Feinstein Institutes Researchers Explore Vagus Nerve Stimulation for Obesity and Related Diseases
Published today in Bioelectronic Medicine – an open-access journal published by the Feinstein Institutes and BMC, part of Springer Nature – and led by Lopa Mishra, MD, co-director and professor in the Institute of Bioelectronic Medicine at the Feinstein Institutes, the review shows growing evidence that stimulating the vagus nerve could offer a much-needed non-drug treatment for obesity. The review provides valuable insights into the complex processes in obesity and related illnesses, specifically looking at TGF-β signaling, which acts as a contributer to metabolic problems and other times helps to regulate them.
The vagus nerve connects the brain to the stomach and other organs. Researchers are now investigating how VNS might interact with TGF-β signaling, potentially fine-tuning its effects to improve metabolic health, while also focusing on the SPTBN1 protein, which acts as a switch for the TGF-β system and may be a promising drug target.
'This research is our response to the urgent need for innovative strategies that combat the global obesity epidemic and its devastating consequences,' said Dr. Mishra. 'By elucidating the intricate interplay between TGF-β signaling, vagus nerve stimulation and metabolic dysfunction, there's potential to identify more precise and effective therapeutic targets.'
Obesity significantly increases the risk of developing several serious diseases, including fatty liver disease, liver damage and liver cancer. Current drug treatments often face limitations, including lack of effectiveness for some individuals, high discontinuation rates due to side effects, and the potential for weight regain after stopping the medication. VNS offers a potential alternative or complementary approach, especially given recent advancements in non-invasive ultrasound stimulation techniques by delivering small, safe electrical pulses to the vagus nerve. Researchers believe they can help people feel fuller faster, leading to reduced food intake and weight loss as the vagus nerve plays a critical role in the signaling the feeling of fullness.
'Dr. Mishra and her team's research on TGF-β and vagus nerve stimulation provides an interesting new insight into the mechanisms of obesity,' said Kevin J. Tracey, MD, president and CEO of the Feinstein Institutes and Karches Family Distinguished Chair in Medical Research. 'These are novel pathways and targets that may one day lead to new therapies.'
The Feinstein Institutes for Medical Research is the global scientific home of bioelectronic medicine, which combines molecular medicine, neuroscience and biomedical engineering. At the Feinstein Institutes, medical researchers use modern technology to develop new device-based therapies to treat disease and injury.
Building on years of research in molecular disease mechanisms and the link between the nervous and immune systems, Feinstein Institutes' researchers discovered neural targets that can be activated or inhibited with neuromodulation devices, like vagus nerve implants, to control the body's immune response and inflammation. If inflammation is successfully controlled, diseases – such as arthritis, pulmonary hypertension, heart failure, inflammatory bowel diseases, diabetes, cancer and autoimmune diseases – can be treated more effectively.
Beyond inflammation, using novel brain-computer interfaces, Feinstein Institutes' researchers developed techniques to bypass injuries of the nervous system so that people living with paralysis can regain sensation and use their limbs. By producing bioelectronic medicine knowledge, disease and injury could one day be treated with our own nerves without costly and potentially harmful pharmaceuticals.
About the Feinstein Institutes
The Feinstein Institutes for Medical Research is the home of the research institutes of Northwell Health, the largest health care provider and private employer in New York State. Encompassing 50+ research labs, 3,000 clinical research studies and 5,000 researchers and staff, the Feinstein Institutes raises the standard of medical innovation through its six institutes of behavioral science, bioelectronic medicine, cancer, health system science, molecular medicine, and translational research. We are the global scientific leader in bioelectronic medicine – an innovative field of science that has the potential to revolutionize medicine. The Feinstein Institutes publishes two open-access, international peer-reviewed journals Molecular Medicine and Bioelectronic Medicine. Through the Elmezzi Graduate School of Molecular Medicine, we offer an accelerated PhD program. For more information about how we produce knowledge to cure disease, visit http://feinstein.northwell.edu and follow us on LinkedIn.
