dentalcorp Holdings Ltd
TSX:DNTL
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dentalcorp Holdings Ltd
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Good morning, and welcome to dentalcorp's Third Quarter 2022 Results Conference Call. [Operator Instructions]
At this time, I'd like to turn the call over to Mr. Nate Tchaplia, Chief Financial Officer of dentalcorp. Please go ahead, sir.
Thank you, operator, and good morning, everyone. Welcome to the dentalcorp Third 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 all that amounts discussed on this call are denominated in Canadian dollars, unless otherwise indicated.
Please note that 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 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, 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?
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 and 9 months ended September 30, 2022. For today's call, I'm going to share a number of those developments with you. 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.
Turning to Slide 3, you'll see that dentalcorp operates within an industry that is a highly recurring, essential health care service, that is cash pay and protection from economic cycles and disintermediation by technologies. Importantly, dental expenditures have experienced strong relative growth during periods of higher-than-average inflation. And accordingly, in the context of the current macro environment, management continues to believe that dentalcorp's favorable cost structure, high margins, low commodity risk, and minimal capital expenditures provide support for the company's continued delivery of double-digit growth in the $18 billion Canadian dental industry.
Our confidence in the business is validated by our third quarter 2022 results. And on Slide 4, you'll see that we completed the third quarter ended September 30, 2022 with approximately $1.3 billion of LTM pro forma revenue and $254 million of pro forma adjusted EBITDA, all supported by healthy adjusted same practice revenue growth of 2.4%. All of this has been made possible by our deep and diverse network of 1,650 plus centers, 2,000 plus hygienists, and 4,800 plus supporting team members across the country from coast to coast.
Our health care professionals continue to deliver the highest standards of care during the reporting period, supporting more than 1.9 million active patients and managing more than 4.5 million patient visits over the last 12 months. As you can see on Slide 5, we continue to leverage our leadership position in the Canadian dental industry by acquiring 14 practices in the third quarter, for a total consideration of $104 million. These practices are expected to generate $13 million in pro forma adjusted EBITDA.
We are also encouraged to see that in the third quarter, and so far in the fourth quarter, that practice valuations are beginning to decline in Canada as access to financing tightens for most buyers across the industry. We're well advantaged in this regard as a well-capitalized partner of choice for independent dentists, and can continue to be judicious about the practices we acquire.
On Slide 6, you will see that we have remained judicious in our multipronged approach to growth and intend to continue growing our business organically through accretive mergers and acquisitions and by driving overall business efficiencies and operating leverage over the medium to long term. This is a playbook that we have refined over the past decade, and we are well prepared to handle any short or longer term fluctuations in the broader economy.
On Slide 7, you will see that our business continues to convert a high percentage of EBITDA into free cash flow and without acquisitions, has the potential to drive our leverage down by more than half a turn per annum to the mid-ones over the medium term. When factoring in our expected acquisition pacing, we believe we can deliver our business by over a quarter turn per annum and operate in the low threes over the medium term, in line with our expectations at the time of our IPO.
Turning to Slide 8, I'm pleased to report that our business, again, has delivered robust growth with third quarter 2022 revenue of $312 million, up 25% over the same quarter last year. And adjusted EBITDA of $59 million, up 28% over the same quarter last year, with adjusted EBITDA margins coming in at 19%. We are also encouraged that adjusted same practice revenue growth was approximately 2.4% for the quarter.
Our insourcing efforts continued to deliver results with 268 practices in our orthodontic acceleration program, up 41% from 190 at the end of the third quarter last year. The outcome of all of this was another strong quarter of adjusted free cash flow of approximately $29 million compared to negative $1 million the same period last year.
As Canada's largest network of dental clinics, we strongly believe in efforts to expand access to dental care and look forward to the implementation of the Canada dental benefit, which would provide eligible participants or guardians with direct upfront tax repayments to cover dental expenses for their children under age 12. The target implementation date for the Canada dental benefit is December 1, 2022, pending Parliamentary approval and Royal Assent of enabling legislation and the program will cover expenditures retroactive to October 1, 2022.
We believe this initiative will have a neutral to moderately positive effect on our business, and we'll continue to support initiatives that contribute to the overall health of Canadians. I'll 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 the call for questions. Nate?
