dentalcorp Holdings Ltd
TSX:DNTL
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dentalcorp Holdings Ltd
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Good morning and welcome to the Dentalcorp Third Quarter Results Conference Call. [Operator Instructions]
At this time, I would like to turn the call over to Mr. Nate Tchaplia, President and Chief Financial Officer of Dentalcorp. Please go ahead, sir.
Thank you, operator, and good morning, everyone. Welcome to the Dentalcorp's Third Quarter Results Conference Call. I'm joined here by Graham Rosenberg, our CEO. 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 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 of date hereof and Dentalcorp assumes no obligation to update or revise them to reflect events, disclosures or circumstances except as required by applicable 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 will now turn the call over to our Chief Executive Officer, Graham Rosenberg, for opening remarks. Graham?
Thanks, Nate, and good morning, everyone. We're 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 September 30, 2024. For today's call, I'm going to share 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. After which, I will provide forward-looking remarks about how our business is trending. As a reminder, Dentalcorp operates in a highly recurring essential health care industry that is cash pay, resilient through economic cycles and insulated from disintermediation by technologies. Importantly, dental expenditures have experienced strong relative growth during periods of higher-than-average inflation.
Accordingly and in the context of the current macro environment, we believe that Dentalcorp's favorable cost structure, high margins, low commodity risk and negligible capital expenditures provide support for the company's continued delivery of balanced double-digit growth in the $22 billion Canadian dental industry. Our confidence in the business is supported by our third quarter results, which met or exceeded our expectations and provide a constructive outlook for the remainder of the year. As you'll see on Slide 3, our results have been made possible by our deep and diverse network of over 10,000 team members across the country. Our teams continued to deliver the highest standards of care during the reporting period as we support more than 2.3 million active patients, including 91% of patients who are recurring, and manage over 5.4 million patient visits annually.
We completed our third quarter ended September 30, 2024 with $1.55 billion of last 12 months pro forma revenue and $288 million of pro forma adjusted EBITDA. As you can see on the next slide, we continued with our balanced approach to drive sustained double-digit growth and we 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. During the quarter, we made an indirect investment in Dental Innovation Alliance VC Fund, which positions Dentalcorp to potentially benefit from a wide range of emerging innovations in dental technology. And subsequent to the quarter following a very successful pilot, we announced a strategic partnership with VideaHealth that will allow Dentalcorp to deploy AI technology across our network.
This will allow us to benefit from enhanced accuracy and consistency in diagnoses and improve patient education among other benefits. This partnership marks a notable milestone in Dentalcorp's long-term agenda and is expected to allow the company to set new benchmarks for clinical excellence and business efficiencies through the use of advanced technology. With respect to M&A, we acquired 4 practices in the quarter for a total consideration of $16 million. These practices are expected to generate $2.3 million in pro forma adjusted EBITDA after rent. We remain as the best positioned and capitalized partner for independent dentists and we'll continue to be disciplined about the practices we acquire.
On Slide 5, you will see that our business continues to operate with robust and expanding margins, low CapEx requirements and capped interest rate exposure on 100% of our existing debt outstanding. We continue to convert a high steady percentage of our EBITDA into free cash flow in any given period and expect this conversion to increase as we continue to realize network-wide operating leverage. Over the last 12 months, our free cash flow conversion increased to 63% on an LTM basis in the quarter, up from 58% in Q3 2023. On Slide 6, as expected, we completed the quarter at 4.0x leverage, down 0.4x from the same time last year. Q3 2024 marks the fourth consecutive quarter of deleveraging. In addition, our bank leverage as calculated under our credit facilities dropped below 4x during the quarter.
On Slide 7, you will see that for the sixth consecutive quarter, we self-funded our acquisition program and we continue to apply this disciplined approach to growth. Subsequent to the quarter, we entered into a blend and extend on our hedges for 100% of our existing debt through January 2028 aligned with the maturity of our credit facilities. When combined with the savings on our bank spread from deleveraging below 4x as calculated under our credit facilities, we have an interest rate ceiling of 6% through January 2028 compared to 6.6% through May 2026 prior to the hedge. We expect to see a $6 million annual improvement or approximately 4% increase to our annual adjusted free cash flow from these interest rate savings.
