Good day, and welcome to the Integer Holdings Corporation third quarter 2022 earnings release conference call. Please note today's conference is being recorded. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question-and-answer session. If you would like to ask a question during this time, simply press star followed by the number one on your telephone keypad. If you would like to withdraw your question, press star followed by the number one again. Thank you. At this time, I will turn the conference over to Tony Borowicz, Senior Vice President of Investor Relations. Mr. Borowicz, you may begin your conference.
Good morning, everyone. Thank you for joining us, and welcome to Integer's third quarter 2022 earnings conference call. With me today are Joe Dziedzic, President and Chief Executive Officer, and Jason Garland, Executive Vice President and Chief Financial Officer. As a reminder, the results and data we discuss today reflect the consolidated results of Integer for the periods indicated. During our call, we will discuss some Non-GAAP measures.
For a reconciliation of these Non-GAAP measures, please refer to the appendix of today's presentation, today's earnings press release, and the trending schedules which are available on our website at integer.net. Please note that today's presentation includes forward-looking statements. Please refer to the company's SEC filing for a discussion of the risk factors that could cause our actual results to differ materially. On today's call, Joe will provide his opening comments and an update on the execution of Integer's strategy. Jason will then review our adjusted financial results for the third quarter 2022, provide additional insight on our product line performance, and review our full year 2022 guidance. Joe will come back to provide his closing remarks, and then we'll open up the call for your questions. With that, I'll turn the call over to Joe.
Thank you, Tony, and thanks to everyone for joining the call today, especially the Integer associates who have continued to execute our strategy through these dynamic times. We thought it would be appropriate to start by providing an update on the supply chain challenges that we highlighted on our October fifth pre-announcement. Since that time, we have eliminated additional sales risk related to the two medical component suppliers because we have received all the material needed to meet our fourth quarter outlook.
For our non-medical products, we have line of sight to component supply from more consistent supplier performance and our dual sourcing strategy for critical components. We continue to intensify our management of the supply chain to reduce operational risk. We have increased the frequency and depth of managing supplier risk, including more frequent tracking, faster escalation of delays and shortages, and executive-level engagement with suppliers. We are also accelerating our proactive measures, including executing insourcing and dual sourcing strategies where appropriate. Also, our updated guidance includes an even more cautious risk adjustment based upon existing supplier performance. Integer's third quarter 2022 financial results were in line with the preliminary view that we released on October five.
Our third quarter sales grew 12% versus third quarter 2021, and adjusted EBITDA grew 5% year-over-year. Integer's 2022 financial outlook remains unchanged from our October five release, with 11%-13% year-over-year revenue growth and adjusted operating income of $180 million-$196 million. The next slide summarizes why the fundamentals of our growth strategy remain strong despite the sales push out caused by the recent supply chain challenges. Integer's growth strategy has not changed, and we are excited about our growth prospects. We are well-positioned in a recession-resilient industry where demand has returned to pre-COVID growth rates. Customers tell us that we are performing better than our competitors despite supply chain challenges, and we believe we will benefit from supplier consolidation trends.
We expect above-market revenue growth of 7%-9% in 2023 due to strong customer demand, a significant backlog, accretive growth from the Oscor and Aran acquisitions, and new product introductions concentrated in electrophysiology, structural heart, and neuromodulation. We expect margin expansion in 2023 from volume leverage, higher prices, and the $8 million in annualized savings from eliminating SG&A positions. Our direct labor environment is improving. We reduced turnover by approximately 17% in the United States and 9% in Ireland during the third quarter. We have achieved our targeted direct labor levels in most of our sites and remain focused on fully training our workforce to operate more efficiently and fulfill the strong demand from customers. Given this progress, we anticipate that a fully staffed and trained workforce will deliver productivity in our operations in 2023 and drive our expected margin expansion. I'll now hand the call over to Jason.
Thanks, Joe. Good morning, and thank you again for joining our call. I'll provide more details on our third quarter 2022 adjusted financial results, summarize our product line sales trends, and conclude with our 2022 outlook. Integer's third quarter results were consistent with our October five preliminary view. At $343 million, our third quarter sales grew 12% year-over-year, with currency being about 100 basis points drag, mostly driven by the euro. Excluding acquisitions and currency, we are up 6% year-over-year.
