Waystar Holding Corp.: Form 10-Q for the period ended Mar 31, 2025
Filed with the SEC on Apr 30, 2025 and accepted by EDGAR at Apr 30, 2025, 16:06 ET.
Management's discussion and analysis
As filed, 35,718 characters, with its headings, lists and tables. Extracted from the main document; charts and exhibits are in the original on sec.gov.
The following discussion and analysis of Waystar Holding Corp. (“Waystar”, the “Company”, “we”, “us”, and “our”) financial condition and results of operations should be read in conjunction with our unaudited consolidated financial statements and the related notes included elsewhere in this Form 10-Q, and the consolidated financial statements and related notes included in the 2024 Form 10-K. In addition to historical information, this discussion and analysis contains forward-looking statements based on current expectations that involve risks, uncertainties, and other factors outside the Company’s control, as well as assumptions, such as our plans, objectives, expectations, and intentions. Our actual results may differ materially from those expressed or implied in the forward-looking statements as a result of various factors, including those described under the sections entitled “Cautionary Statement Concerning Forward-Looking Statements” above and “Risk Factors” in the 2024 Form 10-K and our other filings with the SEC.
Overview
Waystar provides healthcare organizations with mission-critical cloud software that simplifies healthcare payments. Our enterprise-grade platform streamlines the complex and disparate processes our healthcare provider clients must manage to be reimbursed correctly, while improving the payments experience for providers, patients, and payers. We leverage AI as well as proprietary, advanced algorithms to automate payment-related workflow tasks and drive continuous improvement, which enhances claim and billing accuracy, enriches data integrity, and reduces labor costs for providers.
Our software is used daily by providers of all types and sizes across the continuum of care, including physician practices, clinics, surgical centers, and laboratories, as well as large hospitals and health systems. We currently serve over 30,000 clients of various sizes, representing over one million distinct providers practicing across a variety of care sites, including 16 of the top 20 U.S. News Best Hospitals. Our business model is designed such that as our clients grow to serve more patients, their claims and transactional volumes increase, resulting in corresponding growth in our business. In addition, our clients frequently adopt a greater number of our solutions over time and introduce our solutions across new sites of care. In 2024, we facilitated over six billion healthcare payments transactions, including over $1.8 trillion in gross claims volume. As of 2023, we facilitated healthcare payments transactions spanning approximately 50% of patients in the United States.
Our platform benefits from powerful network effects. Our cloud-based software is driven by a sophisticated, automated, and curated rules engine, employing AI to generate and incorporate real-time feedback from millions of network transactions processed through our platform each day. Every transaction we process provides additional data insights across providers, patients, and payers, which are embedded in updates that are deployed efficiently across our client base. This results in cumulative benefits to us over time —as we capture more data from each transaction we process, we leverage that data to continue to improve the Waystar platform through embedded machine learning, advanced algorithms, and other in-house AI technologies to deliver added value to our clients. In turn, the more value we create for our clients, the more likely it is that they will continue to use our products, allowing us to continue to capture more data that results in tangible improvements to our platform. As a result, our clients benefit from faster and more efficient performance from software that is evolving to meet ever-changing regulatory and payer requirements, enabling accurate and timely reimbursement.
We have demonstrated an ability to drive recurring, predictable, and profitable growth. Over 99% of our revenue is either recurring subscription or based on highly predictable volumes. For the twelve months ended March 31, 2025, our Net Revenue Retention Rate was 113.5% and we have 1,244 clients as of March 31, 2025 generating over $100,000 over the same twelve-month period. For the three months ended March 31, 2025, we generated revenue of $256.4 million (reflecting a 14.1% increase compared to revenue of $224.8 million for the same period in the prior year), net income of $29.3 million (compared to net loss of $15.9 million for the same period in the prior year), and Adjusted EBITDA of $107.7 million (reflecting a 16.2% increase compared to Adjusted EBITDA of $92.8 million for the same period in the prior year).
Initial Public Offering
In June 2024, we completed an initial public offering (the “IPO”) of 45,000,000 shares of common stock at a price of $21.50 per share. After underwriting discounts and commissions of $53.2 million, we received total proceeds from the offering of $914.3 million. On July 5, 2024, pursuant to the option granted to the underwriters for a period of 30 days from the date of the Prospectus to purchase up to 6,750,000 additional shares of common stock from us at the IPO price less the underwriting discount, the underwriters exercised the right to purchase 5,059,010 additional shares of common stock, resulting in additional net proceeds of $102.8 million, after deducting underwriting discounts and commissions of $6.0 million. The remaining option to purchase additional shares expired unexercised at the end of the 30-day period. See Item 1, Financial Statements, Note 1 (Business) in the 2024 Form 10-K for more information.
