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Small-Cap Confidential
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Cabot Small-Cap Confidential 245

It was 2007 when James Morales first realized he had sleep apnea. For over a decade he frequently stopped breathing at night, struggled in life and at work due to chronic fatigue, and his wife was always worried about what could happen if he didn’t get help.
Today, James sleeps like a baby. He rocks out of bed, attacks the day doing house projects and in his job. The best thing is he’s not relying on a CPAP machine – complete with hoses and a face mask – to deal with the sleep apnea.

What was his solution?
It’s all laid out in the October Issue of Cabot Small-Cap Confidential.

Cabot Small Cap Confidential 245

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THE BIG IDEA
There are over 100 million people around the world suffering from obstructive sleep apnea (OSA), a condition in which a partially blocked airway prevents airflow to the lungs when a person is asleep. The typical length of a breathing pause is 10 seconds. But it can often be much longer.

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While many of these folks are constantly waking up through the night gasping for air and dealing with low oxygen levels, headaches, dry mouth, lack of energy and even depression, those issues are often the least of their concerns—as is their partner’s annoyance with loud snoring.

Data shows that untreated OSA can double the risk of stroke and sudden cardiac death. The risk of cardiovascular mortality is five times higher.

Why? And what can be done?

The underlying problem is that people with OSA have some sort of airway obstruction that prohibits normal breathing. This can be the result of a person’s throat and tongue relaxing more than normal, large tonsils or tongue, or from being overweight.

In more extreme circumstances, people may suffer from some illness or anatomy issue in the throat that causes it to close completely. Those are complicated conditions that are beyond the scope of what we’re talking about today. Because in most cases, OSA is entirely treatable with relatively simple therapies.

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The most common therapy is continuous positive airway pressure (CPAP). Most of us are aware of this solution and know somebody that uses it.

With CPAP, air is delivered through a mask that’s connected to a hose to a bedside pump. It’s often effective, but compliance isn’t great.

Data shows that only 35% to 65% of people stick with CPAP because, well, they don’t want to sleep with a face mask that’s tethered to a hose and pump.

Another option is to have invasive surgery to permanently change the anatomy of the back of the throat. The two leading procedures are Uvulopalatopharyngoplasty (UPPP) and Maxillomandibular Advancement (MMA). But these require in-patient surgery and long recovery times. Not fun.

Back in the 1990s the huge medical device company Medtronic (MDT) saw there was an opportunity to build a better mousetrap than the mask, hose, pump setup that delivered CPAP therapy—and help people avoid invasive surgeries.

Medtronic’s concept was to design a device that could be implanted in a patient and deliver neurostimulation to the nerve that controls the throat muscles. The patient could go in for a relatively simple outpatient surgery and then turn the device on and off as needed with a wireless remote. No face mask, no hoses, no pump.

Medtronic got to work on the device and started publishing clinical results in 2001. Things kept humming along and in 2007 it spun out the business into a pure-play OSA therapy company with a first-of-its kind implantable neurostimulator technology.

With more trials and more positive data the therapy was approved in Europe in 2011, then the U.S. in 2014. By 2016, 1,000 implants had been completed and this little company was off and running fast enough to prep for an IPO, which was completed in 2018.

The stock hasn’t been immune to the market’s retreat. In fact, it hit an all-time high in late August and has fallen over 20% since. I believe we can start to step in at this level with a partial position to scoop up shares of what could easily be one of the biggest winners in the MedTech field over the next five years.

Here’s the rest of the story of Medtronic’s groundbreaking OSA solution now known as Inspire Therapy.


THE COMPANY


Inspire Medical (INSP) is a $1.3 billion market cap company that’s developed a better solution for people with obstructive sleep apnea (OSA). The leading therapy, continuous positive airway pressure (CPAP), does work. But it’s not very comfortable, it’s loud and, let’s face it – who wants to wear a mask that’s connected to a hose that’s connected to a pump all night? Not even people with OSA. Which is why compliance is so low.

Inspire’s solution is head and shoulders above CPAP. The implanted system, which is inserted in the chest during outpatient surgery, continuously monitors a patient’s breathing and delivers mild hypoglossal nerve stimulation to maintain an open airway.

The therapy has been evaluated in several sleep studies. Inspire’s STAR trial (124 patients for one year and 97 for five years) showed a 70% reduction in the medium apnea-hypopnea index (AHI). AHI measures the number of partial or complete airway blockages that occur in an hour. After five years, 80% of patients continued to use the therapy daily.

