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Operator
Good day, and thank you for standing by. Welcome to Owens & Minor's third quarter 2025 earnings conference call. (Operator Instructions) Please be advised that today's conference is being recorded.
I would now like to hand the conference over to your first speaker today, Will Parrish, Vice President, Investor Relations.
Will Parrish - Vice President, Investor Relations,
Thank you, operator. Good evening, everyone, and welcome to Owens & Minor's third quarter earnings call. Our comments on the call will be focused on the financial results for the third quarter of 2025. The all of which are included in today's press release. The press release, along with the third quarter 2025 supplemental earnings slides are posted on the Investor Relations section of our website.
Please note that during this call, we will make forward-looking statements that reflect the current views of Owens & Minor about our business, financial performance, and future events. The matters addressed in these statements are subject to risks and uncertainties, which could cause actual results to differ materially from those rejected or implied here today. Our expectations, beliefs, and projections are expressed in good faith, and we believe there is a reasonable basis for them. However, there can be no assurance that our expectations, beliefs, and projections will result or be achieved. Please refer to our SEC filings for a full description of these risks and uncertainties, including the Risk Factors section of our annual report on Form 10-K and quarterly reports on Form 10-Q.
Any forward-looking statements that we make on this call or in our earnings press release as today and we undertake no obligation to update these statements as a result of new information or future events, except to the extent required by applicable law.
In our discussion today, we will refer to non-GAAP financial measures and believe they might help investors to better understand our performance or business trends. Information about these measures and reconciliations to the most comparable GAAP financial measures are included in our press release.
Today, I am joined by Ed Pesicka, Owens & Minor's President and Chief Executive Officer; Jon Leon, the company's Chief Financial Officer, and Perry Bernacki, the EVP and CEO of the company's Patient Direct segment.
I will now turn the call over to Ed. Ed?
Edward Pesicka - President, Chief Executive Officer, Director
Thank you, Will. Good afternoon, everyone, and thank you for joining us on the call today. Earlier this month, we announced a definitive agreement with Platinum Equity to sell our Products & Healthcare Services segment, which includes both the medical distribution and Global Products divisions. Built on a strong foundation, we believe P&HS will be better positioned to compete in today's evolving market under Platinum Equity's private ownership model.
We are also excited to be retaining an equity interest in the business due to Platinum's operational expertise and commitment to building on the customer-centric legacy of the business, which will be critical to the future growth of P&HS.
The Owens & Minor name has long been associated with our P&HS business and thus, will follow that business in the transaction. As we near the close of the transaction, we are excited that we will be rebranding the public entity to better represent our trajectory going forward. So as I think about the future, following the divestiture of a Product and Healthcare services, I am thrilled that we can fully align around a single business.
Our capital allocation, strategic priorities, and execution are no longer split. They are unified around advancing the future of home-based care through Patient Direct. And by retaining our higher-margin patient direct business, we will generate improved and more consistent cash flow. Accordingly, we will prioritize debt repayment in the near term to grow our financial flexibility while investing in technology to lower our cost to serve and improve the customer experience.
Now I would like to begin by sharing some of the opportunities we're seeing in the market and how these trends we're tracking continue to support our business, a business that we have grown and strengthened over time.
Beginning with our acquisition of Byram in 2017, we have spent the past eight years firmly establishing ourselves as a leader in the home-based care space. During this time, we have expanded and diversified our payer relationships while broadening our product offering and capabilities. This, combined with our coast-to-coast network gives us the reach and infrastructure to provide support for patients across multiple chronic conditions, including diabetes and sleep apnea. These conditions are not only widespread, they're growing, which creates a tremendous opportunity for us to make a meaningful impact. Over 37 million people in the United States have been diagnosed with diabetes and an estimated 96 million adults aged 18 and older, are living with prediabetes, according to the National Institutes of Health.
In order to capture future growth from these tailwinds, we will focus our investments on technology and automation, which will, one, improve the patient's experience; two, allow us to quickly scale our business; three, increase awareness; and four, further reduce our cost to serve.
