dentalcorp Holdings Ltd
TSX:DNTL
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dentalcorp Holdings Ltd
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Good morning, and welcome to dentalcorp's First Quarter 2022 Results Conference Call. [Operator Instructions]
At this time, I'd like to turn the conference call over to Mr. Nate Tchaplia, Chief Financial Officer of Dental Corp. Please go ahead, sir.
Thank you, operator, and good morning, everyone. Welcome to the dentalcorp First Quarter 2022 Results Conference Call. I'm joined here by Graham Rosenberg, our CEO; and Guy Amini, our President.
Before we start, we would like to remind you that all amounts discussed on this call are denominated in Canadian dollars, unless otherwise indicated.
Please note that the statements made during this call may include forward-looking statements and information and future-oriented financial information regarding dentalcorp and its business and disclosure regarding possible events, conditions or results that are based on information currently available to management, which indicate management's expectation of future growth, results of operations, business performance, business prospects and opportunities.
Such statements are made as the date hereof, and dentalcorp assumes no obligation to update or revise them to reflect events, disclosures or circumstances, except as required by applicable securities law. Such statements involve significant risks and uncertainties and are not a guarantee of future performance or results. A number of these risks and uncertainties could cause results to differ materially from results discussed today. Given these risks and uncertainties, one should not place undue reliance on these statements and information.
Please refer to the forward-looking statements and information and future-oriented financial information section of our public filings, without limitations, our MD&A and our earnings press release issued today for additional information.
For those of you who have dialed into the call, the company has prepared a series of slides to complement our prepared remarks. These slides are available on the Investor Relations section of our website in the Events and Presentations section.
I'll now turn the call over to our Chief Executive Officer, Graham Rosenberg, for opening remarks. Graham?
Thanks, Nate, and good morning, everyone. We are pleased to be with you today to review dentalcorp's recent developments as well as our financial and operating results for the 3 months ended March 31, 2022.
For today's call, I'm going to show a number of those developments with you, and I will then hand the call over to Nate, who will discuss our financial results in detail for the reporting period, after which, I will provide forward-looking remarks about how our business is trending.
With our clearly defined leadership position and strong financial profile, as you can see on Slide 3, we believe that dentalcorp is well positioned to continue its track record of double-digit growth as the only national platform in the $18 billion Canadian dental industry. And a number of key metrics substantiate our continued confidence in our business.
For the fourth quarter ended March 31, 2022, dentalcorp generated approximately $1.2 billion of LTM pro forma revenue and $234 million of pro forma adjusted EBITDA, all bolstered by solid same-practice growth when adjusting for the impact of Omicron and the continued performance of our repeatable acquisition program.
All of this has been made possible by our deep and diverse network of 1,500-plus dentists, 1,800-plus hygienists and 4,300-plus supporting team members. All of these folks during a very difficult period continued to deliver the highest standards of care and our health care professionals support more than 1.7 million active patients and manage more than 4.5 million patient visits annually.
Turning to Slide 4, you will see that we remain disciplined in our approach to growth and intend to continue growing our business organically through accretive M&A and by driving greater efficiencies at both the corporate and practice level and on a long-term basis, through expansion into other geographies, verticals, which advance the health, well-being and vitality of North Americans.
On Slide 5, you will see that our team works within the dental industry that is highly recurring, a central health care service that is cash-pay and protected from economic cycles and disintermediation by technologies.
Importantly, dental expenditures have experienced strong relative growth during periods of higher-than-average inflation. Accordingly, in the context of the current macro environment, management believes that dentalcorp's highly variable cost structure, high margins, low commodity risk and minimal capital expenditures provides a constructive backdrop for the company's continued delivery of double-digit growth.
As you'll see on Slide 6, this quarter marked a significant milestone as we acquired our 500th practice. And this is a testament to the strength of the relationships we have built over the last decade with our dentist partners and the dental industry more broadly. Our pace of acquisitive growth has also accelerated significantly in Q1 to new levels, and I will come to that in a moment.
Turning on to Slide 7. I am pleased to report that our business again delivered strong growth, with first quarter 2022 revenue of $280 million, up 13.4% over the same quarter last year; and adjusted EBITDA of 15.1%, up 7.3% over the same quarter last year; with adjusted EBITDA margins of 17.9%.