Thank you, Graham. We believe that our business is built to handle adverse economic conditions and that our third quarter results demonstrate the strength and consistency in a macro environment brought with high inflation, escalating interest rates and the lingering effects of the pandemic. Turning to Slide 9. Revenue for the 3-month period ended September 30, 2022, was $312 million compared to $250 million for the corresponding period last year, representing an increase of approximately 25%. The increase is attributable to our strong acquisitive and organic growth, including positive contribution from our orthodontic insourcing programs.
As you can see, we reported third quarter adjusted EBITDA of approximately $59 million compared to $46 million in the same quarter last year, and reported third quarter adjusted EBITDA margins of 19%. As a reminder, we do tend to see a high degree of seasonality in our third quarter, with the second quarter typically showing sequential strength over Q3. Adjusted same practice revenue growth was 2.4%, reflecting the effects of Hurricane Fiona, which battered much of Eastern Canada in September.
Looking forward, we continue to be optimistic about our ability to grow the business both through acquisitions as well as organically. With respect to M&A, we completed the acquisition of 14 practice locations with $13 million of pro forma adjusted EBITDA. Turning to Slide 10. You can see that our net leverage and liquidity as of September 30, 2022.
On a net debt basis, we're approximately 4.3x levered at the end of the third quarter. We ended the quarter with liquidity of $833 million, comprised of $133 million in cash and $700 million in debt capacity under our $1.75 billion senior debt facilities, of which approximately $1 billion was drawn at quarter's end. Third quarter and year-to-date adjusted free cash flow was $29 million and $111 million, respectively, which supports our strong balance sheet. Looking ahead, we believe that we'll have ample financial resources to support our overall growth goals while maintaining a robust balance sheet.
We also took an important step to lock in the certainty of our debt costs. During the quarter, we transitioned approximately $500 million of our $1 billion senior debt facilities to a fixed rate of 6.59% through May 2026. The other half of our senior debt facilities remain on a variable rate. At September 30, 2022, the blended aggregate interest rate on our debt was approximately 6.5%.
It is important to note that every 100 basis point increase in our credit facilities is expected to result in a less than 5% impact to our adjusted free cash flow. Overall, we're very pleased with our third quarter 2022 results. We increased organic growth in part through our in-sourcing efforts created ongoing operating efficiencies and closed accretive acquisitions and continue to develop our pipeline.
With that, I will turn the call over to Graham to provide some closing remarks. Graham?
Thanks, Nate. Turning to Slide 11. We remain highly confident in the durability and strength of our business. With our acquisition program meaningfully ahead of plan, we anticipate that we will acquire approximately $5 million to $7 million in pro forma adjusted EBITDA in the fourth quarter of 2022 and expect similarly modest quarterly acquisition pacing in 2023.
We remain well positioned to generate double-digit revenue and adjusted EBITDA growth while generating strong free cash flow to accelerate our pace of delivering bridge as a result of the significant corporate investments we made in 2022. The significant corporate investments made in 2022 were driven by a return to normal levels of spend in sales and marketing, reflecting a return to historical business development activities regarding M&A in a post-COVID environment.
The full year effect of public company costs and meaningful investments to support our most acquisitive year ever. We are encouraged, particularly by the latter, as those investments have enabled us to generate continued strong performance consistent with our targeted investment framework. With these investments significantly behind us, together with the aforementioned relatively modest acquisition pacing, we expect to generate operating leverage while accelerating our deleveraging.
The rest of the management team and I demonstrated our conviction in the outlook of our business by purchasing approximately $1 million worth of shares in the open market during the quarter. We deeply understand our business and its position in the industry, and we are very optimistic about the potential to create significant value for shareholders moving forward. I'd like to thank you all for taking the time to join our call today. That concludes the formal part of our presentation, and I would like to open the call to questions from the floor. Operator?
[Operator Instructions] Your first question comes from the line of Michael Cherny with Bank of America.
Maybe just a point of clarification for Nate. Relative to deleveraging, obviously, that's a mathematical equation in terms of EBITDA growth and debt pay down. Are we to assume that next year you'll have an absolute lower level of debt versus where we sit right now?
