Could you quantify the dollar impact of higher fuel prices in Q1 versus budgeted expectations and explain how fuel procurement mechanics flow through the P&L?

Brian Tierney stated a $3 million impact in March due to the Iran conflict, with full-year guidance incorporating $25M-$30M based on $98 WTI. He explained that roughly half of fuel expense is commodity-price related, representing about 1% of total revenue, with the other half being distribution costs. “It was about $3 million total for March based on what flowed through the P&L. As we look forward within our guidance, we've used the latest -- what we used at the time was about -- WTI was about $98... it added about $25 million or $30 million to the P&L from an expense perspective as well.”

Regarding the $7 million IDR impact, will that magnitude be similar in future quarters for 2026?

Brian Tierney clarified that the $7 million was a decrease in collections from *older* dates of service compared to prior year, and that the magnitude of this delta was 50%-100% higher in Q2-Q4 2025. He noted that most old IDR collections were cleared in 2025, and they are now back to a normal IDR collection cycle. “So we saw a little bit more of the collections from the early dates of service related to IDR really hit across second, third and fourth quarter. So it will be probably in order of magnitude, maybe 50% to 100% higher than what we saw in the first quarter from a delta perspective.”

Does the IDR impetus mean more commercial payers will come in-network, and are you still seeing interest given your high win rates?

Management confirmed continued efforts to bring payers in-network, having signed an agreement with their largest out-of-network payer in Q1, which is expected to reduce IDR adjudications by 12%. They aim for nearly 70% in-network for commercial air transports and leverage their over 90% IDR win rate in negotiations. “During the quarter, effective February 1, we signed an agreement that brought our largest out-of-network payer in-network at reasonable rates and terms, which is expected to reduce our IDR adjudications by roughly 12%. This helps bring the percentage of our commercial air transports that are in network to nearly 70%.”

GMRS

GMR Solutions (GMRS) Q1 FY26 earnings call: guidance and Q&A

Earnings call· Mar 2026 (Q1 FY26)· Health Care· Jun 2, 2026

Source: earnings call transcript

Executive summary

GMR Solutions Q1 FY26 — Strong Revenue and EBITDA Growth Driven by Emergent Services and Operational Efficiency

GMR Solutions delivered robust Q1 FY26 results, showcasing strong revenue and adjusted EBITDA growth, primarily fueled by increased emergent transports and enhanced operational efficiency. The company successfully navigated its post-IPO financial restructuring, significantly reducing financing costs, while strategically expanding its innovative 911 Nurse Navigation program. Management remains confident in its full-year outlook despite anticipated payer mix shifts and rising fuel costs.

Highlights

Q1 revenues reached $1.46 billion, marking a 6.6% year-over-year growth, reflecting strong demand for mission-critical services.
Adjusted EBITDA grew 9.7% year-over-year to $305 million, with EBITDA margin expanding by 59 basis points to 20.9%.
Net income increased 179.9% to $106.3 million, driven by strong operational performance and reduced interest expense.
Successfully reduced annualized financing costs by over $125 million through debt reduction and preferred equity redemption post-IPO.
911 Nurse Navigation solution expanded to 29 communities, with 13 more in implementation, leading to a 47% increase in navigated calls and a 15% reduction in dry runs.

Concerns

The proposed CMS rule on state-directed payments could result in a less than $5 million negative annual impact to GMR.
Expected degradation in payer mix by volume due to the One Big Beautiful Bill Act and ACA exchange subsidy elimination, impacting guidance by $25 million to $30 million for the remaining 9 months of FY26.
Increased fuel costs due to the Iran conflict added approximately $3 million to expenses in March and are factored into higher full-year guidance.
Insurance expense increased by $9.3 million or 27.6% due to higher professional liability claims and third-party premiums.

Guidance & targets

Category	Target	Timeline	Confidence
Full-year 2026 Revenue	$5.89 billion to $6.18 billion high materiality	FY26 · 2026	High
Full-year 2026 Adjusted EBITDA	$1.135 billion to $1.195 billion high materiality	FY26 · 2026	High
Full-year 2026 Cash used for CapEx and aircraft financing as % of total revenue	5.1% and 5.3% medium materiality	FY26 · 2026	High
Long-term Top-line Revenue Growth	mid-single-digit plus high materiality	Long-term	High
Long-term Adjusted EBITDA Growth	high single-digit plus high materiality	Long-term	High
Long-term Adjusted EBITDA Margins	around 20% high materiality	Long-term	High
Long-term Cash for CapEx and aircraft financing as % of revenue	just above 5% medium materiality	Long-term	High
Net Leverage	below 3.3x high materiality	Year-end 2026	High
Net Leverage	3.0x high materiality	FY27 · 2027	High

Segment performance

Segment	Revenue	YoY	QoQ	Margin
Ground Medical Services Includes transports and 911 Nurse Navigation calls. Emergent ground services showed growth, while lower-reimbursing non-emergent and wheelchair transports significantly decreased, aligning with the focus on core emergent services. Patients: 1.3 millionTransports: 1 million911 Nurse Navigation calls: 28,000Same market emergent ground growth: 0.5%Patient encounters not resulting in transport decrease: 0.8%Lower reimbursing non-emergent patient encounters decrease: 7.2%Wheelchair patient encounters decrease: 52.8%	—	—	—	—
Air Medical Services Emergent flights demonstrated growth, supported by a lower weather cancellation rate and improved capture rate, despite a slight decrease in overall emergent air requests. Patients: 34,000Same market emergent flights growth: 1.9%Weather cancellation rate: 17.1%Weather cancellation rate decrease YoY: 81 bpsWeather cancellation rate decrease vs 3-year average: 220 bpsOverall emergent air requests decrease: 0.8%Capture rate: 45.1%Capture rate increase: 87 bps	—	—	—	—