Secondary Offering
On February 24, 2025, the Institutional Investors closed an underwritten public offering of 23,000,000 shares of our common stock (inclusive of the underwriters’ option to purchase additional shares) (the “Secondary Offering”). The Company did not sell any shares in the offering or receive any proceeds from the offering. Pursuant to the terms of the Amended and Restated Registration Rights Agreement, dated as of June 10, 2024, by and among the Company, the Institutional Investors, and certain other parties thereto, we paid $1.4 million in certain expenses on behalf of the selling stockholders related to this offering, while the selling stockholders paid all applicable underwriting discounts and commissions.
Significant Items Affecting Comparability
We believe that the future growth and profitability of our business, and the comparability of our results from period to period, depend on numerous factors, including the following:
Our Ability to Expand our Relationship with Existing Clients
As our clients grow their businesses and provide more services and see more patients, our volume-based revenues also increase. In addition, our growth in revenues also depends on our ability to sell more products and solutions to existing clients, including through cross-selling as our clients adopt additional Waystar offerings as well as up-selling as our clients leverage our solutions across additional providers and sites of care.
Our Ability to Grow our Client Base
We are focused on continuing to grow our client base, which will depend in part on our ability to continue to maintain our product leadership, invest in our research and development team, and maintain our reputation and brand.
Impacts of Our Competitor’s Cybersecurity Attack
Following the February 2024 cybersecurity incident involving one of our competitors, more than 30,000 providers, including a significant number of large health systems and ambulatory providers, began adopting our solutions, and we were able to implement our solutions for many of these new clients in as little as 48 hours. This incident and our response to it generated an approximately $10 million increase in revenue when comparing the three months ended March 31, 2025 and 2024. This increase was due to increased win rates above our historically competitive rates and associated accelerated implementation timeline.
Impacts of the IPO
- Debt Repayment. We used proceeds from our IPO to repay an aggregate of $1.0 billion in outstanding principal amount on our First Lien Credit Facility in the second and third quarters of fiscal 2024. This debt repayment has contributed to lower interest expense for the three months ended March 31, 2025 compared to the same period in the prior year.
- Stock-Based Compensation Expenses. We expect to recognize stock-based compensation expense of $17.9 million per year over the applicable vesting periods in connection with equity awards granted in connection with the IPO. Such stock-based compensation expense will be reflected in our results of operations from the closing date of the IPO through the applicable vesting periods of such awards.
- Incremental Public Company Expenses. Following the IPO, we have begun to incur significant expenses on an ongoing basis that we did not incur as a private company. Those costs include additional director and officer liability insurance expenses, as well as third-party and internal resources related to accounting, auditing, Sarbanes-Oxley Act compliance, legal, and investor and public relation expenses. These costs will generally be expensed under general and administrative expenses.
Components of Results of Operations
Revenue
We primarily generate two types of revenue: (i) subscription revenue and (ii) volume-based revenue, which account for 99% of total revenue for all periods presented. We believe we have high visibility into our volume-based and subscription revenue from existing clients. We refer to the solutions our clients use to better process and understand their payment workflows from payers as provider solutions, and we refer to the products that assist healthcare providers in collecting payments from patients as patient payment solutions. We expect provider solutions will continue to generate the substantial majority of our total revenue, although the revenue mix attributable to patient payment solutions is expected to increase slightly over time.
- Subscription revenue. Reflects recurring monthly provider count fees and minimum amounts owed. The vast majority of subscription revenue is generated by provider solutions, which constituted approximately 70% of total revenue in each of the three months ended March 31, 2025 and 2024.
- Volume-based revenue. Represents recurring fees associated with transaction count or dollar volumes in excess of minimums. Generally, approximately half of our volume-based revenue is generated from provider solutions that are based on transaction count, with the other half from patient payments solutions that are based on either dollar volumes or transaction count.
We also derive revenue from implementation fees for our software, as well as hardware sales to facilitate patient payments. Our implementation fees are billed upfront and the revenue is recognized ratably over the contract term.
