Earnings Call Transcript - VMD 2026-11-05

Operator

Welcome to the call. Welcome to the ViMed Healthcare Third Quarter 2026 Earnings Conference Call. At this time, all participants are in a listen-only mode. A question-and-answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star zero on your telephone keypad. I will now turn the conference over to Trey Fitzgerald, CFO. Thank you, Trey. You may begin.

Trey Fitzgerald, CFO

Thank you, and good morning, everyone. Please note that our remarks in this conference call may include forward-looking statements under the U.S. federal securities laws or forward-looking information under applicable Canadian securities legislation, which we collectively refer to as forward-looking statements. Such statements reflect the company's current views and intentions with respect to future results or events and are subject to certain risks and uncertainties, which could cause actual results or events to vary from those indicated in forward-looking statements. Examples of such risks and uncertainties are discussed in our disclosure documents filed with the SEC or the security regulatory authorities in certain provinces of Canada. Because of these risks and uncertainties, investors should not place undue reliance on forward-looking statements. The forward-looking statements made in this conference call are made as of today, and the company undertakes no obligations to update or revise any forward-looking statements, except as required by law. The third quarter financial supplement and financial news release, as well as the related financial statements, are available on the SEC's website. With that, I'll turn the call over to our Chief Executive Officer, Casey Hoyt. Thank you, Trey.

Casey Hoyt, CEO

Good morning, everyone, and thank you for joining us. Before getting into the results, I want to thank our roughly 1,500 employees. Their daily work with patients and referral partners is what makes our growth possible. I appreciate the care they provide and the work they put into serving more patients as ViMed continues to grow. The third quarter was another strong quarter for ViMed, with a record revenue of $80.7 million, representing 12.2% growth over last year. Just as importantly, that growth translated into stronger earnings. Net income attributable to ViMed increased 32% year-over-year and approximately 68% from the second quarter. We're continuing to grow the business at a double-digit pace, demonstrating the earnings potential of the platform we've built. For the first time since the LeHan acquisition, both the current and prior year quarters include a full three months of LeHan's operations. That gives us a much clearer picture of our growth, with a 12.2% increase reflecting expansion across our existing businesses rather than the incremental revenue contribution of an acquisition. Sleep therapy was a particular source of strength this quarter, and we're also seeing encouraging results from bringing maternal health services into our established bi-med markets. The success in those initial maternal health markets gives us confidence to broaden the rollout. We are now on track to enter two additional states per quarter, beginning in the fourth quarter, establishing a regular pace of expansion. The markets we have already entered are still early in their development. We see years of opportunity to build volume within each state as we develop referral relationships and reach more patients. Each launch adds to that opportunity so growth can continue within our existing markets as we expand into new ones. Breast pumps and related supplies are a practical example of how we can do more with the capabilities already in the company. Leiham brought the specialized experience in this business. BiMed's existing pay relationships and reimbursement capabilities give us a way to extend it into markets we already know. The early results have given us the confidence to take that next step. As we open those markets, we'll be paying close attention to fulfillment and reimbursement. We want the additional volume to become a productive part of the business with reliable service for mothers who depend on us. The two-state cadence gives our teams a clear operating plan for the next stage. Our growing sleep patient population shows how we're expanding BiMed's reach and serving more people. During the quarter, we served 43,861 pap therapy patients, over 6,000 more than the second quarter, and 37.5% above a year ago. Pap setups also increased both sequentially and year-over-year. Growth is coming through in patients receiving therapy, as well as the activity bringing patients into care. Resupply grew alongside that activity. We served 40,918 resupply patients, up approximately 22% from a year ago and 10.5% from the second quarter. Our expanding patient population creates further opportunity to grow resupply, and increasing participation in the program is a priority. We are simplifying order processing to support that growth and make it easier for patients to receive supplies on time with a dependable service that keeps them engaged over the course of their therapy. In ventilation, we have a longer revenue trend to assess under the revised CMS coverage rules issued in 2025. Ventilator rental revenue has increased in each quarter this year from $35.4 million to $36.4 million, and now $37.5 million. For the first nine months, it was approximately 8% above the same period last year. The comparison is particularly meaningful because much of the comparable 2025 period preceded the new CMS coverage rules. Growing ventilation revenue against that comparison supports our confidence and our ability to expand the business under the new framework. More broadly, we view the legislative and rulemaking environment as generally favorable to established providers that are invested in clinical care and compliance. Audit activity has increased across the DME industry, including for providers with strong compliance programs. Our own teams are spending more time and resources responding to those reviews. We are encouraged that CMS is examining its audit contractor model, and it specifically asks how to reduce unnecessary provider burden and protect patient access. We see an opportunity for more targeted, consistent oversight, and we intend to bring our experience to that discussion so providers can develop more of their resources to caring for patients. Our responsibility is to help patients receive the care they need. We support appropriate oversight, and we will advocate for coverage policies and review processes that preserve timely access to medically necessary care. Our clinical team see the needs of these patients every day, and we intend to make sure those needs remain part of the policy discussion. The third quarter showed that we can grow the business under the new coverage framework and convert more revenue into earnings. We are serving more patients, and the opportunities ahead in sleep and maternal health give us the confidence that we can enter the final quarter of the year. Todd, we'll now discuss the financial results and operating priorities supporting our next stage of the growth.