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There can be no assurance that actual results will not materially differ from expectations. Such statements include, but are not limited to, any statements relating to our financial outlook and guidance, including our mission to drive top-line growth and profitability and our ability to attain our financial and operational targets; our expected future financial and business performance, including with respect to the Hims & Hers platform, our marketing campaigns, investments in innovation, the solutions accessible on our platform, and our infrastructure, and the underlying assumptions with respect to the foregoing; statements relating to events and trends relevant to us, including with respect to our regulatory environment, financial condition, results of operations, short- and long-term business operations, objectives, and financial needs; expectations regarding our mobile applications, market acceptance, user experience, customer retention, brand development, our ability to invest and generate a return on any such investment, customer acquisition costs, operating efficiencies and leverage (including our fulfillment capabilities), the effect of any pricing decisions, changes in our product or offering mix, the timing and market acceptance of any new products or offerings, the timing and anticipated effect of any pending or recently completed acquisitions, the success of our business model, our market opportunity, our ability to scale our business and expand internationally, the growth of certain of our specialties, our ability to innovate on and expand the scope of our offerings and experiences, including through the use of data analytics and artificial intelligence, our ability to reinvest into the customer experience, our ability to comply with the extensive, complex and evolving legal and regulatory requirements applicable to our business, including without limitation state and federal healthcare, privacy and consumer protection laws and regulations, and the effect or outcome of litigation or governmental actions in relation to any such legal and regulatory requirements. These statements are based on management's current expectations, but actual results may differ materially due to various factors. The forward-looking statements contained in this press release are based on our current expectations and beliefs concerning future developments and their potential effects on us. Future developments affecting us may not be those that we have anticipated. These forward-looking statements involve a number of risks, uncertainties (some of which are beyond our control) and other assumptions that may cause actual results or performance to be materially different from those expressed or implied by these forward-looking statements. These risks and uncertainties include, but are not limited to, those factors described in the 'Risk Factors' section of each of our most recently filed Quarterly Report on Form 10-Q, our most recently filed Annual Report on Form 10-K, and any of our subsequent filings with the Securities and Exchange Commission (the 'Commission'). 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Key Business Metrics 'Online Revenue' represents the sales of products and services on our platform, net of refunds, credits, and chargebacks, and includes revenue recognition adjustments recorded pursuant to U.S. GAAP, primarily relating to deferred revenue and returns reserve. Online Revenue is generated by selling directly to consumers through our websites and mobile applications. Our Online Revenue consists of products and services purchased by customers directly through our online platform. The majority of our Online Revenue is subscription-based, where customers agree to be billed on a recurring basis to have products and services automatically delivered to them. 'Wholesale Revenue' represents non-prescription product sales to retailers through wholesale purchasing agreements. Wholesale Revenue also includes non-prescription product sales to third-party platforms through consignment arrangements. In addition to being revenue generative and profitable, wholesale partnerships and consignment arrangements have the added benefit of generating brand awareness with new customers in physical environments and on third-party platforms. 'Subscribers' are customers who have one or more 'Subscriptions' pursuant to which they have agreed to be automatically billed on a recurring basis at a defined cadence. The Subscription billing cadence is typically defined as a number of days (for example, billed every 30 days or every 90 days), which are excluded from our reporting when payment has not occurred at the contracted billing cadence. Subscribers can cancel or snooze Subscriptions in between billing periods to stop receiving additional products and/or services and can reactivate Subscriptions to continue receiving additional products and/or services. 