Hi everyone, and welcome to the Q3 2024 presentation. For those joining us for the first time, I'm Charles MacBain, the CEO of Nordhealth, and I have my colleague Mari Orttenvuori, the CFO, on the line as well. Today, as per usual, we'll go through a company update, then veterinary BU update, therapy BU update. Mari will walk us through a financial update, and we'll leave some time at the end for any questions. So please feel free to reserve your questions till the end. Thank you very much. Starting with the company update. So in Q3 2024, year- over- year, we grew 23.7% organically. That was ARR growth. The net retention was around 115% over the last 12 months ending Q3 2024. Our churn rate was 6.2% in the last 12 months in 2024, and our CAC to new ARR was 0.7.
These numbers combine to come up with a lifetime value to CAC of 15.8. At the end of September, we were at an implemented ARR of EUR 41.8 million, so we reached the 40s, and our signed ARR was EUR 43.8 million, which means our ARR per share was EUR 0.53. Let's get to look over time. So if we look year- over- year, right, we have had an annualized CAGR of 56% over the last six years since present management took over. No acquisitions have been done in 2023 and 2024 to date. If we break down this growth, we can see that our organic signed ARR growth has been increasing per period, and we have surpassed year to date 2024 the total amount of signed ARR in 2023, which itself was a record year. Now let's go through the ARR bridge.
As you can see, there's a slightly different slide this time than the last one, so I'll go through it column by column. In Q3 2023, our ARR was EUR 32.3 million. In the last 12 months, we've been able to recruit EUR 2.9 million of ARR in net new customers. In addition, we have been able to have a net upsell, which is upsell minus downsell of 6.8. Good to note that given that CVS originally signed in previous quarters, that the majority of CVS revenue is in net upsell. And then we had a churn of EUR 2 million over that period of time, which ends us having a Q3 2023 ARR excluding other businesses of 40. Going a little bit more detail on the churn, right, so the figure is 6.2%.
However, if you exclude the one-time loss of the Diarium enterprise customer, it would be 5.3%, and if you exclude the sunsetting of Provet Win and VetServe, the churn would be around 4%. And as I said before, we foresee long-term average churn to be around 5%. Then unique in this report is we've had other businesses of EUR 1.8 million, which we've split out from the previous part, right? This includes two things. One is the work that we do in Aspit, which we acquired in 2021 around IT operations, which is not a PMS business, and the second is our online training business, Navicare, which was acquired before I joined in 2018. And those businesses will continue to fluctuate as we try to at least reduce the amount that we spend on or that we sell on IT operations as we slowly wind that business down.
That business will only be wound down when Aspit actually migrates all of its customers to the new platform, as this part of the business also maintains that platform. And that gets us to EUR 41.8 million. And as per usual, our Provet Cloud signed not implemented ARR is EUR 2.1 million. Please note that the Vets4 Pets rollout post-pilot is not included in these ARR numbers. Now looking quarter- over- quarter, we grew 2.4%. We started the quarter at last EUR 39 million of ARR. We've added EUR 0.6 million, so EUR 600,000 roughly of new customers. We've had net upsell around EUR 600,000 and churn of EUR 0.3 million. So as you can see in Q3, if we analyze this churn, it would be around 2.6%. So we're coming back towards our lower churn once these one-time events are going away. From a profitability perspective, our adjusted EBITDA minus CapEx was positive again in Q3 2024.
If we look at 2023 Q3 versus Q3 2024, we can see that the reason for the improvement from EUR -0.8 million to EUR 0.1 million was driven by three primary factors. One was the revenue growth of one point, which added EUR 1.8 million. The second is that our implementation is becoming more efficient, so we're able to have more implementation revenues. And the third, which is a negative impact, is that we've actually been investing to support our growth at EUR 1.2 million. Then going through the adjustments, in Q3 2023, we each had a bonus accrual adjustment of EUR 75,000, and in Q3 2024, a restructuring cost and earn-out adjustment of around EUR 44,000. Now let's dive into veterinary. So high level, on the veterinary side, we've had very strong growth of Provet Cloud year- over- year, right, driven by CVS. Second, the Nordic migration is progressing, albeit slower than anticipated.
