3/4/2025

speaker
Charles McBain
CEO of Nord Health

Everyone is doing well. As per usual, this is the Q4 2024 presentation for Nord Health. So as usual, I'd like to start with introductions. I'm Charles McBain. I'm the CEO of Nord Health. And I also want to introduce Alex. Alex, maybe go ahead.

speaker
Alex
CFO of Nord Health

You're muted. Thanks, Charles. Hello, everyone. I'm pleased to be on this call with you today. I'm Alex. I'm the new CFO at Nord Health. I'm British, and my background is in fast-growing technology companies. Most recently, I was CFO of the Norwegian-American creative services company Superside, and before that, I was CFO of the Belgian e-bike maker Cowboy. I joined NordHealth because I think it's an exciting time for practice management software. There's an increasing consolidation of practices, creating more large enterprise clients who require more sophisticated systems. And I think NordHealth has the best team, the best product and the best strategy to be the winner in this space and deliver the best experience for healthcare professionals and ultimately for patients. So I very much look forward to working with Charles and the rest of the team to grow this business. And I'll now hand it back over to Charles for the company update. Thanks, Alex.

speaker
Charles McBain
CEO of Nord Health

So as usual, we will start with the company updates, and then we'll dive into a veterinary BU-specific update, then a therapy BU-specific update, and then I'll hand it over to Alex for a financial update. And as usual, we will do a Q&A at the end. So please hold off your questions to the end, and you'll be able to use the Q&A feature to be able to ask questions. So starting with the company update. In Q4 2024, year over year, we've been able to grow our ARR organically by over 20%. That growth was driven by a net retention rate of 113%. A churn of 5.1, so still quite low churn. And also, we've been able to recruit net new customers with sales and marketing efficiency, as you can see from the CAC to new AR being 0.7. These numbers coincide to get us to 19.6 LTV to CAC. over the last 12 months ending 2024 Q4. So at the end of Q4, we had an implemented AR of 42.3 million and assigned AR of 44.3. What's important to us is the value per share, right? So the AR per share is currently 53 cents per share. Looking back as we do normally, right? So in 2018, when I joined the company and we bought Nord Health, the recurring revenue was 3.4, right? And today it's 44.3, which is a CAGR of 53%. In that 44.3, we do not include vets for pets and the U.S. enterprise chain post-rollout. So only once rollouts and pilots are successful do we actually include those in our signed AR to be conservative. This is a different way of looking at the charts. This shows the change in ARR year over year. As you can see, every year we've actually been able to acquire more or to grow ARR by a larger amount. Now, if we look at how we grew in 2024, We started the year at 33.9. We were able to get 2.6 million in new customers. Also, we were able to upset our current customers by 6.2 million. Important to note here is that this is primarily driven by the CVS implementation, given that they were previously a new customer, but as they were a current customer now, a lot of the growth and expansion as they rolled out new clinics was in NetApp. And then the second primary driver of that is our private cloud, our pre-user growth. Our churn was 5.1% over the last 12 months. And important to note on this one is that churn always goes slightly high when we're migrating and we're sunsetting individual products, as the last few users actually that decide not to migrate are now considered churn. We have, then we ended 2024 with 40.8 of AR. We've got 2.1 million of signed but not implemented AR, which leads us to 42.9 million of AR. And then our other businesses, which are e-training business and also IT operations business, legacy businesses, AR was 1.5 million. And that's how we get to our 44.3. So moving on to the next slide, this is a slide that we brought back in that I want to help investors understand how we spend money and what our targets are. So when I look at the business, I'm always looking at the ROI that we have on our investments. um that's how i figure out how much to invest in uh different initiatives so let me walk through uh this slide with you so as you can see um recurring revenue has grown from around 16.8 in 2021 to 37.4 right and you can see the growth phrase over there Then what we do is we actually look at the contribution margin. So how much cash have we actually generated despite the fact that we've been