During the quarter, we completed 16 acquisitions for a record of 42 locations which are expected to represent approximately $25 million in 2022 pro forma adjusted EBITDA, another record.
We believe this rapid acquisitive pacing firmly entrenches dentalcorp's position as the acquirer of choice for Canada's leading dental practices and was made possible by the significant investments that we have made in our national business development team and our automated integration capabilities.
Additionally, we have now successfully deployed the $115 million of proceeds raised through a bought deal offering in January 2022 to support the delivery of our accelerated acquisition program in Q1 and coming up in Q2. We have utilized these proceeds to acquire several accretive, larger platform acquisitions, which closed in our first quarter with more to come in our second quarter and through the balance of the year.
During the quarter, we experienced significant pressure from Omicron and -- which drove significant increases in provider absences and patient cancellations. Adjusting for these impacts, our adjusted Same Practice sales growth was approximately 2.7%. Despite ongoing pressure from Omicron, we did see sequential monthly sales growth in Q1 2022 which continued through April and into May at levels materially in line with Q1 on an unadjusted basis, all in concert with an improving macro environment.
Our in-sourcing efforts continue to track above expectations, as demonstrated by orthodontic insourcing with 217 practices in our Ortho Acceleration Program, up 32% from 165 at the end of the first quarter last year and still trending upwards.
The outcome of all of this is another strong quarter of free cash flow of $40.4 million, up almost 3x over the same period last year.
Subsequent to the quarter, we signed an exclusive partnership with Risio Institute to set the foundation for a first-of-its-kind talent solution for training new certified dental assistants across the dentalcorp network. dentalcorp assistants are at the heart of every dental practice. But training currently requires students to leave their jobs and self-funded deployment qualification, which not everyone can do. This partnership leverages our resources and industry relationships to ensure that our practices are a step ahead and having qualified talent to meet the needs of our network.
And we also formed a new partnership with another university, the University of Alberta School of Dentistry, to support student well-being and access to financial aid and education. This partnership will be recognized by naming facilities at the University of Alberta as the dentalcorp Student Lab and the dentalcorp Simulation Lab.
And finally, we were recognized again as one of Canada's best-managed companies for the eighth year in a row and the second year as a Platinum member. This tremendous distinction would not have been possible without our exceptional teamwork, innovation and the resilience of our network of almost 8,000 team members.
Overall, we believe that our first quarter financial results continue to demonstrate the resiliency of our business, particularly in an environment impacted by ongoing COVID-19 restrictions and variant outbreaks in many of our markets.
I will now pass the call over to Nate, who will walk us through the details of our financial results. And then I will share some closing remarks before we open up the call for questions. Nate?
Thank you, Graham. We believe that our first quarter results demonstrate our ability to continue to grow in an uncertain macro market and the overall consistency of dentalcorp's business.
Turning to Slide 9. Revenue for the 3-month period ended March 31, 2022, was $280.2 million compared to $247 million for the same quarter last year, representing an increase of 13.7%. The increase is attributable to our strong acquisitive growth platform, which gained momentum in the first quarter and has continued into the second quarter; and our organic growth, including a positive contribution from orthodontic insourcing, with 217 practices in the Ortho Acceleration Program, versus 165 at the end of the first quarter last year.
As you can see, we reported first quarter adjusted EBITDA of $50.1 million compared to $46.7 million in the same quarter last year. And we reported first quarter adjusted EBITDA margins of 17.9% compared to 18.9% in the first quarter of 2021.
dentalcorp's business was adversely impacted by lost provider days and patient cancellations from Omicron, which had a negative impact of approximately 5.5% to 6% on Same Practice sales growth. As Graham mentioned, excluding these impacts, Same Practice sales growth was positive by approximately 2.7%. Moreover, we experienced a sequential monthly recovery during the reporting period, with February increasing over January, March increasing over February and continuing into the early parts of Q2.
Also notable, our first quarter 2022 marks our first reporting period without any COVID-related financial adjustments. Looking ahead, we continue to be optimistic about recovery through the balance of 2022 and remain highly confident in our ability to grow the business through acquisitions and organically.
Two other important points I'd like to make with respect to our results. One, the first quarter of 2022 featured a week of spring break in our major markets. If you recall, there was no spring break in the first quarter of 2021 due to the pandemic. The break this year had a slightly adverse impact on our results.