As far as total aggregate dollars, no. We will continue to use our debt facilities to fund acquisitions. As a reminder, we fund purchase price in a combination of both debt as well as equity, roughly 20% equity issued to the vendor, 80% in cash and of that 80% is funded by a combination of both free cash flow as well as debt. However, overall, on a leverage perspective, our leverage will come down by a meaningful amount, roughly again to that 5.5% of a turn to the end of the year based on the pacing that we've discussed.
Understood, and helpful clarification. And then I know you're not getting into formal '23 guidance, but as you think about the growth characteristics of the business at this point in time, obviously, there's been a lot of macro-oriented volatility that's been hitting same-store growth relative to the 3% plus that you had expected. When do you think we get back to that normalized same-store level?
It's Guy Amini here. I appreciate the question. Look, our expectation is again, barring some of those unforeseen dynamics that you just alluded to, that next year we should see that. We're optimistic about the change in the regulatory environment that took place not too long ago. And again, as behavior, consumer behavior, patient behavior and operations continue to return to that normalized level, we anticipate next year to look a lot more "normal than before."
Your next question comes from the line of Brian (indiscernible) with Jefferies.
I guess I'll just follow up to the answer a question. As we think about next year and the potential for an economic slowdown, how are you thinking about the defense of your business or the resilience of demand for dental services in Canada?
Yes. It's a theme we've tried to hit on a lot because it's an important dynamic, not just our business, but the Canadian dental industry more broadly. There's a deck that's available both on what we just shared, plus what's available on our investor portal, showing the resiliency of Canadian Dental on a per capita expenditure basis over the last 4-plus decades, which includes 4 or 5 meaningful economic downturns in the broader economy.
And you can see real resiliency underlying dentistry. That's driven by, again, the essential nature of dental care. Canadians put, as they should, a high priority on routine visits to their dentists, to maintain their oral health and/or enhance it. And that both essential nature of it and the recurring nature of it make it a very stable business through all manners of economic cycle.
And so while there are obviously those economic headwinds is everyone staring down the barrel of a recession, or at least contemplating the barrel of a recession, we feel very confident. We've seen how our business performed, for example, through economic headwinds in Alberta back when oil crashed in 2013, 2014 and seeing the performance of our practices there.
Seeing the performance of the industry over the course of 4-plus decades gives us real meaningful data points to feel confident in how we will perform through next year. As it stands today, we're seeing strong patient demand for dental services. That has not waned against some of the uncertainty that's pervading the broader economic market. And so again, as we think about next year, we feel fairly good.
That's awesome. And then I guess just shifting just to labor. Anything you can share with us in terms of what you're seeing in terms of labor for both clinicians and non-clinician staff?
Yes. We've seen some real strength in our people outcomes on the DDS or the doctor side. The growth of Canadian doctors has remained steady through the course of the year as 1% to 2% growth in the number of licensed [indiscernible]. Obviously, the federal government has announced a greater ambition for highly qualified professionals to come to our to come to our shores. And the anticipation is that will include licensed dentists or capable clinicians.
And given the loosening of accreditation standards in Canada, we want to continue to see growth in the dentist pool available clinicians, and we are seeing that. Through the course of the year, obviously, there were challenges around dental hygienists, dental assistants. COVID really took a whack of the available labor pool, whether because people accelerated their retirement, or with child care concerns, and brought out the concerns around health.
There was a real tightening in that market. We are seeing that turn around not fully, but surely. And so again, as we head into next year, we are more encouraged. Albeit not seeing it where we want to be yet, we are more encouraged about the trends on the availability of the skilled labor and dentistry around dental hygienists and dental assistants heading into next year.
Your next question comes from the line of Stephen MacLeod with BMO Capital Markets.
Just curious about the pullback in the pace of acquisitions for next year. Just curious, what's your confidence in continuing to achieve that level even if rates increase incrementally from where they are now?
We have a high degree of conviction around achieving that level. It's an intended modest pullback to drive more short-term delevering. It's an intent to pull back to basically reverts to the mean of $35 million and change that you have acquired EBITDA, given that we're so far ahead of plan in the last 18 months. And we have a very high degree of confidence in hitting those numbers. Nate, do you want to add anything?