increasing the revenue? And so the contribution margin is the best proxy for pre-growth investment cash flow, right? So the way we get the contribution margin is we take the recurring revenue. We remove the COGS, customer service, maintenance R&D. This is all the development costs to maintain the legacy products, which we've acquired, but have not yet migrated. And we also take out G&A costs. So the only thing which is not included there relative to EBITDA-CAPEX is investments in acquisitions, CAC, and R&D. And so that's what we call total investments. And so how we make decisions is we look at how much we invest in those three areas, acquisitions, tax, and R&D, relative to the change in contribution margin over the years. And it's really hard to be able to look at this in one year because a lot of times these acquisitions pay back over a multi-year period. The reason why is when we buy a company, immediately when we buy them, we don't migrate them over. It takes... sometimes two, three years to be able to migrate those customers over and see the benefits of that migration in the contribution market. So as you can see, over the last three years, we've invested almost 65 million euros in tech, R&D, and acquisitions. But we've been able to have a change in contribution margin of almost 13 million euros, which is an ROI of 20%. That being said, we can see the ROI trending up in 2024. And we foresee that over time, as we migrate more, we will see that ROI actually increase relative to the 20% average over the last three years. But that's how we look at the business in the long term. The amount that we invest in either of those three growth investments relative to the change contribution margin. Now let's deep dive into veterinary. Veterinary had a spectacular year with almost 30% year over year implemented ARR growth. The particular reason why we grew was one, we successfully recruited new customers for 1.3 million, but also we were successful with the rollout of CVS and other enterprise clients. In addition, our churn, although it was 4.8 for overall for the year, if we exclude the impact that I mentioned previously, which was the impact of profit-win-vet-serve end of life, leading to a one-time churn, the churn rate would have been 2.9%. So it's a very, very, very low churn on ProVet Cloud that we can see in other legacy products that were not end-of-life. Important to note is that Indy's numbers fed for pets and the U.S. Enterprise post-pilot rollout AR are not included. Looking at profitability, we have been able to improve profitability year over year, where in 2022, the veterinary BU lost almost 3 million euros in Q4 2022 as we were investing into the product very aggressively. We reduced that to negative 1.1 million in 2023. And you can see that we have a 1.5 million improvement in 2024, Q4 relative to the previous year. The drivers of that have been, one, we've been able to grow recurring revenue. The second is that we've been more efficient with professional services. So the profitability of those professional services have increased. But we're still investing more and more in product development, which tampers this improvement. But we've also been more efficient in other costs, as we're seeing product developments yield more efficiency through automation. And there's a small restructuring costs, which are all submitted from here, which you can see are around a hundred K as in euros in Q4, 2024 and similar amounts in 2023. Now, I want to break up the growth of veterinary a little bit more to show you what the drivers of growth are. So in 2021, at the end of that year, which is the year of our IPO, we had roughly a 10.8 million of implemented AR. The majority of that came from the Nordics. So 94% of our AR came from the Nordics. The Nordics has been growing fine over the last few years. However, the majority of our growth has been boosted by our success in international markets. So in 2024, 46% of AR at the end of the year came from outside the Nordics. And that contrasts to the 6% that we had in 2021. Interestingly, 32% of the AR came from what we call our growth markets, which is the UK, US, and Southern Europe. And you can see some quite nice figures here which display our success of organically conquering new markets. You can see the UK is now at 4.3 million of AR. The US grew very well in 2024 and is now at 1.5 million. And we are continuing to grow as well in Southern Europe, which is now at 1.8 million. Interesting as well is that this is implemented AR. However, we do have 2.1 million signed AR that's not yet implemented. And 90% of that actually comes from growth markets. So if we look