TruBridge, Inc.

Greetings and welcome to the TrueBridge third quarter 2025 earnings conference call. At this time, all participants are in a listen-only mode. A brief question and answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star zero on your telephone keypad. As a reminder, this conference is being recorded. It is now my pleasure to introduce your host, Drew Anderson. Thank you. You may begin.

Thank you. Good morning, and welcome to the TrueBridge third quarter 2025 earnings conference call. Leading today's call are Chris Fowler, President and Chief Executive Officer, and Denae Bassey, Chief Financial Officer. This call may include statements regarding future operating plans, expectations, and performance that constitute forward-looking statements made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. The company cautions you that any such forward-looking statements only reflect management expectations and predictions based upon currently available information and are not guarantees of future results or performance. Actual results might differ materially from those expressed or implied by such forward-looking statements as a result of known and unknown risk uncertainties, and other factors, including those described in public releases and reports filed with the Securities and Exchange Commission, including but not limited to the most recent annual report on Quantum 10K. The company also cautions investors that the forward-looking information provided in this call represents their outlook only as of this date, and they undertake no obligation to update or revise any forward-looking statements to reflect events or developments after the date of this call. At this time, I will turn the call over to Mr. Chris Fowler, President and Chief Executive Officer. Please go ahead, sir.

Thank you, Drew. And thank you to everyone for joining us today to discuss our Q3 results. To start the discussion, I want to take a moment to reflect on the meaningful progress we've made to improve the quality of our earnings and our financial performance over the past seven quarters through our continuous focus on streamlining and improving our operations. Specifically, we have expanded margins, accelerated free cash flow generation, and de-levered the balance sheet, all while continuing to support our customers with mission-critical solutions that improve financial and operational performance across rural and community hospitals. Vinay will provide a much deeper dive into the details of the success these initiatives have yielded, but I'm very proud of the work we've done and believe we can replicate these efforts in other areas of the business. Turning to the specifics of the quarter, Our bookings came in at $15.5 million on a TCV basis compared to $25.6 million sequentially and $21 million year over year. While light from an absolute dollar basis, our focus is on continually improving the quality of bookings, which is more evident when you look at the numbers on a year-to-day basis. As we've mentioned in the past, investments we've made to improve our products, specifically within our encoder business, have allowed us to win higher margin deals. Along with positive traction with an encoder, we've seen our percentage of financial health bookings in the 100 to 400-bed space increase from less than 20% in 2024 to more than 30% in 2025. As we continue to succeed in RCM tech and in the 100 to 400-bed space, we create more paths to improve bookings performance quarter over quarter and year over year. While the bookings performance of Q3 was underwhelming, our fourth quarter sales efforts are off to a strong start. Historically, bookings have been weighted towards the end of the quarter, but October meaningfully outpaced what we typically expect to book in the first month of a given quarter. Broadly speaking, our bookings still remain chunky, so we're not claiming victory just yet, but we are pleased with the signs that whatever was restricting pipeline conversion in Q3 seems to have alleviated. In today's operating environment, not all factors are within our control, so we continue to focus on addressing the challenges that are within our control, like ensuring that we have the highest quality talent on board. In early October, we officially welcomed Mike Dalton to the TrueBridge team as our Chief Business Officer. In this role, Mike will be leading sales and marketing and our client success teams. He is focused on building high-performing teams, holding key team members accountable for exceptional client management and consistently delivering enterprise value and measurable impact. Our expectation of Mike is that he will raise our sales efforts to the next level in terms of order and efficiency, providing more visibility into tracking bookings and revenue growth and focusing on those high-quality opportunities I spoke about earlier. He brings a skill set that will empower our team to go after the larger market, which we know is obtainable with the right discipline and focus. To further enhance our performance initiatives, I'm pleased to report that our offshore transition is progressing as we start to operationalize the strategic plan we spoke about last quarter. We continue to fill out our leadership team, including a head of India, to ensure we have the right leaders in place to execute on the plan. The team has made the foundational improvements necessary to ensure success and put in place the thorough metrics-driven approach we believe was imperative to allow us to turn the transition machine back on. As of October 1st, we have begun at a measured pace. Currently, we have two transitions in the works with more coming in the fourth quarter. As we restart our transitions, We are working in close coordination with each customer to provide a clear understanding of the expectations of how the process will unfold. We have also put in place structural support to ensure continuity of staff from our domestic workforce on each transition to guarantee a stable handoff. As we look ahead to 2026, we plan for transitions to accelerate gradually, but will only do so when we are confident it will not cause disruption. As we move carefully through the customers to be transitioned, we will track performance metrics with a hyper focus on stability, communication, and each customer's comfort with the process. We've stated all along that this process is key to continued margin expansion in 2026 and beyond, but we will not sacrifice the quality of our service to get there. Our commitment to the strategic transition process would not receive a great grade if improved client retention wasn't an intended outcome. While the absolute number of client losses increased a little in Q3, our net revenue retention for our core CBO business has shown a couple of points of improvement from the first half of the year. Renewals were stronger in Q3 than in Q2, and that trend continues into October. As we shared previously, we initiated a multi-quarter process earlier this year to enhance client success quality, drive operational efficiency, and strengthen the capabilities of our India team. I believe this, along with the careful and strategic approach we've taken to restart our transition process, will give us the opportunity to improve our long-term client retention. Looking ahead to the end of 2025 and into 2026, The keys to sustainable and durable performance for TrueBridge are clear. First, implementing the rigor that has led to success in improving our financial health into more areas of the business. Two, deliver higher quality bookings. And three, carefully and thoughtfully executing on our strategic transition process and in turn, improving customer satisfaction with the goal of increasing our retention. During the third quarter, We make strategic and effective changes to drive sustainable long-term performance. We know we have the right foundation in place to progress in these areas and look forward to providing updates in the coming quarters. With that, I'll turn the call over to Benay to review the financials. Benay?

