Executive Summary

Q1 2025 delivered top-line and EPS beats and record profitability: revenue $87.21M (+3.7% YoY), Non-GAAP EPS $0.36, and Adjusted EBITDA $18.23M with 20.9% margin; management flagged ~$2M timing tailwinds split between revenue and OpEx that pulled forward benefit into Q1 .
Versus S&P Global consensus, revenue beat by ~$1.0M (+1.2%), EPS beat by ~$0.07 (+24%), while EBITDA (S&P definition) modestly missed; company-reported Adjusted EBITDA materially exceeded the quarter’s guidance high-end, aided by mix and cost actions .
Guidance: Q2 revenue $85.5–$87.5M and Adjusted EBITDA $12.5–$14.5M (sequential step-down on event costs, revenue timing, and labor), FY 2025 revenue maintained at $345–$360M, FY Adjusted EBITDA raised to $60–$66M (from $59–$66M) .
Operational catalysts: ACV bookings disclosure (Q1 ACV $17.34M; TCV $21.98M), two notable Financial Health wins in the 100–400 bed segment, 98% Patient Care retention ex-Centriq, offshore transition toward a 60% target and AI-driven automation plans .

What Went Well and What Went Wrong

What Went Well

Adjusted EBITDA and margin outperformed guidance; EBITDA margin expanded to 20.9% (+860 bps YoY), driven by revenue growth, offshoring, and disciplined cost management. “Adjusted EBITDA exceeded the high end of guidance” and “gross margins improved,” with Financial Health GM +700 bps YoY .
Strong bookings and new logos: Q1 bookings $22.0M (TCV) and $17.34M (ACV), including “two wins in Financial Health… significant expansion of scope” and a “competitor displacement in Patient Care” .
Balance sheet progress: net leverage ratio reduced to 2.4x; CFO highlighted $3M principal paydown in Q1 and $26M since Jan 2024; cash from operations improved by $7.4M YoY to $5.76M .

What Went Wrong

Timing tailwinds that benefited Q1 will reverse in Q2: ~$1M revenue timing and ~$3M event costs (user conference and rescheduled sales kickoff), plus ~$1M COLA and incremental labor investments, driving a sequential EBITDA step-down .
Bookings mix implies delayed revenue recognition: management noted ~25% of bookings will have little to no impact on 2025 revenue due to elongated go-live schedules, especially for larger deals .
Customer satisfaction/retention headwinds in Financial Health CBO: “slightly elevated levels of customer satisfaction challenges” as offshoring scales; Q1 renewals were 9 of 11, but CFO cited sequentially flat DSOs and anecdotally more prudent client cash behavior amid policy uncertainty .

Financial Results

Metric	Q3 2024	Q4 2024	Q1 2025
Revenue ($USD Millions)	$83.83	$87.36	$87.21
GAAP Diluted EPS ($)	$(0.66)	$(0.38)	$0.03
Non-GAAP EPS ($)	$(0.21)	$0.05	$0.36
Adjusted EBITDA ($USD Millions)	$13.82	$17.24	$18.23
Adjusted EBITDA Margin (%)	16.5%	19.7%	20.9%

Segment revenue breakdown:

Segment Revenue ($USD Millions)	Q3 2024	Q4 2024	Q1 2025
Financial Health	$54.27	$54.65	$56.13
Patient Care	$29.56	$32.71	$31.08

KPIs (Q1 2025):

KPI	Q1 2025
Bookings (TCV) ($USD Millions)	$21.98
Bookings (ACV) ($USD Millions)	$17.34
Recurring Revenues ($, % total)	$81.97 (94%)
Cash from Operations ($USD Millions)	$5.76
Net Leverage Ratio (x)	2.4x
DSO improvement vs prior year (days)	12

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
Total Revenue ($USD Millions)	FY 2025	$345–$360	$345–$360	Maintained
Adjusted EBITDA ($USD Millions)	FY 2025	$59–$66	$60–$66	Raised
Total Revenue ($USD Millions)	Q2 2025	—	$85.5–$87.5	New
Adjusted EBITDA ($USD Millions)	Q2 2025	—	$12.5–$14.5	New

Earnings Call Themes & Trends

Topic	Previous Mentions (Q3 2024, Q4 2024)	Current Period (Q1 2025)	Trend
Bookings consistency & disclosure	Bookings strengthened; pipeline confidence ; Q4 bookings $14.27M	Q1 bookings $22.0M (TCV), ACV introduced at $17.34M	Improving transparency; sequential acceleration vs Q4
Offshore/global workforce & margins	Offshoring progress; margin expansion underway ; Q4 EBITDA margin 19.7%	EBITDA margin 20.9%; moving toward 60% offshore by YE 2025	Continuing expansion and efficiency gains
Client retention (Financial Health)	—	9 of 11 renewals; focus on client delight and standardized workflows	Stabilizing with execution focus
Patient Care SaaS & new logos	Analytics offering resonating; pipeline solid	Two net new EHR customers; 4 net new SaaS customers; 98% retention ex-Centriq	Ongoing SaaS shift and strong retention
Macro/policy/tariffs	Risk factors cited in filings	“Absolute uncertainty” on policy; potential cautious spending; monitoring Medicare/reimbursement	Cautiously watchful
AI/automation initiatives	Analytics traction mentioned	Plan to “accelerate innovation… automate CBO workflows”; customers intrigued by AI	Increasing emphasis
Balance sheet & leverage	Leverage ~3x YE 2024	Net leverage down to 2.4x; $3M principal repaid in Q1; $26M since Jan 2024	Improving capital structure