at signed AR, this would be even more acute. The second is driver growth in veterinary has been our success with enterprise. So ProBitCloud is a very good solution for enterprise. And we are very well positioned to capture the enterprise opportunity as we call it, which is the opportunity to acquire or to provide the PMS for companies which are currently doing a consolidation in countries. If we look at in 2021, we were the number one provider of PMS enterprise in the Nordics. Now in 2024, we are now the number one provider of PMS to enterprise in Europe. And we can see that our share, the enterprise share of Total AR has grown from 21% in 2021 to 41%. So enterprise is a bigger and bigger part of our business. And we can also see, just like in the previous slide, international was driving our growth, that enterprise is also driving our growth, where 57% of our growth in the last three years has come from enterprise clients. But what's also important to note in an enterprise strategy is the customer concentration, in that despite our focus on enterprise, our customer concentration remains low and that our top three customers together compose less than 21% of our AR. Then our next project is obviously we grow organically, but we also grow via acquisition. And so the key to making sure that acquisitions are successful is the migration. So our cloud, so basically the percentage of AR which was on cloud products, private clouds, was 37% in 2021. Now it's 74%. In 2024 specifically, 1 million euros of AR was migrated from legacy to private cloud. The churn rate for non-clad products was 9% in 2024, which is a good result relative to the previous migrations. We were successfully able to sunset that certain probit win. And now we're working on migrating probit net in Finland, Stana Malus in Norway, and VegVision in Denmark. Now onto the therapy updates. Therapy, the focus of therapy has been to build a unified platform based on the easy practice software that we can migrate all Aspect customers to. Despite our focus on migration, we were still able to grow our AR around 9.2%. As you can see, our net retention rates, including price increases, was one on one. The reason why is that our churn was 5.4, which was quite good churn for therapy, given that we've got easy practice and we're doing migration. And that was a lower churn than in 2023, which is 7.8%. So we can see our improvements in product are yielding less churn on easy practice. And also we don't have the one-off effect of physios churn for the iron. Looking at profitability, our adjusted therapy BU EBITDA minus CAPEX remained positive in 2024. We slightly grew our profitability and the drivers of that was one recurring revenue growth, 0.4 million, but that was offset by an increase in product development of 0.4 million. that product development increases mostly targeted at additional recruitment of engineers and product managers and designers for the unified platform. We're also slightly more efficient with a decrease in other costs of around 100,000. And we emitted around 400,000 in restructuring costs in 2022, none in 2023, none in 2024. Similar to the country breakdown for veterinary, we can see the country breakdown for therapy, where we have been able to grow in therapy by going international. In the therapy case though, we have grown mostly through acquisitions in those markets. We have not gone into a net new market organically with the exception of Finland and other markets. You can see here on the graph that the 7.6 is mostly Aspit, which was acquired in 2021. We can see then the addition of Denmark and other in 2022, the acquisition of EasyPractice. And as mentioned on my first slide from therapy, the current focus is migration. And so that's why we've been seeing slower growth in 2024 and we should foresee slower growth as well in 2025 due to migration. Once migration is completed, we will resume work on add-ons and potentially new country expansion as well. Now let's take a look at the therapy migration. So in 2021, 30% of our AR was on our cloud products. And today it's 45. We have only begun the migration of OSPIT with 100,000 of AR migrated in 2024. But what's very impressive is that churn for a non-cloud products was actually quite low at 2.5%. So the approach we're taking is to make sure that we keep that churn as low as possible by having a wonderful migration experience and to make sure there's good feature overlap between the legacy platform and the new platform. In 2025, we'll be focused on this migration. We'll see significant strides towards migration being progress. Now I'll hand it over to Alex for the financial update.