As a reminder, our third quarter sales would have been approximately $15 million higher if not for the deteriorating deliveries performance and missed commitments from primarily three suppliers. Our adjusted EBITDA in the quarter was $63 million, up $3 million compared to last year, which is an increase of 5%. Adjusted operating income was $46 million, slightly below third quarter 2021. The supplier delays reduced adjusted operating income by approximately $12 million, with $8 million of that driven by the lower sales volume and $4 million from higher manufacturing costs.
Manufacturing costs are higher due to increased wages, freight, and adding 5% more direct labor in the third quarter in an effort to deliver the high end of sales guidance we had provided in July. As an offset to higher manufacturing costs and cost of goods sold, we saw lower SG&A expense in the third quarter from a year-to-date benefit to align incentive compensation with our updated guidance. That said, we expect the fourth quarter SG&A to be higher than the third quarter and similar to second quarter levels. Though the fourth quarter includes a benefit from the annualized savings from our restructuring actions, our fourth quarter is typically the highest quarterly SG&A spend in the year as it includes end-of-year costs and services.
With adjusted net income at $32 million, we delivered $0.95 of adjusted diluted earnings per share, down $0.10 from the third quarter of 2021. I'll give some more color on our adjusted net income on the following slide. The third quarter adjusted net income decreased $3 million compared to the third quarter of 2021, primarily driven by higher interest expenses, partially offset by a $1 million benefit from the currency due to the stronger dollar. The $3 million in higher interest expenses is impacted by the increasing U.S. interest rate environment, but also from an increase in our principal amount of debt outstanding being more than $300 million higher than last year due to the Oscor and Aran acquisitions.
Although approximately 11% of our debt is fixed through an interest rate swap, the rest moves with LIBOR, and therefore, we expect interest expense to continue to increase through the rest of the year. That said, we subscribe to the view that floating with the market produces the best outcome over the long term. Our adjusted effective tax rate was 13.6% in the third quarter of 2022, compared to 13% in the third quarter of 2021, creating a year-over-year headwind of roughly $0.01 per share. The third quarter 2022 rate benefited from discrete items in the quarter. We project an increase in the fourth quarter rate and a total year adjusted effective tax rate of 15.5%-17%.
In the third quarter of 2022, we generated $28 million in cash flow from operating activities, up 47% sequentially from the second quarter. Inventory has grown $55 million through the first three quarters, with $16 million being added in the third quarter, with the single biggest driver being the products that we did not ship because of the supplier delays. We expect inventory to reduce in the fourth quarter. Our $22 million of free cash flow, third quarter year-to-date reflects the impact of the $55 million of inventory increase and the $42 million of year-to-date CapEx spend as we continue organic investments in capabilities and capacity for growth. We still expect to spend between $65 million and $75 million in capital expenditures in 2022.
With our net total debt balance peaking in the second quarter following the acquisition of Aran Biomedical, we decreased it by $13 million since that time to $925 million at the end of the third quarter. Our debt leverage at the end of the third quarter was 3.8 x trailing four-quarter adjusted EBITDA, down slightly from the second quarter. Although we are still temporarily above our target range of 2.5-3.5 x in the third quarter of 2022 due to the Aran acquisition, we expect to improve our leverage again in the fourth quarter and expect to be between 3.4 and 3.7 x leverage. We'll now transition to a discussion of our product line sales.
Trailing four-quarter reported sales grew 12% in the third quarter of 2022, with strong growth across all product lines. Beginning with our first product line, Cardio & Vascular sales were up 14% in the third quarter compared to the third quarter of 2021. As we have previously discussed, we continue to face a challenging supply chain environment that ultimately caused sales to be pushed out of the quarter. Despite this impact, we grew double digit on strong demand and backlog in the high-growth electrophysiology and structural heart markets. We have also seen strong performance from both the Oscor and Aran acquisitions, which continue to accelerate our Cardio & Vascular sales growth. Trailing four-quarter sales continued strong year-over-year growth, up 18%.
We expect this momentum to continue throughout the year. Moving to Cardiac Rhythm Management & Neuromodulation, sales grew 8% in the third quarter, with sales growth primarily from our Oscor acquisition. This includes the impact of the supplier delays that affected our neuromodulation products, as previously discussed. Trailing fourth quarter sales posted year-over-year growth of 7%. In our Advanced Surgical, Orthopedics, and Portable Medical product line, our third quarter sales were up 17%, driven by the beginning of our multi-year portable medical exit plan as we work with our customers to provide the products they need to transition production. We also generated low double-digit growth in the Advanced Surgical and Orthopedics business in the third quarter. Trailing fourth quarter sales was roughly flat year-over-year. Finally, we will wrap up the product line discussion with Electrochem, our non-medical segment.