Yes. I think just to add on that is our pipeline continues to remain incredibly strong. Our position as the partner of choice continues to expand. And as we discussed on the call, we did hedge 50% of our debt roughly, which provides us with a very stable capital pool. There is no requirement for us to raise any additional equity capital nor debt capital, as we have roughly $833 million of liquidity that's available to us. So this is very much a decision that we are making constructively for 2023, again, to revert back to the mean pacing of acquisitions as well as prioritizing deleveraging. We have the ability to increase it, however, again. This is a conscious decision that we've made.
And then I was just wondering, is there any way to quantify the impact from the Hurricane Fiona in the quarter on same practice revenue growth?
Yes, it's roughly in the neighborhood of 0.2% to 0.3% as it relates to same practice revenue growth.
Your next question comes from the line of Doug Miehm with RBC Capital Markets.
I just wanted to follow on one of the last questions with respect to the pacing of acquisitions. And I'm curious to know if this was a decision that was made internally or with input from the institutional client base? As you've gone out and talked to people post the very strong, I'd say, number of acquisitions that you've done in Q1 and Q2 this year.
Yes. This is very much an internal decision that was made. Again, given the pacing of acquisition that we've enjoyed over the last 18-plus months, it's a reversion back to the mean pacing of acquisitions we communicated during the IPO. This allows us to focus again on continuing to deliver the double-digit growth year in and year out, with a continued focus on organic growth as well as deleveraging. So again, this was a management-driven decision.
Okay. Perfect. So then as you've been out speaking to people, I'm just curious, what's the input you're hearing from people in terms of any concerns that they have and how you might change the way you're running the business to moderate what's been happening in the market lately?
Yes. I think your sales desk would probably have just as much of feedback as we do. So I think we've never seen such a great dislocation between the share price and the performance of our business. We're very pleased as to how the business has performed and have a very positive outlook as to what we will accomplish in 2023.
Your next question comes from the line of Scott Fletcher with CIBC.
I have a question on the impact of inflation on customer spending. I'm curious if you're seeing any impact to sort of more discretionary areas of spending, whether that's more so on the ortho side, and whether that could be a headwind to same practice sales growth going forward as inflation stays high?
Scott, it's Guy here. Let me take that one. So a couple of things. One, when we look at last periods of historically high inflation, you see again dentistry in Canada on a per capita basis outperform by close to 500 basis points. So again, when you look at history, you've got a meaningful precedent to feel confident in dentistry's resiliency through not just economic downturn, but even periods of high inflation.
We do see and/or anticipate some probable deferral of, call it, highly elective dentistry like clear aligner therapy. That said, our expectation is, and we've got a reasonable basis for this expectation, that we will see growth year-over-year in the volume of our clear line of therapy that's being delivered through our network. While you could anticipate possibly some deferral of those cases to a later date, we do expect to see growth year-over-year in a meaningful way.
Okay. Great. And then another follow-up on the monitoring pace of M&A. Would that come with any sort of change to how you structure the deals, whether that be the amount of equity consideration or contingent consideration that is built in?
No. As it relates to structure, no. Our structure has been consistent since day one with a focus on alignment, and that's proven to be successful over our 11-year track record here. What we are seeing again is a reduction in valuation and expect to continue to see those valuations come down. So again, continue to drive organic growth and being opportunistic with our acquisitions into 2023.
Your next question comes from the line of Adam Buckham with Scotiabank.
So I want to focus on margins. Obviously, a fairly strong quarter from an adjusted EBITDA margin standpoint. Are you able to provide some color on the drivers there? And maybe first, forward-looking into Q4 as well. Any color there, whether some of these are there any onetime things to think about or sustainable?
Yes. So thanks for the question. As far as the margins this quarter, again, the business does have certain seasonality and timing of expenses. What I'd expect is as we continue through the balance of the year, our margins being consistent with what you've seen kind of in Q3 and prior. We do, however, again, have a focus on continuing to drive operating leverage from the significant investments that we made in the beginning of the year to support our greatest acquisitive year ever. And knows that operating leverage and margin expansion will begin to come through in 2023 in more of a consistent manner.