Turning to the next slide, you will see a comparison of valuation and free cash flow yields versus our peers. At the end of the quarter, we were trading at a 37% discount to our total peer group and at the same time, we are currently trading at an 8.8% free cash flow yield compared to our total peer group of approximately 3.1%. Turning now to Slide 9. I'm delighted to report that our business delivered revenue of $375.4 million in the third quarter of 2024, up 11.4% over the same period in 2023 and adjusted EBITDA of $68.9 million, up 13.1% over the same quarter last year. Our adjusted EBITDA margin came in at 18.4%, an improvement of 30 basis points over Q3 of 2023. Same practice revenue growth was strong at 4.2% for the quarter and we delivered free cash flow per share of $0.19 for the quarter representing an increase of 36.4% over the same quarter last year.
The outcome of our operational efficiencies was a strong adjusted free cash flow for the quarter of $36 million, up 37.6% over the same quarter last year, enabling us to fund the entirety of our acquisition program with free cash flows for the sixth consecutive quarter. Subsequent to the quarter-end, we completed 9 acquisitions that are expected to generate $8.5 million in pro forma adjusted EBITDA after rent thereby substantially reaching our annual target of $20 million in acquired EBITDA. As we look to the fourth quarter of 2024, we anticipate revenues to increase by 8% to 10% over Q4 2023 while delivering 3.5% to 4.5% same practice revenue growth with expected adjusted EBITDA margins increasing by 20 basis points over the fourth quarter of 2023.
I will now pass the call over to Nate, who will walk us through the details of our financial results and share some closing remarks before we open the call for questions. Nate?
Thank you, Graham. With regards to the Canadian Dental Care Plan, we have now treated over 60,000 CDCP patients and over 90% of our practices are accepting CDCP patients. Under the CDCP, we have and will continue to deliver services at rates that are consistent with our usual and customary fees, which ensures the high quality of care that all of our patients receive, both new and old. Based on the most recent information from the Canadian government, we expect that in 2025 patients between the ages of 18 to 64 will be eligible to receive care under the CDCP. The start date has not yet been determined by the Canadian government. Overall, we continue to see the CDCP as a favorable development for both the Canadian public and dental professionals and expect it to be modestly positive for Dentalcorp. Our quarterly results, which met or exceeded expectations in all respects, demonstrate the strength and predictability of our business.
Turning to Slide 10. Revenue for the 3-month period ended September 30, 2024, as Graham mentioned, was $375 million compared to $337 million for the corresponding period last year, representing an increase of approximately 11%. The increase is attributable to our continued acquisitive and organic growth including an increase in the number of practices participating in the CDCP throughout the quarter. As you can see, we reported third quarter adjusted EBITDA of approximately $69 million compared to $61 million in the same quarter last year and reported third quarter adjusted EBITDA margins of 18.4% representing 30 basis points of margin expansion year-over-year as we continue to realize operating leverage following the significant investments in corporate infrastructure throughout 2022 and 2023. Looking forward, we continue to be confident about our ability to grow the business through acquisitions and organically.
Turning to the next slide, you can see our net leverage and liquidity as of September 30, 2024. On a net debt basis, we were approximately 4.0x levered at the end of the third quarter, deleveraging by 0.4x over Q3 2023. As Graham alluded to earlier, we blended and extended the hedges on 100% of our existing debt through January 2028 aligned with the maturity of our credit facilities. When combined with the savings in our banks spread from deleveraging, we have interest rate ceiling of 6% through January 2028 compared to 6.6% through May 2026 prior to the hedge. We expect to see $6 million annual improvement or approximately 4% to our adjusted free cash flow from the interest savings. Third quarter and last 12 months adjusted free cash flow was $36 million and $146 million, respectively, which support our strong balance sheet position. We ended the third quarter 2024 with liquidity of $425 million comprised of $72 million in cash and $353 million in undrawn debt capacity under our senior debt facilities.