A lot of the resources were put on CVS, and we still have EUR 4.1 million of ARR still on VetVision, Provet Net, or Sanimalis, which are three softwares, legacy software, which are still alive today. Our product development efforts are focused on migrating to the new front end, which will be a big benefit for our customers in terms of the new design that they will receive then, and secondly, the speed at which the new front end is dramatically better than the current front end, and the second thing, which is from a development perspective, it allows us to be way quicker with developments and to modularize the front end with components. The second thing is improving the core workflows, right? In Provet Cloud, right, over the years, we've grown by adding a lot of different features.
Now we have a huge amount of features, which, and that's one of the reasons that a lot of the enterprise customers like Provet Cloud, but we want to focus on refining those features, making sure that the core most common workflows are very, very efficient and that we provide great information so that to enable our users to provide great care, and the last but not least is enterprise functionality. We're continuously adding improvements for how enterprise customers that have many different clinics can be able to manage all of their locations on one platform. Lastly, profitability has improved as we're growing revenues faster than costs, and particularly we're improving onboarding profitability. Now looking year- over- year again, we grew 35.4% in the last 12 months. EUR 1.8 million came from new customers. EUR 5.4 million came from net upsell.
As I reminded before, CVS post-pilot rollout is included there, and we had a churn of EUR 0.9 million, so churn is around 4.8%, right? This equates to a net retention rate of about 125%. In those numbers, we also have included the Provet Win and VetServe product churn. If we excluded those, it'd be around 2.5%. Now looking quarter- over- quarter, we grew 4.1% quarter- over- quarter. The net upsell was driven primarily by our pool user growth, and the new customer acquisition accounted for around 39% of the growth. From a profitability perspective, we have been able to improve profitability from EUR -400,000 roughly to EUR +400,000, which is an EUR 800,000 improvement, which was driven by growth, right? Recurring revenue growth, which added EUR 1.6 million. Improvements in profitability of implementation, right? EUR 0.3 million.
Despite that, we've also invested in people tools to be able to support that growth. We've invested EUR 1 million. Now onto therapy. On therapy, we've been focused our development efforts on building our unified platform, which was based on the EasyPractice platform to meet the needs of Norwegian therapists and enable us to upgrade Aspit customers. To date, we've migrated 60 customers, users of 7,600 roughly, and no migrated customers have churned. The feedback is very good on the new platform. Our strategy is to target users based on the feature that they use, and we are currently in the process of piloting the Norwegian HealthNet, HealthVault, and DigiCare in Q4 2024, which would unlock a much bigger pool of users to be able to migrate. The amazing thing about this migration is that it can be almost fully automated, right?
There's no people involved in training because the system is intuitive. Onboarding is almost fully automated, and so is data migration. They've done a real good job in terms of smoothing out that process. ARR growth year- over- year was 9.3%. This is short of the 10% plus target that we have, and it's due to the higher churn and downsell as well as the delayed price increase for EasyPractice. Our booking portal launch in Finland has been a success. We have over 1,000 therapist profiles now on Nordhealth.fi, and patients have made over 3,000 bookings. The next step, which we will be starting in late November, will be to substitute the current online booking of Diarium onto the new booking portal. We're looking forward to that UX/UI improvement. Now looking at how we grew on the therapy side.
In Q3 2023, we started at EUR 14.4 million, and we added 1.1 million new customers. The majority of these new customers actually came from self-service as well, which is one of the unique things about this business where you can have a self-service sales funnel or marketing funnel to the brand. Then we added EUR 1.4 million in net upsell, but our churn was quite low. So it was quite high, which was 7.9% or EUR 1.1 million. But it would be 5.9% if we excluded this loss of an enterprise customer. Good to note, as I mentioned earlier, that there are no price increases in the last 24 months for EasyPractice, and we're aiming to change the pricing model in early 2025. Therapy quarter- over- quarter growth was roughly flat as new customer gains were offset by churn and net upsell.
