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Waystar Holding Corp.: Q4 FY2025 earnings call

What management said about Q4 FY2025, from the documents filed with the SEC on 17 February 2026: press release. Guidance figures: 4 new. The quarter’s numbers.

Key takeaways

  • Fourth-quarter revenue up 24%: Fourth-quarter revenue was $303.5 million, up 24% from $244.1 million a year earlier. Net income was $20.0 million, or $0.10 per diluted share, a 7% net margin. Source
  • Subscription revenue up 38%: Fourth-quarter subscription revenue was $167.8 million, up 38%, against $134.5 million in the third quarter. Source
  • 1,391 clients above $100,000: Clients contributing over $100,000 of last-twelve-month revenue numbered 1,391, up 16% year-over-year. Source
  • Net revenue retention at 112%: Net revenue retention was 112%, down from 113% in the third quarter. Source
  • Adjusted EBITDA margin 43%: Adjusted EBITDA was $129.1 million in the quarter, a 43% margin, against 41% a year earlier. Full-year adjusted EBITDA was $462.1 million, a 42% margin. Source
  • Fourth-quarter operating cash flow $67 million: Cash flow from operations was $67 million in the quarter and unlevered free cash flow was $80 million. Source

“Our 2026 guidance reflects a robust pipeline, accelerating demand for an end-to-end AI-powered platform, and disciplined execution to sustain durable, profitable growth.”

Matt Hawkins, Chief Executive Officer

Guidance

AreaPeriodFigureAgainst last quarter
Total revenue Sourcefiscal year 2026$1.274 billion to $1.294 billionNew
Adjusted EBITDA Sourcefiscal year 2026$530 million to $540 millionNew
Non-GAAP net income Sourcefiscal year 2026$317 million to $335 millionNew
Diluted non-GAAP net income per share Sourcefiscal year 2026$1.59 to $1.68New

What changed from last quarter

  • New guidance: Guidance for fiscal 2026 is given in this release; the previous release gave guidance for fiscal 2025. Source

Results and growth drivers

  • Fourth-quarter revenue up 24%: Fourth-quarter revenue was $303.5 million, up 24% from $244.1 million a year earlier. Net income was $20.0 million, or $0.10 per diluted share, a 7% net margin. Source
  • Full-year revenue up 17%: Full-year 2025 revenue was $1,099.3 million, up 17% from $943.5 million. Net income was $112.1 million, or $0.61 per diluted share, a 10% net margin. Source
  • Non-GAAP earnings per share reported: Non-GAAP net income per diluted share was $0.36 for the fourth quarter and $1.42 for fiscal 2025. Source

Revenue by type

  • Subscription revenue up 38%: Fourth-quarter subscription revenue was $167.8 million, up 38%, against $134.5 million in the third quarter. Source
  • Volume-based revenue up 11%: Fourth-quarter volume-based revenue was $134.2 million, up 11%, against $132.3 million in the third quarter. Source
  • Fiscal-year subscription and volume split: Fiscal 2025 subscription revenue was $558.4 million, up 22%, and volume-based revenue was $534.8 million, up 11%. Source

“We are leading healthcare’s AI transformation by advancing the autonomous revenue cycle, leveraging unmatched proprietary data and deep domain expertise to deliver meaningful outcomes for providers.”

Matt Hawkins, Chief Executive Officer

Clients and retention

  • 1,391 clients above $100,000: Clients contributing over $100,000 of last-twelve-month revenue numbered 1,391, up 16% year-over-year. Source
  • Net revenue retention at 112%: Net revenue retention was 112%, down from 113% in the third quarter. Source
  • About 30,000 clients served: The company serves approximately 30,000 clients, representing over 1 million providers, including 16 of 20 institutions on the U.S. News Best Hospitals list, down from 17 of 20. Source

Margins and expense lines

  • Adjusted EBITDA margin 43%: Adjusted EBITDA was $129.1 million in the quarter, a 43% margin, against 41% a year earlier. Full-year adjusted EBITDA was $462.1 million, a 42% margin. Source
  • Cost of revenue rose: Cost of revenue, excluding depreciation and amortization, was $92.6 million in the quarter, up from $79.5 million. Full-year cost of revenue was $348.2 million. Source
  • Sales, marketing and G&A increased: Sales and marketing was $49.2 million and general and administrative $43.7 million in the quarter, against $39.0 million and $23.0 million a year earlier. Source
  • Louisville relocation and severance costs: Louisville office relocation added $0.6 million of lease costs in the quarter and $1.3 million for the year. Executive severance was $0.6 million for the year. The company excluded these from non-GAAP results. Source

Cash flow, debt and acquisitions

  • Fourth-quarter operating cash flow $67 million: Cash flow from operations was $67 million in the quarter and unlevered free cash flow was $80 million. Source
  • Full-year cash flow $310 million: For fiscal 2025 cash flow from operations was $310 million and unlevered free cash flow was $365 million. Source
  • Net debt and leverage rose: Net debt was $1,395.0 million at year-end, up from $1,061.4 million, and adjusted net leverage was 3.0x against 2.8x a year earlier. Cash and equivalents fell to $61.4 million from $182.1 million. Source
  • Acquisitions paid in stock and cash: Common stock issued for acquisitions totaled $620.8 million, and acquisitions used $629.5 million of cash, net of cash acquired, during the year. Source

Strategy and platform scale

  • AI-led autonomous revenue cycle: Management described advancing the autonomous revenue cycle, using proprietary data and domain expertise in its AI-powered platform. Source
  • Platform processes 7.5 billion transactions: The platform annually processes over 7.5 billion healthcare payment transactions, up from 6 billion, spanning about 60% of U.S. patients, up from 50%. Source
  • Acquisition and integration costs rose: Acquisition and integration costs were $14.9 million in the quarter and $21.1 million for the year, against $0.2 million and $0.9 million a year earlier. Source

Figures management reported

FigureReported
Net revenue retention rate Source112%
Clients contributing over $100,000 in LTM revenue Source1,391, up 16%
Approximate client count Sourceapproximately 30,000
Large customers on U.S. News Best Hospitals list Source16 of 20 institutions
Subscription revenue Source$167.8 million, up 38%

Risks management discussed

  • Financial: Some non-GAAP guidance items are hard to forecast, so the company has not reconciled them to GAAP measures. Source

Earlier plans management reported on

  • Ahead: Management said the Iodine acquisition is being integrated ahead of plan. Source

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.