Okay. Great. Second one for me. So just in the prepared remarks, you spoke about reductions in average multiples that you're seeing in the market. I'm just curious if you guys can provide some commentary around how multiples have trended with previous tightening cycle, obviously, looking at the 2017, 2018 period historically. If you can provide some context of the magnitude of multiple contraction versus increases in the funding rate.
Yes. I think without providing and going into any specificity, I think what we've seen to date, if you compare our Q3 valuations to Q1 and Q2, it's down 10% to 15%. And again, we negotiated those deals and signed LOIs over the last number of months, which was reflective of a macroeconomic environment that was not as high of an interest rate environment as we are today. So I have an expectation that those valuations will continue to come down. By what magnitude? I'm not prepared to make any comments here today.
Okay. Great. Congrats on the quarter.
Your next question comes from the line of Gary Ho with Desjardins Capital Market.
Maybe a first one for Nate. You just talked about seasonality for Q4. I imagine this year, Q4 could be a bit stronger just given that people want to use up the benefits before the year-end. Have you seen that come through so far in the quarter? Any color you can provide on volumes?
It's Guy here. Look, I think you're right. When you think of the 4 quarters of the year, Q2 and Q4 tend to be our strongest quarter. Whether that's a correlation between benefits and behavior, or in our view, it's more just indicative of the frequency of visits a person would naturally take over the course of the year. When you space out your hygiene visits, you tend to fit them in sort of the spring, fall, or winter. What we're seeing, again, is strong patient demand coming into the fall months. Typically, you get that lag between demand; requests for booking and by the time they show up in your practice. And so our expectation is a relatively strong fourth quarter with strong momentum, I think into the first quarter of next year.
Okay. Great. And then next question, just to follow-up on the interest rate hedging. You did roughly $500 million. Nate, wondering if that's an optimal level you want to put on looking out? Or is there more work to be done there?
Yes. I think as it stands today, that's a level that we, as a team, are comfortable with. Time will tell.
And when you say comfortable that's on an absolute basis or on a kind of percentage of debt?
$500 million being hedged.
Your final question comes from the line of Endri Leno with National Bank.
I'm calling behalf of Endri. And just one question for me. Could you provide some color on any potential impact or incremental CapEx in costs related to the Quebec Tourist and Traders new sterilization standards for dental practices?
Yes. So, it's Nate here. what Quebec has put forward... And again, I think it's still in discussion. Every province continues, and historically has, doing evaluation on operating protocols. This is nothing new for the business and we continue to expect our maintenance CapEx as communicated historically to be in and around that $30,000 per practice on an annual basis.
So just to reiterate that, it's been a proposal that's not been adopted, nor do we expect it to be adopted as proposed?
I'll also layer in. We've made it a matter of strategic priority as an organization to set a high standard of safety in our practices and we approach that from a national perspective. And what I mean by that is we set a high bar. While there are variability and standards as it relates to infection prevention and control, province to province, our approach has always been to set a high bar consistent across our practices coast-to-coast, and that's been fully baked into the network as it stands today. And so we don't anticipate those proposed requirements to come through. But if there is an enhancement of the rules in Quebec, we don't anticipate there be a delta between where those stand and where our network is, generally speaking.
There are no further questions at this time. I will turn the call over to Graham Rosenberg for closing remarks.
Thank you, operator, and thank you, everyone, for your time today. As you've seen from our results, we continue to demonstrate our business as a double-digit grower in all material respects, both revenue, EBITDA, and adjusted free cash flow. We are highly resilient business that will continue to operate well through all economic cycles. We have a very deep pipeline of M&A opportunities.
We've been very judicious around M&A, continuing to drive strong returns on our invested capital and strong performance underpinned by strong performance of those acquisitions in the post-acquisition period. We're rigorous around capital allocation, having a balanced capital structure. And I think you can see from our expectations for next year that we will continue to drive double-digit growth with delevering, effectively returning value to the equity by delevering. And we continue to grow double digits with a balanced approach to growth.
So we feel really good about our business. We feel good about the macros as it relates to our business and the operating news are going to continue to garner through the significant investments that we've made in our corporate infrastructure intentionally over the last 18 months. With that, operator, I think we're done. Thanks, everyone. Have a great day.
Thank you for participating. This concludes today's conference. You may disconnect at this time.