Data from the first 508 patients (of 2,000) in the ongoing ADHERE Patient Registry also looks great, showing a 79% reduction in AHI, 42% reduction in daytime sleeping, and high compliance, patient satisfaction and preference over CPAP.

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The bottom line is that study after study show that Inspire therapy works. It helps patients with much more regular breathing patterns, more consistent blood oxygen levels, far fewer rude awakenings due to gasping for air, and much higher compliance than CPAP.

That’s why Inspire Therapy was first approved in European markets in 2011, by the FDA in 2014 and, just recently, in Japan. It is the first and only FDA-approved neurostimulation technology that’s clinically proven to be a safe and effective treatment for moderate to severe OSA.

Adoption and insurance coverage are spreading across the country. There are currently 245 centers in the U.S. where Inspire therapy is available. In terms of lives covered in the U.S., the latest tally is 142 million through 41 coverage policies. Additionally, six of the seven Medicare Administrative Contractors (MACs), covering 44 states, have issued draft coverage. Official Medicare coverage is expected to be secured in early 2020.

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On the downside, it is true that going in for surgery, even outpatient surgery, to have a device implanted in one’s body represents a hurdle to adoption – no matter how significant the benefits. But the clinical data, Inspire’s revenue growth trajectory, and the adoption of insurance coverage, suggest the benefits far outweigh the physical, emotional and fiduciary costs.

With adoption catching on Inspire has been growing rapidly. Revenue was up 75% in 2018 and should be up another 60% this year.

Who Qualifies for Inspire Therapy?

Inspire therapy isn’t for everybody. It’s not for people with central sleep apnea (CSA), which is when the brain stops sending messages to breathe during sleep. This is usually the result of some other illness. It’s also not for people who have a complete concentric collapse, which is when the soft palate (the area behind the roof of the mouth) totally collapses due to factors Inspire won’t help with.

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The treatment is indicated for patients with moderate to severe OSA. This includes people who have an AHI in the 15 to 65 range.

In the U.S. (but not in Europe), qualified patients must be at least 22 years old and have been confirmed to fail or be unable to tolerate CPAP for at least four hours, five nights a week.

If a patient is believed to qualify the next step is to see an ear, nose and throat (ENT) surgeon. The surgeon will put them to sleep with appropriate drugs and perform a sleep endoscopy to see if their AHI falls into the approved range. They will run a thin, flexible camera through the patient’s nose and evaluate the entire upper airway, from the tip of the nose to the voice box.

If a patient is approved, the process requires surgery and then, about a month later, device activation.

In terms of the U.S. market opportunity, there are roughly 17 million people in the U.S. with moderate to severe OSA. About 2 million of them are prescribed a CPAP device. Cut out one third of them due to anatomy issues and then take around 35% that just can’t deal with CPAP. That gets you to roughly 500,000 potential patients.

With a price of a little over $20,000, the implied market opportunity is roughly $10 billion. Inspire should generate sales of $100 million in 2020, so there’s plenty of room to grow!


THE PRODUCT


Inspire therapy works by delivering electrical stimulation to the hypoglossal nerve, which causes the slight forward movement in the back of the tongue. This keeps the airway open and allows the patient to inhale freely.

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There are four key parts to the system, including a remote control and three implantable components; a pressure sensing lead to detect when a patient is trying to breath, a neurostimulator to house the electronics and battery, and a stimulation lead to deliver electrical stimulation to the hypoglossal nerve.

The technology works because of a proprietary algorithm that tracks breathing patterns and tells the neurostimulator when to do its thing.

Step one is to have the Inspire system implanted. It requires outpatient surgery that takes around two hours. Healing time is typically a few days before normal daily activities and a few weeks before doing anything too strenuous – just enough time for the incisions to heal. OTC pain meds are usually enough during the healing phase.

Surgery is straightforward. General anesthesia is given, and three small incisions are made: one under the lower jaw for the stimulation lead, a second in the upper right chest for the neurostimulator, and a third near the ribs for a pressure sensing lead to monitor the patient’s breathing cycle.

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The whole system is tested in the OR, the wires for the electrodes are tunneled under the skin and the patient gets sewn up, good as new!

After 11 years or so a simple outpatient surgery is required to replace the battery in the cyborg’s chest.