Thanks, Chris, and good morning, everyone. Let me take a few minutes to highlight some of our financial achievements over the past two years review our third quarter results, and then provide additional color on our outlook for the remainder of the year. We have come a long way since I joined in January 2024 with significant improvement on adjusted EBITDA margins, free cash flow, and leverage. specifically adjusted EBITDA margins are expected to expand approximately 600 basis points from 2023 to year end. Year to date, free cash flow has improved dramatically by $20 million. And we have paid down debt by approximately 35 million, reducing our net leverage position by more than two terms, all amidst a complex operational backdrop. As Chris mentioned, since the end of 2023, we have meaningfully improved the quality of our earnings, and we believe we are in significantly better position today than just two years ago. One of our top priorities was to drive efficiency and cost optimization across the organization. We put in place many process improvements, including an ROI-driven assessment of our spend, clear accountability to the business units, and the monthly forecast reviews of the business. Throughout 2024, we implemented cost optimization decisions along with a change in mindset throughout the organization, resulting in an adjusted EBITDA margin of 16.5% for the year, a 340 basis point improvement compared to 13.1% in 2023. Based on the midpoint of our guidance, we are on track to reach 19% margin for the full year, yielding another 260 basis points increase. Continuing with the same mindset, we have identified and are in process of actioning additional cost optimization opportunities in combination with incremental net savings expected from the global workforce transition. I'm confident that as these actions compound, we will be able to deliver continued improvement in our margin profile in 2026 and beyond. Further, disciplined ROI-driven cost management and investment decisions have significantly optimized our product development spend. As a result, capitalized software spend has decreased by 30% from approximately 18 million in the first three quarters of 2023 to approximately 12.5 million in the first three quarters of this year. Additionally, year-to-date capitalized software spending as a percent of revenue has come down to 4.8% from 7.2% in the corresponding period. These efforts, along with the working capital improvements, have resulted in growth in our cash balance from $3.8 million at the end of 2023 to approximately $20 million today. In addition, free cash flow, which we define as operating cash flow, less capex, was $15 million year-to-date in 2025 compared to a cash outflow of $5 million in the corresponding period in 2023. Further, we have also continued to strengthen our balance sheet through disciplined debt reduction, paying down debt by approximately $35 million since January 2024 and improving our net leverage ratio from 4.4 times in Q4 2023 to approximately 2.2 times by Q3 2025. This also marks the third consecutive quarter with net leverage below 2.5 times, highlighting our consistent focus on balance sheet improvement and capital efficiency. As cash generation continues to accelerate, we are well positioned to conclude the year with a meaningfully stronger financial foundation. Turning now to our Q3 2025 financial performance. Total revenue for the third quarter was $86.1 million, an increase of approximately 2% compared to a year ago. However, I'd like to point out the year-over-year growth included approximately $1 million impact from the sunset of our centric product in the patient care unit. Normalizing for this, revenue would have been up 2.8% versus the prior year. Further, recurring revenue