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Good morning, ladies and gentlemen, and welcome to the Think Research Corporation's Third Quarter 2022 Financial Results Conference Call. [Operator Instructions] I would now like to turn the conference over to Mr. Sachin Aggarwal, CEO. Please go ahead.
Thank you, operator, and good day to everyone who's joining us this morning. Also joining me on the call today is our CFO, John Hayes, who's going to review the financial results in more detail after I discuss some operational achievements during the third quarter and the first 9 months of fiscal 2022, which continues to produce record revenue results despite some seasonal slowdowns that typically occur in our clinics and in our clinical education segment during the summer months.
Now before I go into our operational results, I just want to briefly review who we are and what we're trying to accomplish. Think Research is an industry leader in delivering knowledge-based digital health software solutions. Our evidence-based health care technology solutions support the clinical decision-making process in order to facilitate better health care outcomes. Our focused mission is to become for clinicians an essential data service that organizes the world's health knowledge so everyone can get the best care. The company gathers, develops and delivers knowledge-based solutions globally to customers, which typically includes enterprise clients, hospitals, health regions, health care professionals and/or entire governments.
The company has gathered a significant amount of data by building its repository of knowledge through its network and a group of companies, including our acquired companies. Think's data and software division licenses its solutions to more than 13,000 facilities for over 300,000 primary care, acute care and long-term care doctors, nurses and pharmacists that rely on the content and data we provide to support their practices. In addition, the company collects and manages pharmaceutical and clinical trials data in its clinical research division. Millions of patients and residents annually receive better care due to the essential data that think produces, manages and delivers. Think also operates a Clinical Services division, which is a network of digital first, primary care clinics and medical clinics providing elective surgery.
The company's financial performance during the first 9 months of 2022 reflects the impact of the acquisitions and integrations of 4 companies from 2021 that continue to transform the business today. Overall, the company's clinical research division showed strong and expected recovery, while the clinical data and software division and Clinical Services division had seasonal slowdowns. So first, to clinical research. After some clients and project delays in the clinical research division that we disclosed in Q2, we're very happy to report that the revenue performance of that division recovered nicely in Q3. More importantly, in our view, has been the success that we've achieved in sales during the quarter when we announced $12.8 million of new contracts which has helped us to build the largest contracted backlog ever for our clinical research division.
This has dramatically improved our revenue and earnings visibility in Q4 and throughout fiscal 2023. I will touch on this later as I close with a view on our outlook. I'm pleased to report that sales success from Q3 also continues into Q4. We've also achieved significant sales success in our clinical education category. After signing a top 5 global pharmaceutical company in Q2, we won a significant add-on to that contract in Q3, which makes it the largest single clinical education contract ever won by Think. It gives us the brand reputation and the confidence to seek more major global contracts going forward.
In our software and data division, the eReferrals program continues to deliver significant growth for us, and it helps to establish Think Research as an increasingly essential software and data provider in the province of Ontario. Our digital front door program is also gaining significant traction across multiple jurisdictions throughout the world as hospital networks everywhere struggled to maintain positive clinical outcomes despite increasing traffic and declining access to quality staff or qualified staff. Now I'd like to invite John Hayes, our Chief Financial Officer, to review the financial results in detail for the quarter and year-to-date. After we review the financials, I'm going to conclude with a bit of an outlook, which offers some thoughts on how we plan to become an essential data service for clinicians. Over to you, John.
Thanks, Sachin. Before I get into the review of our financials, I just want to say I'm really happy that I joined Think Research on a permanent basis. I believe the Think strategy to become an essential data solutions provider to clinicians is a winning opportunity, especially considering the solutions we've built, acquired and integrated over the past couple of years. With our sales and pipeline momentum, we have better visibility in how Think will deliver on this potential. I'm glad to be part of it. Today's results, along with all of our risk disclosures can be found in our MD&A and financial statements, which have been posted to SEDAR earlier today. For more details regarding risks, cautionary notes and other disclosures regarding quarterly and year-to-date performance, we urge investors and analysts to take the time to review these documents.