speaker
Alex
CFO of Nord Health

Hello again. So turning our attention to reported revenues, in Q4 2024, we did 12.1 million of revenue, which is a 19.5% increase versus the same quarter last year. It's encouraging that the majority of that growth has been in our recurring revenues, which grew by 22.4% from 8.7 million in Q4 2023 to 10.7 million in Q4 2024. The largest items contributing to that growth in recurring revenue are the rollout of CVS in 2024 and the growth in ARPU and new users in Provit Cloud. The share of recurring revenues in Q4 2024 was 88.5%, up from 86.4% in Q4 2023. On the next slide, we see that for the full year 2024, reported revenues grew by 24% from 36.8 million to 45.7 million. Recurring revenue grew at a healthy rate of 21.5% from 33.1 million in 2023 to 40.2 million in 2024. We also had a large amount of other revenue in 2024, totaling 5.5 million. This is primarily related to the implementation work for our large enterprise deals. Therefore, that other revenue should ultimately translate to increased recurring revenue as those clients roll this out into their clinics. The share of recurring revenue in 2024 was 88% versus 89.8% in 2023. Looking now at quarterly adjusted EBITDA minus capex, we've seen significant improvements from Q4 2023 to Q4 2024, with it improving from minus 2 million to minus 0.5 million. The primary improvement has been the increase in revenues by 2 million versus Q4 last year. Of that, we reinvested 0.6 million into increased product development spend. As a reminder, adjusted EBITDA minus capex for us means that we remove any non-recurring items from the standard EBITDA minus capex in Q4 2024. This adjustment was 0.1 million. On to the next slide, we see a similar story for the full year adjusted EBITDA minus CapEx. This improved from minus 6.1 million in 2023 to minus 1.2 million in 2024. The biggest driver of this improvement is the annual increase in revenues of 8.8 million. We reinvested 2.7 million of this into increased product development and other costs, including sales and marketing and G&A, increased by 1.2 million. Looking now at cash flow, in Q4 2024, we had a cash outflow of 0.5 million, which is an improvement of 2.7 million compared to Q4 2023. The drivers of this improvement are an increase in profitability of 1.3 million versus Q4 last year. We also had a good quarter for cash receivables collection in Q4 2024, which meant our decrease in trade debtors was 0.8 million better than it was in Q4 2023. Other working capital changes amounted to a 0.6 million improvement versus Q4 last year. Looking at cash flow annually, the annual adjusted cash flow in 2024 was minus 2.6 million, which is an 8 million improvement versus 2023. The main driver of this was the improvement in profitability by 4.2 million. The other big item was a one-off working capital change in 2023. Here in 2023, we gave certain clients reduced upfront billing terms in exchange for larger than inflation price increases. This created a 3.8 million adverse working capital impact in 2023, which impacted the net cash flow for that year. Finally, looking at the December 2024 balance sheet, we see very few changes to the balance sheet in September 2024. There were no changes in goodwill in Q4 except amortization. There were no material equity transactions in Q4. There were no movements in treasury shares in Q4, and we didn't take any financing in Q4. Cash as of December is 19.6 million, of which 15.5 is invested in money market funds. The intangible assets are primarily capitalized R&D, and Nord Health's equity balance is healthy at 73.6 million. Full detailed financial statements, including P&L balance sheet and cash flow, are in the appendices, and I'll now turn it over to Charles to talk about 2025.

speaker
Charles McBain
CEO of Nord Health

Thank you very much. So looking ahead to 2025, I want to highlight a few different initiatives that we have ongoing. On the veterinary side, when the primary one is to complete the CVS rollout, we have migrated the small animal first deputy clinics and we're now migrating the referral hospitals and the equine hospitals at some point as well to farm animal clinics. The second is we have signed up Vets for Pets and also this American Corporate. And we want to make sure that the pilot, and also we've got looking to recruit additional, but for now we are looking for pilot success on those two corporates and to begin implementing these customers in UK and US. The third is we want to be able to sign a net new enterprise customers given our success with previous enterprise engagements. On the therapy side, the main focus is to migrate the majority of Aspect customers to Unified Platform. Unified Platform is the renamed name for EasyPractice. The actual name of the platform differs depending on country and depending on specialty, but the software is actually called Unified Platform, so you'll see us mention that a few times. And the second one is that we're launching our AI dictation in clinical notes in 2025, which has the potential also to increase the average revenue per user as we have provided more value for the users. Now, on the guidance, in 2024, our recurring revenue grew 21.8% versus 2023 with December 31st, 2023 constant currency. This is at the top end of our guidance, so we're happy about that. And adjusted e-dominance capex improved from negative 6.1 in 2023 to negative 1.2 in 2024. We did not have a guidance on that, but it's nice to see a good improvement in our profitability. Looking forward to 2025, we are guiding a 12 to 17% organic growth in recurring revenues with December 31st, 2024 constant currency, excluding acquisitions. Acquisition would be on top. In addition, our adjusted EBITDA minus capex, we're looking for roughly breakeven plus or minus 2 million in student acquisitions. This provides some flexibility to be able to be more aggressive in case we have a faster rollout or in case there's a great R&D initiatives that we want to take advantage of. Otherwise, the next meeting, which will be for the Q1 2025 results, will be on the 13th of May 2025. And as Alex mentioned, our four-year financial calendar can be found on our company website, as well as the full financials. Now on to Q&A. So if anyone has questions, please use the Q&A functionality. or razor.

