and ground emergency medical services, plus additional value-added offerings. For Q2 2026, total company net revenue was $1.49 billion, a 3.3% year-over-year increase. Air medical services saw 6.9% year-over-year volume growth, driven by strong demand and improved capture rates, contributing approximately 30-35% of total revenue. Emergent ground transport volumes increased 2.4% year-over-year driven by same-store demand, while non-emergent ground transports intentionally decreased 3.0% as the company redirects resources to higher-acuity, higher-reimbursement work. Total patient encounters for core emergent and nurse navigation services grew 3.7% year-over-year, while lower-reimbursement non-emergent encounters declined. Adjusted EBITDA for the whole company was $284.5 million, an 11.8% year-over-year decrease, with an adjusted EBITDA margin of 19.1%. The year-over-year decline was driven primarily by a $74 million reduction in favorable prior-period revenue estimate adjustments related to No Surprises Act claims, which benefited Q2 2025 results.

• Payer mix risk: Expiration of ACA exchange subsidies has shifted some patients from commercial insurance to self-pay, creating a $16 million quarterly headwind to revenue and EBITDA, with geographic variation in the magnitude of impact that is still being assessed
• Geopolitical and inflation risk: The ongoing Iran conflict has driven higher fuel costs, as well as broader inflationary increases in related costs including crew travel, shipping, and supplier fuel surcharges that increase operating expenses
• Reimbursement and regulatory risk: Ongoing lobbying by health plan groups seeking changes to the Independent Dispute Resolution (IDR) process established under the No Surprises Act creates uncertainty around future reimbursement levels for out-of-network claims
• Operational risk: Weather and wildfire activity, particularly in western U.S. markets, can disrupt air medical operations and impact capture rates and volume

Q: What are the current trends in IDR (No Surprises Act) revenue adjustments, and how will the year-over-year comparative impact play out in the second half of 2026? / A: Last year's Q2 had $79 million in favorable out-of-period estimate adjustments for older No Surprises Act claims, while Q2 2026 only had $5 million in such adjustments. Management has refined its estimation ability, and future adjustments are expected to stay in a narrow range around zero (plus or minus $5 million). Last year's second half had just under $100 million in total out-of-period benefits, similar to the first half of 2025, so the comparative step-down impact will be similar magnitude in H2 2026 as it was in H2 2026.

Q: What is driving improved air service capture rates, and what is the planned pace of air base expansion for the rest of the year? / A: Q2 2026 had better weather across most markets than the prior quarter, which was the main driver of improved capture rates. Underlying initiatives including adding IFR-capable aircraft (which mitigate weather-related cancellations), investments in recruiting pilots and clinical staff, and the transport.net platform also support improved capture over time. Three new air bases were added in Q2, not 10 as some had modeled. A small number of aircraft deliveries are pushed from 2026 to 2027, which is not material, and all expansion is tied to signed contracts so the pace remains consistent with prior plans.

Q: What is the current 911 nurse navigation footprint, what is the long-term target, and what is management's approach to M&A after the IPO? / A: Nurse navigation currently covers 29 communities with 19.7 million covered lives, and has significant room to expand across three categories of opportunities: existing markets, new municipal contracts, and new health system partnerships. GMR has added nurse navigation capacity with a new second hub in Phoenix and is ready to scale. GMR has a pipeline of ~15 potential M&A targets ranging from small to large, but current market valuations and GMR's stock price have made management more cautious. Management is prioritizing deleveraging to the 3.0x net leverage target first, and will only pursue accretive, strategically aligned deals especially those that add adjacent capabilities or expand scale in existing integrated markets.

Q: What percentage of air revenue is currently in-network, and what are the benefits of in-network contracts relative to IDR? / A: Approximately 69% of air revenue is in-network as of Q2 2026, with additional large contracts pending. GMR accepts in-network rates that are slightly below average IDR award levels, because in-network contracts deliver significant non-price benefits: faster payments, fewer medical necessity denials, and lower administrative friction, which more than offset the lower stated rate. GMR continues to work to bring more large payers in-network, but will continue to use IDR for payers that will not agree to reasonable in-network rates.