Todd Zehnder, COO

All right. Thank you, Casey, and good morning, everyone. All figures are in U.S. dollars, and our full results have been filed with the SEC. And I'll refer to information included in the quarterly financial supplement, which is also available on our investor relations website. Net income attributable to BiMed was $4.6 million, or 11 cents per diluted share, compared with $3.5 million, or 9 cents per diluted share a year ago, and $2.8 million, or 7 cents per diluted share in the second quarter of this year. Net income increased 32% year-over-year and approximately 68% from the second quarter. Adjusted EBITDA was $17.1 million, an increase of approximately 6% from the prior year quarter, and 24% sequentially. Adjusted EBITDA margin was 21.1%, compared with 17.6% in the second quarter, and 22.4% a year ago. The sequential margin expansion was approximately 350 basis points. Revenue continued to grow this quarter, and SG&A declined from the second quarter. Both contributed to the sequential increase in profitability, with several compensation and benefit adjustments also affecting the results. Revenue increased 3.3% from the second quarter, with growth across rentals, equipment and supply sales, and services. Other equipment rentals grew approximately 13.1% year-over-year, and equipment and supply sales grew approximately Only 23.7%, supported by sleep and women's health. Ventilator rental revenue was $37.5 million, up 7.4% from a year ago, supported by higher average patient count. Gross profit was $46.2 million, or 57.3% of revenue, compared with 57.5% a year ago and 57.7% in the second quarter. Revenue from sales and services represented 32% of revenue, compared with 30.1% a year ago. The year-over-year shift towards equipment and supply sales affects gross margin because these offerings generally carry lower margins than equipment rentals while also requiring less capital investment. As we discussed last quarter, we added a new distribution partner that, together with our existing suppliers, gives us supplier capacity well beyond our current needs across all product lines to support future growth. We are still implementing the related cost savings and expect them to improve gross margin by approximately 50 basis points once fully in place. SG&A was $35.5 million, or 44% of revenue, compared with 47.5% in the second quarter and 44.4% a year ago. SG&A declined approximately $1.6 million sequentially. Year-over-year, revenue grew faster than SG&A, even as we added resources to support the larger business. Lower compensation-related accruals and benefit expense contributed to the sequential decline. Phantom stock expense also came down substantially, as expected, following the large mark-to-market adjustment in the second quarter associated with the increase in our share price. Benefit rebates also reduced expense during the quarter. Regular payroll and software spending increased as we added capacity to serve a growing patient population. That additional capacity is supporting higher volumes, including a 12% sequential increase in the pack resupply orders. At the same time, billing expense declined approximately 12% as revenue grew, reflecting the workflow changes and implementation timing. Our focus is on getting more volume through with the people and systems that we have in place. Compliance is another area where our personnel and systems can provide a competitive advantage as oversight increases across the industry. Enforcement and claims audit activity have picked up, and our teams are devoting more resources to those reviews. The documentation and follow-up work adds administrative and professional costs, and in some cases can extend payment timelines. Our success rate under these audits remains very strong. Those outcomes support our confidence in the care we provide and the documentation supporting it. Our teams are focused on submitting complete responses and moving reviews towards resolution. The increase in accounts receivable had several drivers this quarter. Audit-related payment timing was one contributor, alongside other billing and collection factors, including delays associated with system migrations. We believe the related revenue remains fully relizable. These delays have extended the timing of cash collections and temporarily tied up more cash and working capital. Collections in October were extremely strong, so we are confident that this will work itself out during the fourth quarter. Operating cash flow was $11.5 million. After net capex of $7.5 million, free cash flow was $4 million. Net CapEx represented approximately 9.2% of revenue. For the first nine months of 2026, operating cash flow was $35.5 million and free cash flow was $15.2 million, compared with $33.5 and $17.3 million, respectively, a year ago. Lower equipment sales proceeds also affected the year-to-date cash flow comparison, as the prior year period benefited from the ventilator return program. On a trailing 12-month basis, free cash flow was approximately $26.1 million. The business continues to generate cash after funding equipment needs, although the current quarter's collection timing reduced cash conversion. We continue to reduce debt and return capital during the quarter. We repaid approximately $2.1 million of term debt and repurchased and canceled 115,000 shares for approximately $1 million. At September 30th, cash was $9.7 million, and borrowings under our credit facility were $5.3 million, with nothing on the revolver. We made an additional $2 million term loan repayment in October, further reducing our outstanding debt. Our first use of capital is supporting the growth within BiMed, including the maternal health expansion and the needs of the larger sleek business. We retain the flexibility to consider acquisitions that fit our operations and return requirements and to repurchase shares when the value is attractive. The balance sheet allows us to evaluate those choices without committing to a fixed allocation among them. Turning to our outlook, we are raising the lower end of our full-year revenue guidance and now expect revenue of $316 million to $320 million, compared with our previous range of $314 to $320 million. We are narrowing our adjusted EBITDA guidance to $64 million to $66 million, compared with our previous range of $64 million to $68 million. With nine months complete, the narrower range reflects our results through September and our updated expectations for the fourth quarter. We are also lowering our net capex outlook to 8% to 9% of revenue, compared with 8.5% to 10% previously. The increasing contribution from less capital-intensive offerings reduces the equipment investment needed to support our growth. Our revised outlook anticipates sequential growth in both revenue and adjusted EBITDA in the fourth quarter and excludes any potential future acquisitions or strategic transactions. As we finish the year, our operating priorities include improving collections and preparing the next maternal health markets for the rollout Casey described. We are seeing demand in the areas where we have addressed resources, and our job is to turn that actively into earnings and cash as the business grows. With that, we'll wrap up our prepared remarks and take your questions. Operator, please open the line.