speaker
Operator
Webcast Moderator

Stop sharing.

speaker
Charles McBain
CEO of Nord Health

All right. So we've got a question on why lower growth guidance expectation compared to 2024? Thank you for the question. So the reason why we have lower growth guidance and expectation compared to 2024 is that we see on the therapy side that the focus is mostly on migration. And we want to continue that focus more aggressively. than we did in 2024. We divided our investments partly on growth, partly on migration. And in 2025, we want to fully focus on migration. So we will see the top line actually growing less fast on the therapy side. and then last year, most likely. In addition, on the veterinary side, we had a rapid acceleration with CVS, and we have a broader range because of the fact that it's hard to predict the pace at which enterprise customers will actually be implemented. It could be that they decide to implement quickly, but it could also be that given circuits are out of control, that they decide to implement slower. So that is why we've got a larger spread Any other questions? Wait a minute or so. Let's see if there's any other questions. We've got another question. I'll repeat the question. Can you tell us more about the American New Customer Um. No, not yet, is the answer. The current American customer is in pilot phase. And until they have succeeded with the pilot, they have not yet allowed us to release the full name of the customer. The reason for that is that they want us to ensure that they're a current software supplier is informed before making the change. The second question is, what are your expectations for the US in the coming couple of years, given the announced pilots? If the pilot is successful, when do you expect the rollout? So as you can see in the slide, we have been quite successful in the US in 2024. We are now 1.5 million of recurring revenue. The US is a very competitive market relative to other markets. There are some good competitors there. And so we have to be, oh, execute very well in terms of product development, support quality and implementation quality in order to be successful in the US. I foresee us continuing to be successful with enterprises, especially if we're successful with this pilot, as it'll be a very good reference point for us to be able to use to attract other enterprise customers. In terms of the second part of the questions, if the pilot is successful, when do you expect to roll out? That's always a very hard one. Usually, the pilot can last between three months to 12 months. And post-pilots, depending on the number of clinics, and also the speed at which the customer wants to implement, it can be between six months and even 24 months. So that is the rough timelines for an average customer. That being said, implementing a PMS software is a big amount of work. not just the work that's involved in the implementation, but also it's a time at which they want to have a digital transformation. And we are one part of that digital transformation. A lot of the times as part of this rollout, they also, for example, change their pricing, their item of coding, they change the suppliers, they also build apps on top of our software. And that is the real blocker for the implementation, not so much our ability to implement or the software itself. Any other questions?

speaker
Operator
Webcast Moderator

Great.

speaker
Charles McBain
CEO of Nord Health

Well, thank you very much for everyone's time. And have a nice day. And we'll see you again in the Q1 2025

Disclaimer

This conference call transcript was computer generated and almost certianly contains errors. This transcript is provided for information purposes only.EarningsCall, LLC makes no representation about the accuracy of the aforementioned transcript, and you are cautioned not to place undue reliance on the information provided by the transcript.

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