Cost of Revenue (Exclusive of Depreciation and Amortization)
Cost of revenue includes salaries, stock-based compensation, and benefits (“personnel costs”) for our team members who are focused on implementation, support, and other client-focused operations, as well as team members focused on enhancing and developing our platform. Cost of revenue also includes costs for third-party technology such as interchange fees and infrastructure related to the operations of our platform, including communicating and processing patient payments, and services to support the delivery of our solutions. Third-party costs for patient payments solutions are approximately 60% of the revenue generated from these solutions, while third-party costs for provider solutions are approximately 6% to 8% of the associated revenue, in each case, for the three months ended March 31, 2025 and 2024.
Sales and Marketing
Sales and marketing costs consist primarily of personnel costs, internal sales commissions, channel partner fees, travel, and advertising costs.
General and Administrative
General and administrative expenses consist of personnel costs incurred in our corporate service functions such as finance expenses, legal, human resources, and information technology, as well as other professional service costs.
Research and Development
Research and development costs consist primarily of personnel costs for team members engaged in research and development activities as well as third-party fees. All such costs are expensed as incurred, except for capitalized software development costs.
Depreciation and Amortization
Depreciation and amortization consists of the depreciation of property and equipment and amortization of certain intangible assets, including capitalized software.
Other Expense
Other expense consists primarily of interest expense and related-party interest expense, inclusive of the impact of interest rate swaps.
Income Tax Expense/(Benefit)
Income tax expense/(benefit) includes current income tax and income tax credits from deferred taxes. Income tax expense/(benefit) is recognized in profit and loss except to the extent that it relates to items recognized in equity or other comprehensive income, in which case the income tax expense/(benefit) is also recognized in equity or other comprehensive income.
Results of Operations for the Three Months Ended March 31, 2025 and 2024
The following table provides consolidated operating results for the periods indicated and percentage of revenue for each line item:
($in thousands)
| | | Three months ended March 31, 2025 ($) | (%) | 2024 ($) | (%) | Change ($) | (%) |
|---|---|---|---|---|---|---|---|
| Revenue | | $256,435 | 100.0% | $224,792 | 100.0% | $31,643 | 14.1% |
| Operating expenses | | | | | | | |
| Cost of revenue (exclusive of depreciation and amortization) | | 83,345 | 32.5% | 75,192 | 33.4% | 8,153 | 10.8% |
| Sales and marketing | | 40,123 | 15.6% | 33,780 | 15.0% | 6,343 | 18.8% |
| General and administrative | | 23,300 | 9.1% | 26,135 | 11.6% | (2,835) | (10.8)% |
| Research and development | | 11,078 | 4.3% | 10,320 | 4.6% | 758 | 7.3% |
| Depreciation and amortization | | 33,380 | 13.0% | 44,174 | 19.7% | (10,794) | (24.4)% |
| Total operating expenses | | 191,226 | 74.6% | 189,601 | 84.3% | 1,625 | 0.8% |
| Income from operations | | 65,209 | 25.4% | 35,191 | 15.7% | 30,018 | 85.3% |
| Other expense | | | | | | | |
| Interest expense | | (18,257) | (7.1)% | (55,812) | (24.8)% | 37,555 | (67.2)% |
| Related party interest expense | | (643) | (0.3)% | (1,372) | (0.6)% | 729 | (53.1)% |
| Income/(loss) before income taxes | | 46,309 | 18.1% | (21,993) | (9.8)% | 68,302 | NM |
| Income tax expense/(benefit) | | 17,040 | 6.6% | (6,061) | (2.7)% | 23,101 | NM |
| Net income/(loss) | | $29,269 | 11.4% | $(15,932) | (7.1)% | $45,201 | NM |
Revenue
($in thousands)
| Revenue | | Three months ended March 31, 2025 ($) | (%) | 2024 ($) | (%) | Change ($) | (%) |
|---|---|---|---|---|---|---|---|
| Subscription revenue | | $125,041 | 48.8% | $106,079 | 47.2% | $18,962 | 17.9% |
| Volume-based revenue | | 129,918 | 50.7% | 117,144 | 52.1% | 12,774 | 10.9% |
| Services and other revenue | | 1,476 | 0.6% | 1,569 | 0.7% | (93) | (5.9)% |
| Total Revenue | | $256,435 | 100.0% | $224,792 | 100.0% | $31,643 | 14.1% |
Revenue was $256.4 million for the three months ended March 31, 2025 as compared to $224.8 million for the three months ended March 31, 2024, an increase of $31.6 million, or 14.1%, of which $19.0 million was attributed to subscription revenue from new and existing clients, almost all of which was generated by provider solutions. Another $12.8 million was attributed to volume-based revenue primarily related to expansion of existing client usage and acquired clients, almost all of which was generated by patient payments solutions.