Operator

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

Ilya Zubkov, Analyst — Freedom Brokers

Good morning, and thank you for taking my question. First is on the sales side. I see that sleep resupply patients grew 10.5% sequentially, but equipment and supply sales grew only about 2%. I'm just wondering if the gap is timing, price mix, or the contribution from women's health, and how should we think about revenue per resupply patient from there?

Trey Fitzgerald, CFO

Yeah. Hey, Elia. Good morning. Yeah, when we think about the sales line as particularly in the maternal health and resupply, you are correct. There was a strong 2Q, so if you're thinking about 3Q sequentially, I think the resupply was stronger. There's nothing that really comes to top of mind that was any sort of reduction off of 2Q, other than 2Q is just a really strong quarter as well in that regard. You know, it sets the stage for really what we expect is probably our largest growth in 4Q will be in that line. You're going to see the best seasonality in 4Q for the sleep resupply side of the business. And further pull through in sort of that PAP therapy that we were talking about this quarter with increased setups and increased rental patients is going to transition to resupply in the back half of this year, or the fourth quarter, rather.

Ilya Zubkov, Analyst — Freedom Brokers

Good, thank you. And one on margin, please, if I may. As the sales mix shifts toward lower margin, less capital intensive lines, what financial KPIs are targeting over the next two, three years, and what would you consider as a normalized margin framework?

Todd Zehnder, COO

Well, I would say that we want to grow all the way down the line from an EBITDA and net income perspective, but I think as we do move into more. Sales and services and have no CapEx net income growth probably becomes a little bit more important for us versus adjusted EBITDA. That also will translate into free cash flow, which you're hearing us talk a lot about because it's extremely important to us. And I think our trail in 12 months, I said it was maybe $26, $27 million after growing organically this quarter, 12 and a half percent. So we're pretty pleased with that. We're not going to get too hung up on the exact EBITDA margin as we continue to move, but I definitely think we'll stay up in the 20-plus percent adjusted EBITDA for the time being.