This quarter marks the fourth consecutive quarter increase in our interest coverage as defined by our last 12 months pro forma adjusted EBITDA after rent divided by net interest expense, which currently sits at 3.5x, up from 3.3x in Q2 2024. Overall, we are pleased with our third quarter 2024 results. We increased organic growth, realized ongoing operating efficiencies and expanded margins, continued to delever the balance sheet, completed accretive acquisitions for the year and continued to develop our pipeline. Turning to Slide 12. We remain highly confident about our future opportunities. As we look ahead to the remainder of Q4 2024, we expect to achieve same practice revenue growth of 3.5% to 4.5% for Q4 and we remain on track to meet or exceed our full year targets on adjusted EBITDA margin expansion of 20 basis points to 18.4%, 15% to 20% adjusted free cash flow growth per share and balance sheet deleveraging as previously discussed. As of today, we have substantially met our 2024 acquisition budget.
Thank you all for joining our call today. This concludes the formal part of our presentation. I would now like to open up the call for questions. Operator?
[Operator Instructions] Our first question comes from the line of Brian Tanquilut with Jefferies.
This is Meghan Holtz on for Brian. Congrats on the quarter. I know this might be a little early, but can you speak to any headwinds and tailwinds for 2025? And then just on the Q4 same practice revenue guide, how much of that is coming from CDCP patient volume versus underlying demand?
Great question. Let's start with 2025. And as mentioned earlier on the call, as the CDCP continues to roll out, there's still a little bit of uncertainty as to the timing around the 18 to 64 cohort and when they will become eligible. As we saw at the beginning of this year, there was slight disruption in both patient expectation as well as understanding how to kind of comply and make use of the program. I think we expect to have a little bit of disruption if the program continues to roll out into 2025. Again there's no certainty that it will. The one positive here is all of our practices or call it 90% plus of our practices are now participating in the CDCP. So the disruption that we would have seen at the beginning of this year is going to be far reduced given that our practices have now been fully onboarded into the program. As far as the guide for Q4 really being supported by the CDCP patients, I'd say it's really back to normal as it relates to the patient flow. I think what we do see is for the 65 plus, the 18 and below and the disabled population that have now made use of the program and have become eligible; we've gone through that education both at our practices and with our patients and we expect that patient flow to be consistent with what we've seen historically.
Your next question comes from the line of Gary Ho with Desjardins.
Maybe just going back to the EBITDA margins, there are I guess 2 parts. It was particularly strong and better than your guidance this quarter despite the Partner's Conference I think within the quarter. Anything to highlight that drove this outperformance or onetime? And then second part on your Q4 guidance, same thing on the EBITDA margin, maybe a bit softer than what we were expecting. Any comments here or just some conservatism built in especially given your kind of last comment here that it could meet or exceed your full year 18.4% target?
That's a great question. So as it relates to really what the drivers are, I think we continue to see the significant operating leverage on the investments we've made in our corporate infrastructure. Those are coming through and are really amplified by the strong organic performance that we're seeing at our practices as well as the EBITDA margin drop-through. So nothing outside of really executing on our strategy and realizing the investments in our teams and technology that we've made over the last number of years that really contributed to the outperformance in Q3. As it relates to Q4, what I'd say is we expect to be at the upper end of our ranges that we put forward here. The business continues again to see strong patient demand, strong performance and the margin expansion from our operating leverage. So don't expect to see a significant change from the performance that we've seen overall in Q3 going in to finish the year strong in Q4.
Your next question comes from the line of Doug Miehm with RBC Capital Markets.
Maybe Graham, when you think about the self-funding of your model here, you've been able to do that for some time. But at some point it's going to allow you to start to increase the cadence of acquisitions if you chose to. Can you talk about how you think about that capital allocation right now?
Yes. Look, we obviously made a conscious effort to delever to a level that was satisfactory for a company of our size in the public markets. And when we look back, we've always spoken about $25 million to $30 million plus or $30 million plus of M&A on an annual basis over any 3-year period. If you look back from the end of this year and say $20 million and change back 3 years, we're in that range. We expect to continue to be able to be in that range over the medium term while deleveraging. I think the free cash flow generation and the self-funding has aligned with deleveraging at this point in time given the scale of the business. But given that we've obviously continued to scale up and grow at double digits, we feel that we'll continue to be able to delever while increasing our acquisition pacing if we so choose, maybe not totally self-funding, but certainly deleveraging while we move through the piece. So whilst deleveraging and self-funding have been synonymous with one another and necessary for each other, if you will, self-funding's been necessary to drive deleveraging. Given the economies and the level that we're at today, we can probably [ talk ] it up a bit if we so chose while still deleveraging.
