Mathew Blackman • Stifel

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COO and CFO Keith Pfeil clarified that there was no material change to the guide, as headwinds from biologics and neuromonitoring were already contemplated. He expressed confidence in 'clawing back' the delayed enabling technology sales and seeing a spine business uptick now that supply chain issues are resolved. CEO Dan Scavilla declined to provide specific Q2 guidance.

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CFO Keith Pfeil acknowledged some minor drags in Q4, including higher inventory write-offs and bad debt expense, but characterized them as small. CEO Dan Scavilla expressed confidence in the 2025 guidance, highlighting the planned synergy capture and overall execution strategy as key drivers for the upcoming year, implying the annualized Q4 run-rate is not the sole basis for the forecast.

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COO & CFO Keith Pfeil outlined that 2025 top-line growth would be driven by increased cross-selling in the U.S. and internationally, while bottom-line improvements would come from annualized synergies and a focus on managing spending. He noted that significant margin benefits from manufacturing in-sourcing are expected more in the back half of 2025 and into 2026.

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Executive Jason Clemens confirmed that pump growth contributed a couple of million dollars but noted no significant change in the trend for basal CGM adoption. Executive Suzanne Foster added that the improvement stems from 'good old-fashioned leadership and execution,' with a strong team, better processes, appropriate technology deployment, and a more focused and leveraged commercial team.

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CFO Jason Clemens confirmed the 40 basis point guidance drag is solely from the completed Q4 asset sale. Regarding the Diabetes segment, Clemens stated that pump revenue is now stable with expectations for modest growth, but the company is not yet committing to growth in the larger CGM business until performance is proven, despite encouraging signs.

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CEO Suzanne Foster explained that acquiring new CGM patients requires improving operational timeliness and service levels to support the sales force, not just expanding it. CFO Jason Clemens confirmed that based on competitor performance and manufacturer reports, the end market is likely growing in the upper-single to lower-double digits, highlighting AdaptHealth's internal execution gap. Foster also detailed organic growth plans, including nationalizing health system partnerships and increasing covered lives through managed care contracts, supported by an expanded enterprise sales team.

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CFO Julie Andrews confirmed the one less selling day was a headwind of just over 1.5% to Q1 growth and that remaining quarters have the same number of days as the prior year. She detailed the guidance reduction as $5 million from U.S.-funded NGO business and the remainder from spine and biologics channel disruption. She noted that while some of this impact (pricing and softness) was felt in Q1, the majority is expected in Q2.

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CFO Julie Andrews confirmed the guidance includes a $23.4M headwind from the M6 exit and a $4M FX impact, noting the strong EBITDA outlook is due to underlying margin expansion and the lower profitability of the discontinued M6 business. CEO Massimo Calafiore elaborated that 7D adoption is primarily with new accounts through earn-out agreements that are outperforming targets. He emphasized this success directly translates to higher utilization of Orthofix implants, drives customer conversion, and supports a sustainable growth rate for the spinal implant business.

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CFO Julie Andrews expressed confidence in the targets, identifying overall market growth as the main external variable. She clarified that the mid-teens EBITDA target for 2027 is a "milestone, not a goalpost," acknowledging the company's structure has changed since it previously reached 20%. Regarding cash flow, Andrews stated the company is focused on cash conversion but wants to maintain optionality for strategic investments, such as insourcing manufacturing, before providing a specific metric.

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Executive Patrick Miles explained that new reps typically take 12-18 months to fully adopt and sell ATEC's proprietary procedures. Executive J. Koning supported this with a 23% same-store sales growth figure, demonstrating strong performance in established territories. Regarding EOS, Miles noted that most placements are with new customers and that while historically used in pediatrics, ATEC is successfully driving adoption in the adult deformity segment, describing the strategy as being in its 'first inning' with significant runway.

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Executive J. Koning stated there was no material impact from hurricanes or IV shortages, with any minor disruption expected to be recovered. Executive Patrick Miles explained that new sales reps are on a ramp that can take 12-24 months to fully reflect in business results due to non-competes and hospital access processes, but confirmed they have the inventory needed and that same-store sales continue to grow strongly.

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CFO Leigh Vosseller confirmed the pricing impact was in the correct ballpark and established this as a 'new bar' for future expectations. She noted that while the DME channel was the primary driver, the pharmacy channel also provided a meaningful price benefit despite low volumes, signaling future opportunity.

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Leigh Vosseller, Executive Vice President and Chief Financial Officer, explained that the primary factor in Q4 was a muted seasonal curve in the final weeks of December, rather than shipping delays, which were a smaller contributor. She confirmed these factors were considered in the 2025 guidance and that underlying business trends like MDI conversions and renewals remain strong.

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EVP and CFO Leigh Vosseller celebrated a return to year-over-year new start growth, marking the second consecutive quarter of increased MDI conversions. She noted that new pumpers constituted over half of shipments, with MDI users making up more than half of that group, a trend consistent with Q2. The sequential pump shipment increase from Q2 to Q3 was modest due to typical seasonality.

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COO Vivek Jayaraman explained that IFC growth is driven by both new customer acquisition and expanded use within existing accounts, with some hospitals moving to 100% adoption. While declining to provide 2025 guidance, Jayaraman noted that new BLA approvals and increased hospital capacity for new projects are creating meaningful tailwinds for future growth.

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CEO Adam Elsesser expressed confidence in the stroke business, noting that interest in competitors' large-bore catheters is waning, which positions Penumbra's aspiration portfolio well for continued growth. He was "thrilled" by the Medtronic-Philips partnership, viewing any effort to raise stroke intervention awareness as beneficial for the entire field and all patients, without specific device-level competitive implications.

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CEO Kevin Sayer emphasized that all pivotal studies for their partners' AID systems were conducted with Dexcom sensors. He highlighted Dexcom's strong partner relationships, superior product accuracy, and long-standing market leadership in the Type 1 space as key defensive strengths they will leverage to maintain their position.

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