Included within the revenue increase over the period is an estimated $10 million due to heightened win rates above our historically high rates and accelerated implementation timelines related to the cybersecurity incident involving one of our competitors in February 2024.
Cost of Revenue (Exclusive of Depreciation and Amortization)
Cost of revenue was $83.3 million for the three months ended March 31, 2025 as compared to $75.2 million for the three months ended March 31, 2024, an increase of $8.2 million, or 10.8%. The increase was primarily driven by $6.3 million in increased costs stemming from higher transaction volumes and associated third-party costs, including higher platform usage, of which approximately $8.6 million was from costs associated with patient payment solutions, offset by a decrease of $2.3 million decrease from costs associated with provider solutions, primarily from timing of prior acquisition synergy attainment.
Sales and Marketing
Sales and marketing expense was $40.1 million for the three months ended March 31, 2025 as compared to $33.8 million for the three months ended March 31, 2024, an increase of $6.3 million, or 18.8%. The increase was driven by an increase in channel partner fees and amortization of the internal sales commission deferred contract costs assets of $4.5 million associated with revenue growth. Additionally, there was an increase of $1.0 million in personnel costs and $0.9 million in stock-based compensation expense.
General and Administrative
General and administrative expense was $23.3 million for the three months ended March 31, 2025 as compared to $26.1 million for the three months ended March 31, 2024, a decrease of $2.8 million, or 10.8%. $8.2 million of the decrease was primarily driven by third party fees paid in connection with the refinancing of the First Lien Credit Facility and payoff of the Second Lien Credit Facility in February 2024. This was partially offset by a $2.6 million increase in stock-based compensation expense, as well as increased personnel costs of $1.6 million.
Research and Development
Research and development expense was $11.1 million for the three months ended March 31, 2025 as compared to $10.3 million for the three months ended March 31, 2024, an increase of $0.8 million, or 7.3%. The increase was primarily driven by increased stock-based compensation expense of $0.6 million.
Depreciation and Amortization
Depreciation and amortization expense was $33.4 million for the three months ended March 31, 2025, as compared to $44.2 million for the three months ended March 31, 2024, a decrease of $10.8 million, or 24.4%. The decrease was due to several intangible assets becoming fully amortized in the three months ended December 31, 2024, driving a decrease in intangible amortization.
Other Expense
Total interest expense was $18.9 million for the three months ended March 31, 2025 as compared to $57.2 million for the three months ended March 31, 2024, a decrease of $38.3 million, or 66.9%. $27.6 million of the decrease, net of the impact of interest rate swaps, was driven by First Lien Credit Facility paydowns during 2024 totaling $1.0 billion. Additionally, $8.9 million of the decrease was due to a loss on extinguishment of debt that occurred during the three months ended March 31, 2024.
Income Tax Expense/ (Benefit)
Income tax expense was $17.0 million for the three months ended March 31, 2025, as compared to an income tax benefit of $6.1 million for the three months ended March 31, 2024, an increase of $23.1 million. The increase was primarily driven by the increase in pre-tax income/(loss), as well as additional deferred tax expense related to non-deductible stock-based compensation expense recognized in the current period.
Non-GAAP Financial Measures
We present adjusted EBITDA, adjusted EBITDA margin, non-GAAP net income, and non-GAAP net income per share as supplemental measures of financial performance that are not required by, or presented in accordance with, GAAP. We believe they assist investors and analysts in comparing our operating performance across reporting periods on a consistent basis by excluding items that we do not believe are indicative of our core operating performance. Management believes these non-GAAP financial measures are useful to investors in highlighting trends in our operating performance, while other measures can differ significantly depending on long-term strategic decisions regarding capital structure, the tax jurisdictions in which we operate, and capital investments. Management uses these to supplement GAAP measures of performance in the evaluation of the effectiveness of our business strategies, to make budgeting decisions, to establish discretionary annual incentive compensation, and to compare our performance against that of other peer companies using similar measures. Management supplements GAAP results with non-GAAP financial measures to provide a more complete understanding of the factors and trends affecting the business than GAAP results alone provide.