Another core area for us is sleep apnea, where it is estimated that 85 million adults in the United States have some degree of OSA, with approximately 70 million of those presently undiagnosed or undergoing the diagnosis process. While the use of GLP-1s has increased in recent years, recent studies published by the land expect the use of GLP-1s to reduce the prevalence of OSA by only 4% over the next 25 years.
This is a significant opportunity for us to serve these future patients. It also further demonstrates the value of our preferred provider agreements where new patients are encouraged to begin their lifelong treatment journey with us supporting better health and a better quality of life.
Earlier this year, CMS proposed rules regarding competitive bidding around home-based healthcare and DME. Since entering the home-based care space, our top priority has always been and will continue to be ensuring patients receive the products and services they need, reliably and on time. While competitive bidding programs have historically raised questions about patient choice and supplier access, we believe our scale, expertise, and the quality of the products we distribute positions us as a standout partner in any environment.
As we await further guidance from CMS, we are actively collaborating with industry partners and advocacy groups to maintain a strong, transparent dialogue that keeps patient outcomes at the center of the conversation.
Before I turn the call over to Jon to discuss our third quarter financial performance and our thoughts on the year-end, I would like to close my thoughts today on where we're going in 2026. With the divestiture of Product and Healthcare services expected to close in the first quarter of 2026, we are incredibly excited about the future as a pure-play business in the home-based care space.
As our business grows organically through our preferred provider agreements such as our recently announced agreement with Optum and an aggressive sales strategy, we are diligently focused on controlling our balance sheet through debt pay down, managing operational cost controls, and lowering the cost to serve and accelerating our cash flow generation.
As we close out 2025 and look forward to 2026, we will begin the next evolution for Owens & Minor, with myself, Jon, and Perry Bernacki, the Executive Vice President of our Patient Direct business, remaining at the home of our organization. I would like to thank all our teammates who have done a great job of staying focused on serving our customers.
With that, I will now turn the call over to John to discuss our financial performance in the third quarter and our outlook for the rest of 2025. Jon?
Jonathan Leon - Chief Financial Officer, Executive Vice President
Thanks, Ed. And good afternoon, everyone. We were very excited to announce the signed agreement for the sale of the Products & Healthcare Services segment a few weeks ago. I've had the pleasure of getting to know and working with the Platinum Equity team and absolutely believe they are the right ones for the P&HS business.
Further, we're extremely excited about our future as a Pure-Play Home-Based Care Company with all the positive attributes that come with it as Ed detailed. We look forward to having a simpler business model and a cleaner investment thesis. We also believe our ability to dedicate investments solely into the subtractive space will lead to much greater results for all stakeholders.
As you will recall from last quarter, the Products & Healthcare Services segment is being accounted for as an asset held for sale, discontinued operations. So unless stated otherwise, my remarks today will focus solely on the continuing operations, which, as a reminder, is made up of our Patient Direct business and certain functional operations and identified stranded costs from the separation.
Also, please note that any discussion about the financial results and outlook for the business will cover only non-GAAP financial measures. You can find GAAP to non-GAAP financial reconciliations in the press release followed a short time ago and residing on our website.
Turning now to the third quarter results. Revenue was $697 million, compared to just under $687 million in the third quarter of last year. Last year, in the third quarter, there was a $6 million onetime revenue benefit from a multiyear claims reprocessing matter. This impacted the growth rate by about 80 basis points. In the quarter, there was decent year-over-year growth in the key categories of sleep therapy, ostomy, and urology.
Diabetes is nearly flat compared to the third quarter of 2024, which showed better year-over-year performance compared to the second quarter. We continue to ramp up efforts to recapture stronger diabetes growth through improved therapy adherence and capturing more customers across our entire ecosystem of both DME and our own pharmacy channel. Overall, we would expect revenue in Q4 to show a similar year-over-year growth rate but be seasonally improved from the third quarter in absolute dollar terms.