The patient is given a month to heal before the Inspire system is activated. This is done in the clinic via a wireless connection to the device. To activate, the physician uses a programming tablet to turn the system on and tune it. Variable parameters include strength of the stimulating pulse, sensitivity of detection, timing and length of pulse and which part of the stimulating electrode to use. Most patients are all good with the default settings, except for pulse strength, which is frequently customized to be just strong enough to move the tongue out of the way without being uncomfortable.

Patients can control the strength of stimulation too, within safe parameters. They have a remote control to turn on at night (it has a 30-minute delay to allow you to fall to sleep) and off in the morning. They can also pause stimulation as needed.

The Business Model

Inspire sells its systems to hospitals and ambulatory surgery centers in the U.S. and Europe through direct sales forces. Salespeople focus their efforts on ENT surgeons and sleep centers. The company also markets direct-to-consumer through a new website and other methods to drive awareness. Customers are reimbursed for Inspire therapy costs through commercial payors, the Veterans Health Administration (VHA) and Medicare. Major growth drivers include the number of implanting centers doing Inspire therapy, the number of procedures they can complete and the ease with which reimbursement can be secured. Many of these variables are dependent on the performance and stick-to-it-iveness of territory managers and salespeople.

Major Growth Initiatives To Follow

Expand Indications: Inspire has submitted a Premarket Approval (PMA) to the FDA to expand approval for patients as young as 12 years old. The therapy is also a good candidate to treat adolescents with Down Syndrome, which could help 125,000 patients in the U.S. Roughly 30% to 60% of children with Down Syndrome suffer from OSA, versus 1% of the general public, and CPAP compliance is far worse.

Expand Coverage, Including Medicare: Inspire’s growth is explicitly tied to the number of people who qualify for insurance coverage. As coverage goes up, not only are more lives covered, but there is far less work involved for patients, Inspire’s salespeople, and physicians who have, up until recently, needed to submit prior approvals and go through the appeals processes if coverage is denied at first. Factoring in appeals (Inspire has an internal reimbursement team working on these), the approval rate was close to 90%. But this process is still time consuming and annoying.

Thankfully, reimbursement trends are strong. One year ago, only 3 million lives were covered. Subsequent to the end of Q2 new coverage has been announced, pushing the total up to 41 policies and 142 million lives. In terms of Medicare coverage, draft local coverage determinations (LCDs) proposing coverage of Inspire therapy have been published by six of the seven Medicare Administrative Contractors (MACs), which collectively cover 44 states. The final MAC is expected to publish an LCD in early-2020. There is a review period after each LCD is published and then it takes a few months to get a final LCD published, meaning we should start to pin things down in 2020.

Direct-To-Patient Initiatives: Inspire began a new marketing initiative in early 2019 to better educate prospective patients about the benefits of Inspire therapy. This involved a new website (just launched), logo and marketing message to drive the “no mask, no hose, just sleep” message home. Management reports that website visits are up 48% to 2 million in the first half of 2019 and doctor searches are up 41% to 341,000.

Grow the number of Medical Centers: Inspire is in 245 of the roughly 1,000 to 1,500 hospitals in the U.S. (out of a total pool of 4,000) already selected by management as a good fit. The company activated 19 new U.S. medical centers in Q2 2019, well above guidance of 12 to 14 new centers, and expects to keep adding 12 to 14 per quarter, implying it should end the year with 269 to 273. With centers averaging just three procedures per quarter, but plenty of them capable of doing 10 or more, there appears to be an enormous market for Inspire to grow into.

Expanding the salesforce: Inspire is building out its salesforce to go after the U.S. opportunity now, and global opportunity later. With six new territory managers added in Q2 2019 it now has 59 total. And management expects to add four to five new territory managers a quarter in 2019, implying it should end the year with roughly 69 territory managers. To support this growth management elevated an internal candidate to Chief Commercial Officer (CCO) and has been placing regional VPs as well.

Expansion in Japan: In June 2019 Inspire received full regulatory approval in Japan. The company is now working with the appropriate agencies to establish reimbursement levels that are on par with those in the U.S. and Europe. Nothing is set in stone yet and Inspire has no sales team presence in Japan. But clearly the plan is to get things going here and we should expect word on the path forward in upcoming quarters.