Interesting to note though is that the churn is actually improving quarter- over- quarter. However, the net upsell was low, and this is because of the fact that we have been delayed on the migration, and as a result, we have provided discounts to some customers to be able to compensate them for that delay. Looking at profitability, we have decreased profitability by about EUR 200,000, and the rationale is that although recurring revenue growth has added around EUR 200,000, we've added EUR 400,000 of costs in product development mostly, but also a little bit in support as we have to now support two platforms, both the legacy platforms and the new platform, and the faster we migrate over that new platform, the better we can be from a security standpoint, from a user standpoint, so there's a big incentive for us to be able to simplify and migrate all those users. That's why we've been investing. Mari, over to the financial update.
Thank you, Charles. So let's go through the third quarter reported financials next. Our total revenues in the third quarter grew by 26.9% year- over- year from EUR 8.8 million- EUR 11.2 million. Reported recurring revenues have grown by 25.9% from EUR 8.2 million- EUR 10.4 million from the previous year. Share of recurring revenues of the total revenues have remained at the same level as in the previous year at around 93%. As already mentioned, the organic growth of our total revenues has been mainly due to our ability to grow recurring revenues significantly, with ARR growth at the end of the third quarter already exceeding the 2023 full year ARR growth.
The main driver for the growth has been the increase in recurring revenues, which were up by EUR 2.1 million from the previous year, where the growth was yet again mainly driven by veterinary cloud products. There is now less currency fluctuation in the Swedish and Norwegian krona, and there is no material impact from the effects on the result on year-over-year basis. As of today, our U.K. pounds denominated revenues have in fact exceeded our Norwegian krona denominated revenues, and already over 50% of our recurring revenues are denominated in a foreign currency. Weakening of any of the foreign currencies would have an impact on our reported revenues. Also, revenues from implementation projects were up by EUR 0.3 million, and this is in line with the growth in recurring revenues overall. Moving on to the adjusted EBITDA.
Our adjusted EBITDA improved from EUR 0.7 million- EUR 1.4 million year- over- year, and adjusted EBITDA margin improved from 7.8%- 12.5%. So we have yet again had an excellent quarter in terms of revenue and profitability, and also reaching positive EBITDA minus CapEx for a second quarter on a roll. As mentioned, increase in recurring revenue was driving profitability in the third quarter. That was up by EUR 2.1 million from the previous year. But with the growing revenues, we have also had increase on our cost base. And these cost increases relate mainly to headcount, as in particular Provet Cloud implementation and support teams have grown in order to ensure all of our ongoing and new implementations and migrations to Provet Cloud, as well as supporting all of our new and existing customers with high quality.
Also, we have been investing more in the EasyPractice product development, and we have also completed a senior management hire as the new therapy lead started in September. But we are committed to improving our profitability on a sustainable and long-term basis, but without compromising our ability to grow and win market share. And as such, we will continue to make investments to grow also going forward. Then, on to cash flow. We have improved our free cash flow by EUR 1.6 million year- over- year. And as we have mentioned before, our cash flow has seasonality due to our various invoicing cycles, and we will see some impact from changes to our invoicing from the biannual to monthly invoicing cycle if we compare cash flows on a year-over-year basis, and that we will have until the beginning of next year.
But the main driver for the improvement on our free cash flow, however, is the improvement in profitability, and we are steadily improving towards long-term positive free cash flow. But I remind you still that we will be seeing some fluctuation in our cash flows between quarters also going forward, especially during the first quarter due to our billing schedules, and we will not compromise our commitment in developing our products so that we will gain market share, which in turn will lead to long-term profitability of Nordhealth. So wherever needed, this may also impact our future cash flows. There has been very little change in our cash balance since the previous quarter. Cash equivalents and investments in total decreased from EUR 20.4 million to EUR 20 million during the quarter.