And two, the majority of our acquisitions for the first quarter closed towards the very end of the quarter and therefore had a minimal impact on our reported financial results. We will start to see the financial impact of these acquisitions to a much greater degree in our second quarter and onwards.
Turning to the next slide, you can see that our net leverage and liquidity as of March 31, 2022. The company completed a bought deal offering for total gross proceeds of $115 million in January 22, which further strengthened our liquidity. On a net debt basis, we're approximately 4x levered at the end of the first quarter.
We ended the quarter with liquidity of about $514 million, comprised of $164 million in cash and $350 million in debt capacity under our $1.3 billion senior debt facilities, of which, $950 million was drawn at quarter end.
Looking ahead, we believe that we will have ample financial resources to support our acquisitive growth goals while maintaining a strong balance sheet. We will also continue to evaluate scenarios to fortify our balance sheet if opportunities align with our long-term strategy.
Overall, we are very pleased with our first quarter 2022 results. Despite Omicron's impacts, factors that are largely within our control, including closing accretive acquisitions, expanding our pipeline, increasing organic growth through our insourcing efforts and realizing ongoing operating efficiencies, continue to meet or exceed our expectations.
With that, I'll turn the call over to Graham to provide some closing remarks. Graham?
Thanks, Nate. Turning to Slide 11. We remain very optimistic about our business prospects going forward. dentalcorp has established itself as the acquirer of choice for leading dentists with a demonstrated ability to add value to acquire dental practices. At the end of the first quarter 2022, we had 745-plus total opportunities in our pipeline and 200-plus opportunities in more advanced stages of negotiation.
Secondly, dentistry's resilience as a highly recurring essential health care service is reflected in the sequential Same Practice sales growth we experienced through the first quarter of 2022, through April and into May. And when combining the strength of our acquisition program, we expect to deliver double-digit revenue growth in the second quarter 2022 over the first quarter 2022.
And in closing, we expect our overall growth agenda, coupled with the realization of ongoing operational efficiencies, to achieve further margin expansion to continue to generate double-digit growth in revenues, adjusted EBITDA and free cash flow growth per share.
I'd like to thank you all for taking the time. That concludes the formal part of our presentation. And I would like to open the call to questions. Operator?
[Operator Instructions] Your first question comes from Steph Wissink with Jefferies.
Our first question is related to the recapture rate. Maybe you can give us some sense of when Omicron hit your business, how quickly were you able to recapture that discounted revenue -- chunk of revenue? And have you fully recaptured it at this point? Or do you expect some of it to be recaptured in Q2?
I'd say that through the -- all of Q1, there were impacts of Omicron. The impacts of Omicron are still with us in Q2. But what we're very pleased with is as we did see, again, a very positive and quick recovery from the more impacted time with the lockdowns in the early part of the year. February showing more positive results over January, again, March over February. And then as we go into April and into the early parts of May, the same-store results that we are seeing are matching, on an unadjusted basis, what we reported in Q1 on an adjusted basis. So all in all, still positive results and a strong recovery despite the continued impacts of Omicron.
And one thing that I'd like to highlight is, as we pull together that provider and patient cancellation adjustment, we're not adjusting to a full capacity. We were looking at the provider days and patient cancellations as they presented themselves in Q1 of 2021, which was still a heavily impacted period. But again, the prevalence of Omicron as well as the infection rates were far more significant in Q1 2022 versus the COVID impact in Q1 2021. And again, our results, we are pleased with. And the recovery has been strong.
Okay. That's helpful. And then just a second question on Q2 is related to the timing of acquisitions. You mentioned in your remarks that they were late in the quarter. So can you give us any sort of context for how we should think about the sequential revenue in Q2 versus Q1, just to help frame up the contribution of those acquisitions?
Yes. So from a revenue growth quarter-over-quarter, it would be in the low double-digit growth quarter-over-quarter.
Your next question comes from Patricia Baker with Scotiabank.
I have one question and then just a follow-up to the discussion on the Omicron impact. And I just want to get some clarity here, Nate, because it's written one way in the press release, and then you just said something interesting about what you're seeing in Q2 so far is matching, on an unadjusted basis, adjusted.
So I just -- so what you're seeing in Q2 so far, are you seeing Q2 running at the same rate as the unadjusted Q1? Or the -- on an unadjusted basis, it's running at the adjusted basis of Q1?