The Bottom Line

Revenue was up 74% in 2017 and 75% in 2018. The company is not profitable; EPS was -$1.08 in 2018. In Q2 2019 (reported August 6) revenue grew 65% to $18 million and EPS of -$0.32 was a 7% improvement over the comparable quarter in 2018. Both results were better than expected, and growth in both the U.S. (87% of revenue) and Europe (13% of revenue) was over 60%. Gross margin went up 2%, to 82.8%, as a new sensing lead was rolled out. Operating expenses rose by 60%, driven by growth in the sales forces and costs associated with the direct-to-patient marketing programs. Inspire burned $23.5 million in Q2 and ended the quarter with $164.7 million in cash. It has just over $24 million in debt.

On the Q2 conference call management increased 2019 revenue guidance to a range of $73 million to $75 million, implying 44% to 48% revenue growth. But analysts see that as conservative given expanding coverage and are calling for revenue of $80 million, which represents 60% growth. Adjusted EPS loss is seen around $-1.50. Looking out to 2020 analysts see revenue up 25% and EPS loss of -$1.58. I think those numbers are more placeholder than anything and will be updated once we get through Q3 and get a better sense of expectations for new medical centers and covered lives growth in 2020.


RISK


Official Medicare Coverage Decisions Don’t Materialize: The risk of this is decreasing dramatically given the LCDs from six of the seven MACs, but until things are official some questions remain.

Detrimental Change in Reimbursement Rates: Inspire’s revenue is very closely tied to reimbursement rates in the U.S., and to a lesser degree in Europe. Suffice to say investors would like to see rates stay consistent.

Slower Adoption by Doctors: At the end of the day Inspire needs surgeons to recommend Inspire therapy. While the trends here are positive there’s still a lot of upside potential for medical centers to move from an average of three surgeries a month to many multiples of that. If that growth doesn’t pan out Inspire’s growth trajectory will be affected.

Likelihood of Stock and/or Debt Offerings: Inspire should have plenty of cash to get through the next 12 months, but at some point it will need to complete a stock or debt offering to fund operators. It’s unknown how this will impact the stock price; sometimes these events are positive as new investors come into the stock. But sometimes the stock gets hit.

Non-Diversified Business: Inspire is all in on Inspire therapy. There is no other source of revenue. Anything materially bad with product development, reimbursement, patient acceptance, etc., could hurt its growth trajectory.


COMPETITION


Inspire competes with other neurostimulation technology options for second-line therapy to treat patients with moderate to severe OSA. While it’s the only player with a neurostimulation therapy approved by the FDA in the U.S., other companies are working to commercialize solutions. Beyond the U.S. Inspire competes with LivaNova, which markets a neurostimulation device (trials are going on in the U.S.). It also competes with other surgical treatment options for mild to moderate OSA, such as UPPP, MMA and robotic tongue reduction surgery. To a limited degree Inspire competes with the variety of sleep aid devices that are on the market and with CPAP. But since the therapy is indicated for patients that have failed, or can’t tolerate CPAP, there isn’t direct competition here.


THE STOCK


Trading Volume: Inspire has a market cap of $1.3 billion and trades an average of 263,000 shares daily. That means just under $15 million worth of stock trades each day. Our subscriber group shouldn’t move this stock. Heavy days are around 600,000 shares, and that’s happened four times over the last six months.

Historical Price: INSP went public in May 2018 at 16 and immediately popped 56%, then climbed to 58 by the end of August 2018. The stock pulled back 40% into the mid-30s last fall and spent October through December trading in the 35 to 54 range. Shares began to climb off the 40 level in January, peaked at 64 in February, then pulled back again, into the high 40s. The next breakout came in July when the stock traded above 69, and it hit an all-time high of 71.71 in early September. INSP began to retreat soon after and with the decline accelerating this week shares are now 22% off their all-time high and just broke below their 200-day line. Stepping back, this looks like a hot stock that needed some time to consolidate its rather significant post-IPO gains.

Valuation & Projected Price Target: With insurance coverage expanding rapidly and risk seemingly decreasing across the board INSP should be able to trade at a solid premium to peers, meaning a forward price-to-sales ratio of around 17 to 18 is feasible (in a better market than this). That implies a share price target of around 72 to 75, which is roughly 30% to 35% above where the stock is now. I think this is a very reasonable return expectation over the next year in a sketchy market, especially given INSP has already traded at that level. Further upside potential (especially in a better market) is likely, in my opinion, provided the expected positive coverages come through, medical center adoption trends accelerate, and expanded indications come to fruition.

