Hi everyone, and thank you very much for making the time for our Q4 2023 presentation. For those that have not met us yet, my name is Charles MacBain, I'm the CEO of Nordhealth. I'm here with my colleague, Mari Orttenvuori, the CFO. So, we're going to focus on two different areas. First is a general company update, and then that I will go through, then Mari will go through a financial update, then we'll end with a Q&A session. So starting with the company update. The in the last 12 months in Q4, so in 2023, our organic ARR grew 23.3%. This was driven by a net retention of 114%. And was tempered by a slightly higher churn than historically due to reasons we'll go into later in the presentation of 4.9%.
In terms of growth efficiency, our customer acquisition cost to new ARR that we were able to sign was 1.5%. And this customer acquisition cost includes marketing, sales, and also the profit or losses that we make from implementations in professional services. However, even with the slightly higher churn that we had this year, which is very much a one-off, we can see that our lifetime value to customer acquisition cost is still very high at 10.4%. We ended the year with an implemented ARR of 36.6% and a signed ARR of 38.5%. The difference between implemented and signed is the amounts that we have booked but have not been yet gone live. The sort of clinics are not using the system yet, but they've signed for the system. That means that year-end 2023, we ended ARR per share at 0.46%.
Now, taking a little bit of a step back to look a little bit at the history, right, over the last five years, we've been able to grow the signed ARR over 11x , right? This has been done, as we said, through a combination of organic growth, and also acquisition. So this means that we've had a CAGR of 62% over these years. Important to note that in 2023 we did not make any acquisitions, so, growth came purely from organic. The second thing which is important to note is that within these numbers, the 38.5%, we do not include, any revenue post-pilot for the two big enterprise customers that we signed in 2022, one in 2023, CVS and Vets4Pets. So only the pilot, revenues are actually added to this graph. Now, looking at how this has developed during 2023 in the last final quarter.
We started the quarter of Q4 with EUR 32.6 million ARR. We recruited EUR 700,000 worth of new customers. And we had an upsell of 1.6%. This net upsell was primarily driven by Provet Cloud user growth and also ARPU growth, which was driven by add-on sales. And then we had a churn of 0.4%, which is mostly coming from Diarium and somewhat from EasyPractice as well. So we ended Q4 2023 with EUR 36.6 million of ARR and they signed. You can see the difference which is purely Provet Cloud signed on implemented revenue of EUR 2 million to get us to EUR 38.5 million. Now looking year-over-year, so at the end of Q4 2022, we started at EUR 29.7 million, right? We've recruited a significant number of new customers. This is quite well split between veterinary and therapy. We also had a very strong net upsell year.
Again, primarily driven by Provet Cloud. So you see this theme not only in Q4, but also throughout the year. Provet Cloud's average revenue per user increased quite a bit given that we've been upselling new add-ons such as the whiteboard, referral portal, Provet Pay, right? And also driven by user growth as our current customers are opening new locations or growing their current locations, thereby leading to additional users coming onto the platform. And we had a churn of EUR 1.5 million. The next slide, we can see how this divides between veterinary and therapy. As we can see, veterinary had a very, very strong growth this year, right? They were able to recruit EUR 1.3 million worth of new customers. We were able to get EUR 4.7 million net net upsells, so very, very strong performance of net upsell.
This reinforces one of our core strategies, which is this enterprise strategy in which we can actually, as we capture a customer, we continue expanding as they expand their user base. Then we had a very low churn of 0.2%, which is equivalent to 1.6% churn. Which is a spectacular number. Then on the therapy side, we had slightly slower growth. Obviously, we're focusing mostly on the migration of our customers from Aspit to EasyPractice in Norway and development surrounding that. However, we did have very strong new customer acquisition and this is the nature of the product-led nature of the EasyPractice product that we acquired and is our flagship product and that they can recruit very efficiently lots of new customers. So we got EUR 1.5 million worth of new customers in 2023.