Ilya Zubkov, Analyst — Freedom Brokers

Great. Thank you so much. I'll pay the line.

Operator

Our next question is from Mike Patuski with Barrington Research. Please proceed with your question.

Mike Patusky, Analyst — Barrington Research

Hey, good morning, guys, and forgive me, I missed the first five minutes, so if you cover this, forgive, but in terms of the vent patient number in the quarter, that to me looks a little soft and sequentially down, and I'm just curious, is that a function of just sort of the higher hurdle, sort of service hurdle with the NCD, or can you speak to that? Is there anything to be concerned about in that patient number? Thanks.

Casey Hoyt, CEO

Yeah, I think you have a little bit of that, Mike, just with there's still an education process going on with the sales force and our referral partners. And so whenever you have change with how the approval process goes for these patients, sometimes you have some referral sources get a little bit gun shy. However, I mean, the demand is there. I see that what's happening despite us going through those hurdles, the competitor appears to be struggling a little bit more than we are just because we're so narrowly focused in complex respiratory. So, I think there's market share to be gained here as we... We've established that baseline of education and looked at the future of really getting to these patients. We know the patients are not going away. We're still in an underserved population. They're going in and out of the hospital. It's just, you know, our job to just continue to give these referral sources the confidence that, look, we can manage the compliance on these patients despite having all these new rules that the NCD has laid out. And so it's been. A little bit of taking time to establish that new normal, but I would say that, call it, 80% of the work is done, and, you know, we're excited about the patient population for the future.

Trey Fitzgerald, CFO

Yeah, hey, and, Mike, this is Shrey. Let me add some context to that, too. I think we talked about it in the prepared remarks, but that active patient count is a point in time. Sometimes it can be, especially in the NCD, where we have some kind of noise in some of the... The compliance-related active billing versus hold and those sort of things. But in the quarter, we had higher active average patients throughout the quarter, and that's why you're seeing vent revenue growing sequentially, but the point in time right at the end of the month went down a little bit. So that created a little bit of noise. We think we're going to, you know, we'll start to stack that up here in 4Q and into 2027.

Mike Patusky, Analyst — Barrington Research

So, I mean, would you expect sort of a sequential increase in Q4 versus Q3? Because last year, you guys actually saw a slight decline from Q3 to Q4 in terms of Venn patients. Given what you just said, I mean, would you expect maybe a slight bump in Q4 versus Q3?

Todd Zehnder, COO

That's the trends we're seeing right now, Mike. Yeah, we do expect that. And I just think that with all the change that's going on, whether it's NCD-related or other changes going on, I think the Vint active patient count has been a little bit more wobbly. And obviously, we've gotten a lot bigger. But yeah, the current trends are showing that we will be back up in the fourth quarter.

Mike Patusky, Analyst — Barrington Research

Okay, and then just one more, and I'll let other folks have a shot here. In terms of, and again, forgive if I missed this, but in terms of, you know, the maternal health piece, did you guys talk at all, or could you talk about, you know, progress you're making in terms of, you know, turning on states or your progress in sort of getting a plan together for turning on states over the next year? Could you just speak to sort of where you are in that rollout? Thanks.

Casey Hoyt, CEO

Yeah, I mean, I'm not going to go into this particular state, but it's going to be a two-state cadence, and we've already established our fulfillment partner, which has been a huge win in terms of creating the operational efficiencies for Lehan and their team who are leading the maternal health sector to really scale. Our network development team is in a good spot where they're moving ahead into the next states with establishing the contracts and making sure that reimbursement is where it needs to be before we go into a particular state. We've been analyzing a lot of data on expecting mothers and birth rates and things of that nature for those particular states to where we go into the right ones first. So our team is really excited about the sales force that we've been dropping in behind some of these states. You know, we're seeing higher conversion rates from... Those referral partners that the sales folks are boots on the ground calling on. And so, you know, they're driving a good portion of the sales as we get those contracts up and running. So that's a brand new model, if you will, to Leigh Ann. So, you know, you put the technology in place where you're getting in front of the expectant mothers that Leanne's built, and then you double down with some boots on the ground, and you improve those conversion rates, and you got the right states and the right reimbursement. It's a recipe for success. We're super excited about it. We expect to continue to grow it.

Mike Patusky, Analyst — Barrington Research

All right. Terrific. Thanks, guys.