continued to be high, around 94% of our total revenue. Financial health revenue of 54.5 million in the quarter represented approximately 63% of the total company revenue and was essentially flat year over year. Mid-single-digit growth in our CBO business and strong growth in encoder revenue were offset by slow performance in other products. Financial health gross margin of 46.2% were almost flat compared to the prior year as labor efficiencies were offset by incremental investments in the stabilization of CBO business. Patient care revenue was 31.6 million, reflecting 5.3% year-over-year growth, primarily driven by growth in staff and some non-recurring revenues offset by the sunsetting of Centric. Excluding Centric, Growth in patient care revenue would have been 8.9% in the third quarter. Patient care gross margin expanded meaningfully to approximately 60%, an increase of nearly 370 basis point versus last year, driven by continued operational efficiencies in vendor, spend, and labor costs. Operating expenses of $40 million represented 46% of revenue and were roughly flat to the prior year, a slight increase in investments in product development for encoder and financial health and in support functions were offset by lower non-retiring costs. All of this resulted in third quarter adjusted EBITDA of $16.3 million with an 18.9% margin, representing 155 basis point improvement compared to 17.3% in the third quarter of 2024. This margin expansion is primarily driven by gross profit improvement and our disciplined approach to cost management. We ended the quarter with $19.9 million in cash, an increase of $11.3 million, 132% year-over-year, and an increase of $7.6 million sequentially, primarily driven by improved profitability, lower interest expense, and disciplined working capital management. Net debt was approximately 144 million, and our net leverage ratio improved to 2.2 times, marking our strongest leverage position in several years. In Q3, we repaid approximately 2 million on our debt, including normal amortization payments, bringing our total payments to approximately $35 million since January 2024. Finally, turning to guidance for the fourth quarter and the rest of the year. For the fourth quarter of 2025, we expect revenue of $86 million to $89 million and adjusted EBITDA of $16.5 million to $19.5 million. And for the full year 2025, we expect revenue of $345 million to $348 million and adjusted EBITDA of $65 million to $68 million. Once again, we will be increasing the adjusted EBITDA guidance for the full year, despite lowering the midpoint on revenue. At the revised midpoint, margins expand approximately 260 basis points compared to the prior year, driven by a continued focus on prudent cost management and ROI-driven cost rationalization. As communicated in the past quarters, we expect the adjusted EBITDA margin in Q4 2025 to be around 20% at the guidance midpoint. While we will not provide formal 2026 guidance until early next year as usual, we do want to take this opportunity to share that we believe we will deliver further adjusted EBITDA expansion, margin expansion of around 200 basis points from the midpoint of our full year 2025 guidance. This is primarily driven by the next level of cost optimization actions we have identified and are in process of realizing, along with the net savings from the next phase of global offshore transitions. Through the first three quarters of the year, I'm pleased with the meaningful progress in improving the quality of our earnings and looking forward to end the year on a strong financial footing. There is still more work to be done and will continue to be laser focused on continuous improvement. Thank you, and I will now turn the call over to Christine for questions.