Excellent. And then when you think about the free cash flow conversion as a percentage of EBITDA, which looks very strong over the last year obviously, can you talk about where you could ultimately see that number over a 3- to 5-year period like what range perhaps?
I think if we unpack really what the main driver is between our EBITDA and free cash flow, it's really our interest carry, right? And as it sits today on nearly $1 billion of debt or just over $1 billion of debt at the 6% carry so call that now on a go-forward basis somewhere in that $60 million mark, assume that to continue to be flat, right? So if we model out that 4% plus organic growth with the drop-through to EBITDA, the leverage that we're going to be able to get on our corporate infrastructure and our $25 million plus of acquired EBITDA; you're going to see that free cash flow conversion continue to increase at a rate consistent with what you've seen this year into the future.
Your next question comes from the line of Scott Fletcher with CIBC.
Just a follow-up on the last question. I think you've talked before about '25 being a year where you're going to look at cash taxes. Can you sort of give us at least a rough overview of how cash taxes in '25 are going to impact that free cash flow conversion at least in the '25 basis?
Yes. We're still sitting on a considerable amount of tax losses as we enter into 2025. Expectation is we should become a taxpayer at the end of the year. It's something that as we get a little bit more clarity, we'll provide the market with a better understanding; but it's not to impact our ability to grow and fund our acquisitive program at consistent or slightly elevated paces into 2025.
Okay. That's helpful. And then just a question on the announcement of using some of the AI tools in the clinics. Is there any sort of financial or operational impact that will show up in the numbers or like is this more of just nice for the dentist to be able to rely on some new technology?
Yes. So this is one of the most exciting things that I know I've seen in my 10-plus years in the dental field and in speaking to many of our partner dentists. It's probably one of the most exciting things in their career that they've seen. I think one, it's going to improve the standard of care and it's going to improve the opportunities to identify coaching moments and training moments. But what it will also allow is another tool for patient communication and patient education. This is something that we piloted for 12-plus months in a select group of our practices and we've seen significant operational benefits in those practices, which we believe to be scalable as we roll it out to the balance of our network. It's not something that we've included in our 2025 4% plus organic guide, but it will be accretive to them.
Your next question comes from the line of David Kwan with TD Securities.
Just on the CDCP, I think in the past you guys have talked about kind of working through existing patients before taking on new ones. I'm curious where you are on that if you are taking on new ones. And then just related to that, in terms of the adult cohort coming online for next year, are you seeing any patients deferring their appointments until they expect to get coverage even though there's no specific timing yet?
Great question, David. So as it relates to taking on new patients, absolutely we're through that. So I'd say as we stand today for the most part, we're seeing patient behavior across almost all the cohorts be consistent with what our expectations would be. I think there is and has been a slight elevation in cancellation and deferral rates through the year and we expect that to maybe slightly ramp as we get into 2025 if there are any announcements around the expansion of the cohorts. Again as we sit here today outside of what the federal government has shared with us, which is they are going to expand the program, dates are uncertain and uncertainty creates some uncertain behavior. But as we sit here today, there hasn't been any material shifts in patient volumes and patient behaviors; but that could change.
Your next question comes from the line of Stephen MacLeod with BMO Capital Markets.
Lots of great color so far. A lot of my questions have been answered, but I just wanted to follow up on a couple of things. Just with respect to -- can you just give an update as to where we stand in terms of pricing and inflation and how you expect that to evolve as we sort of turn the page into 2025?
Absolutely. Thanks for the question, Stephen. I think overall from an inflationary perspective, I think we're all thankful that that's come down here in 2024, which has allowed us to catch up on our overall pricing to cost match. As we sit and think about 2025 expectations, what's been consistent in the dental industry and has allowed for the predictability of the business is that the provincial associations, as you know, set price with reference to the prior year's inflation and that's always been in that 2% to 3% range. Given that we've reverted close to normal levels of inflation in '24, my expectations would be in that range for pricing next year.
Okay. That's helpful. And then just with respect to acquisitions, I mean Q3 was a bit light, Q4 year-to-date obviously very strong. So just wondering I mean is that just timing related or is there anything else going on? And then I guess as we roll the calendar to 2025, would you still expect that $20 million-plus number to be intact for next year?