Operator

Thanks, Mike. Once again, if you'd like to ask a question, please press star 1 on your telephone keypad. Our next question is from Dave Storms with Stonegate. Please proceed with your question.

Dave Storms, Analyst — Stonegate

Good morning, fellows, and thanks for taking my questions. Maybe just wanted to stick with the maternal health rule out there. Do you have any further comments on what we should expect in terms of growth curves? I know you mentioned two states per quarter, it sounds like. Should those states be pretty much fully developed after that quarter, or is that just to get them on their feet before moving to the next two states?

Casey Hoyt, CEO

I mean, I can start, if you can finish with the growth rate. No, they for sure will not be fully developed during that quarter. That's just the onboarding process. So, for example, you know, we did add, like, Texas as our first state. I mean, we're still doing so much work in Texas. That was last year. So, it's just a ramp up of having new hunting ground to go into. But it does, the business does start coming in. Almost immediately, just because of the technology that we have and the marketing that we do in those current states. But then you have a growth strategy after that where you drop it in boots on the ground and really getting better at conversions and so on and so forth. So, yeah, that cadence is really just new hunting ground, and it'll be increasing along the way throughout the year. Yeah, I'll just, I mean, kind of exactly what Casey said.

Todd Zehnder, COO

You start out, you have. Hopefully, most of the contracts, but you don't have all of them. You start with digital marketing, and then as you gain traction, you put more personnel there. So the growth curve definitely takes some time. We've seen growth consistently throughout the year in Texas, and we just now started two other states. So we would expect that to happen, and the cadence will continue, like Casey said in his remarks, a state or two every quarter going forward. So it will continue ramping over time is the short answer.

Dave Storms, Analyst — Stonegate

That's a great clarity. I appreciate that. Speaking with that, you mentioned in your answer there that the boots on the ground are going to be important and the people there are going to be important. I know in the past we've talked about Salesforce training. Maybe any updates there on how that's progressing, what you're seeing, what kind of efficiencies that could be driving?

Casey Hoyt, CEO

Are you talking specifically in maternal?

Dave Storms, Analyst — Stonegate

Specifically in maternal, but also if you want to expand that to the rest of the business.

Casey Hoyt, CEO

Yeah, I mean, the training is very important to us. We feel like the better our training gets, the more efficient all of our new sales reps onboard new patients. So, we're constantly dumping resources into further training. The breast pump sale is really... It's way easier, if you will, than it is to train a complex respiratory rep, and so you're basically chasing that order and making sure that you have the appropriate documentation in place. to authorized billing. And so when you have some help with some people to chase some of those things down that technology can't do, your conversion rates in those particular states go up. But from a sales standpoint, it's a pretty easy sell. It's just got to find somebody who likes to work hard and stay busy and stay in front of these referral partners.

Dave Storms, Analyst — Stonegate

That's perfect. I appreciate that. One more, if I could sneak it in. I know you mentioned in the prepared remarks that you have a strong balance sheet that gives you some optionality for additional M&A. Just any thoughts as to what you're seeing on this front? Would that take the shape of another lands? You know, is there a target profile you would think about? Anything like that? The pipeline's active.

Casey Hoyt, CEO

I mean, look, here's another way of looking at it. I mean, last year we looked at over 40 deals and we passed on them. You know, the reason that you'll see us pass on these deals is because it's less expensive for us to go in and organically grow next to them versus purchasing them. And so it takes a unique acquisition such as Lehans, such as H&P, which has the Perhaps a geographic coverage gap, or maybe some insurance contracts that we don't have, or a new service line like Lehan did for us to get really hot to trot about the M&A gain. But make no mistake about it, they're out there and we look at them constantly. It's just we're pretty darn picky because we organically grow so much faster and it's just more efficient to do it that way than going in and spending too much money.

Todd Zehnder, COO

Yeah, and I'd say that to add to that, The reasons for M&A really haven't changed in the priorities and the requirements. Basically, treating patients in the home is the first and really the most important. And then, like Casey said, if we can get geographic expansion, payer expansion, or even like we've proved out the product expansion, those are the priorities with M&A. We don't need to go acquire another vent company in an area that we have a lot of success in. That's our organic model, and we believe firmly in that.

Dave Storms, Analyst — Stonegate

Understood. Thank you for taking my questions, and good luck in the next quarter. Thanks, Dave.

Operator

Our next question is from Andrew Graham with Odinson Partners. Please proceed with your question.