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Nutex Health Inc.: Q4 FY2025 earnings call

What management said about Q4 FY2025, from the documents filed with the SEC on 5 March 2026: press release. Guidance figures: 1 new. The quarter’s numbers.

Key takeaways

  • Full-year revenue rose 82.4%: Total revenue for 2025 was $875.3 million, up $395.3 million from $479.9 million, with the hospital division supplying most of the increase. Source
  • Adjusted EBITDA up 152.6%: Adjusted EBITDA attributable to Nutex Health was $259.6 million, up 152.6%; EBITDA was $168.6 million, up 70.6%. Both are non-GAAP measures in the release. Source
  • Fourth-quarter revenue fell 41.1%: Fourth-quarter revenue was $151.7 million versus $257.6 million, a decrease of 41.1%. Management attributed the decline primarily to two items. Source
  • $55.0 million one-time arbitration true-up: A cumulative true-up of $55.0 million covered 18,950 arbitration claims that arbitrators found ineligible under the IDR process, for submissions from July 2024 through December 2025. Source
  • Adjusted fourth-quarter revenue up $18.1M: Excluding both items, fourth-quarter revenue was $206.7 million versus $188.6 million, up $18.1 million, which management attributed to higher patient visits. Source
  • IDR-linked share of hospital revenue: Of hospital revenue, $527.8 million, about 63%, related to higher acuity claims and success through the IDR process. Source
  • Fourth-quarter Adjusted EBITDA down 80.8%: Fourth-quarter EBITDA was $25.7 million, down 67.4%, and Adjusted EBITDA was $16.6 million, down 80.8%; both are non-GAAP measures. Source
  • Cash balance rose to $185.6M: Cash and cash equivalents stood at $185.6 million at December 31, 2025, with long-term debt, net of $29.2 million and total assets of $918.5 million. Source

“Compared to 2024, we delivered improvements across nearly all key financial metrics.”

Tom Vo, M.D, MBA, Chairman and Chief Executive Officer of Nutex Health

Guidance

AreaPeriodFigureAgainst last quarter
Share repurchase SourceNext six monthsup to $25.0 millionNew

What changed from last quarter

  • New: A second repurchase program of up to $25.0 million over six months was authorized, stated as intended to offset dilution from stock compensation obligations. Source
  • New: Three micro-hospitals were opened during 2025 and early 2026. Source
  • Ended: Management said all previously disclosed material weaknesses in internal controls over financial reporting were remediated in 2025. Source

Full-year results and drivers

  • Full-year revenue rose 82.4%: Total revenue for 2025 was $875.3 million, up $395.3 million from $479.9 million, with the hospital division supplying most of the increase. Source
  • Operating income more than doubled: Operating income for 2025 was $275.6 million versus $130.7 million, a $144.9 million improvement year over year. Source
  • Diluted EPS rose to $10.48: Net income attributable to Nutex Health was $70.8 million versus $52.1 million; diluted EPS was $10.48 versus $9.69 for 2024. Source
  • Adjusted EBITDA up 152.6%: Adjusted EBITDA attributable to Nutex Health was $259.6 million, up 152.6%; EBITDA was $168.6 million, up 70.6%. Both are non-GAAP measures in the release. Source

Fourth-quarter revenue and one-time items

  • Fourth-quarter revenue fell 41.1%: Fourth-quarter revenue was $151.7 million versus $257.6 million, a decrease of 41.1%. Management attributed the decline primarily to two items. Source
  • $55.0 million one-time arbitration true-up: A cumulative true-up of $55.0 million covered 18,950 arbitration claims that arbitrators found ineligible under the IDR process, for submissions from July 2024 through December 2025. Source
  • CMS directive prompted the true-up: Management linked the true-up to a mid-2025 CMS directive for dispute entities to clear their backlog, which reduced active disputes compared with 2024. Source
  • Prior-year $69.0 million moved into Q4 2024: The second item was $69.0 million of arbitration revenue from third-quarter 2024 submissions that had been recorded in the fourth quarter of 2024. Source
  • Adjusted fourth-quarter revenue up $18.1M: Excluding both items, fourth-quarter revenue was $206.7 million versus $188.6 million, up $18.1 million, which management attributed to higher patient visits. Source

“We are continuing to add to a record year with 82% revenue growth, Adjusted EBITDA attributable to Nutex Health of $259.6 million, a 126.4% increase in gross profit and a record high cash balance of $185.6 million.”