'Monthly Online Revenue per Average Subscriber' is defined as Online Revenue divided by 'Average Subscribers', which amount is then further divided by the number of months in a period. 'Average Subscribers' are calculated as the sum of the Subscribers at the beginning and end of a given period divided by 2. December 31, 2024 Assets Current assets: Cash and cash equivalents $ 1,124,582 $ 220,584 Short-term investments 20,033 79,667 Inventory 141,800 64,427 Prepaid expenses and other current assets 69,151 31,153 Total current assets 1,355,566 395,831 Restricted cash 368 856 Goodwill 117,753 112,728 Property, equipment, and software, net 205,480 82,083 Intangible assets, net 40,657 43,410 Operating lease right-of-use assets 71,661 10,881 Deferred tax assets, net 84,229 61,603 Other long-term assets 1,868 147 Total assets $ 1,877,582 $ 707,539 Liabilities and stockholders' equity Current liabilities: Accounts payable $ 105,009 $ 91,180 Accrued liabilities 65,671 53,013 Deferred revenue 98,417 75,285 Operating lease liabilities 3,135 1,889 Total current liabilities 272,232 221,367 Convertible senior notes, net 969,467 — Operating lease liabilities 71,786 9,456 Other long-term liabilities 1,401 — Total liabilities 1,314,886 230,823 Commitments and contingencies Stockholders' equity: Common stock – Class A shares, par value $0.0001, 2,750,000,000 shares authorized and 217,381,434 and 212,459,586 shares issued and outstanding as of June 30, 2025 and December 31, 2024, respectively; Class V shares, par value $0.0001, 10,000,000 shares authorized and 8,377,623 shares issued and outstanding as of June 30, 2025 and December 31, 2024 23 22 Additional paid-in capital 711,998 719,155 Accumulated other comprehensive income (loss) 822 (324 ) Accumulated deficit (150,147 ) (242,137 ) Total stockholders' equity 562,696 476,716 Total liabilities and stockholders' equity $ 1,877,582 $ 707,539 Expand CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME (In Thousands, Except Share and Per Share Data, Unaudited) Three Months Ended June 30, Six Months Ended June 30, 2025 2024 2025 2024 Revenue $ 544,833 $ 315,648 $ 1,130,843 $ 593,819 Cost of revenue 128,637 59,035 283,958 108,111 Gross profit 416,196 256,613 846,885 485,708 Gross margin % 76 % 81 % 75 % 82 % Operating expenses: (1) Marketing 217,862 144,922 449,097 275,475 Operations and support 66,490 41,453 129,523 80,200 Technology and development 37,848 18,654 67,762 33,978 General and administrative 67,273 40,554 115,883 75,122 Total operating expenses 389,473 245,583 762,265 464,775 Income from operations 26,723 11,030 84,620 20,933 Other income and expense, net 6,130 2,394 8,728 4,894 Income before income taxes 32,853 13,424 93,348 25,827 Benefit (provision) for income taxes 9,652 (127 ) (1,358 ) (1,402 ) Net income 42,505 13,297 91,990 24,425 Other comprehensive income (loss) 986 (6 ) 1,146 (44 ) Total comprehensive income $ 43,491 $ 13,291 $ 93,136 $ 24,381 Net income per share attributable to common stockholders: Diluted $ 0.17 $ 0.06 $ 0.37 $ 0.11 Weighted average shares outstanding: Basic 224,373,375 214,618,037 223,187,936 214,035,065 Expand CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (In Thousands, Unaudited) Six Months Ended June 30, 2025 2024 Operating activities Net income $ 91,990 $ 24,425 Adjustments to reconcile net income to net cash provided by operating activities: Depreciation and amortization 18,741 6,644 Stock-based compensation 60,584 43,074 Net accretion on securities (1,060 ) (2,281 ) Benefit for deferred taxes (10,346 ) — Impairment of long-lived assets — 114 Amortization of debt discount and issuance costs 1,047 — Non-cash operating lease cost 4,594 1,221 Non-cash acquisition-related costs 2,985 — Non-cash other (1,315 ) 412 Changes in operating assets and liabilities: Inventory (77,373 ) (18,124 ) Prepaid expenses and other current assets (38,081 ) (1,430 ) Other long-term assets (10 ) (47 ) Accounts payable 5,146 16,156 Accrued liabilities 11,737 (24 ) Deferred revenue 23,132 13,257 Operating lease liabilities (1,798 ) (1,140 ) Earn-out payable — (2,825 ) Net cash provided by operating activities 89,973 79,432 Investing activities Purchases of investments — (97,539 ) Maturities of investments 60,569 126,095 Investment in website development and internal-use software (7,961 ) (6,191 ) Purchases of property, equipment, and intangible assets (101,392 ) (13,793 ) Acquisition of business, net of cash acquired (5,100 ) — Net cash (used in) provided by investing activities (53,884 ) 8,572 Financing activities Proceeds from issuance of convertible senior notes, net of debt discount 970,000 — Purchases of capped calls related to convertible senior notes (47,800 ) — Proceeds from exercise of vested stock options 6,497 16,472 Payments for taxes related to net share settlement of equity awards (62,475 ) (22,281 ) Proceeds from employee stock purchase plan 2,970 1,622 Payments for debt issuance costs (3,041 ) — Repurchases of common stock — (47,996 ) Payments for acquisition-related earn-out consideration — (3,190 ) Net cash provided by (used in) financing activities 866,151 (55,373 ) Foreign currency effect on cash and cash equivalents 1,270 1 Increase in cash, cash equivalents, and restricted cash 903,510 32,632 Cash, cash 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Non-GAAP Financial Measures In addition to our financial results determined in accordance with U.S. GAAP, we present Adjusted EBITDA (which is a non-GAAP financial measure), Adjusted EBITDA margin (which is a non-GAAP ratio), and Free Cash Flow (which is a non-GAAP financial measure) each as defined below. We use Adjusted EBITDA, Adjusted EBITDA margin, and Free Cash Flow to evaluate our ongoing operations and for internal planning and forecasting purposes. We believe that Adjusted EBITDA, Adjusted EBITDA margin, and Free Cash Flow, when taken together with the corresponding U.S. GAAP financial measures, provide meaningful supplemental information regarding our performance by excluding certain items that may not be indicative of our business, results of operations, or outlook. We consider Adjusted EBITDA, Adjusted EBITDA margin, and Free Cash Flow to be important measures because they help illustrate underlying trends in our business and our historical operating performance on a more consistent basis. We believe that the use of Adjusted EBITDA, Adjusted EBITDA margin, and Free Cash Flow is helpful to our investors as they are used by management in assessing the health of our business, our operating performance, and our liquidity. However, non-GAAP financial information is presented for supplemental informational purposes only, has limitations as an analytical tool, and should not be considered in isolation or as a substitute for financial information presented in accordance with U.S. GAAP. In addition, other companies, including companies in our industry, may calculate similarly-titled non-GAAP financial measures or ratios differently or may use other financial measures or ratios to evaluate their performance, all of which could reduce the usefulness of Adjusted EBITDA, Adjusted EBITDA margin, and Free Cash Flow as tools for comparison. Reconciliations are provided below to the most directly comparable financial measures stated in accordance with U.S. GAAP. Investors are encouraged to review our U.S. GAAP financial measures and not to rely on any single financial measure to evaluate our business. Adjusted EBITDA is a key performance measure that our management uses to assess our operating performance. Because Adjusted EBITDA facilitates internal comparisons of our historical operating performance on a more consistent basis, we use this measure for business planning purposes. 'Adjusted EBITDA' is defined as net income before stock-based compensation, depreciation and amortization, acquisition and transaction-related costs (which includes (i) consideration paid for employee and nonemployee compensation with vesting requirements incurred directly as a result of acquisitions, and (ii) transaction professional services), payroll tax expense related to stock-based compensation, impairment of long-lived assets, interest income and expense, net, and income taxes. 'Adjusted EBITDA margin' is defined as Adjusted EBITDA divided by revenue. In the second quarter of 2025, we revised our definition of Adjusted EBITDA to include payroll tax expense related to stock-based compensation, which comprises employer taxes incurred upon vesting of restricted stock units and upon exercise of nonqualified stock options. As a result of recent trends in our stock price, this amount was not considered significant for prior periods and, accordingly, prior period disclosures were not recast to conform to the current presentation. Some of the limitations of Adjusted EBITDA include (i) Adjusted EBITDA does not properly reflect capital commitments to be paid in the future, and (ii) although depreciation and amortization are non-cash charges, the underlying assets may need to be replaced and Adjusted EBITDA does not reflect these capital expenditures. In evaluating Adjusted EBITDA, you should be aware that in the future we will incur expenses similar to the adjustments in this presentation. Our