Adjusted EBITDA, adjusted EBITDA margin, non-GAAP net income, and non-GAAP net income per share are not recognized terms under GAAP and should not be considered as an alternative to net income (loss) or net income (loss) margin as measures of financial performance or cash provided by operating activities as a measure of liquidity, or any other performance measure derived in accordance with GAAP. Additionally, these measures are not intended to be a measure of free cash flow available for management’s discretionary use, as they do not consider certain cash requirements such as interest payments, tax payments, and debt service requirements. The presentations of these measures have limitations as analytical tools and should not be considered in isolation, or as a substitute for analysis of our results as reported under GAAP. Because not all companies use identical calculations, the presentations of these measures may not be comparable to other similarly titled measures of other companies and can differ significantly from company to company. A reconciliation is provided below for our non-GAAP financial measures to the most directly comparable financial measure stated in accordance with GAAP. Investors are encouraged to review the related GAAP financial measures and the reconciliation of non-GAAP financial measures to their most directly comparable GAAP financial measures, and not to rely on any single financial measure to evaluate our business.
Adjusted EBITDA and Adjusted EBITDA Margin
We define adjusted EBITDA as net income / (loss) before interest expense, net, income tax expense / (benefit), depreciation and amortization, and as further adjusted for stock-based compensation expense, acquisition and integration costs, asset and lease impairments, costs related to amended debt agreements, and costs related to our IPO and the Secondary Offering. Adjusted EBITDA margin represents adjusted EBITDA as a percentage of revenue.
The following table presents a reconciliation of net income / (loss) to adjusted EBITDA and net income / (loss) margin to adjusted EBITDA margin for the three months ended March 31, 2025 and 2024:
($in thousands)
| | | Three months ended March 31, 2025 | 2024 |
|---|---|---|---|
| Net income/(loss) | $29,269 | $(15,932) | |
| Interest expense | | 18,900 | 57,184 |
| Income tax expense/(benefit) | | 17,040 | (6,061) |
| Depreciation and amortization | | 33,380 | 44,174 |
| Stock-based compensation expense | | 6,744 | 2,528 |
| Acquisition and integration costs | | 229 | 302 |
| Costs related to amended debt agreements | | — | 10,402 |
| IPO and Secondary Offering expenses | | 1,430 | 164 |
| Other (a) | | 754 | — |
| Adjusted EBITDA | | $107,746 | $92,761 |
| Revenue | | $256,435 | $224,792 |
| Net income/(loss) margin | | 11.4% | (7.1)% |
| Adjusted EBITDA margin | | 42.0% | 41.3% |
(a) Adjustments relate to additional lease costs due to the relocation of our Louisville office totaling $0.2 million and executive severance totaling $0.5 million for the three months ended March 31, 2025.
Non-GAAP Net Income and Non-GAAP Net Income Per Share
We define non-GAAP net income as GAAP net income / (loss) excluding the impact of stock-based compensation, acquisition and integration costs, asset and lease impairments, costs related to our IPO, and the Secondary Offering, and costs related to amended debt agreements and amortization of intangibles. The tax effects of the adjustments are calculated using a management estimated annual effective non-GAAP tax rate of 21%, which is based on our statutory federal tax rate and provides consistency across interim reporting periods by eliminating the effects of non-recurring and period specific items. Due to the differences in the tax treatment of items excluded from non-GAAP net income, our estimate tax rate on non-GAAP net income may differ from our GAAP tax rate.
Non-GAAP net income per share is shown on both a basic and diluted basis and is defined as non-GAAP net income divided by the basic or diluted weighted-average shares, respectively.