Jon Bates, Chief Financial Officer of Nutex Health

Segments and mature hospital revenue

  • Hospital division revenue up 188%: Hospital division revenue was $844.2 million, up 188.0% from $449.1 million, and accounted for most total revenue. Source
  • Population health revenue increased: The population health management division reported $31.1 million of revenue for 2025, compared with $30.9 million for 2024. Source
  • Mature hospital revenue up 73.4%: Revenue from hospitals opened before December 31, 2021 rose 73.4% in 2025 compared with 2024, against a 200.0% rise reported for the first nine months. Source

Arbitration claims and collections

  • IDR-linked share of hospital revenue: Of hospital revenue, $527.8 million, about 63%, related to higher acuity claims and success through the IDR process. Source
  • IDR submissions between 50% and 60%: Management said it has submitted 50-60% of claims through the IDR process; the prior release gave 60-70% of visits. Source
  • Prevails in over 85% of determinations: When an award determination is made, the company said it currently prevails in over 85% of determinations, with average collection over 85% of wins; the prior release cited over 80%. Source
  • Arbitration costs near 26% of revenue: Arbitration costs were about 26% of arbitration-related revenue, compared with 24-26% stated in the prior release. Source

Costs, margins and profit

  • Contract services expense increased: Contract services expense was $190.3 million, up from $100.8 million, and payroll was $158.1 million, up from $117.5 million. Source
  • Gross profit more than doubled: Gross profit was $444.3 million for 2025 versus $196.3 million for 2024, as shown in the statement of operations. Source
  • Stock-based compensation rose to $117.0M: Stock-based compensation was $117.0 million versus $16.6 million, tied to earn-out shares for under-construction and ramping hospitals; the fourth quarter showed $(2.6) million. Source
  • Fourth-quarter operating income fell: Fourth-quarter operating income was $30.9 million versus $114.3 million, a decrease of $83.4 million. Source
  • Fourth-quarter Adjusted EBITDA down 80.8%: Fourth-quarter EBITDA was $25.7 million, down 67.4%, and Adjusted EBITDA was $16.6 million, down 80.8%; both are non-GAAP measures. Source

Visits and mature hospital volume

  • Mature hospital visits fell in Q4: Visits at mature hospitals decreased 0.3% in the fourth quarter compared with the same period of 2024. Source
  • Mature hospital visits rose for year: For the full year, visits at mature hospitals increased 1.3%, after a 1.8% increase the prior release reported for the first nine months. Source
  • Emergency visits and admissions grew: Management said both emergency room visits and inpatient admissions grew year over year, which it linked to increased demand and strengthened operational performance. Source

Cash, capital and shareholder returns

  • Operating cash flow reached $248.1M: Net cash from operating activities was $248.1 million for 2025, versus $23.2 million for 2024; fourth-quarter operating cash flow was $70.4 million, versus $0.1 million. Source
  • Cash balance rose to $185.6M: Cash and cash equivalents stood at $185.6 million at December 31, 2025, with long-term debt, net of $29.2 million and total assets of $918.5 million. Source
  • Second buyback program authorized: The board authorized a second repurchase program for the next six months, under which repurchases may be made in open market transactions. Source
  • Members' distributions rose to $74.3M: Members' distributions were $74.3 million in 2025, against $6.4 million in 2024, and members' contributions were $0.8 million. Source
  • Stock repurchases of $5.0M in 2025: The cash flow statement shows $5.0 million of cash used for stock repurchases and retirements in 2025, with none in 2024. Source

Hospital expansion and growth plan

  • Three micro-hospitals opened recently: Management said three new micro-hospitals opened during 2025 and early 2026, expanding the national footprint. Source
  • Growth plan spans new and existing sites: Management said the growth plan includes de novo hospital development and increased patient volumes at existing facilities. Source

Coming up, as management said on 5 March 2026

  • Repurchase timing at company discretion: Timing and share numbers for repurchases are at the company's discretion and may be affected by market conditions and other factors. Source

Figures management reported

FigureReported
Hospital division visits, full year 2025 Source188,279
Hospital division visits, fourth quarter 2025 Source48,205
Hospital facilities Source27 facilities in 12 states

Risks management discussed

  • Financial: Management said it lacked sufficient history before September 30, 2024 to estimate prevailing determinations, award amounts or collectibility of arbitration awards. Source
  • Financial: Management described future share issuance tied to stock compensation obligations for under-construction and ramping hospitals as a source of dilution. Source

Earlier plans management reported on

  • Met: The prior release said audit revisions were behind the company; the current release says all previously disclosed material weaknesses were remediated in 2025.

Other quarters

Summarised with AI from the documents the company filed with the SEC. Every point is checked against the filing before it is shown: management’s own words word for word, figures against the line or table row they come from. A point that fails the check is left out. Source opens the filing at that line.