presentation of Adjusted EBITDA should not be construed as an inference that our future results will be unaffected by these expenses or any unusual or non-recurring items. We compensate for these limitations by providing specific information regarding the U.S. GAAP items excluded from Adjusted EBITDA. When evaluating our performance, you should consider Adjusted EBITDA in addition to, and not as a substitute for, other financial performance measures, including our net income and other U.S. GAAP results. Free Cash Flow is a key performance measure that our management uses to assess our liquidity. Because Free Cash Flow facilitates internal comparisons of our historical liquidity on a more consistent basis, we use this measure for business planning purposes. 'Free Cash Flow' is defined as net cash (used in) provided by operating activities, less purchases of property, equipment, and intangible assets and investment in website development and internal-use software in investing activities. Some of the limitations of Free Cash Flow include (i) Free Cash Flow does not represent our residual cash flow for discretionary expenditures and our non-discretionary commitments, and (ii) Free Cash Flow includes capital expenditures, the benefits of which may be realized in periods subsequent to those in which the expenditures took place. In evaluating Free Cash Flow, you should be aware that in the future we will have cash outflows similar to the adjustments in this presentation. Our presentation of Free Cash Flow should not be construed as an inference that our future results will be unaffected by these cash outflows or any unusual or non-recurring items. 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3 hours ago
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Year-to-Date 2025 Compared to Year-to-Date 2024 For the six months ended June 30, 2025, revenues were $147.9 million, an increase of 2.5% over revenues of $144.3 million for the first six months of 2024. Operating income for the first six months of 2025 increased by 1.6% to $10.3 million, compared to $10.1 million for the first six months of 2024. The increase in operating income was primarily attributable to higher revenues, sublease income associated with the sublease that commenced during the second quarter of 2025, and lower bad debt expense, partially offset by higher expenses to support investments in several areas of the business, primarily in our platform and SaaS applications, resulting in higher labor costs, cloud hosting, third-party software, and amortization of capitalized software. Net income for the first six months of 2025 increased to $9.7 million, compared to $9.4 million for the first six months of 2024. Earnings per share were $0.32 per share (diluted) for the first six months of 2025, compared to $0.31 per share (diluted) for the first six months of 2024. Adjusted EBITDA increased by 2.8% to $33.8 million for the first six months of 2025, compared to $32.9 million for the first six months of 2024. Other Business Updates On May 8, 2025, the Company announced a share repurchase program approved by the Board of Directors under which the Company is authorized to repurchase up to $25.0 million of its outstanding shares of common stock. Pursuant to this authorization, repurchases may be made from time to time in the open market, including under a Rule 10b5-1 plan, through privately negotiated transactions, or otherwise. During the second quarter of 2025, the Company repurchased shares valued at $18.1 million pursuant to this authorization, and the Company continued to repurchase shares pursuant to this authorization during the third quarter, completing the program in July by repurchasing shares valued at $6.9 million. The share repurchase program terminated in July when the maximum dollar amount was expended. On August 4, 2025, the Board of Directors approved a quarterly cash dividend under the Company's dividend policy of $0.031 per share, payable on August 29, 2025 to holders of record on August 18, 2025. Financial Outlook for 2025 The Company is updating its guidance for 2025 for certain of the measures set forth below. For a reconciliation of projected adjusted EBITDA, a non-GAAP financial measure defined later in this release, to projected net income (the most comparable GAAP measure) for 2025, see the table included on page nine of this release. The Company's guidance for 2025, as set forth above, reflects the Company's assumptions regarding, among other things, expectations for new sales and renewals. This consolidated guidance does not include the impact of any acquisitions or dispositions that we may complete during 2025, gains or losses from changes in the fair value of non-marketable