And we also had a net upsell through a combination of, so pricing changes, upselling additional add-ons, but also user growth as the end market is also growing. But we had also quite high churn. This was driven by two things. One is, the primary impact is that, as we had mentioned in previous quarters, we lost our second largest customer for Diarium. The reason for the loss is that the customer was acquired by an enterprise customer which also had general practice clinics or doctors' clinics and they wanted to have one software for both the GPs' clinics and also the therapy clinics. And, Diarium and EasyPractice, we only focus on therapists, not GPs. So we cannot provide a unified software for both.
And the second thing, as in previous quarters, right, the great thing about EasyPractice is that they can actually recruit very cheaply lots of customers, but that means that quite a few of the customers try it out for a few months and also churn. Right? So what we see is that the churn was 7.8% for the year, but excluding this one-off from Fysios, we can see a 5.6% churn. Now diving deep a little bit more into churn rate to see how this looks over time, right? You can see that on average, despite the slightly higher churn that we had in 2023, right, our average churn rate has been around 2.6% of the last five years.
And although we do believe that targeting smaller customers of EasyPractice will have higher churn due to the nature of these businesses going out of business more frequently. We anticipate churn will return to less than 4% in 2024. Now on the right-hand side, you can see Net Retention Rate. That is, we have a Net Retention Rate of 113.7%. So it was slightly above what we've had historically, but not meaningfully. And we anticipate Net Retention Rate to average above 110% in 2024. Now on the profitability side, our profitability improved quite significantly in 2023. As a result of the fact that our revenues grew, our recurring revenues, but we did not actually increase the headcount dramatically, right? It was relatively stable as we'll see in later slides. And also we're starting to see the benefits of migration, right? And efficiencies that come around with migration.
We'll continue to see those, as we continue migrating customers over to our flagship products. But as you can see, our EBITDA minus CAPEX loss was decreased from EUR 11.8 million- EUR 6.1 million. And our adjusted EBITDA loss decreased from -5.4% to -0.7%. And just to reiterate that our target is to have adjusted EBITDA minus CAPEX in Q1 2025 be break-even. Now we discussed headcount. As you can see, we ended Q4 2022 with around 400 and we're ending 2023 with around 385. So there's been a slight decrease in the headcounts, but over the period, relative to last year. Then on the migration, we have made some progress on migration, as you can see from in 2023. On the therapy side, we've increased migration.
The reason why we see Q4 2023 migration being lower than the previous months is because of this Fysios churn. Right? However, we can also see that on the veterinary side, we're continuously migrating more and more of the ARR onto our flagship platform, Provet Cloud. Thank you. Now off to Mari for the financial update.
Thank you, Charles. So let's take a look at the final quarter numbers in a bit more detail. Our total revenues in the final quarter grew by 20% year-over-year. And that growth is driven by veterinary cloud products as already presented. If calculated on a constant currency basis, growth in total reported revenues would have been 25%. With 36% of our revenues being earned in Norway and 11% in Sweden when calculated on a full-year basis.
The weakening of the Norwegian and Swedish krona has had a really big impact on our reported revenues. Share of recurring revenues in the final quarter was 86%. And that is impacted by a higher level of paid development revenues earned during that quarter. So the relative share of recurring revenues is slightly below our full-year share, which is at 90%. Adjusted EBITDA improved from -EUR 1.1 million - EUR 0.7 million and adjusted EBITDA margin improved from -13% to -7%. On recurring revenue, our reported recurring revenues have grown by 19% from EUR 7.4 million- EUR 8.7 million. And on a constant currency basis, the growth would have been 25% as well. In terms of euros, the currency impact on recurring revenues has been over EUR 600,000 on the final quarter and about EUR 2.2 million on a full-year basis. So that is a pretty significant impact.
In the third quarter, adjusted EBITDA margin was positive, but in the final quarter, we are back at - 7%. However, on a full-year basis, adjusted EBITDA margin improved from - 18% to - 2%. So improvement has been really quite remarkable during the year. The full-year numbers are included in the appendices to this presentation. Although there's been some decrease in headcount overall during the year, recruitment activity has a little bit picked up again in the second half of the year. So our personnel costs have increased slightly during the final quarter. But primarily, the final quarter profitability has been impacted by payroll seasonality and additional spending on marketing and security audits for our products. On cash flow, we've improved our free cash flow by EUR 2.1 million in 2023.