GMRS operating KPIs by quarter

GMRS operating KPIs stated on its earnings calls, by fiscal quarter
KPI	This call Mar 2026 Q1 FY26	Jun 2026 Q2 FY26	Change vs prior quarter
Patients Ground medical services	1.3M+ We provided ground medical services to over 1.3 million patients, which includes more than 1 million transports, along with over 28,000 calls through our 911 Nurse Navigation offer. Source: earnings call transcript	1.3M+ 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. Source: earnings call transcript	—
Patients Air Medical Services	34K+ During the quarter, we provided Air Medical Services to over 34,000 patients. Source: earnings call transcript	36K+ During the quarter, we provided air medical services to over 36,000 patients. Source: earnings call transcript	—

Operating figures the company stated on at least two of the calls shown, checked against each call's transcript. Click a figure to read the sentence. A dash means it was not stated that quarter.

Deals & partnerships

Largest out-of-network payer Customer contract

Agreement signed effective February 1, 2026, bringing the largest out-of-network payer in-network at reasonable rates and terms.

Risks & headwinds

Proposed CMS rule on state-directed payments Annual

Less than $5 million negative annual impact

Mitigation:Evaluating potential impacts, potential for share gains from municipal providers.

Degraded payer mix from One Big Beautiful Bill Act and ACA exchange subsidies Remaining 9 months of FY26

$25 million to $30 million impact

Mitigation:Factored into guidance; closely monitoring payer mix.

Higher fuel costs due to Iran conflict Q1 2026 and full year 2026

$3 million impact in March; $25 million to $30 million for full year guidance

Mitigation:Factored into guidance; considering fuel hedging as a potential option.

Increased insurance expense Q1 2026

$9.3 million or 27.6% increase to $43 million

Mitigation:Driven by increased professional liability-related claims and third-party premium expenses.

Q&A highlights

Can you unpack the ACA attrition impact experienced in Q1, detail benefits from ACA-related volumes in 2025, and what's factored into 2026 guidance for ACA volumes?

Management noted minimal ACA impact in Q1 but anticipates a $25M-$30M headwind for the remaining 9 months of FY26 due to payer mix degradation from the One Big Beautiful Bill Act and ACA exchange subsidy elimination, observing a 1% mix shift out of commercial in April. They clarified that 2025 did not see significant movement.

“Total exchange and One Big Beautiful Bill Act impact that's in our guidance for the year, really for the last 9 months, is in that $25 million to $30 million total range.”

asked by Benjamin Rossi · answered by Brian Tierney

2 min read 6 chapters

Detailed narrative

IPO and Strategic Focus

GMR Solutions successfully completed its IPO, marking a significant milestone after refocusing on emergency care, which led to increased profitability and a strengthened financial profile. The company emphasizes its role as the 'front line of the front line' in healthcare, serving 5.5 million patients annually across over 60% of the U.S. population.

This strategic shift has positioned GMR to publicly demonstrate the value of EMS as a critical healthcare service.

Operational Innovations and Expansion

The company highlighted its innovative offerings, including 911 Nurse Navigation, Concierge Platform, and Transport.NET, designed to streamline EMS systems and improve patient care. The 911 Nurse Navigation program, which aims to reduce dry runs and inappropriate transports, expanded to 29 communities with 13 more in implementation, resulting in a 47% increase in navigated calls year-over-year and a 15% reduction in dry runs in historical markets.

Regulatory Landscape and Advocacy

GMR is actively engaging with Congress to advocate for modernized air and ground ambulance reimbursement from CMS based on cost data. The company also discussed a proposed CMS rule on state-directed payments, which could limit Medicaid payments to 100%-110% of Medicare rates for targeted provider groups.

While this rule is estimated to have a less than $5 million negative annual impact, management sees potential for market share gains from municipal providers who may face increased pressure.

Payer Mix Dynamics and Collections

The company reported a Q1 FY26 payer mix by net transport revenue of 57% commercial, 25% Medicare, 9% Medicaid, 7% other, and 2% self-pay, showing a positive mix shift towards emergent transports. While IDR-related collections from older dates of service decreased by $24 million year-over-year, GMR benefited from $16 million in collections related to California's state surprise medical billing legislation.

The company's high IDR win rate (over 90%) is leveraged in renegotiating expiring air contracts and bringing new payers in-network.

Labor and New Business Growth

Crew staffing metrics are in line with expectations, with total crew wages up 3.0% year-over-year and a 77 basis point decline in crew vacancy rate, reflecting continued investment in staff. GMR remains optimistic about new business opportunities in core EMS, 911 Nurse Navigation expansion, and municipal ambulance contracting.

The company secured $20 million in new market growth and $47 million in incremental annualized revenue from new agreements in the quarter, actively responding to RFPs for rural health transformation programs.

Capital Structure and Deleveraging

Post-IPO, GMR significantly improved its financial position by reducing preferred equity holdings by $250 million and achieving over $1.15 billion in total debt reduction and preferred equity redemption. This restructuring resulted in a $46 million reduction in annualized term loan interest expense and a $73 million reduction in annualized preferred equity dividend accrual.

Net leverage after the IPO was approximately 3.5x, with a clear target to reduce it below 3.3x by year-end 2026 and to 3.0x in 2027.

Summary of the company's earnings call; see how call summaries are prepared. Not investment advice.