Third quarter sales increased 24%, driven by strong demand across the environmental, energy, and military markets, despite sales being lower than they could have been in the energy market due to supplier delays. Trailing fourth quarter sales grew 18% year-over-year, driven by the continued recovering energy market. We'll now transition to our updated expectations for 2022. The full year outlook is consistent with our October fifth update. Starting with sales, we are forecasting sales to be in the range of $1.35 billion-$1.38 billion, an increase of 11%-13% versus last year. This includes the noteworthy sales performance from our Oscor and Aran acquisitions.
On an organic basis, considering the $35 million sales delay, we expect sales to grow 4%-6% compared to 2021. As previously shared, our updated adjusted EBITDA and adjusted operating income forecast was impacted by approximately $25 million, with $17 million from lower sales volume due to the supplier delays and $8 million of higher manufacturing costs from increased wages, freight, and additional direct labor. With these impacts, we expect 2022 adjusted EBITDA to be between $244 million-$260 million, which is flat to 7% year-over-year growth. We expect our 2022 adjusted operating income to be between $180 million-$196 million, reflecting a decline of 4% to a growth of 5%.
Adjusted EPS is expected to be between $3.57-$3.97. Our adjusted EPS outlook includes the impact of the delayed sales, higher manufacturing costs, higher interest expense, and our latest view of adjusted effective tax rate, which, as mentioned earlier, is projected to be between 15.5%-17% for the year. We now expect cash flow from operations between $110 million-$125 million. This estimate is inclusive of the inventory investment we have made through the third quarter as we continue to execute strong demand and the impact of supplier delayed shipments. It also includes our latest adjusted EBITDA outlook. Consistent with our strategy, we are maintaining our outlook on capital expenditures as we have continued to invest organically in the business to drive growth.
We still expect to spend between $65 million-$75 million of CapEx and now expect to generate free cash flow between $40 million-$55 million. Most of the free cash flow we expect to generate will be used to reduce net total debt by $35 million-$50 million. We expect to end the year with our leverage ratio between 3.4 and 3.7 x adjusted EBITDA, close to within our target range of 2.5-3.5 x. With that, I'll turn the call back to Joe. Thank you.
Thanks, Jason. We have intensified our supply chain management to deliver for our customers and patients. Our financial outlook is unchanged, and we expect to end the year with 11%-13% year-over-year sales growth despite supply chain challenges. In 2023, we expect sales growth of 7%-9%, which is approximately 300 basis points faster than the markets we serve. We also expect margin expansion in 2023 from volume leverage, higher prices, and efficiencies from a more fully staffed and trained direct labor workforce. We remain focused on executing our strategy. We have our largest ever new product development pipeline. Customer demand is at an all-time high.
We have successfully added the direct labor needed to fulfill on this demand. We are positioned to deliver strong sales growth in 2023 with margin expansion. As we stabilize labor and supply chain, we remain confident in our ability to deliver on the financial objectives of our strategy to grow sales 200 basis points faster than the market, grow profit twice as fast as sales, and maintain debt leverage between 2.5 and 3.5 x adjusted EBITDA. Thank you for joining our call this morning. I will now turn the call back to our moderator for the Q&A portion of our call.
At this time, I would like to remind everyone in order to ask a question, press star then the number one on your telephone keypad. We'll pause for just a moment to compile the Q&A roster. Your first question comes from the line of Matthew Mishan with KeyBanc.
Good morning, Matt.
Matthew, your line is open.
Good morning. Sorry about that. I was on mute. I just first wanted to start off on margins, Joe. You guys have given the 7%-9% revenue growth for next year. Without giving initial guidance, just how should we think about some of the moving pieces of margins next year, like headwinds and tailwinds, and maybe some of the company's specific initiatives you guys are implementing at this point that should help improve?
Certainly. Thanks for the question, Matthew. As we look at 2023, we're confident we can expand margins. I will start with, you know, we're gonna go from this year and our prior years having priced down with customers to next year, it's going to be price increases. That's an immediate impact that changes the trajectory of a kind of a core element of what we've been doing the last five years. That'll be a positive. We've added significant direct labor this year, significantly more than we've been able to increase output. We are focused right now on training our workforce. We do not anticipate increasing our direct labor headcount in the fourth quarter.