The following table presents a reconciliation of net income/(loss) to non-GAAP net income and non-GAAP net income per share for the three months ended March 31, 2025 and 2024:
($in thousands)
| | | Three months ended March 31, 2025 | | 2024 |
|---|---|---|---|---|
| Net income/(loss) | $29,269 | $(15,932) | ||
| Stock-based compensation expense | | 6,744 | | 2,528 |
| Acquisition and integration costs | | 229 | | 302 |
| Costs related to amended debt agreements | | — | | 10,402 |
| IPO and Secondary Offering expenses | | 1,430 | | 164 |
| Other (a) | | 754 | | — |
| Intangible amortization | | 28,115 | | 39,080 |
| Tax effect of adjustments | | (7,827) | | (11,020) |
| Non-GAAP net income | | $58,714 | | $25,524 |
| | | | | |
| Non-GAAP net income per share: | | | | |
| Basic | | $0.34 | | $0.21 |
| Diluted | | $0.32 | | $0.20 |
| Weighted-average shares outstanding: | | | | |
| Basic | | 172,188,237 | | 121,675,298 |
| Diluted | | 180,691,994 | | 127,095,087 |
(a) Adjustments relate to additional lease costs due to the relocation of our Louisville office totaling $0.2 million and executive severance totaling $0.5 million for the three months ended March 31, 2025.
Key Performance Metrics
Net Revenue Retention Rate
We also regularly monitor and review our Net Revenue Retention Rate.
The following table presents our Net Revenue Retention Rate for March 31, 2025 and 2024, respectively:
($in thousands)
| | Twelve months ended March 31, 2025 | 2024 |
|---|---|---|
| Net Revenue Retention Rate | 113.5% | 108.8% |
Our Net Revenue Retention Rate compares twelve months of client invoices for our solutions at two period end dates. To calculate our Net Revenue Retention Rate, we first accumulate the total amount invoiced during the twelve months ending with the prior period-end, or Prior Period Invoices. We then calculate the total amount invoiced to those same clients for the twelve months ending with the current period-end, or Current Period Invoices. Current Period Invoices are inclusive of upsell, downsell, pricing changes, clients that cancel or chose not to renew, and discontinued solutions with continuing clients. The Net Revenue Retention Rate is then calculated by dividing the Current Period Invoices by the Prior Period Invoices. Our total invoices included in the analysis are greater than 98% of reported revenue. We use Net Revenue Retention Rate to evaluate our ongoing operations and for internal planning and forecasting purposes. Acquired businesses are included in the last-twelve month Net Revenue Retention Rate in the ninth quarter after acquisition, which is the earliest point that comparable post-acquisition invoices are available for both the current and prior twelve-month period.
Customer Count with >$100,000 Revenue
We also regularly monitor and review our count of clients who generate more than $100,000 of revenue.
The following table sets forth our count of clients who generate more than $100,000 of revenue for the periods presented:
| (For the 12 month period ended) | March 31, 2025 | 2024 |
|---|---|---|
| Customer Count with > $100,000 Revenue | 1,244 | 1,080 |
Our count of clients who generate more than $100,000 of revenue is based on an accumulation of the amounts invoiced to clients over the preceding twelve months. The invoices for acquired clients are included starting in the first full calendar quarter after the date of acquisition.
Liquidity and Capital Resources
Overview
We assess our liquidity in terms of our ability to generate adequate amounts of cash to meet current and future needs. Our expected primary uses on a short-term and long-term basis are for working capital, capital expenditures, debt service requirements, and investments in future growth, including acquisitions. We have historically funded our operations and acquisitions through our cash and cash equivalents, cash flows from operations, and debt financings. We believe that our existing unrestricted cash on hand, expected future cash flows from operations, and additional borrowings will provide sufficient resources to fund our operating requirements, as well as future capital expenditures, debt service requirements, and investments in future growth for at least the next 12 months. To the extent additional funds are necessary to meet our long-term liquidity needs as we continue to execute our business strategy, we anticipate that they will be obtained through the incurrence of additional indebtedness, additional equity financings, or a combination of these potential sources of funds. In the event that we need access to additional cash, we may not be able to access the credit markets on commercially acceptable terms or at all. Our ability to fund future operating expenses and capital expenditures and our ability to meet future debt service obligations or refinance our indebtedness will depend on our future operating performance, which will be affected by general economic, financial, and other factors beyond our control, including those described under “Risk Factors” in the 2024 Form 10-K.
On March 31, 2025 and December 31, 2024, we had restricted cash of $25.7 million and $22.4 million, respectively, which consists of cash deposited in lockbox accounts owned by us which are contractually required to be disbursed to participating clients on the following day, as well as cash collected on behalf of healthcare providers from patients that have not yet been remitted to providers. These funds payable are not available for our use and liquidity and are offset on our balance sheet by an aggregated funds payable liability.