Yes, absolutely. It's purely timing and that's why it's difficult to have it spread evenly quarter-over-quarter. As we all know, summer months are more difficult to get things done given vacations and priorities of both the vendors as well as advisers. What we are very pleased to note is we're complete $20 million plus of acquired EBITDA for the year as we're speaking on this call today with some additional deals to close through to the end of 2024. So we will be ahead of our plan for 2024 and what this is allowing us to do is build a very strong pipeline going into 2025 with the expectation of continuing in that $20 million plus in acquired EBITDA into next year.
Okay. Glad to hear you'll walk through it today, which is great. Thanks, Nate. Appreciate the color.
Your next question comes from the line of Daryl Young with Stifel.
Just one quick one for me. With respect to the CDCP, have you seen any significant changes in the mix of services or anything to call out there around the CDCP patient versus a traditional patient in terms of spend?
I think there's really 2 types of CDCP patient, right? So one of the CDCP patients would be those that have been seeking dental care and paying out of pocket for years and years and years. Really those patients are just getting a little bit more money in their pocket to spend on additional services, more comprehensive services, which is of course accretive to the overall business. The other patient which ultimately is one that wasn't able to access or seek the care; given the support here, they're able to now go to the dentist. Some of these patients may not have gone to the dentist for many, many years so the type of care they are receiving might be a little bit more emergent and comprehensive in nature. So overall, I'd say it's a positive contributor to the practices. We're happy that both patients are able to get access to the program and ultimately access to the care that they do need.
Your next question comes from the line of Tania Armstrong with Canaccord Genuity.
Congrats on the quarter. Quick question for me. On the number of practices, we saw that tick down sequentially from 551 to 550 and that's despite the handful of tuck-ins that you did in the quarter. Just wondering if there were any location consolidations during Q3 and whether this, a, contributed to the better-than-expected margin that we saw; and b, is something that you continue to look at and would continue to look at in 2025?
Tania, great question. The consolidations is something that we continue to evaluate. It's absolutely part of our strategy and one of our arms of growth where we acquire practices in areas where we have practices with excess capacity and bring their patients and teams to operate in a more efficient and margin accretive way. So absolutely, that is the reason for the practice count and is a positive contributor to our overall margin performance.
Your next question comes from the line of Allen Lutz with Bank of America.
This is Dev Weerasuriya on for Allen Lutz. Nate or Graham, I'm just sitting here kind of digesting your comments around the CDCP. It seems like it might be slightly more beneficial than prior expectations. I also saw that the Canadian government is increasing the initiatives for awareness of the program. It seems like they're doing a little bit more advertising. Do you think that most of the CDCP benefit I guess in terms of volume lift has kind of come through or as the 18 to 64 population gets rolled out, is there some sort of like a step function change in volumes that's expected in 2025? And maybe a way to frame that, if you look at organic patient growth I think in the 2% to 4% range, what would that look like with the CDCP fully rolled out you think?
Thanks for the question, Dev. So I think first off, if we take a step back and really look at the 2 groups, right; you have the 65 plus, the 18 and below and the disabled population that's eligible today; and that truly is the nonworking population that would be at risk of not having access to care. Canadians in the working age between 19 and 64 predominantly will have some type of either employer sponsored insurance coverage or other type of coverage, which we don't believe if CDCP is rolled out to that group, there's going to be a significant increase in volumes. Will it be accretive? Yes. It puts more dollars in their pocket to consume dentistry and for a group that isn't able to access care, will provide them that avenue to do so.
I think if you look at the federal government's disclosures, what they are seeing is that their expectations of patient enrollment and volumes through the program are significantly below levels where they thought they would be at this point in time, which just shows that there's still some positive tailwinds as it relates to the existing cohorts to get educated and get put through the program. Overall, it will be positive. It continues to be positive, but it's still very much early days, right? If we go back in the rear view when the program rolled out in May, a very small number of dentists were participating in the program, which clogged up the opportunity for patients to benefit themselves with the program. It was only in mid-July after the alternative pathway opened up where the majority of dentists across Canada began to participate in the program. So we're only really a few months into it, early days; but overall it continues to be positive.
[Operator Instructions] As there are no further questions at this time, that concludes the Q&A session and today's conference call. Thank you all for participation. You may now disconnect.