On an unadjusted basis, it's running at the adjusted basis rate.
Super. Okay. So that's -- all of those combinations, that's the more positive one.
And then I just want to look at the M&A pipeline. And you're now indicating that you're in more advanced discussions with 200 potential acquisitions. At the end of Q4, that number was 150. So it looks like a really good pace there, taking potential practices into the more advanced status. But if we take into account the fact that you closed on 42 deals in the quarter. So probably that you're doing an even better job than that 150 to 200 would imply. Is that fair?
Yes. I think what's important to note is those 42 practice locations represented 16 acquisitions. So we did have the privilege of partnering with some tremendous platforms, mid-market platforms across the country. So those opportunities are both a mix of individual locations as well as mid-market opportunities that do ultimately have more than a one-to-one relationship as far as acquisition's location.
And you indicated at the time of Q4 that you were seeing more of those mid-market acquisitions or multiple practice acquisitions, that continues to be the case?
That does continue to be the case. And given our, again, continued investments in our infrastructure and leadership role as a leading dental partner for these mid-market operations, we do see that, that does continue. And we will have additional mid-market opportunities that we will be closing in Q2.
Your next question comes from Scott Fletcher with CIBC.
I just had a question on the practice acquisition multiples. It looks like they were -- we understood they were going to be higher, but it looks like it came in at 8.8x on an average basis. Just wondering if you could disaggregate that a little bit and sort of break that into maybe what the mid-market numbers were looking like and what the single practices are looking like?
Yes. So from a bifurcation perspective. If you look at the onesies and twosies, as we call them, those came in the mid to high 8s. And the mid-market opportunities came in, on a blended basis, in the low double digits, which is in line with what we communicated at Q4 and in line with expectations.
Okay. And then so somewhat of a follow-up. It seems like the average practice size was closer to $600,000 in the quarter in terms of the EBITDA they're generating. That's a bit of a step down from the previous quarters. Is it a stretch to say that these mid-market -- the individual practices within the mid-markets are somewhat smaller than a standard clinic? Or is that just some noise in the quarter?
Yes. I wouldn't say that the size of practice differs amongst the mid-market group versus on a stand-alone location. I think it's just -- we're looking at a sample size of 42 locations versus the aggregate of our platform. So you will see that ebb and flow, but we expect it all to always come back to the average.
Your next question comes from Stephen MacLeod with BMO Capital Markets.
Just wanted to follow up on a couple of things here. You talked about the proceeds from your bought deal largely having been deployed now. Can you just -- I just didn't see it in the press release, but how much was deployed in Q1 versus much will be deployed in Q2?
Look, from -- as far as the total purchase price that was funded in Q1, it was in excess of the $115 million gross that we raised in January. So it was all deployed in Q1, and we continue to have the capital base of $514 million, both from $164 million of cash and undrawn capacity on our delayed draw facilities to fund our continued growth into Q2 and beyond.
Okay. That's great. And then just with respect to these larger platforms, I was wondering if you could just give a little bit of color around what they look like with respect to the size? Like number of practices per platform. Any sort of color around that would be helpful.
Yes. So as far as size, we're across multi provinces as far as the platforms that we did partner with. They range anywhere from 5 to 20 locations each. And ultimately, the attractiveness is it gives us a partnership with an entrepreneurially driven leading dentist or group of dentists that will continue to accelerate our path in those markets. These groups, again, we value and are very accretive to us, given the ability for us to apply our infrastructure, our technology and know-how to continue to drive their successful track record.
Great. And then maybe just finally, on the orthodontic insourcing strategy. I know you gave sort of the practice acceleration, which is great. Wondering if you've seen -- how you've seen that trend with respect to like take-up within the practices where it's been deployed. Are you seeing now increased takeout? Does it translate into the numbers? I'm wondering if you could give a little color there.
It's Guy here. I just want to make sure I'm being responsive. Are you wondering whether practices that go through the program start seeing some incremental growth and penetration of the existing plus new patient base as a result of delivering the treatment? Is that the question?
Yes, that's right. Thanks for clarifying.