Of this EUR 20 million, EUR 15.4 million is invested in money market funds as at the end of September, and cash balance was EUR 4.6 million. We have EUR 43 million of goodwill on our balance sheet, and there's been no change to that since the previous quarter except for amortization. The EUR 13.2 million intangible assets consist almost entirely of capitalized development expenses, and we have recorded additions amounting to EUR 1.3 million during the quarter, and that also reflects our commitment to product development. The capitalization ratio on a year-to-date basis was 47%, which is not very aggressive. Our investments in product development are significantly higher than what has been capitalized. We have not had any material equity transactions during the third quarter, and our equity remains strong at EUR 76.5 million.
During the third quarter, we made a very small remaining share payout from our treasury shares under the performance share program that was launched in 2023. And in total, approximately 21,000 shares were transferred to the participants under the program, and leaving the company to still hold over 1.1 million shares in treasury. We have not obtained any external financing during the quarter, nor do we have any material earn-out liabilities remaining on our balance sheet, so no change there from the previous quarter either, and the detailed third quarter financials are included in the appendices.
Thanks, Mari, so to conclude, our PMS ARR, practice management software, right, which is based in veterinary and therapy business units, grew by 23.7% year- over- year if we use year-end 2023 currency rates. Our recurring revenue grew 21.7% year-to-date 2024 versus year-to-date 2023 using 2023 constant currency.
Our EBITDA minus CapEx was positive in Q2 and positive in Q3 2024. So on guidance, last quarter, we decided to drop EBITDA minus CapEx breakeven by Q1 2025 guidance, given that we've been able to reach that in both Q2 and Q3, and we want to provide ourselves flexibility to do what's right for the customer and also not be too conservative given the fluctuations that are caused by one-off implementations from enterprise customers. The second is that we are increasing our recurring revenue December 31st, 2023, constant currency growth guidance for 2024 versus 2023 from 15%-20% to 18%-23%. And we will provide 2025 guidance as part of the Q4 announcement.
Now, on the financial calendar, our Q4 2024 results presentations will be held on the 4th of March 2025, and you'll be able to find the full year financial calendar as well on our website, and there's a link attached. Thank you very much. Now, on to questions. What we'll do is that, feel free to raise your hand, or if you have other questions, feel free to just ask them in the chat, and I see we have one question in the chat. So I'll start with that one. I'll repeat the question first, and then I'll give an answer to the question either myself or Mari. The question was, how does the Vets4 Pets rollout plan look like? How much is there left of the agreed CVS rollout? So the CVS rollout was done mostly for small animal first opinion clinics.
We still have to roll out their referral hospitals and some equine hospitals as well as mixed practices. It's always tough to determine timing of those, right, because we are slightly at the mercy of these enterprises and their aides. Same thing with the Vets4 Pets rollouts. It will be very similar to what we did with CVS. There's an initial pilot phase, which should happen sometime early H1 2025. Thereafter, right, we will have a better idea of if any development is needed or further improvements for the rollout to happen, and based on that, the rollout will happen thereafter, right? It is hard to, again, judge when the rollout will happen exactly, given the fact that we cannot foresee the problems that will come up, if any.
That's one of the reasons that we decided to drop the Q1 guidance is because there's quite a lot of fluctuation, so it's quite hard quarter- over- quarter to be able to understand what is the exact timing of implementation. We've got a second question from, which is, when do you hope to complete the majority of the migrations to Provet and EasyPractice, and what is the potential cost savings when the migrations are completed? We'll start with Provet, and then we'll go to EasyPractice. On the Provet side, we still have four different platforms to migrate. We've got Sanimalis, which is in Norway. We have Provet Net in Finland, and we have VetVision in Denmark, and then we've got Vetera in the DACH region.
Our focus is to continuously migrate them over time and as efficiently as possible, but we are taking a long-term view and making sure it's the right time for our customers too, right, and so it's hard to give a precise date for when the migration will be completed for Provet, but in the Nordics, we're hoping that we will have everyone migrated in 2025 or latest 2026. In the DACH region, it's unclear yet when we want to have the migration. Interesting about Germany as well is there's a slight fear of cloud software, which is dissipating, but it still is a fear, and so server-based software is actually still something that people request. However, that is changing, and so we look forward to being able to improve the quality of software by launching Provet Cloud at some point in the DACH region.