For the nine months ended September 30, revenue was nearly $2.1 billion, up 3.4% with last year's Q3 onetime benefit that I just mentioned, having a 30 basis point impact on growth compared to 2024. Similar to the quarter, growth for the year-to-date period was led by sleep therapy, ostomy, and urology as well as smaller categories, including chest wall oscillation, which, although still small, has shown phenomenal growth and demonstrates our ability to successfully expand our therapy portfolio.
Adjusted EBITDA for the third quarter was $92 million compared to $108 million in last year's third quarter. Here, that same onetime $6 million benefit from last year falls straight through to adjusted EBITDA and hinder reported EBITDA growth by nearly 500 basis points. Additionally, product cost increases and higher health benefit costs were only partly offset by lower general costs such as delivery, outsourcing, and occupancy expenses.
It is important to realize that the third quarter adjusted EBITDA for continuing operations of course, includes the normal adjustments to EBITDA of interest, income taxes, depreciation and amortization and less than $1 million of exit and realignment charges.
So the $92 million earned is an appropriate representation of cash earnings before interest and taxes. This return to a higher earnings quality is quite different from what we've been able to report over the past several quarters. There will certainly be periods of time where there are cash adjustments in the adjusted EBITDA figure, but this is an example of what is meant when we refer to a cleaner and simpler investment story as a result of the divestiture.
For the year-to-date period, adjusted EBITDA was $285 million, a reported 6.3% increase compared to $268 million for the nine months ended 2024. On the larger year-to-date adjusted EBITDA amount, last year's third quarter onetime $6 million benefit was an approximate 230 basis point drag on the year-to-date growth rate. Third quarter results include $11 million of stranded costs, which is the same as last year's third quarter and the second quarter of 2025. Year-to-date stranded costs were $25 million versus $39 million for the same period in 2024. We continue to believe the annualized stranded costs from the divestiture will be approximately $40 million.
Adjusted net income was $0.25 per share, which compares to $0.36 per share in the third quarter of 2024. For the nine months ended September 30, adjusted net income per share was $0.80 versus $0.64 in the same period last year.
We are affirming our guidance for 2025 full year of revenue between $2.76 billion and $2.82 billion, adjusted net income between $1.02 and $1.07 per share and adjusted EBITDA between $376 million and $382 million. Based on my earlier comments around fourth quarter revenue, we expect full year revenue to come in towards the bottom of the guidance range.
On the guidance assumption slide that has been posted to the Investor Relations section of our website, you will notice that the interest expense range has increased as a result of a change in the allocation of these expenses between continuing and discontinued operations. We believe the increase in interest expense will be offset by lower stock compensation expense, and as a result, the EPS guidance range is unchanged.
Turning to the balance sheet and cash flow. At September 30, net debt was $2.1 billion. Since year-end 2024, the increase in debt is related to the expenses to exit the previously planned Rotech acquisition, which were paid in June of approximately $100 million. And more recently, cost to remedy a challenging start-up of a new kitting facility for the Products & Healthcare Services segment, which has led to a temporary inventory imbalance. Work needed for that P&HS kitting facility is ongoing. And as a result, the net debt level at the end of this year is expected to be only slightly lower than at September 30.
While detrimentally impacting third quarter cash flow, as shown in the consolidated cash flow statement, the overbought inventory from the start-up will benefit customer demand across the P&HS business lines in the coming months and reduces the cash need to be spent over that same time period.
It's important to recognize that more than 100% of the cash used from operating activity in the three and nine-month ended periods was due to the discontinued operations and that continuing operations, inclusive of stranded costs, generated cash from operating activity. In fact, in measuring levered free cash flow as adjusted EBITDA from continuing operations less CapEx from continuing operations, and less all interest costs across both continuing and discontinued operations. There was $28 million of free cash flow in the third quarter and $78 million through the first nine months of the year.