First, I want to discuss our total revenue and business line contributions. Q3 2022 revenue was $18.4 million, up 82% from Q3 2021, while revenue for the first 9 months of the year grew to $57 million, a 99% increase compared to the same period last year. Q3 2022 revenues from each of Think's primary business lines were as follows: -- our Software and Data Solutions revenue was 34% of total revenue at $6.3 million compared sequentially to $6.9 million or 37.4% of total revenue in Q2. The sequential decline reflects lower participation in the company's education programs during the summer months. Our clinical research revenue was 48.3% of total revenue and $8.9 million compared sequentially to $7.3 million or 39% of total revenue in Q2. This revenue growth is attributable to recovery from the Q2 study delays that we highlighted in our last conference call as well as to new contract wins in the quarter.
As Sachin mentioned earlier, these wins in the quarter have also provided visibility into higher revenue for clinical research in Q4 and into 2023. Clinical Services revenue was 17.6% of total revenue at $3.2 million compared to $4.3 million or 23.3% of revenue in Q2. The decline reflects revenue seasonality as fewer procedures are conducted during the summer months, coupled with staff turnover related to a tight labor market. Now let's switch to gross profit, which totaled $8.7 million for Q3 and $27.2 million in the first 9 months of this year. Respectively, these represent increases of 104% and 78% over the comparable periods in 2021, primarily related to higher revenue stemming from acquisitions, supplemented by organic revenue growth. Year-to-date, our operations generated gross margin of 48% for the 9 months ended September 30 compared to 53.3% for the same period last year.
The decline in gross margin reflects the change in revenue mix arising from various acquisitions completed in 2021 in general and our biopharma clinical research operations in particular. Give or take a few percentage points out away due to seasonality of the various business lines, this gross margin should be considered a good baseline going forward. Although it's a non-IFRS measure, we monitor adjusted EBITDA closely. And I'm happy to report that adjusted EBITDA has improved with Q3 reflecting a loss of $700,000 compared to a loss of $3.4 million in Q3 2021 and a loss of $1.6 million compared sequentially to Q2 of this year. The quarter-over-quarter improvement reflects the impact of reduced operating expenses and cost of sales achieved under our cost optimization program.
Improving our cost efficiencies remains a constant priority. We expect this trend in improving adjusted EBITDA to continue into Q4 and beyond. Adjusted EBITDA margin reflected the same improvement at negative 4% in Q3 compared to negative 34% in Q3 2021. For the first 9 months of 2022, adjusted EBITDA margin was negative 4.5% compared to negative 22.3% for the first 9 months of 2021, with improvements attributable to realized cost synergies and overall revenue scale relative to last year. Now let's review expenses. By focusing on reducing cash operating expenses, Think has removed $11.5 million in total annualized operating expenses since we began integrating our acquisitions in 2021.
We gained an annualized value of $5.8 million in fiscal year 2021 and an additional $5.7 million in the first 9 months of fiscal year 2022. We are always looking for more expense savings and there may be some remaining. However, with cost synergies already realized, we believe Think is now positioned to realize significant expense leverage over the larger revenue streams that we expect going forward. General and administration expenses were $6.6 million for Q3 and $20.7 million for the first 9 months of 2022. G&A increased by 6% for the quarter and 32% over the first 9 months of 2022 compared to the prior year.
Expense growth reflected higher overall personnel costs as the business grows, partially offset by recognized cost reductions that are driving the expense trend lower as a percent of revenue. Sales and marketing expenses associated with awareness raising and other activities to elevate the Think brand totaled $2.3 million in Q3 and $7 million for the first 9 months of 2022, increasing by approximately 12% for the quarter and 15% for the year. Think's results are now demonstrating the expense leverage that we engineered to our cost savings program.
