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    David Macdonald

    Managing Director and Senior Equity Research Analyst at Truist Securities

    David Macdonald is a Managing Director and Senior Equity Research Analyst at Truist Securities, specializing in healthcare and consumer defensive sectors with coverage of companies such as Encompass Health, Guardian Pharmacy Services, DaVita, The Ensign Group, Molina Healthcare, Labcorp, Quest Diagnostics, and Tenet Healthcare. Macdonald has issued over 1,000 price targets and ratings on 34 stocks, maintaining an average success rate of approximately 58% and an average return of 5.3%, with top recommendations generating exceptional results such as a 51% gain on Tenet Healthcare in just five days. He joined Truist Securities after previous experience at other firms, steadily rising through research roles since the early 2000s, and is recognized for his data-driven, performance-oriented approach. Macdonald holds FINRA securities licenses and has built a reputation for timely actionable insights across a range of healthcare equities.

    David Macdonald's questions to RadNet (RDNT) leadership

    David Macdonald's questions to RadNet (RDNT) leadership • Q2 2025

    Question

    David Macdonald of Truist Securities asked about the expected incremental capacity and labor leverage from new technologies like TechLive and C-Mode, initial feedback from the iCAD customer base, and the status of payer conversations regarding EBCD reimbursement.

    Answer

    Howard Berger, Chairman, President & CEO, provided examples of increased capacity, such as a 42% reduction in MRI room closures in New York due to TechLive. He noted it was too early for specific iCAD feedback but expressed confidence in the team and ongoing payer discussions for EBCD. Mark Stolper, EVP & CFO, added that RadNet is also expanding its physical footprint with 22 new de novo centers planned through 2026.

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    David Macdonald's questions to RadNet (RDNT) leadership • Q2 2025

    Question

    David Macdonald of Truist Securities asked about the incremental capacity and labor leverage from new technologies like TechLive and C-Mode once fully rolled out in 2026. He also inquired about initial feedback from the iCAD customer base and any new conversations with payers regarding EBCD reimbursement.

    Answer

    Howard Berger, Chairman, President & CEO, provided examples from the New York market where TechLive reduced MRI room closures by 42% and software upgrades created capacity for 4-5 more scans per day. He noted it is too early to comment on iCAD feedback but is pleased with the team. He also mentioned that payer conversations for EBCD are ongoing and it's a matter of time for broader adoption. Mark Stolper, EVP & CFO, added that 22 de novo centers are planned for 2025-2026, adding about 5% more capacity.

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    David Macdonald's questions to RadNet (RDNT) leadership • Q4 2024

    Question

    David MacDonald of Truist Securities inquired about the recovery timeline from the Q1 weather and wildfire impacts, any early learnings from the DeepHealth OS rollout, and the dynamics of the M&A pipeline, including specifics on how the Palm Beach OB/GYN partnership materialized.

    Answer

    Dr. Howard Berger (Executive) explained that the California wildfires had a severe, widespread impact similar to a major snowstorm, but confirmed that business volumes had returned to normal by mid-March with no expected impact on Q2. Regarding the DeepHealth OS, he noted it was still early but highlighted the enthusiastic internal collaboration to automate processes and create capacity. Dr. Berger also detailed that the Palm Beach OB/GYN group initiated contact due to dissatisfaction with their prior service, and RadNet was able to quickly expand the partnership from professional services to include its full suite of Digital Health solutions, creating a valuable case study.

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    David Macdonald's questions to Pennant Group (PNTG) leadership

    David Macdonald's questions to Pennant Group (PNTG) leadership • Q2 2025

    Question

    David Macdonald of Truist Securities asked about the long-term sustainability of the strong revenue per occupied bed in the senior living segment, pre-closing spending related to the Amedisys-UnitedHealth deal, and the company's M&A strategy if the final home health rule remains unfavorable.

    Answer

    CEO Brent Guerisoli stated that while recent revenue per occupied room growth has been high, it is expected to normalize to mid-single digits long-term. John Gochnour, President & COO, detailed pre-closing investments in leadership training and service center resources. Guerisoli added that an unfavorable rule could create M&A opportunities, but all growth decisions will continue to be based on leadership availability, operational strength, and deal viability.