Before taking questions, I'd like to say we're very bullish on the outlook for the home-based care business and recognize that it's a very exciting time in the history of Owens & Minor. We look forward to getting on the road, sharing our enthusiasm, and having the market better appreciate the attractiveness of the home-based care space.
With that, I'll now turn the call back to the operator for Q&A. Operator?
Operator
(Operator Instructions) Michael Cherny, Leerink Partners.
Daniel Clark - Equity Analyst
This is Dan Clark on for Mike. First one from us. I appreciate all the color you gave on results in 3Q and how you're thinking about the rest of the year. At a high level, how should we think about the durability of these trends going into 2026? And then would love to hear the follow-up just how you're selling into the Optum channel is going thus far?
Edward Pesicka - President, Chief Executive Officer, Director
This is Ed. I'll start. Selling in the Optum channel, it's new. We're just -- we just recently signed a preferred provider agreement we're tracking where we expect to track on that, but it's going to create more and more opportunities for us as we move forward.
Regarding going forward in '26, we haven't published '26 data or information yet. We'll do that when we get closer to -- when we get to -- when we report the full year results for the business.
Jonathan Leon - Chief Financial Officer, Executive Vice President
Yeah. I would just add, Dan, there's really not much secular going on that would change the trends. I'll remind you that we discussed in our 10-Q filed tomorrow morning that there'll be a large customer loss in the continuing operations in 2026 that will impact the full year. But absent that, we expect a fairly strong 2026. As I said, we'll put guidance out with the fourth quarter results.
Operator
Kevin Caliendo, UBS.
Kevin Caliendo - Equity Analyst
I guess it's sort of a follow-up to that in terms of trends. Like how should we be thinking about this company's business or outlook for 2026. Is there anything you can lay out in terms of how the trends are migrating, how we should think about modeling it? Broadly speaking, I know you're not here to provide guidance, but there's obviously so many moving parts and how to think about run rates or anything like that would be super helpful.
And the same around free cash flow for 2025 and maybe how to think about free cash flow trend beyond where we are. I appreciate the color on what the normalized cash flow was this quarter?
Jonathan Leon - Chief Financial Officer, Executive Vice President
Yeah. It's Jon. I'll crack it starting that. So if you think about the trends going forward, the continuing operations, you see, not dissimilar trends on an organic basis, you would normally see. I think we'll have absence the [LV], exiting in one customer, which we have talked about quite a bit. And it's like I say -- I said, there's more detail in our 10-Q, you'll see tomorrow on that.
But absent that, I think we'll have a pretty decent top line growth rate, call it, organically, if you will, after net loss and some margin improvement and cash flow improvement given the absence of that loss of that contract as we've talked about before, that is not a margin attractive, we're necessarily cash flow positive contract that's being lost. So that will certainly improve.
From a free cash flow, on a continued off space as I tried to outline in my prepared remarks. I think you expect Q4 to look a lot like Q3 from a continuing off spaces, I think we will have some nice free cash flow. As we go to '26, again, the trend shouldn't necessarily change. We'll be losing the heavy CapEx burden of that one large contract, but we will have stranded cost. So we have to -- we'll begin to actively take out once the divestiture closes.
And as well, there's the start of the other divestiture-related costs that we'll be paying really more so in the back half of 2026. So I wouldn't expect it to be not totally dissimilar to '25, recognizing that we'll have a number of those one-off costs around the divestiture, which we have generally sized that are part of the press release we put out around the divestiture itself.
Kevin Caliendo - Equity Analyst
That's helpful. If I can ask a quick follow-up. The balance sheet, there's so many moving pieces on here and current debt and timing. I know there's a lot going on here, so it's hard to get a full picture just on this one point in time. But relative post the acquisition -- or post the divestiture, excuse me, and where you sit -- you have obviously talked with your credit agencies and everything else, your lenders.
Are there -- is there any risk to covenants or anything that needs to change within those covenants coming out of this, post now that you've announced the deal and everything else is done and you're a month past? Is that all?