Our liquidity is influenced by many factors, including timing of revenue and corresponding cash collections, the amount and timing of investments in strategic initiatives, our investments in property, equipment, and software, as well as other factors described under “Risk factors” in the 2024 Form 10-K. Depending on the severity and direct impact of these factors on us, we may not be able to secure additional financing on acceptable terms, or at all.
Cash Flows
Cash flows from operating, investing, and financing activities for the three months ended March 31, 2025 and 2024, are summarized in the following table:
($in thousands)
| | | Three months ended March 31, 2025 | | 2024 | | Change Amount | Change |
|---|---|---|---|---|---|---|---|
| Net cash provided by operating activities | $64,249 | $10,730 | $53,519 | 498.8% | |||
| Net cash used in investing activities | | (29,857) | | (5,560) | | (24,297) | 437.0% |
| Net cash provided by financing activities | | 10,744 | | 20,210 | | (9,466) | (46.8)% |
| Net increase in cash and restricted cash | | $45,136 | | $25,380 | | $19,756 | 77.8% |
Cash Flows Provided by Operating Activities
Cash flows provided by operating activities were $64.2 million for the three months ended March 31, 2025 as compared to $10.7 million for the three months ended March 31, 2024, an increase of $53.5 million. This increase is largely driven by the increases in revenue and net income and changes in working capital.
Cash Flows Used in Investing Activities
Cash flows used in investing activities were $29.9 million for the three months ended March 31, 2025 as compared to $5.6 million for the three months ended March 31, 2024, an increase in cash used of $24.3 million. Cash flows used in investing activities increased due to the purchase of short-term investments totaling $24.4 million during the quarter-ended March 31, 2025.
Cash Flows Provided by Financing Activities
Cash flows provided by financing activities were $10.7 million for the three months ended March 31, 2025 as compared to cash flows provided of $20.2 million for the three months ended March 31, 2024, a decrease of $9.5 million. A decrease of $21.4 million was the net impact of refinancing our First Lien Credit Facility refinancing and paying off our Second Lien Credit Facility, each during the three months ended March 31, 2024. This decrease was offset by an increase of $10.6 million in proceeds received from options exercised during the three months ended March 31, 2025.
Indebtedness
Refer to Item 1, Financial Statements, Notes 11 (Accounts Receivable Securitization) and 12 (Debt), for a description of our Credit Facilities.
Critical Accounting Policies and Estimates
The above discussion and analysis of our financial condition and results of operations is based upon our consolidated financial statements. The preparation of financial statements in conformity with GAAP requires management to make estimates and judgments that affect the reported amounts of assets, liabilities, revenue, and expenses, and disclosures of contingent assets and liabilities. Critical accounting policies are those that we consider to be the most important in portraying our financial condition and results of operations and also require the greatest amount of judgments by management. Judgments or uncertainties regarding the application of these policies may result in materially different amounts being reported under different conditions or using different assumptions.
There have been no material changes to our critical accounting policies and estimates from those disclosed in the 2024 Form 10-K.
Recent Accounting Pronouncements
Refer to Item 1, Financial Statements, Note 2 (Summary of Significant Accounting Policies).
JOBS Act Election
We are currently an “emerging growth company,” as defined in the JOBS Act. Under the JOBS Act, emerging growth companies can delay adopting new or revised accounting standards until such time as those standards apply to private companies. We have elected to use this extended transition period for complying with new or revised accounting standards that have different effective dates for public and private companies until the earlier of the date we (i) are no longer an emerging growth company or (ii) affirmatively and irrevocably opt out of the extended transition period provided in the JOBS Act.
Market risk
As filed, 1,622 characters, with its headings, lists and tables. Extracted from the main document; charts and exhibits are in the original on sec.gov.
We are exposed to certain market risks arising from transactions in the normal course of our business. Such risks are principally associated with credit risk and interest rate risk.
Credit Risk
Credit risk involves the possibility that a counterparty will not meet its obligations under a financial instrument or client contract, leading to a financial loss. Concentrations of credit risk with respect to our clients are limited due to our diversified client base.
We routinely assess the financial strength of our clients through a combination of third-party financial reports, credit monitoring, publicly available information, and direct communication with those clients. We establish payment terms with clients to mitigate credit risk and monitor its accounts receivable credit risk exposure. However, while we actively seek to ensure credit risk, there can be no assurance that in the future it will be able to obtain credit risk insurance at commercially attractive terms or at all.