In the first 9 months of 2022, gross profit grew by 78%, while OpEx grew by only 45%. And for those of you who like to remove the amortization component of operating expenses, the total G&A, R&D and sales and marketing costs grew by only 26% in the year to September 30 compared to the 78% growth in gross profit. Sequentially, from Q2 to Q3, our results showed $1.6 million of cost savings in cost of sales and OpEx through aggressive cost management. So we're continuing our senior management focus on expense and cash management going forward. Net loss decreased by $4.4 million for Q3 2022 to $6.5 million and by $1.3 million in the first 9 months of 2022 compared to the same period in 2021.
The decreases and losses are primarily attributable to the expense leverage I just referenced, along with reduced acquisition and restructuring-related costs. During and subsequent to the quarter, we negotiated with our lenders and creditors to maximize our financial flexibility and liquidity to meet increasing demand for our solutions while we manage toward sustained cash flow and profits. In Q3, we announced that Scotiabank amended and restated its credit facility to harmonize the terms of its existing credit facilities with the terms of the credit agreement with Beedie Capital. This also included foregoing the testing of certain covenants until December 1 of this year.
And the alignment of terms and covenants by Scotiabank is just going to help us more simply manage to those covenants since they match they're the same ones as Beedie Capital. Subsequent to quarter end, we revised certain terms relating to the deferred consideration of $6.5 million owed to the sellers in BioPharma, again, with a view to providing financial flexibility to the business going forward. Earlier this month, we drew down an additional $3 million of the $25 million convertible debt facility with Beedie Capital with a conversion price of $0.43 per share.
In addition, we have nearly completed a private placement of $3 million worth of common shares at $0.40 per share, which represents a premium to the 20-day VWAP. This financing was also led by Beedie Capital. The additional liquidity provided by these financings will provide the working capital Think needs to convert our growing backlog into revenue while further strengthening our balance sheet. Think's cash balance at September 30 totaled $4.4 million compared to $6.3 million at the end of last year.
In Q2 of this year, the company borrowed $10 million from Beedie Capital in the convertible loan, which netted the company $8.9 million after transaction costs. Cash allocations during the first 9 months of 2022 included payments of $2.4 million on lease liabilities, $2.3 million for finance costs, investments of $2.9 million in intangible assets, $400,000 in property and equipment with another $400,000 of cash consideration being paid related to a 2021 acquisition. And with that, I will turn the call back to Sachin.
Thank you, John. I just want to emphasize once more that our objective is to grow revenue with improving margins by becoming an increasingly essential solutions provider for health care clinicians everywhere so that they can deliver the best outcomes for patients. We've effectively optimized most of our operations to deliver on this objective with solid expense leverage going forward. We're gaining significant pipeline momentum and our backlog has never been stronger, especially in our clinical research business. We're very excited about the visibility we have into both Q4 and for the coming full fiscal year. With that evidence, we are reiterating our guidance.
Fourth quarter revenue run rate will be between $84 million and $90 million annualized, and pro forma adjusted EBITDA will range between $6 million and $9 million annualized. We therefore expect that the quarter will come in at somewhere between $21 million and $22.5 million, with adjusted EBITDA, a positive adjusted EBITDA of approximately $1.5 million to $2.3 million. We are very encouraged that our strategies are paying off, and I'd like to just remind investors of what we are focusing on and why we expect to gain more leverage in our model. First, we're adding more users to current licenses by promoting adoption and usage. There's a lot of room for us to grow, to increase users and usage of already deployed solutions.
And as we add more users, our solutions become more essential to those licensees, which gives us pricing power and create switching barriers. A great example of this is eReferrals, our digital referrals business, that connects primary care doctors to specialists. Essentially, it replaces fax-based referrals with our digital platform. Under this Ontario-wide contract, usage grew to more than 273,000 transactions in Q4, and this is up from 264,000 in Q2. We're now consistently exceeding a run rate of 1 million digital referrals per year and thereby introducing thousands of practitioners to Think Research and more of our essential software and data solutions.