Jonathan Leon - Chief Financial Officer, Executive Vice President
No, we're good. Not at all. We just actually sent our covenant compliance to lenders and agencies in the last 48 hours. Very comfortable and compliance, and we expect to remain comfortably compliant throughout.
Operator
(Operator Instructions) Daniel Grosslight, Citi.
Daniel Grosslight - Analyst
I was hoping you could provide a little bit more detail on how these preferred vendor agreements work? And as we think about the loss of Kaiser next year, you've mentioned many times that that's not an attractive piece of business from a margin perspective. But how many of these larger preferred vendor agreements do you think you would need to sign to fill that Kaiser hole on the profitability from a profitability standpoint?
Edward Pesicka - President, Chief Executive Officer, Director
Yeah, I'll start with that. And then obviously, we'll have Perry add some color onto this too. I mean, I think we did lose the large customer contract. It was a unique contract in that sense. And as Jon talked about it, when we looked at the EBITDA compared to CapEx on it -- It was not a very positive cash flow generating business. So that alone will take very, very little additional revenue to pick up and cover that. And again, not to cover the revenue, but to cover the EBITDA and the cash flow.
And then in addition to that, Perry, let me let you add additional color on and what you're seeing and how you're thinking about those preferred provider agreements and the ramp of them.
Perry Bernocchi - Executive Vice President, Chief Executive Officer of Patient Direct Segment
Thanks, Ed. And from a standing of the Optum agreement, it's in its early stages. As I said, we have 450 forward-facing salespeople that are marketing to over 100,000 potential referral sources within Optum. What it does do is give us a preferred position within the Optum close network as Apria and Byram as the leading home care home-based DME provider. So that is a go-to-market strategy from a push and a pull perspective within Optum.
Further point, it will take less contracts or less revenue growth to cover the loss of -- the contract that we are losing, given everything that Ed outlined and Jon outlined, it won't take much for us to replace from a margin -- from a gross margin and an EBITDA perspective.
Daniel Grosslight - Analyst
Got it. And just as a follow-up, I wanted to dig a little bit more into that issue in P&HS that is weighing on free cash flow. I think you mentioned with the kidney client. Can you just maybe explain that in a little bit more detail and it is a little bit tough to look at your cash flow and balance sheet given cash flows on a consolidated basis and balance sheet is continued and discontinued operations. So maybe if you can help just parse out where in that cash -- cash flow statement that headwind sits.
Edward Pesicka - President, Chief Executive Officer, Director
Yes. So I think there's a couple of things. I know, Jon in his script, he tried to basically parse out as much as the possible he could what the free cash flow looks like a continuing operations basis based on continuing obviously EBITDA, the CapEx as well as consolidated interest in the space. This has to do with -- we are opening up a new kitting facility outside of the US. There's a normal start-up costs associated with that.
And the biggest thing was the over acquiring of inventory to make sure we could make the kits and had it on there for scale. It's something that will work itself out through the next quarter plus but it really is associated with a brand-new start-up of our kitting facility outside of the US to make sure we have the ability to have diversified kitting both in the US and external US for our customers. And the bulk of that will show up in inventory as well as the change in payables we saw in this quarter.
So Jon, I don't know if you want to add additional.
Jonathan Leon - Chief Financial Officer, Executive Vice President
No, it's basically right in my remarks, I mean, what we're doing now is making sure that, that burns off effectively that we serve all the customers' needs and the kitting business and that it has -- that defers other need for other capital across the business, both kitting and otherwise for the rest of the year. So it should burn itself off, but it will take a few months to do so.
Operator
This concludes the question-and-answer session. I'll turn the call to Ed for closing remarks.
Edward Pesicka - President, Chief Executive Officer, Director
Great. Thank you, operator. It's really an exciting period in the history of Owens & Minor. We're incredibly excited about the future as a pure-play supplier in the home-based care. And I look forward to sharing this progress with everyone early next year. So thank you, everyone.
Operator
This concludes today's conference call. Thank you for joining. You may not disconnect.