Interest Rate Risk
Our exposure to interest rate risk is related to our First Lien Credit Facility, which bears interest at SOFR plus 2.25% as of March 31, 2025. A hypothetical 100 basis point increase or decrease in the current effective rate would have an impact on our interest expense of approximately $3.1 million for the three months ended March 31, 2025.
In order to limit exposure to risk, we maintain derivative instruments with creditworthy institutions to hedge against changing interest rate fluctuations. We utilize interest rate swap contracts and other non-derivative hedging instruments to manage such risk.
Controls and procedures
As filed, 1,408 characters, with its headings, lists and tables. Extracted from the main document; charts and exhibits are in the original on sec.gov.
Disclosure Controls and Procedures
Under the supervision and with the participation of our management, including the Chief Executive Officer and Chief Financial Officer, we conducted an evaluation of the effectiveness of our disclosure controls and procedures (as such term is defined in Rule 13a-15(e) and 15d-15(e) under the Exchange Act) as of the end of the period covered by this report. Based on this evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures were effective as of such date. Our disclosure controls and procedures are designed to ensure that information required to be disclosed in the reports we file or submit under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms and that such information is accumulated and communicated to management including the Chief Executive Officer and Chief Financial Officer, as appropriate, to allow timely decisions regarding required disclosures.
Changes in Internal Control Over Financial Reporting
There were no changes to our internal control over financial reporting (as defined in Rule 13a-15(f) under the Exchange Act) that occurred during the quarter ended March 31, 2025 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
Figures reported in this filing
Standardized line items from the XBRL in this filing, for the period ended 2025-03-31. Comparative periods it repeats are left out.
| Line item | Period | Value | XBRL concept |
|---|---|---|---|
| Revenue | 3 months2025-01-01 to 2025-03-31 | $256.4m | us-gaap:RevenueFromContractWithCustomerExcludingAssessedTax |
| Research and development | 3 months2025-01-01 to 2025-03-31 | $11.1m | us-gaap:ResearchAndDevelopmentExpense |
| Operating income | 3 months2025-01-01 to 2025-03-31 | $65.2m | us-gaap:OperatingIncomeLoss |
| Income tax | 3 months2025-01-01 to 2025-03-31 | $17.0m | us-gaap:IncomeTaxExpenseBenefit |
| Net income | 3 months2025-01-01 to 2025-03-31 | $29.3m | us-gaap:NetIncomeLoss |
| Diluted EPS | 3 months2025-01-01 to 2025-03-31 | $0.16 | us-gaap:EarningsPerShareDiluted |
| Basic EPS | 3 months2025-01-01 to 2025-03-31 | $0.17 | us-gaap:EarningsPerShareBasic |
| Diluted shares (weighted) | 3 months2025-01-01 to 2025-03-31 | 180,691,994 shares | us-gaap:WeightedAverageNumberOfDilutedSharesOutstanding |
| Operating cash flow | 3 months2025-01-01 to 2025-03-31 | $64.2m | us-gaap:NetCashProvidedByUsedInOperatingActivities |
| Capital expenditure | 3 months2025-01-01 to 2025-03-31 | $5.4m | us-gaap:PaymentsToAcquireProductiveAssets |
| Cash and equivalents | At period end2025-03-31 | $224.0m | us-gaap:CashAndCashEquivalentsAtCarryingValue |
| Current assets | At period end2025-03-31 | $440.6m | us-gaap:AssetsCurrent |
| Total assets | At period end2025-03-31 | $4.62bn | us-gaap:Assets |
| Current liabilities | At period end2025-03-31 | $141.3m | us-gaap:LiabilitiesCurrent |
| Total liabilities | At period end2025-03-31 | $1.49bn | us-gaap:Liabilities |
| Long-term debt | At period end2025-03-31 | $1.22bn | us-gaap:LongTermDebtNoncurrent |
| Current portion of debt | At period end2025-03-31 | $11.7m | us-gaap:LongTermDebtCurrent |
| Shareholders' equity | At period end2025-03-31 | $3.13bn | us-gaap:StockholdersEquity |
Source: SEC EDGAR, the filing index for accession 0001410578-25-001048. Last ingested by Listed: Nov 5, 2026, 14:04 ET. Listed shows no prices and gives no investment advice.