This is a good improvement in itself, but it's pivotal to know that the majority of our Aspit customers in Norway have, in fact, changed from biannual to monthly invoicing cycle as of the beginning of this year. Meaning 2024. What this really means is that previously our Aspit customers were invoiced in June and in December, and the majority of the customer payments were received already in December for the December invoicing. However, in December 2023, we did not do any invoicing. As the first invoicing under the new billing schedule was made in January this year, this has had an estimated impact of EUR 3.5 million on our net working capital for 2023. Had we not made this change, our 2023 free cash flow would have been approximately EUR 7.2 million instead of the - EUR 10.7 million.
And likewise, this will have a positive impact on our networking capital this year when compared to 2023. So our balance sheet remains strong and cash on the balance sheet remains strong and withdrawals from the money market funds relate to either to the payment of the EasyPractice earnout for EUR 1 million that was paid in January or to the share buyback programs that were completed this year as we financed the share purchases through withdrawals from the money market funds. We now have scalable processes in place and we are looking to become EBITDA minus CAPEX positive by the first quarter of 2025. So our cash spend will further decrease and will turn into positive and that allows us to finance our investments in product development or in any potential M&A going forward.
We have EUR 49 million of goodwill on our balance sheet and there's been no new acquisitions or impairments of goodwill recognized during the year. The EUR 12.6 million intangible assets consist almost entirely of capitalized development expenses where we have recorded additions during the year amounting to EUR 5.2 million and amortizations amounting to EUR 3.2 million on the capitalized development expenses. Equity is strong. During the year, as already mentioned, we completed two share repurchase programs. Those amounted to EUR 2.3 million in total. During the first half of the year, we issued a performance share program that is targeted for the key personnel. The shares that we have acquired have been acquired also for that purpose.
The company has no external financing and we have no material earnout liabilities remaining on our balance sheet and the liabilities consist of operative items such as quotes and advances received. The detailed final quarter and full-year financials you can find in the appendices. We have also issued the second half interim report today and that can be found on our company web pages. The consolidated group finance statements will be issued on April 1 2th. Our first quarter results will be presented on May 14th.
Thank you, Mari. Now, just to conclude, so I think the key points from 2023 and also Q4 and then looking forward to 2024. In 2024, recurring revenue growth will continue. We're not expecting any significant increase in headcounts. Thereby this will drive EBITDA minus CAPEX margins improvements.
Diving a bit by business unit on the veterinary business unit, where our focus will be on implementing CVS and Pets at Home in the UK. The second will be to continue to acquire new customers, both corporate and independents in the US, UK, and Spain. Right? The third is this migration in Norwegian customers as well as Danish customers over to Provet Cloud and in addition to some Finnish customers. On the therapy side, we are focusing on migrating Aspit customers over to EasyPractice. Scaling the booking portal, which was successfully launched last year in Finland under the domain nordhealth.fi. Third is to be able to acquire new customers in Finland still on Diarium and in Norway and Denmark on EasyPractice. Just reiterating our guidance for 2024, right? So, and looking at 2023 guidance. So we grew recurring revenue 21% in 2023.
In constant currency basis, beating our 15%-20% guidance. We're on track to reach our EBITDA minus CAPEX break-even by Q1 2025. The guidance for 2024 remains the same for EBITDA minus CAPEX, right? Also we are forecasting a 15%-20% recurring revenue growth with constant currency. That means that September 2023, in terms of actually. Thank you very much for your time. If there's any questions, feel free to raise your hand or use the chat for questions. Okay. We have a few more seconds to see if there's any questions. Well, it seems that there's not no questions. Thank you very much, everyone, for your time, and we will connect again for the Q1 2024 results. Thank you.
Thank you.