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    David Macdonald's questions to Aveanna Healthcare Holdings (AVAH) leadership

    David Macdonald's questions to Aveanna Healthcare Holdings (AVAH) leadership • Q2 2025

    Question

    David Macdonald of Truist Securities requested a comparison of labor metrics like hiring and retention today versus 12-18 months ago. He also asked about the M&A environment and strategy, particularly for PDS, following the Thrive acquisition.

    Answer

    CEO Jeff Shaner explained that success has come from strategically aligning caregiver capacity with preferred payers, which unlocked growth, rather than a broad change in the labor market. On M&A, he confirmed Aviana has the liquidity to be active. While previously interested in Home Health, they are now more cautious pending the final rate rule. He reiterated that the company's focus is on growth through M&A, not debt paydown, and will seek thoughtful, deleveraging deals in PDS and Home Health.

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    David Macdonald's questions to Option Care Health (OPCH) leadership

    David Macdonald's questions to Option Care Health (OPCH) leadership • Q2 2025

    Question

    David Macdonald inquired about the nature of conversations with payers regarding site-of-service redirection, the growth trajectory of Ambulatory Infusion Suite (AIS) utilization, details on the advanced practitioner model, and legislative progress recognizing home infusion cost savings.

    Answer

    CEO John Rademacher confirmed heightened payer interest in site-of-care initiatives and noted the advanced practitioner model allows Option Care Health to serve more complex patients and those not covered by Medicare fee-for-service. He also mentioned positive legislative recognition of cost differentials. CFO Mike Shapiro added that AIS penetration reached 35% of nursing visits, driven by chronic patient utilization.

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    David Macdonald's questions to Option Care Health (OPCH) leadership • Q1 2025

    Question

    David MacDonald inquired about a potential 'halo effect' on the chronic business from supporting payers on the acute side. He also asked for specific best practices being adopted from the Intramed acquisition and whether AI initiatives could reduce bad debt in the acute segment.

    Answer

    CEO John Rademacher confirmed that helping payers with complex acute cases creates goodwill that benefits the entire portfolio. He identified Intramed's advanced practitioner model and its next-gen pharmacy system as key learnings. CFO Michael Shapiro added that AI and automation are being used to create 'clean claims,' which improves the speed of collections and reduces bad debt across the business.

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    David Macdonald's questions to Option Care Health (OPCH) leadership • Q3 2024

    Question

    David MacDonald inquired about the IV solution supply chain, asking how supply has trended since the recent hurricanes and if it's expected to resolve by year-end. He also asked about the market opportunity from a major competitor exiting certain therapies and requested more detail to quantify the financial impact of the STELARA pricing changes.

    Answer

    CEO John Rademacher stated that while they are seeing encouraging signs of increased IV supply, a full recovery timeline is hard to predict. He confirmed that competitor exits create an attractive medium-term growth opportunity once supply normalizes. CFO Michael Shapiro added that Q4 guidance incorporates various recovery scenarios for the IV supply and clarified that the chronic inflammatory category, which includes STELARA, represents roughly 20% of total revenue.

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    David Macdonald's questions to Guardian Pharmacy Services (GRDN) leadership

    David Macdonald's questions to Guardian Pharmacy Services (GRDN) leadership • Q4 2024

    Question

    David MacDonald of Truist asked if the Inflation Reduction Act (IRA) has affected the M&A pipeline or deal pricing. He also sought more detail on PBM contracting changes and questioned whether the 2024 improvement in vaccine clinic profitability would create an annualization tailwind in 2025.

    Answer

    Executive David Morris noted the M&A pipeline remains robust and suggested the IRA has not hurt it, and may have even helped slightly. Executive Fred Burke declined to share specific negotiation details with PBMs but confirmed they are actively engaged in finding a solution. Regarding the vaccine clinics, Morris clarified the profitability benefit was concentrated in Q4 and does not create a significant tailwind for 2025, as its profitability is lower than the core business. Burke added the point was to explain the strong Q4 EBITDA growth.

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    David Macdonald's questions to Guardian Pharmacy Services (GRDN) leadership • Q3 2024

    Question

    David MacDonald asked for additional details on discussions with payer partners regarding the Inflation Reduction Act (IRA), inquired about any notable hurricane impacts factored into Q4 guidance, and sought further updates on the Heartland acquisition's performance.