Management Commentary

“We are off to a strong start for 2025, delivering first quarter results that exceeded our expectations… we paid down additional debt, bringing our leverage ratio to 2.4x.” — Chris Fowler, CEO .
“Q1 adjusted EBITDA margin of 20.9% was 860 bps better than prior year… largely due to revenue growth combined with the global workforce initiative and expense management; Q1 benefited from approximately $2 million of timing.” — Vinay Bassi, CFO .
“We signed two deals in the 100–400 bed hospital market segment… land-and-expand based on performance.” — CEO .
“We will standardize our global hiring process and establish a centralized workplace… goal of ~60% of CBO clients supported offshore by end of 2025.” — CEO .
“Our customer retention stands at 98% excluding Centriq… expanding wallet share via new SaaS bundles and TruBridge Analytics.” — CEO .

Q&A Highlights

Policy/tariff uncertainty: Management sees “absolute uncertainty” around budgets and reimbursement; potential second-half headwinds but revenue cycle performance remains a priority for customers .
Offshore/onshore savings: CFO targeted mid-single-digit millions of net savings in 2025 from reducing duplicity and driving productivity, contingent on execution pace under new Financial Health leadership .
EBITDA cadence: Sequential Q2 step-down due to ~$3M event costs, ~$1M revenue timing reversal, and ~$1M labor/COLA; midpoint of full-year EBITDA guide supported by cost initiatives and mix .
Patient Care mix: Non-subscription EHR bookings lower as SaaS overtakes one-time revenue; smoothing implementations over contract life to reduce lumpiness .
Financial Health wins: Two deals in 100–400 bed cohort—one just over 100 beds, one near upper end—both recurring scope expansions following successful pilots .

Estimates Context

Metric	Consensus (S&P Global)	Actual	Surprise
Revenue ($USD Millions)	$86.214*	$87.208	+$0.994 (+1.2%)*
Primary EPS ($)	$0.291*	$0.36	+$0.069 (+23.8%)*
EBITDA ($USD Millions, S&P definition)	$14.475*	$13.947*	−$0.528 (−3.6%)*

Values retrieved from S&P Global. Company-reported Adjusted EBITDA was $18.231M (20.9% margin), which differs from S&P’s EBITDA definition and exceeded the high end of company guidance . Estimates likely need upward revision on EPS and margin trajectories given cost actions and mix, while revenue cadence should reflect elongated implementations on larger wins .

Key Takeaways for Investors

EPS and margin beat with clear operational drivers; however, expect a Q2 reset on timing and events before margins re-accelerate in 2H on offshoring, resource management, and mix — tactically bullish on profitability trajectory .
Bookings quality improving with ACV disclosure; larger deal sizes extend go-live timelines—model more back-end loaded revenue conversion and potential 2026 uplift .
Financial Health retention is the key swing factor; watch execution on standardized workflows, India capabilities, and AI-enabled automation to stabilize and improve CBO performance .
Patient Care is showing durable SaaS shift and 98% retention ex-Centriq; incremental analytics and bundles could support ARR growth and margins .
Balance sheet strengthening (2.4x net leverage; debt paydown) lowers risk and increases strategic flexibility; supports higher EBITDA conversion focus .
Macro/policy remains a watch item; management is proactively engaging clients—near-term caution may affect sales cycles, but RCM value proposition is counter-cyclical .
Trade implication: after the Q2 step-down, monitor Q3 bookings levels and cost execution as catalysts for estimate revisions and re-rating on sustained margin expansion .

Appendix: Additional Data Cross-References

Total recurring revenue $81.97M (94%) in Q1; Financial Health recurring $55.26M; Patient Care recurring $26.71M .
Operating income $8.16M; GAAP net income $0.46M; diluted GAAP EPS $0.03; Adjusted EBITDA reconciliation detailed with non-GAAP adjustments and 20.9% margin .
Q4 2024: revenue $87.36M; Adjusted EBITDA $17.24M (19.7% margin); Non-GAAP EPS $0.05 .
Q3 2024: revenue $83.83M; Adjusted EBITDA $13.82M (16.5% margin); Non-GAAP EPS $(0.21); Financial Health revenue $54.27M (64.7% mix) .

TruBridge, Inc. (TBRG)·Q1 2025 Earnings Summary