equity investments, or impairment of long-lived assets. Commenting on HealthStream's results, Robert A. Frist, Jr., Chief Executive Officer, HealthStream, said, 'Our financial performance in the second quarter of 2025 showed year-over-year increases in each of the major categories we highlight in our earnings release, including record quarterly revenues of $74.4 million, up four percent over the second quarter of last year. As we kick-off the second half of the year, I believe HealthStream's solutions are well positioned to continue helping healthcare organizations achieve greater workflow efficiencies, which, at this time, is of heightened focus throughout the healthcare industry.' A conference call with Robert A. Frist, Jr., Chief Executive Officer, Scott A. Roberts, Chief Financial Officer and Senior Vice President, and Mollie Condra, Head, Investor Relations and Communications, will be held on Tuesday, August 5, 2025, at 9:00 a.m. (ET). Participants may access the conference call live via webcast using this link: To participate via telephone, please register in advance using this link: A replay of the conference call and webcast will be archived on the Company's website in the Investor Relations section under 'Events & Presentations.' Use of Non-GAAP Financial Measures This press release presents adjusted EBITDA, a non-GAAP financial measure used by management in analyzing the Company's financial results and ongoing operational performance. In order to better assess the Company's financial results, management believes that net income before interest, income taxes, stock-based compensation, depreciation and amortization, and changes in fair value of, including gains (losses) on the sale of, non-marketable equity investments ('adjusted EBITDA') is a useful measure for evaluating the operating performance of the Company because adjusted EBITDA reflects net income adjusted for certain GAAP accounting, non-cash, and/or non-operating items which may not, in any such case, fully reflect the underlying operating performance of our business. We believe that adjusted EBITDA is useful to investors to assess the Company's ongoing operating performance and to compare the Company's operating performance between periods. In addition, certain short-term cash incentive bonuses and performance-based equity awards are based on the achievement of adjusted EBITDA (as defined in applicable bonus and equity grant documentation) targets. Adjusted EBITDA is a non-GAAP financial measure and should not be considered as a measure of financial performance under GAAP. Because adjusted EBITDA is not a measurement determined in accordance with GAAP, adjusted EBITDA is susceptible to varying calculations. Accordingly, adjusted EBITDA, as presented, may not be comparable to other similarly titled measures of other companies and has limitations as an analytical tool. This non-GAAP financial measure should not be considered a substitute for, or superior to, measures of financial performance, which are prepared in accordance with GAAP. Investors are encouraged to review the reconciliations of adjusted EBITDA to net income (the most comparable GAAP measure), which is set forth below in this release. About HealthStream HealthStream (Nasdaq: HSTM) is the healthcare industry's largest ecosystem of platform-delivered workforce solutions that empowers healthcare professionals to do what they do best: deliver excellence in patient care. For more information about HealthStream, visit or call 615-301-3100. HEALTHSTREAM, INC. Condensed Consolidated Balance Sheets (In thousands) (Unaudited) June 30, December 31, 2025 2024 ASSETS Current assets: Cash and cash equivalents $ 52,102 $ 59,469 Marketable securities 38,517 37,748 Accounts and unbilled receivables, net 31,467 35,322 Prepaid and other current assets 22,310 20,583 Total current assets 144,396 153,122 Capitalized software development, net 44,580 43,370 Property and equipment, net 11,914 10,741 Operating lease right of use assets, net 16,262 17,453 Goodwill and intangible assets, net 240,710 246,768 Other assets 42,286 39,312 Total assets $ 500,148 $ 510,766 LIABILITIES AND SHAREHOLDERS' EQUITY Current liabilities: Accounts payable, accrued, and other liabilities $ 27,002 $ 31,466 Deferred revenue 88,376 84,227 Total current liabilities 115,378 115,693 Deferred tax liabilities 15,101 14,596 Deferred revenue, noncurrent 1,198 1,655 Operating lease liability, noncurrent 15,891 17,366 Other long-term liabilities 2,013 2,101 Total liabilities 149,581 151,411 Shareholders' equity: Common stock 235,041 252,432 Accumulated other comprehensive loss (1,278 ) (2,049 ) Retained earnings 116,804 108,972 Total shareholders' equity 350,567 359,355 Total liabilities