Buy Range (next two months): My wide preferred buy range is between 46 (the stock’s eight-month low and 18% below where it is now) and 64 (about the middle of the last three month’s trading range and where the stock peaked in February). Given the recent market volatility and reality that stocks, including INSP, could swing around in the near term we’re starting with half a position. BUY A HALF

The Next Event: Management should announce official Q3 2019 results and host a conference call around November 6.

Inspire Medical (INSP) Financials

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Inspire Medical (INSP)
5500 Wayzata Boulevard
Suite 1600
Golden Valley, MN 55416
844-672-4357
http://www.inspiresleep.com

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UPDATES ON CURRENT RECOMMENDATIONS


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Buy means accumulate shares at or around the current price.
Hold means just that; hold what you have. Don’t buy, or sell, shares.
Sell means the original reasons for buying the stock no longer apply, and I recommend exiting the position.
Sell a Half means it’s time to take partial profits. Sell half (or whatever portion feels right to you) to lock in a gain, and hold on to the rest until another ratings change is issued.

If you didn’t utter the words “the stock market stinks” this week then you have thicker skin than I do.

It’s been a challenging time, there’s no doubt about that. And during these down cycles it’s easy to see the glass as half empty. Just go down the list of impeachment talk, global growth slowdown, U.S. manufacturing and services data looking worse and then, if you’re more into shorts than sweaters, the reality that winter is marching straight toward us.

On the other hand, and it’s a big hand, the market had been ripping higher for months and while things are slowing down, we’re not in a recession (at least, not yet). More people than ever have jobs, the market is still within spitting distance of all-time highs and some rotation out of the narrow class of leading growth stocks and into value and other areas is probably better for the overall health of the market.

Yes, some shine has been removed from many of our stocks. But when the sun comes out, they still give off a nice sparkle. Our average portfolio gain of 68% still compares quite favorably to the small-cap index, which has returned a big fat nothing over a comparable period.

Cutting through all that we could speculate upon, the big question now is whether it’s time to pull back some more, sit pat, or start building up positions that we reduced a few weeks ago.

My position is that it’s time to sit pat, other than putting a little money to work in this month’s new addition, Inspire (INSP).

While the macro-economic data doesn’t look superb (though today’s jobs report is somewhat encouraging) and all the junk going on in Washington is discouraging, at best, many of our stocks have come in a lot. And the likelihood of another Fed rate cut has gone up dramatically.

Today will be a telling day, and as we get into next week investor focus will start to turn more and more toward the upcoming earnings season. Let’s take it a day at a time here and continue to monitor our portfolio positions carefully. Should things take another leg down, we’ll act swiftly.

But in the meantime, let’s see if buyers continue to step in and support some of these great stocks that stumbled a little in September.

Changes this week

None

Updates

AppFolio (APPF) was one of the stalwart performers in of our portfolio this week, posting a modest 1% gain. Equally important, the stock has stayed above support around 88, though the intraday low of 90 yesterday was a close call. HOLD.

Arena Pharmaceuticals (ARNA) was down 1% this week on no news. It’s still searching for support and, long term, the opportunity is still massive. This is one stock where manufacturing and services data don’t really matter. Arena is not generating revenue and won’t be for several years, even if things do go well with all trials! Obviously, sentiment matters to most stocks. But in terms of impact on the business, Arena’s underlying value should be unaffected by most of the issues circulating the globe right now. BUY.

Avalara (AVLR) was headed for a horrible week until yesterday when shares popped back up near 70 to cut the weekly decline to a mere -4%. That gives you some sense of how terrible the market has been for high-growth SaaS names when we’re calling -4% a victory. The most important thing is that AVLR bounced right at a rational support line around 66, which is where it gapped up to in early May (see chart below). There’s nothing new here. It’s a great company that’s growing quickly and should be owned, even if the position size gets cut as the stock falls. For now, I’m keeping at hold. If AVLR breaks below 66, we’ll take more partial profits. HOLD.

Bandwidth (BAND) was flat this week as the stock continues to teeter on the edge of being cut from our portfolio. As I’ve been saying, 64.5 looks like the last zone of support before shares slide off and into the abyss (at least temporarily). At the same time, BAND trades right on its 200-day line and the combo of that and the aforementioned support zone increase the odds of shares rising from here, in my view. That’s why I’ve kept at buy for aggressive investors. That said, we’re not going to be irrational just because a few lines on the chart can paint a seemingly bullish picture. If the stock falters, I’ll cut it. BUY.

