SI-BONE, Inc. 10-Q Summary: Q1 2026
Business Context and Reporting Period
This report covers the quarterly period ended March 31, 2026. SI-BONE, Inc. is a medical device company developing solutions for patients with compromised bone, focusing on sacroiliac joint dysfunction, spinopelvic fixation, and pelvic trauma. The company operates as a single reporting segment with the majority of revenue derived from the United States.
Key Financial Metrics
| Metric | Q1 2026 | Q1 2025 |
|---|---|---|
| Revenue | $52.6 million | $47.3 million |
| Gross Profit | $41.9 million | $37.7 million |
| Gross Margin | 79.8% | 79.7% |
| Net Loss | $(4.3) million | $(6.5) million |
| Diluted EPS | $(0.10) | $(0.15) |
| Cash & Marketable Securities | $144.7 million | $147.8 million (Dec 31, 2025) |
| Long-Term Debt | $35.6 million | $35.6 million |
| Operating Cash Flow | $(2.4) million | $(4.9) million |
Material Changes vs. Prior Period
- Revenue Growth: Revenue increased 11.2% year-over-year, driven by higher U.S. procedure volumes, expanded product adoption, and growth in ambulatory surgical centers (ASCs) and office-based labs (OBLs). International revenue grew 33.9%.
- Profitability Improvement: Net loss narrowed by 33.7% to $4.3 million, primarily due to revenue growth and a reduction in operating expenses relative to the prior year.
- Operating Expenses: Sales and marketing expenses rose 6.9% due to headcount increases and higher commissions. Research and development expenses decreased 7.5% due to project timing.
- Liquidity: Cash and cash equivalents decreased by $8.7 million during the quarter, primarily due to net cash used in operating and investing activities.
- Lease Obligations: The company entered a new 102-month operating lease for office space in San Jose, California, in February 2026, recording a $6.6 million right-of-use asset and $6.5 million lease liability.
Outlook, Risks, and Contingencies
- Liquidity Outlook: Management believes existing cash and marketable securities ($144.7 million) are sufficient to fund operations for at least the next 12 months. However, future capital needs may arise for new product launches and inventory requirements.
- Legal Proceedings: The company is cooperating with a U.S. Department of Justice investigation regarding the Anti-Kickback Statute and Civil False Claims Act related to meals and consulting payments to healthcare professionals. The company cannot currently estimate the financial impact or duration.
- Debt Covenants: The company remains in compliance with all financial covenants under its Fourth Amended Loan Agreement with First-Citizens Bank. The loan matures in September 2029, with principal repayments beginning in October 2027 (subject to performance milestones).
- Risk Factors: Key risks include reliance on a limited number of suppliers, potential impacts of tariffs on international sales, reimbursement determinations by third-party payors, and the outcome of ongoing legal investigations.
Investor Verification Checklist
- Verify the status and potential financial impact of the ongoing DOJ investigation regarding the Anti-Kickback Statute.
- Monitor the company's ability to maintain gross margins amidst potential tariff impacts and supply chain cost fluctuations.
- Assess the sustainability of revenue growth driven by ASC and OBL adoption versus hospital settings.
- Review the timeline for the first principal repayment on the $36 million term loan (currently October 2027) and the achievement of performance milestones that could extend this date.
- Track the utilization of the new San Jose office space and the associated lease obligations against projected revenue growth.