We feel we have the level we need to run for some period of time into 2023, and our focus is on training the workforce to get the proficiency in the manufacturing operations to drive the efficiencies. We believe that's going to be a meaningful contributor to helping us. With 7%-9% sales, you get volume leverage on that direct labor that we do not anticipate needing to increase in the near term. We also get volume leverage on the overhead in the facilities and volume leverage on the operating costs, which we've already taken specific actions to lower our SG&A costs next year by an annualized $8 million. We implemented that at the end of the third quarter. We see those as positive trends.
We also have new products that are introducing and, you know, we all know new products, typically, that's the highest price you're gonna see in the marketplace, when you launch them. That's going to help also. We've got strong growth, and we continue to drive meaningful synergies in Oscor, the acquisition we did at the end of 2021, who are performing better than we expected this year. They're driving meaningful efficiencies, and the synergies with customers has been significant. We see significant growth and additional synergies there. Those are some of the very Integer-specific things that we expect to drive margin expansion next year. The supply chain environment remains challenging.
That's a fact, but I think we're all in the same boat, and you've seen that with most everyone's earnings announcements this quarter, the pressures there. You know, we feel that we're managing those effectively. We obviously had some gaps in the third quarter and we need to improve on those, and we have. We're getting much deeper with suppliers. We're escalating issues faster, and I'm personally engaging with the suppliers that are challenging, as are other leaders, other members of leadership team. We think there's some very specific Integer actions that we've taken that will ensure we expand margins next year and that we'll be able to manage in this continued volatile, difficult supply chain environment.
Is it fair to assume as a starting point for next year that you get back to your two to one, you know, op income growth to revenue growth? Or should we be a little bit more cautious to start the year given the supply chain environment?
We're not prepared to give that level of granularity for 2023. That's absolutely our goal as we look long term. We're confident when we get to a more stable labor and supply chain environment, we're confident that we can continue to grow profit twice as fast as sales. We're not ready to give 2023 guidance just yet, but we think we've taken some meaningful actions to ensure margin expansion. The price increases as opposed to decreases with the meaningful amounts of direct labor we've added this year. Our focus is on training them. We've increased inventory meaningfully, and now we believe we're gonna be able to start to reduce some of that inventory where we've built up maybe more safety stock than what we need. We do expect to be able to expand margins next year. We're just not ready right now to tell you what that guidance is gonna be. We'll provide that on our fourth quarter earnings call.
Okay. How should we be thinking about your $200 million-$250 million target for, you know, M&A on an annual basis? You know, that program was implemented, you know, before some of these supply chain issues, before, like, interest rates have risen. You know, how are you adapting that M&A program to the current environment?
Yeah. Great question, Matt. We continue to look at the opportunities that align with our strategy. We think we've been very transparent, and we are looking for tuck-ins. We are looking for acquisitions that expand our capabilities to enable us to offer a more vertically integrated solution to our customers in those higher growth end markets. We've been very targeted, very specific. We think the Oscor and Aran acquisitions are great examples where we've either added new and differentiated capability to further vertically integrate and serve our customers. We think Oscor is an expansion of what we already do that's in our wheelhouse, where we can generate significant synergies and offer more to our customers.
We continue to look at that. Obviously, we remain very committed to our 2.5-3.5 x leverage. That doesn't mean that when you do an acquisition, you might bump up into the high 3s. But we have a very near-term plan to get back within 2.5-3.5. We remain very active in looking at opportunities. We don't get to decide when a seller sells. If we were to incentivize them, that probably would require an above-market price. We're not doing that, but we remain very active and also very committed to our 2.5-3.5 x leverage. We think the results that we've been able to deliver with Oscor, and we think Aran will also demonstrate this over time. We think that demonstrates that our strategy and our ability to both acquire, integrate, and drive the synergies. We think we've demonstrated our capability there and feel that this is an important part of our strategy going forward. It's tuck-ins and it's within the framework of our leverage target.
Okay. I think it'd be helpful for investors to understand, you know, how you think about your exposure to neuromodulation. I mean, I'd probably guess like legacy Integer is more, was more focused obviously on spinal cord stimulation. It's, you know, some of the more areas that are growing faster are outside of that. How should we think about, you know, where you're exposed at this point?
Certainly. Today, our sales lean more towards the spinal cord stimulation, for sure. Our pipeline and our emerging customers lean much more towards those emerging therapies, whether it's sleep apnea or incontinence or treating epilepsy or cochlear applications or heart failure. There are a lot of non-spinal cord stimulation therapies that are in development that are part of our pipeline. Although spinal cord stimulation is getting some news today around reimbursements and around the growth rates, maybe it's mid-single digits instead of high single digits. Our pipeline is not only it includes spinal cord stimulation, of course, but it's also neuromodulation. Think about the pipeline is heavily weighted towards non-spinal cord stimulation.