Cardlytics (CDLX) has been a good soldier since I added it to the portfolio a month ago. Sure, the stock’s 13% off its all-time high and 9% below where we added it. But there’s been no breakdown and CDLX is still above its 50-day line. The five-month pattern of higher highs and higher lows is very much intact, for now. Usage with Chase is growing, and we await the Wells Fargo launch in Q4. Both should drive meaningful growth in billings and revenue. BUY.

Domo (DOMO) is badly wounded but its overall condition hasn’t deteriorated this week. We’re still biding our time and looking for some strength to sell into. HOLD.

Everbridge (EVBG) has finally strung together a series of four consecutive days in the green, an impressive feat given that the world seemed to be falling apart all around it this week. It may be that the correction is finally over. It doesn’t hurt that management announced the company won a five-year contract with California to upgrade the state’s outdated 911 system on Thursday (news may have leaked earlier in the week). The Everbridge Platform will enable the state’s Integrated Public Alert & Warning System (IPAWS) communications to reach 38 million residents and all first responders. Innovative functionality will allow the Next Generation 911 system to reroute calls to various agencies. HOLD.

EverQuote (EVER) was taken down a notch this week and hit its lowest price in five weeks (around 19.5). That’s far from a disaster, but shares are now just below their 50-day line and are looking a little precarious given that most other stocks that posted big gains in 2019 have given a large portion back. If we see shares move much below 20 we may take another round of partial profits. HOLD.

Goosehead Insurance (GSHD) was a little wild this week and fell from the top of its recent trading range around 52 to the bottom, near 40. That decline only took two days, though shares recovered throughout Wednesday’s session and are now back near the middle of their trading range (near 44). There’s no change in the big-picture story. It’s a good business and the stock has been relatively resilient lately. BUY.

Quanterix (QTRX) continues to be quite volatile but popped back up into the low 20s yesterday. We trimmed this position a few weeks ago. No news. Keep holding half. HOLD.

Q2 Holdings (QTWO) took two legs down this week along with many other growth stock names but, like many others, bounced on Thursday. Shares are now working their way back from their 200-day line. I still like the stock and think the growth trajectory looks fantastic. That picture looks even more compelling after the recently announced purchase of Precision Lender, Q2’s biggest acquisition ever. Precision Lender sells software that helps bankers structure, price, and negotiate good lending deals through a variety of insights and coaching tools. The acquisition immediately helps Q2 build out the commercial and corporate aspects of its business and add solutions that are distinctly different from consumer-facing digital banking platforms. The price paid will be $510 million and should increase Q2’s addressable market by roughly $2 billion, focused mostly on the larger tier-1 banks. It also opens up a lot of cross-selling opportunities given Precision Lender has around 150 customers, with little overlap with Q2’s 400 customers. Management says Precision Lender’s growth is faster than core Q2, implying roughly 30%, or better growth. I like the deal and think it’s a rational next step for a very attractive digital banking/fintech company. BUY.

Rapid7 (RPD) has been beaten up lately but we took partial profits a few weeks back, so we did reduce our pain a little. The stock’s moving with the broader security stock group, meaning it bounced back yesterday and looks OK as of early Friday. For now, keep holding. HOLD.

Repligen (RGEN) story isn’t much different from most of our other stocks. It was up at 52-week highs just over a month ago and now it’s more than 20% lower. But the story and the growth profile are still fantastic. I’m keeping at buy and think between 72 and 78 it’s a heck of a bargain. If RGEN slips below 70, I’ll become much more concerned (not only about this stock, but the market in general) as that would mark a breach of both the 200-day line and the level from which the stock launched a strong rally back in early May. BUY.

Veracyte (VCYT) hasn’t worked well for us since we got into the position but as I’ve been saying there’s no real issue to poke at. We just got in when the market was a little toppy and shares have pulled back slow and steady since. They’re near their 200-day line now, and still within the roughly 21 to 30 price range where they’ve spent most of the last six months. BUY.

Please email me at tyler@cabotwealth.com with any questions or comments about any of our stocks, or anything else on your mind.


The next Cabot Small-Cap Confidential issue is scheduled for November 1, 2019.

Cabot Wealth Network
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