Thank you. We will now be conducting a question and answer session. If you would like to ask a question, please press star 1 on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star 2 if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment please while we poll for questions. Thank you. Our first question comes from the line of Sarah James with Cantor Fitzgerald. Please proceed with your question.

Hey, everyone. Happy Friday. This is Gabby on for Sarah. I had a quick question about bookings coming in at 15.5 million and appreciate the fact that they're higher quality bookings, but can you talk about where this landed in terms of your internal initial expectations for bookings in the quarter and if we should expect the cadence of bookings to be higher with lower, with higher EBITDA margin from here?

Yeah. Good morning, first of all, Gabby, and please share our congratulations to Sarah as well. Obviously, not the number that we were looking for. I would say we're probably 20% off the number of what we were expecting for the quarter. And again, it wasn't like we saw a negative decision influence on this. It was more of a delayed decision. And I think that that's showing through in the early success of Q4 and what we're seeing in October. I will say we are being very intentional on the bookings that we're going after on the patient care side, focused on our conversion to the SAS model, which is a larger overall booking and does have some more complexity. So it has expanded the buying decision at the customer level. On the financial health side, we continue to be optimistic about the opportunity that's out there. We've just got to continue to get these hospitals to see the value and the need for the additional services to come in. As the regulatory landscape settles down a little bit, I do think that the focus on improvement for the RCM side of the house for the hospitals will continue to be a priority and will lead to increased bookings efforts going forward.

And on the margin question that you asked on, sorry, on the bookings, Gabby, we are seeing an improved quality from a margin also. Like, for example, bookings for our encoder business, which is like a very high 70%, 80% margin, year-to-date 2025, the bookings percent for encoder in the last year to this year has almost doubled. The more we get, the better margin we have, but obviously the mix of the bookings obviously have a bearing, but I think we have seen a trend to the positive.

Okay, great. And then just one more follow up on that, if I could. In the conversations where the hospitals are choosing to delay implementation, Are you seeing that any commonality and if it's reference to Medicaid funding cuts coming through on Big Beautiful Bill or is the $50 billion Rural Hospital Fund and that benefit coming up at all in your conversations? And could that be in the tailwind in 2026?

Yeah, I think it will be a tailwind. Again, I think the uncertainty is, again, not changing people's decision. It's just delaying them for just a beat. We are seeing that pick up. I think there's also the impact of the vast majority of our hospitals are on a calendar year budget cycle. So you take the impact of the budget process and what they're doing, what they're trying to figure out relative to what the OBBB may have an impact on their next year as creating some delay. But again, as they're shoring up what their spending needs are for 26, we're starting to see those decisions accelerate.

Okay, awesome. Thank you so much.

Thanks, Gabby.

As a reminder, if you would like to ask a question, press star 1 on your telephone keypad. Our next question comes from the line of Jeff Garrow with Stevens. Please proceed with your question.

Yeah. Good morning, guys, and thanks for taking the questions. Maybe we'll follow up a little bit on the booking front and, you know, great to hear the mention of October booking success. Sounds like that, you know, kind of reflects timing, maybe some decisions pushing out of Q3. So, with that, was hoping you could discuss kind of the broader pipeline, the state of the pipeline. And then kind of help us level set bookings growth expectations for the year. You know, just more specifically, if some decisions pushed out from Q3 into Q4, is there enough in the pipeline that, you know, kind of pro forma back half of the year could deliver in line with, you know, maybe what you were intending or, you know, could compare it to last year as well if there should be an expectation for overall growth or not?