    Answer

    Fred Burke, an executive, confirmed that productive discussions with payers are ongoing but are sensitive. David Morris, an executive, added that the company is confident in navigating the IRA issue for 2025-2026. Morris also stated that the Q4 hurricane impact was minimal and that the Heartland acquisition is progressing well, with synergies expected in 2025 and significant growth opportunities manifesting.

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    David Macdonald's questions to ENSIGN GROUP (ENSG) leadership

    David Macdonald's questions to ENSIGN GROUP (ENSG) leadership • Q3 2024

    Question

    David MacDonald inquired about the specific reasons for the high volume of M&A activity in Colorado and requested an update on progress in Tennessee. He also asked for any preliminary high-level thoughts on growth opportunities, headwinds, and tailwinds for 2025.

    Answer

    Executive Chad Keetch explained that the Colorado activity was opportunistic, driven by a strong local team and reputation rather than state-specific factors. He confirmed Tennessee is a key growth market with announcements expected soon. CEO Barry Port added that the company is well-prepared for growth in new geographies and expressed confidence in 2025, citing strong organic growth fundamentals and a robust acquisition pipeline.

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    David Macdonald's questions to PACS Group (PACS) leadership

    David Macdonald's questions to PACS Group (PACS) leadership • Q2 2024

    Question

    David MacDonald inquired about the robust M&A pipeline, the potential for skilled mix and occupancy improvements in recent acquisitions, the company's internal controls on M&A pacing, and the effect of high-quality scores on payer negotiations in new markets.

    Answer

    Executive Derick Apt confirmed the M&A pipeline is strong, with significant upside in skilled mix and occupancy in newly acquired facilities. He noted that M&A pacing is governed by deal cost, balance sheet capacity, and human capital availability. President and COO Joshua Jergensen added that high-quality scores are fundamental to their strategy, enabling them to secure a 'seat at the table' with managed care providers, which leads to better contracts and reimbursement for higher acuity patients.

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    David Macdonald's questions to PACS Group (PACS) leadership • Q2 2024

    Question

    David MacDonald inquired about the M&A pipeline, specifically the skilled mix and occupancy opportunities in recent acquisitions, the internal governors pacing M&A activity, and the impact of quality scores on payer negotiations in new markets.

    Answer

    Executive Derick Apt confirmed the M&A pipeline is robust, with recent acquisitions offering significant upside as their skilled mix and occupancy rates are well below PACS's averages. He stated that M&A pacing is governed by deal cost, capital availability, and human capital readiness, while maintaining a baseline expectation of acquiring 20 facilities annually. President and COO Josh Jergensen added that high CMS quality scores are fundamental to securing favorable contracts with managed care payers, which is a key part of their strategy for driving revenue growth in new and existing markets.

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    David Macdonald's questions to PACS Group (PACS) leadership • Q1 2024

    Question

    David MacDonald of Truist Securities asked about leveraging quality metrics in payer contracting, the maturation timeline for facilities in the 'Ramping' cohort, and whether the CMS minimum staffing rule could accelerate M&A opportunities.

    Answer

    Joshua Jergensen, President and COO, explained that quality metrics like high star ratings and low rehospitalizations are key in payer negotiations and drive occupancy. Derick Apt, an executive, added that over 70 Ramping facilities are maturing ahead of schedule, and while the staffing rule presents challenges for smaller operators, it could increase M&A opportunities for PACS, which evaluates targets based on a comprehensive scorecard.

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    David Macdonald's questions to PACS Group (PACS) leadership • Q1 2024

    Question

    David MacDonald inquired about how PACS leverages its superior quality metrics in payer contract negotiations and the potential to share in the value created. He also asked about the maturation timeline for facilities in the 'Ramping' cohort and whether the proposed CMS minimum staffing rule could accelerate M&A opportunities.

    Answer

    President and COO Josh Jergensen explained that quality is a key competitive advantage, with high star ratings and low rehospitalization rates being crucial gating items in payer negotiations, which in turn drives occupancy. Executive Derick Apt added that many facilities are nearing maturation and performing well. He noted the CMS rule could increase M&A opportunities from smaller operators, and PACS would evaluate these based on a scorecarding method, assessing if a facility's model can be evolved.

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