Short answer is very much so. We see a meaningful uptick in number of Invisalign cases on a per month basis within the first 30 days post going through the program. The average practice was at a 0 to 1 Invisalign case a month before the program. That gets generated up to 3 to 4 in certain cases, excess of that, depending on patient size base within the first 6 months. And we see continued growth even 12 months plus beyond going through the program, both due to getting a chance to see more and more existing patients doing the scan, speaking to them about the treatment as well as it being a driver of new patient acquisition as often patients will look for a GP clinic that also offers this and allows us to use it as a lever to acquire new patients.
So short answer is yes. Long answer is there's definitely a ramp-up within 30 days post program. And it's a continued ramp-up even 12 months beyond, driving incremental revenue.
Your next question comes from Daryl Young with TD Securities.
Just with respect to the same-store sales growth, and I think you mentioned that you weren't adjusting to max capacity. That just got me thinking about the furlough times again. Is there any clarity on when that may come off? And then is there a way to quantify how much additional capacity or same-store sales growth upside could come from that?
Wish had a crystal ball for the regulatory side. I know there's been constant discussions between the public health authorities and the variety of different dental health regulated authorities governing in respect to the furlough times. The reality is, I think, given that Omicron still presents a large degree of case exposure among the current population, no one seems to be in a rush to adjust for those things. And arguably, they shouldn't be.
And so I think as we continue to still see meaningful community rates of Omicron or COVID-related variants, we'll continue to have those furlough time restrictions in place. Hopefully, as things normalize, variants subside or degree of risk decreases, the regulatory authorities will adjust for that. But I wouldn't hold our breath in the near term for that to change.
And so just to recall the second half of your question, how do we think about that from an overall impact? I think we saw a significant impact to last year on the hygiene side of the business, given the decreased ability to see the same number of patients during the course of the day. We're still seeing sort of the same degree of impact this year as well. And so I wouldn't say that, that has changed at all. But we do think it could be a meaningful lift to pre-COVID efficiency capacity levels as soon as these restrictions subside.
Okay. Terrific. And then you've got a lot of programs, a lot of great programs, for patient aggregation, I'll call it, in terms of hellodent and your PC health app. Is there an opportunity to increase hours to drive greater throughput in terms of evenings or weekends? Or how much slack is potentially in the system that could ramp up here?
Yes, we continue to try to identify those opportunities. We still think we're at sort of artificially restricted capacity. And so whether it's ours, finding the right opportunities to leverage density given that the market we're in, having providers available as key as you saw through Q1 with lots of providers directly or indirectly impacted by positive COVID, we were limited by having individuals available to expand those hours. But again, as those numbers subside, so too sure our ability to expand hours and capacity more generally.
Your next question comes from Gary Ho with Desjardins.
Maybe just follow on the multiple discussions just given the macro uncertainty, rising rates, et cetera, do you foresee the valuation soften a bit in the back half of this year? Or do you not foresee this changing over the near term?
Yes. I think as the macro environment and we continue to operate in a macro backdrop,of COVID through 2020, through 2021, and ultimately, given our high free cash flow, our advanced pipeline, our continued investments in our corporate infrastructure and our confidence in our operating know-how and playbooks, we feel very confident to continue on an acquisitive pace and continue to execute on our M&A agenda.
So albeit we're not discounting the macro environment that we are operating, we continue to evaluate the best allocations of our capital and the best path forward for the business, both from an operating perspective as well as execution on its acquisitive agenda.
So you're not seeing the valuation or you don't foresee the valuation changing materially from where it is today?
Yes. So we don't see it changing materially, certainly some upside. We believe there will be some down, maybe, right? But that all said, our capabilities -- and I think what people really need to focus on is our ability to drive returns out of those deals, including the mid-market deals, which generally have corporate interest. We're giving you gross numbers.
So generally have a corporate infrastructure, many corporate infrastructure that we can take out. Our ability to drive efficiencies, purchasing efficiencies and margin expansion on supply, our ability to drive revenue growth is so much greater. Even in year 1, not only in same-store comps in terms of the revenue growth, our abilities in that regard are so much greater than where they were even 2 years ago, that even at the slightly elevated multiple for those mid-market platforms, we are able to drive our threshold returns in the same manner, obviously different levels, but in the same manner in terms of quantum that we are with the smaller deals. And that's what we focus on.