Yeah, first of all, good morning, Jeff, and thanks for being on the call. The short answer is I would say I wouldn't draw a straight line to the second half of the year based on the early success of October kind of covering up the shortfall in Q3 at the very top of it. With that being said, you know, obviously we are focused on driving as much performance from a bookings perspective into this year as we can. Obviously, Mike has stepped in with guns blazing at the first of October, and while a leadership change can also lead to a little bit of disruption, we're pleased with the continuity and the smooth transition that we've seen from Don to Mike and how the team has rallied behind him. So, with that said, we're off to a good start. We've got the bookings, we've got the pipeline coverage to cover what we expect for Q4. However, what we could see is a very similar outcome to Q3, which is those bookings continue or those pipeline decisions continue to delay. We try to balance the optimism that we're seeing with making sure that we're setting the right expectations, obviously. So with that said, we're very focused on making sure that we convert on those opportunities to close this year. I think the balance of the rest of this year will also set up how we're looking into going into next year. What is positive as we see the pipeline build is that there is coverage on a lot of fronts. You heard Vinay talk about the encoder and the success we're seeing there. We're seeing that same optimism build on the patient care side with the SAS bundle opportunities. And again, in the financial health, both from a cross-sell standpoint and into that new space. So now it's just a matter of seeing that pipeline convert to those bookings opportunities.

Excellent. I appreciate that and want to follow up on one thing there on the new sales leadership, just kind of hoping to get a little bit more detail on kind of what's needed. What's the path from here? What's the process for improvement? You know, I want to recognize there have been efforts over the last couple of years to increase quality and consistency of bookings. And, you know, I think for the most part, you've had positive returns there. So curious how or whether new leadership will need to bring in new tenants and rebuild from the ground up? Or is there a case to be made that that might can just be an immediate difference maker as you try to convert more of that pipeline to close bookings?

Yeah, excuse me. That's a very fair question. I would say it's probably a mix of both, right? I mean, if you look at how we've gone through the other areas where we brought new leadership, I think we want to make sure that we're taking advantage of the talent and the continuity that we have, but also make sure that we're finding the resources and the talent that have been down the roads that we're trying to go down. I think the financial health organization is a great example of that. where we brought in additional talent and leadership under Meredith that have been a part of a transition to India or operating in a successful global environment. So I think that Mike will do the same thing. I think that we're, you know, going to make sure that we have the right infrastructure in place for him. I'm excited about also tying together the sales, marketing, and the client success function together under him. so that we do have that holistic view of a customer, both in the pipeline and all the way through as we onboard them, and that we've got single ownership there and accountability to deliver on the fronts that are most important to us, which is the retention and the growth. So a long-winded way of saying, you know, I think that we're going to give Mike the latitude to bring in the team and support him to make sure that we're able to achieve the bookings goals that we've got set for ourselves over the coming years.

Excellent. That helps. One more for me. I want to make sure to hit the retention front. And I'll ask it in part as a housekeeping question, whether you have the recurring backlog number that usually shows up in the 10Q on hand. And then from a fundamental perspective, I want to recognize that that's a bit of a legacy metric. But given the focus on renewals and retention and recurring revenue, I think there's a case to be made that it's as important as ever. So, Would appreciate any color on whether you guys are managing to that backlog. I guess most specifically the recurring backlog metric internally.

Thanks. Yeah. So we do look at the backlog because we run it this way. And that number obviously will be in the 10Q coming up in the next few hours. So on how we do it, just to give you a little color more is on backlog for that number there's Contracted and non-contracted, contracted revenue is at a client level monitored with ins and outs to it. And like we said, in financial health, it's like 95, 96% is generally how we start the year. Like if you look at our recurring numbers that I say right now, it's 94%, financial health is like 95, 96%. So we have a huge... But obviously, the ins and outs of that is attrition that happens and how the bookings fill in that gives the impact on the growth rate. But I think the backlog number should be coming out in the next few hours.

Understood. Thanks. I'll hop back in the queue.

Our next question comes from the line of Gene Manheimer with Freedom Capital. Please proceed with your question.