As well, increasingly, our content is becoming part of standard workflows for hospitals and health systems, which make our solutions stickier with more practitioners using our software regularly. Second, we aim to increase revenue per user by increasing the number of services and solutions that a licensed user adopts and uses regularly. We have a better product road map now that prioritizes customer requirements in both our knowledge and connectivity offerings. Finally, with the user base now exceeding 300,000 clinicians, we believe that direct user licensing could generate entirely new revenue streams. For example, we're now cross-promoting and cross-selling pharmacist education solutions directly to pharmacists that are on our Pharmapod incident management network.
Our new product road map includes creating entry points so that third parties can leverage our platform to reach these 300,000 plus clinicians. Already, new clinical knowledge customers are paying Think for access to this platform, thereby creating new payment streams for existing technology. You should expect some forthcoming announcements that will really bring this to life. We've also worked hard over the past few quarters to digitize internal processes and workflows to improve our scalability and to maximize the expense leverage that John outlined in his remarks a few minutes ago. For example, this year, we digitized patient onboarding for our clinical research business.
This helps to both accelerate and improve the quality of studies. The impact of this of this should be to help increase gross margins as well and also our capacity to onboard more projects. We are digitizing elements of our operations across business lines, so you should see some announcements of major milestones in this area soon as well. As we transform into a solutions-based organization focused on essential clinician data, we are excited with our annual growth rates and our path to profitability. Due to the nature of some of our lines of business, we expect the quarterly variances in performance due to project work that will show up in our results as delays or accelerations in programs. However, we're extremely excited about the prospects for Think over the coming quarters to be a profitable, high-growth company. With that, this concludes our prepared remarks, and I'd ask the operator to open the line for questions.
[Operator Instructions] Your first question comes from the line of Jerome Dubreuil from Desjardins.
So first one for me is if you can maybe provide an update on your data and software pipeline. Maybe if there is significant work being done right now on projects that aren't still generating revenue. And overall, what you're seeing coming in that specific segment of your business?
Yes. Thanks, Jerome. I'm very happy to. We continue to have a very significant number of new closes, new contract executions on a month-by-month basis in our data and software solutions business. And most of them are medium-sized or small-sized. So those are not items that we typically press release.
What I would say is that we have never had a bigger pipeline of very large contracts, jurisdiction-wide contracts than we do right now that are either in RFP or negotiation stage. So you should expect to see more from us in that particular area in terms of announcements over the coming couple of quarters. We also see material ongoing growth or expect growth in some of our much larger contracts, so that's our health care navigation or digital front door solution in the province of Ontario and the digital referrals contract here in the province of Ontario, 2 of our larger ones, where we expect to see continued growth over the coming quarters and the coming year.
Your next question comes from the line of Rob Goff from Echelon.
As you indicated, BioPharma was $8.9 million in the quarter. I believe the previous high was $9.2 million for Q4 of '21. Given your recent wins, should we look at that as an incremental, say, $3 million per quarter? Can you see it pushing through a run rate of $10 million or $12 million? Just sort of if you could sort of level set us there on expectations.
Yes. I'm going to partially turn this one over to John. But what I will say is that our overall capacity to execute on contracts, there's sort of 2 things that are happening here. So number one is, I think we've spoken during previous calls about shifting from bioequivalent studies over to Phase I studies. What that does is it lowers the number of patients that are in clinic at any given time and actually spreads them out.
So you're not doing a single cohort with a large volume of patients, you're doing many cohorts with small volumes of patients. Those are all... As a consequence, you actually you actually increase the capacity of the actual clinics. And as a reminder, we have 2, one here in Toronto and 1 in St. Louis. So overall, that allows us to increase our capacity. And so as a consequence, I would say that the previous high watermark of 9, we can and should be able to exceed that. Now, can we exceed it... Can we double it? Probably not. But can we push it up under our current circumstances? We can for sure, with... Maybe, John, do you have anything to add to that one?