Okay. This last one, you mentioned that you've secured the components and supplies, you know, to meet your guidance in the fourth quarter. I'm assuming like you're talking right at that midpoint of the guidance, given it-
Correct.
Million range. We'll see how the supply chain evolves from there, as far as the, you know, whether or not that's up or down.
That's absolutely correct, Matt. We put the products that we had the supply chain issues with and that we discussed during the pre-announce. We said, "Let's only include what we have physically on hand so that we de-risk those products on the medical side." We're confident on the non-medical, given the dual sourcing and given the performance of those suppliers. We've been working on ensuring that the pipeline of those products are flowing and committed for 2023 volumes, now that we've taken care of the fourth quarter for those, as well as the other suppliers. There's other suppliers we continue to work with as well to address the supply chain. You know, most of the issues when we talk to suppliers, it points back to labor.
You know, I can highlight in the U.S, our labor turnover improved by 17%, which is a positive, and I think that's some of the actions we've taken. We've heard that the labor environment, I wouldn't say that it's good, it still remains challenging, but it does show signs of improving. We also improved the labor turnover in other places around the company as well. We think we're hearing that with some of our suppliers, that they're also improving their ability to supply, and we think it's pointing to an improving labor environment in some places. It still remains very challenging. I think you've heard that across the board on earnings calls this quarter.
Okay. Thank you very much, Chris.
Thanks, Matt.
Your next question comes from the line of James Sidoti with Sidoti.
Hi. Good morning. Thanks for taking the question.
Good morning, Jim.
First thing, I think you said, organic growth was about 6% in the quarter. I just want to confirm that, Oscor and Aran sales are in that $18 million-$19 million range. Is that right?
From a growth rate, James?
I guess, what were Oscor and Aran sales in the quarter?
Yeah, we haven't shared all those on a quarterly basis, but yeah, the organic is 6% and so that would be the difference in that growth rate.
Yeah. Okay. All right. You know, looking at the annual guidance with just the fourth quarter left, it's a $0.40 range there. You know, what are the factors that get you to the high end of that?
Yeah. We are continuing to certainly manage the supply chain environment, and that has been the biggest variable for us, obviously, as we've looked at the impact in the third and the fourth quarter. We're certainly driving the team and the sites to deliver more. As we've talked about, the customer demand is strong. Inasmuch as we can you know continue to get the materials we need or more than maybe what we're expecting, that will deliver and feed a pipeline to help us to be able to deliver more on the high side of the sales. That's gonna be the biggest driver, Jim, to get on the high range.
Yeah, it sounds like you're confident the demand is there. You know, the biggest issue is being able to supply that demand, you know, to meet that demand. Is that correct?
Absolutely. All right. We've talked a fair amount about how strong that demand is, both in our backlog as well as certainly the conversations we're having with customers and forecasts that they're giving us. This is about having the material on hand and getting that through our shops out to our customers.
All right. Last one. You know, you didn't give an implicit gross margin guidance, but you know, you did indicate that sales and SG&A expense is gonna be up relative to the September quarter. It seems like you are expecting an improvement in gross margin in the fourth quarter compared to the third quarter. Is that because these labor issues have improved or suppliers have improved or you know, what's driving that improvement?
Yeah. Think about this. On the third quarter, most, you know, we dropped about 100 basis points right from the run rate over in the first half, and that was certainly impacted by the stranded labor we talked about, right? As we lost sales from our suppliers, we had stranded labor and then the other costs that we've talked about as well. In the fourth quarter as we get volume higher, we get the benefit of that leverage, and as well as continuing to really manage our costs the best we can. There's certainly, again, the environment out in manufacturing, but we believe that with the higher sales, we'll be able to absorb a bit of that.
To your point, the implicit guidance has us increasing in the fourth quarter.
Good. That was it for me. Thanks again for taking the questions.
Thanks, James.
Again, if you would like to ask a question, please press star, then the number one on your telephone keypad. There are no further questions at this time. I'll now turn the call back to Tony Borowicz for any closing remarks.
Great. That was quick. Thank you everyone for joining today's call. As always, a replay of this call is available on our website as well as the presentation that we just covered. Thank you again for your interest in Integer, and that does conclude today's call.
Thank you for participating. You may disconnect at this time.