Thanks. Good morning. Let's see. I just had two quick ones. The patient care revenue was, you know, the best growth we've seen in some time. You called out a combination of SAS, filled, and non-recurring. I mean, since that SaaS build is pretty gradual, I'm thinking, you know, you recognize some good non-recurring business in the quarter. Can you tell us what specifically customers are buying in those cases?

Yeah, so you're right. There are two parts to that. Obviously, based on few wins of the past shows up as a double-digit growth. But the non-recurring part is a mix of implementation revenues when it gets recognized, because sometimes it gets recognized at the time. Then there are other non-recurring revenues for some regulatory-related concerns. and regularly related stuff that we do. So we do see an uptick and some of compared to last year, we saw in this quarter a little bit more. But if you see that swings happen, my Q4 of 24 was a much higher number because of these. So the swings on other than SaaS are continued build on our partner ecosystem that we see on products like MultiView and all. Sometimes we do have some hardware sales requested by the customers and some ancillary products.

Okay, great. That's helpful, Vinay. Thank you. And my follow-up would be, you know, your comment earlier was encouraging to hear, if I heard it right, 200 bps of EBITDA margin expansion expected next year. I'm thinking that that's going to be due primarily to continued cost efficiencies, or should we infer that there could be an acceleration of revenue growth next year? Thank you.

That's a great question. That's a great question, and I think you guys know me well by now. For me, 200 BIPs is primarily from the cost optimization first, and that's not just a whole part of it. As you saw last year, it's a continued effort, and it will continue. We did the lowest level last year, which was all that Chris and I and the leadership team could see. And then over the years, we built our next level of optimization with help from internal teams and our advisor, external advisors. And this momentum that we started more in the second half of this year is targeting a little more complex solutions like patient care support, um tech support cloud ops um and roi driven on some other products so that line of sight um and the potential that i see next year and you at least that dna i can say we have built in there we are maniacally going to make sure it falls to the bottom line so that's one of the big drivers for that number, along with the benefits that we would see from the global workforce optimization should be there. Now, obviously, some implicit scenarios on revenue growth has been built, but as Chris said, it's a little early for us to give that guidance. from a various scenario analysis we did, we felt getting that 200 bps from our midpoint of our guidance was very achievable. And that is what we felt to share with you because four quarters back, We shared that we will be touching 20% in Q4 25. And that was a good goal for us. So it helped us be laser focused. So at this point, we felt 200 bps over and above was we could see a few paths to get there.

Yeah. And I think, you know, Gene, I think there's also a trend that we're trying to create here. So if you go back. Two years ago is when they came in and you're seeing the stability and the financial improvement in the company. That's the first layer of the cake. The second layer is Meredith and her team coming in and stabilizing the financial health business and accelerating and delivering on that opportunity. for the global transitions, which is going to be the big driver in the margin expansion next year. And then now we brought in Mike to really kind of focus on that upsized opportunity from a sales growth and quality of bookings going forward. So it's the three layers of the cake that we built. We've shown that we can bring that right talent, deliver on the financial excellence. We're delivering on the on the performance from the financial health and the stabilization of that business. And now we look forward to success on the sales front going forward. So, you know, just continuing to replicate a model that seems to work in each of the areas to put it all together to extract the value we think is still ready to unlock in the organization.

Yeah, that's great color. Thank you.

Thank you. Mr. Fowler, we have no further questions at this time. I'd like to turn the floor back over to you for closing comments.

Thank you. And thank you to all for your continued interest in Tritbridge. And thanks to all of our team members for their continued efforts at the company and all that they do. And lastly, a very early happy Veterans Day. We express our gratitude to all those that have served our great country and hope everyone has a wonderful weekend. And thanks again. Good night.

Ladies and gentlemen, this does conclude today's teleconference. You may disconnect your lines at this time. Thank you for your participation, and have a wonderful day.