Yes. I think Sachin, you've really hit on the core points because Rob, I have to say that I had some similar concerns, early in September, I'm looking at all the orders, and I on, are we going to be able to push all this through because the numbers are bigger than we've seen in the past. And we're talking with the folks at BioPharma, they gave me confidence that we could, and it's not unlimited, right? But by shifting from bioequivalence to Phase I, they expect that we're going to have more capacity.
And then also just by streamlining operations, that's going to give us some opportunities for full clinics as well. I mean, one of the things that happened earlier on in the year, and we spoke to study delays in for Q2. And what happened then was like we weren't really overbooked. And so we couldn't slide in other studies sort of really quickly. But now when the clinics full, and we've got some actually extra orders, if a study suddenly finds itself delayed, we've got enough other studies in the hopper that we can kind of keep things going. So there's a bunch of factors at play that give us confidence that we're going to be able to have more revenue through BioPharma than previously. And I mean that was one of the things I wanted to make sure before we gave our guidance for Q4 back at the end of August. I just want to make sure that we actually would be able to deliver on that before we publish any guidance. So that's the only point I wanted to add.
[Operator Instructions] Your next question comes from the line of Doug Taylor from Canaccord Genuity.
You stuck with the run rate revenue guidance for Q4 here. My question is, can you speak to what's required to deliver annual numbers in 2023 that are consistent with that guidance or exceed that guidance? That's in terms of both software sales, BioPharma bookings activity levels within the clinic network. Are there any puts and takes we should be taking into consideration when mapping out 2023?
Well, I think you've named the basics that we're not expecting Q4 to be a dramatic blip in terms of a go-forward revenue overall. We have a pipeline, we have backlog, and we have some significant growth coming from, as I've mentioned previously, Doug, on some of our Software and Data Solutions offerings. So all of those things will come into play. And I think we're starting to see sort of a new steady run rate. It may not be perfect. As John has mentioned, there is a little bit of seasonality to a couple of our businesses. But beyond that, I think we're pretty pleased and excited about the Q4 representing a new baseline.
You have a follow-up question coming from the line of Jerome Dubreuil from Desjardins.
I just want to squeeze 2 more in, if possible. Maybe one other for John here. You kind of mentioned that you think this is a good baseline for gross margins going forward. So should we be modeling gross margins around the 47% for next year?
Yes, fair question. I mean there's variability in the different revenue lines. My current model is actually a little higher than that, but there's some fluctuation depending on whether or not you have strength in clinical research versus Software and Data Solutions. So if you model to that number, Jerome, I don't think you'll be disappointed.
Great. That's helpful. And then the second one, since you got a lot of growth coming in the pipeline that you seem to be seeing. Is there any kind of abnormal working cap requirements that we should be thinking of for the next borrowers?
Okay. Yes, really fair question. And part of why we drew down our additional convertible debt from the Beedie convertible debt facility is that we do see some working capital requirements. I mean we're working with our clinical research organization, which has a substantial revenue component. It was almost half of our revenue in Q3. And those are big studies. So we are working towards changing the payment milestones a little bit to improve our working capital so that we aren't funding the studies for too long before we get paid.
And then, of course, in the our SaaS business, the working capital tends to be quite good because we get paid typically near the start of the contract. But in the knowledge business, sometimes you can also find yourself waiting for payments. So what we've done is we've modeled all of these divisions separately from a working capital perspective, so we have a way better visibility into how much working capital each one consumes. And so as we model that out, we looked at how much capital we were going to need to be able to fulfil all of these objectives for the next year. And that was what set the number of exactly how much capital that we wanted to draw down and raise in terms of new equity in order to meet our objectives for the coming year.
Your next question comes from the line of Kris Thompson from PI Financial.
Guys, on the clinical services business, you mentioned revenue is down quarter-over-quarter on seasonality. I get that. But year-over-year, it was also down about 9%, 10%. What's happening at HealthCare Plus and Clinic 360?