and shareholders' equity $ 500,148 $ 510,766 Expand HEALTHSTREAM, INC. Condensed Consolidated Statements of Cash Flows (In thousands) (Unaudited) Six Months Ended June 30, June 30, 2025 2024 Operating activities: Net income $ 9,721 $ 9,394 Adjustments to reconcile net income to net cash provided by operating activities: Depreciation and amortization 21,621 20,706 Stock-based compensation 1,940 2,154 Amortization of deferred commissions 6,017 5,956 Deferred income taxes 467 (542 ) Provision for credit losses 391 1,802 Loss on equity method investments 107 82 Other (776 ) (746 ) Changes in assets and liabilities: Accounts and unbilled receivables 3,465 449 Prepaid and other assets (10,324 ) (5,569 ) Accounts payable, accrued, and other liabilities (4,224 ) (9,282 ) Deferred revenue 3,692 2,985 Net cash provided by operating activities 32,097 27,389 Investing activities: Purchases of marketable securities, net of proceeds (27 ) (5,330 ) Proceeds from sale of non-marketable equity investments — 765 Purchase of other investments (500 ) — Purchases of property and equipment (3,372 ) (914 ) Payments associated with capitalized software development (14,500 ) (13,552 ) Net cash used in investing activities (18,399 ) (19,031 ) Financing activities: Taxes paid related to net settlement of equity awards (1,075 ) (861 ) Payment of cash dividends (1,890 ) (1,700 ) Repurchases of common stock (18,121 ) — Net cash used in financing activities (21,086 ) (2,561 ) Effect of exchange rate changes on cash and cash equivalents 21 1 Net (decrease) increase in cash and cash equivalents (7,367 ) 5,798 Cash and cash equivalents at beginning of period 59,469 40,333 Cash and cash equivalents at end of period $ 52,102 $ 46,131 Expand Reconciliation of GAAP to Non-GAAP Financial Measures (1) Operating Results Summary (In thousands) (Unaudited) Three Months Ended June 30, Six Months Ended June 30, 2025 2024 2025 2024 GAAP net income $ 5,389 $ 4,168 $ 9,721 $ 9,394 Interest income (958 ) (944 ) (1,889 ) (1,848 ) Interest expense 25 25 50 49 Income tax provision 1,478 1,132 2,393 2,448 Stock-based compensation expense 836 1,094 1,940 2,154 Depreciation and amortization 10,867 10,370 21,621 20,706 Adjusted EBITDA $ 17,637 $ 15,845 $ 33,836 $ 32,903 (1) This press release presents adjusted EBITDA, which is a non-GAAP financial measure used by management in analyzing its financial results and ongoing operational performance. Expand This press release includes certain forward-looking statements (statements other than solely with respect to historical fact), including statements regarding expectations for financial performance for 2025 and our quarterly dividend policy, that involve risks and uncertainties regarding HealthStream. These statements are based upon management's beliefs, as well as assumptions made by and data currently available to management. This information has been, or in the future may be, included in reliance on the 'safe harbor' provisions of the Private Securities Litigation Reform Act of 1995. The Company cautions that forward-looking statements involve known and unknown risks, uncertainties, and other factors that may cause the actual results, performance, or achievements to be materially different from future results, performance, or achievements expressed or implied by the forward-looking statements, including as a result of negative economic conditions, changes in U.S. policy, adverse developments impacting the healthcare industry, tariff and trade-related developments, inflationary pressures, geopolitical instability, legal requirements and contractual restrictions which may affect continuation of our quarterly cash dividend policy and the declaration and/or payment of dividends thereunder, which may be modified, suspended, or canceled in any manner and at any time that our Board may deem necessary or appropriate, as well as risks referenced in the Company's Annual Report on Form 10-K for the year ended December 31, 2024, filed on February 28, 2025, the Company's Quarterly Report on Form 10-Q for the three months ended March 31, 2025, filed on May 9, 2025, and in the Company's other filings with the Securities and Exchange Commission from time to time. Consequently, such forward-looking information should not be regarded as a representation or warranty or statement by the Company that such projections will be realized. Many of the factors that will determine the Company's future results are beyond the ability of the Company to control or predict. Readers should not place undue reliance on forward-looking statements, which reflect management's views only as of the date hereof. The Company undertakes no obligation to update or revise any such forward-looking statements.