On the EasyPractice side, we are currently migrating customers from Aspit Physica on CPAS to EasyPractice. This should probably take between another roughly 18-24 months. The potential for migration on Provet, probably it's hard to say, but it's at least EUR 1 million, and it's probably at least EUR 3 million on the EasyPractice side. The driver of these savings are one is the fact that we don't have to maintain two platforms. The second is that the number of support tickets per user is dramatically lower on the new platforms than on the legacy platforms. And three is that there's a lot of licenses required to operate these softwares, and those three are the main drivers of the cost savings as we migrate. The next question was, could you talk about developments in the non-Nordic markets? Any sales development in the U.S.?
So the U.S. and U.K. are key growth markets currently on the Vet side. We are progressing in the U.S. with talks with enterprises as well as on the SME side. And it's the same situation in the U.K. where we are progressing with talks with enterprises as well as growing the SME base. So we're very happy with the performance of the U.K., which has even surprised us, right, on the upside, and the U.S. market is continuing to develop quite well. Both have a positive IRR that meets our hurdle for when we look at the CAC investments in those markets. Next is how much of the year-over-year veterinary IRR growth comes from CVS versus other customers. We mentioned in the slides that a significant percentage of the upsell, if I go back to this slide, came from, it was primarily from CVS.
We do not like to comment specifically on specific customers, but it's the primary driver of this EUR 5.4 million. Next question, could you elaborate on the other opportunities you see with enterprise customers? Have you identified opportunities outside of the Nordics and U.K.? Our focus for enterprise customers is in the U.K., U.S., as well as in Iberia, where a lot of our Nordic customers have expanded to, which means in Italy, in Spain, and in Portugal where we launched recently. The majority of the market, though, and the growth will come from the U.K. and U.S., even though Iberia is a growing market in terms of the number and size of corporates; it's still quite much in its infancy when it comes to the level of corporatization. So the main opportunities I see for growth in user count that's important is in the U.K. and U.S.
That being said, we see significant opportunities as well for average revenue per user expansion as we continue upselling our current add-ons and develop new add-ons. And a final question we have is, how is the development of a solution tailored to U.S. market progressing? Do you still see opportunities for significant development in this market? So we are localized for the U.S. market, but localization is, it's a grayscale, right? There's not all localized to, and you can always add more features, better workflows, and more integration. So if we are localized in the U.S., we've got 100+ customers using our software every day in the U.S. So we are localized, but I think that the main, there are two main things we have to do in the U.S. in order to win.
One is the focus around upgrading our front end, improving our UX/UI to make sure that the most common workflows are flawless. That is a big, big driver because in the end, these markets, even in the big U.S. markets, reputation is really important. So I want to make sure our vets love our products and tell their friends about it because that's the main way that we've grown in the Nordics and every other market, right? The second thing is once we is to improve our marketing in the U.S. where we have to currently our name is not as well known as it should in the U.S. relative to U.K., for example. I really like working in the U.S. and U.K. because it raises the bar, and it's a more competitive, these are two more competitive markets.
However, that competitiveness drives us to achieve much tougher goals in terms of quality of UX, quality of UI, and performance and so on, and that raises the boats and the bar for everyone else in our European markets. The way we think about all these markets is I look at how much we spend CAC versus the return on that investment, and as long as it makes sense, we'll continue doing that, and making sense that we mentioned it's a 20%+ hurdle. Another question, do you want to comment on the payments module and the commercial sales development there? Yes, we have had very good success with our payment module, which is called Nordhealth Pay for the therapy side and Provet Pay for the veterinary side, which is powered by Adyen.
What we look at is the attachment rates are quite strong on the veterinary side, and we are continuously increasing the payment volume. We'll add some more information maybe in Q4 about that to give a bit more clarity. Good, let's see if there's any other questions. Nope, it seems I've answered all the questions. Thank you very much, everyone, for your time. I was really happy with the questions as well, so thanks for that. It makes it more entertaining. Have a wonderful quarter, and we look forward to coming back to you with our Q4 results in next year. Thank you very much.
Thank you, bye-bye.