Thanks, Kris. Overall, there's nothing in particular other than seasonal declines. We do have a few rental doctors. So these are folks that don't perform surgeries for us but may rent the facility for the purpose of conducting their own surgeries. Those are very, very low margin businesses or very low margin opportunity for us. Lower than average of pretty much everything else that we do. And so we have been discouraging or increasing the rates and discouraging too much in the way of rental docs in order to increase our in-house capacity. So there is some decline in the rental surgeons, which is, again, helps boost our gross margin overall. So that is a 2022 phenomenon, Kris, but you're probably seeing some decline year-over-year.
We have a follow-up question coming from Rob Goff of Echelon.
So this is probably more for John. We've hit you on revenues and gross margins. Can we talk about OpEx, like when you've gone from $16.3 million for Q2 to $14.1 million for Q3, is that a good run rate? Or are there additional savings that we can look forward to?
Yes, fair question, Rob. And so as I look out into each of the quarters going forward, the cost savings that we have realized so far, we've captured a good chunk of them in Q3. There is more to come in Q4. But if you were to sort of set that Q3 number as a bit of a run rate, you're probably not going to be too far off. I hope that's helpful. Feel free to ask more details if you want me to go further.
You also have a follow-up question coming from the line of Doug Taylor of Canaccord Genuity.
We got to get back in the queue if we want to ask a follow-up. Let's talk a little bit more about the balance sheet. You raised more capital here last week. You've got deferred payments, I believe, upcoming here related to BioPharma. I think a question a lot of investors are looking for is an answer to how can we get them comfortable with the expected dilution related to some of these deferred payments that you have up and coming, which can be satisfied in stock. What are your intentions with those deferred payments? Can you update us on your thoughts there?
Let me give it a start, and John can layer on. Thanks Doug. So the primary objective of that, of the new payment plan on the BioPharma deferred consideration was to create additional flexibility for the company. If paid all at once are paid all historically, then of course, it's all... It would have all been stock, given working capital needs and so on and so forth, by stretching it out over an 18-month period and by giving us ability to pay in either cash or in stock.
And if paid in cash, we also get some discount leverage. So we actually pay less in cash than the actual amount. So the consequence of all that being the financial flexibility allows us, particularly as we head into an overall positive EBITDA and towards the back half, positive cash flow is what we'd be targeting. That gives us flexibility to reduce some of that dilution over time. And of course, that's an important thing for investors. It's also a very important thing for management and for our Board team.
I don't have anything to add.
You have a follow-up question coming from the line of Kris Thompson from PI Financial.
Just to continue on my earlier thought process here on HealthCare Plus, the Clinic 360. Historically, you said that was a flywheel for you to test your software. Is this still an important business to have? Is this something you guys could divest since the balance sheet is looking pretty tight?
Yes. Listen, of course, our Board considers all options at all times in respect of how core or noncore any of our businesses are. I will say we actually genuinely do test and use a number of our software solutions in our clinics. And frankly, the clinicians at those organizations also participate in a number of our software and database product workshops, guiding our products as we go forward.
In fact, we just had a number of them participate in planning sessions with respect to our education solutions. So there is some cross-pollination, Kris. That being said, I think just based on our sales pipeline, I think you can expect to see that more of our focus is on the Software and Data Solutions side of the business. And at present, with the significant growth of BioPharma, we're putting a lot more of our attention there. So thanks for that question, Kris, and I hope that gives you some guidance.
There are no further questions at this time. I'll be turning the call over back to Mr. Sachin Aggarwal for any closing remarks.
Listen, thank you, everyone, for continuing to join us and continuing to pay attention and give us your time and energy. We know how difficult of a market it is overall and your attention and your thoughtful questions and the thoughtful work that you do is genuinely appreciated by everyone at Think Research because we know there are so many other companies out there. So your time and energy are greatly valued by us. So with that, thank you for taking part in the call today. And we look forward to some really exciting Q4 results, and we look forward to discussing those with everyone on the call. With that, have a great day.
Thank you, sir. Ladies and gentlemen, this concludes your conference call for today. We thank you for participating and ask that you please disconnect your lines. Have a lovely day.