Got it. Okay. And maybe as a related question, Graham, since I have you. It's a bit difficult to see from an outsider looking in, and you've completed quite a few acquisitions. So I'm wondering if I look at certain vintage of acquisitions, say, 2019 or even 2018, what has been the top line and kind of EBITDA organic growth been if you were to ex out some of the increased costs and/or negative COVID-related impacts? Have you done that back-testing analysis? And how would that look like?
Yes, that's not something that we disaggregate and discuss.
Okay. Great. And then just last question. Nate, you mentioned fortifying balance sheet. I know you still have $514 million in dry powder. You've been quite busy on the acquisition front. Just curious what options you're looking at. Can you remind me what leverage level you're comfortable operating at?
Yes. And consistent with our communications in Q4, we raised the bought deal capital of $115 million to fund our increased pacing. Ultimately, we ended the quarter in the low 4s and expect to be in the low 4s in the short to medium term. As again, we continue to execute on an accelerated M&A pacing, and really good leverage is purely driven by the success that we are seeing from our investments in our business development team and the record pipeline that we have built.
In the medium to long term, we do expect leverage to continue to decline with a long-term target in the high 2s, low 3s. And ultimately, if you run it out, you'll see on a sustained basis, once we reach, call it, a consistent level of acquisitive pacing over the next 36-plus months, we will be self-funding on our acquisitions.
Again, as a reminder, we do fund our deals with a combination of dentalcorp equity, which is issued to the vendor, along with cash, as well as the increased free cash flow generation of the business.
Your next question comes from Tania Armstrong Whitworth with Canaccord.
On some of these mid-market platforms, can you describe if the acquisition playbook is any different than the onesies and twosies? For instance, are you looking at processes with, I guess, more than 2 partner dentists? And Graham mentioned something interesting just that the corporate infrastructure can be stripped out in these targets. What kind of incremental margin expansion -- I guess, how many more points can you get over a single practice location in terms of synergies?
Yes. So the stand-alone locations within the mid-market groups look very similar to the rest of our platform. If you look at them across our base, again, what we really like about them is these are platforms that have been built with an understanding and with a small infrastructure, ultimately, which put together their teams and is allowing them to drive their growth, again, without our advanced infrastructure, our advanced playbooks and our technology that we're able to overlay.
Individually across these groups, multiple dentists, they're from an operatory number as well as a square foot footprint, they do mimic the rest of our acquired base.
From a growth perspective, both from a cost synergy as well as our ability to drive organic growth, the margin expansion as well as the revenue growth acceleration from our playbooks would be slightly higher than what we would see in a onesie to twosie acquisition, more so on the margin expansion side. On the revenue playbooks, it would ultimately be in line with what you would see on a single and double acquisition.
Okay. Excellent. And then I think there were a small amount of costs related to implementation of new corporate systems and the vendor consolidations, which I believe you've mentioned on previous calls. Can you talk to whether this -- these costs are expected to persist through the remainder of the year? Or was this a one-time item?
Yes. So these costs are related to our upgrades in our ERP as well as HR systems primarily. The implementation and investments and the customizations really began post-IPO. Expectation is for that to be complete and launched into Q4 and expect those costs to be complete in 2022 with no additional, call it, investments necessary 2023 post.
Okay. Excellent. And then sorry, one more small administrative question, I guess. I just want to confirm the purchase consideration for the targets acquired in Q1. Was that $220 million as stated in the press release? Or was it $229 million as stated in the financials?
It would be $220 million.
There are no further questions at this time. Please proceed.
Great. Thank you, operator. Thank you, everybody, for taking the time. As usual, we always enjoy the dialogue.
Look, in closing, we remain focused on our business. The current backdrop is not overly concerning for us, given our current performance and dentistry historic performance in inflationary environments. We have a very strong pipeline supporting our M&A agenda, and our pipeline has never been stronger. Our playbooks for growth are on pace, certainly the controllables and the improving backdrop around COVID should continue to be additive to that. And margin control is firmly in hand, and we'll continue to work our way above labor efficiencies and supplier efficiencies and costs.
So overall, we feel really good about the business and have a high degree of conviction around delivering double -- sustain double-digit growth across all key metrics.
We'd like to thank you again for taking the time, and look forward to chatting with some of you later on in the morning. Thanks. Thanks, operator.
Ladies and gentlemen, this concludes your conference call for today. We thank you for participating and ask that you please disconnect your lines. Have a great day.