With that, why don't we get started? Good morning, everyone. Thank you for taking the time to join us for our next presentation. We're very excited to have Medline here with us. For those of you who don't know me, I'm Glen Santangelo. I'm the analyst at Barclays that covers Medline. To my right is Jim Boyle, the CEO of the company. To his right, Mike Drazin, who's the CFO of the company, and Karen King heads the Investor Relations function that I think many of you may know. With that, you know, let me just say, I mean, congratulations to you guys for all that you've accomplished in the last sort of year. I mean, the biggest IPO of 2025. How exciting.
I mean, it's performed very well out of the gate, so, you know, congrats to you all on that success. It's been exciting to watch and as you just mentioning, a long time coming. I feel like covering the distributors for 25 years, I feel like we've been watching you guys in the shadow continuing to grow, and it's great to see it finally come to the public market. Congrats on all of that.
Thank you.
All right. Well, why don't we just sort of jump right into it? You know, since you are new, and I think probably most people here probably know you, but maybe not everybody does. I think it may be worth, Jim, just giving a minute or two on a thumbnail sketch on the business, you know, so people can maybe better understand Medline and sort of what differentiates the company from the competition.
Sure, yeah. Good morning. Good to see everyone. Medline is the largest vertically integrated medical surgical manufacturer and supply chain solution provider serving all points of care in healthcare. Our mission is to make healthcare run better. We do that by driving improved clinical, financial, and operational outcomes. The number one way we drive value to our customers is through the depth and breadth of our brand. We make 190,000 Medline Brand products. The first 30 years of the company, we were solely a manufacturer of medical supplies. We didn't get into primary distribution until 1996. I like to say we're a manufacturer that distributes. We're not a distributor trying to be a manufacturer. I mean, at the core DNA of who the company is, a manufacturer first.
That's where we drive most of the value to our customers. We guarantee savings on the brand, it's where we drive most of the income to the business. We are also the largest supply chain solutions provider in healthcare today. We have 29 million sq ft of distribution space. We own our fleet of over 2,000 trucks. We employ our drivers. We have $4.5 billion of inventory on hand that drives 98%-99% fill rates, which is best in class in healthcare. From a clinical solutions perspective, our job is to help our customers deliver better patient outcomes. How do we work with them in those never event situations? Think about hospital-acquired infections, hospital-acquired conditions.
We deploy our clinicians, along with intelligent design products to help make sure the patient is leaving better than when they came in. We do that in a pretty robust fashion. The organization is. We're 59 years old. We have 59 years of consecutive growth, 18% CAGR since day one. I've been here since 1996. When I started, the company was roughly $400 million. It's been an amazing journey. We finished last year at $28 and a half billion. It's been a pretty cool business to be a part of.
That's excellent. Mike, maybe I'll shift it to you, given that the company just reported its first quarter as a publicly traded company and gave your initial guide for fiscal 2026. Maybe just give a quick financial thumbnail, talk about 4Q, talk about the guidance, and then we can sort of dive right into it.
Revenues for the fourth quarter were strong. We generated revenues of $7.8 billion, up almost 15% year-over-year. Keep in mind that there's one extra day in the quarter, so adjusted for days, we still performed well with growth of 13%. Adjusted EBITDA, about $805 million. That's roughly flat year-on-year, but you have to take into consideration the fact that we had over $140 million of tariff headwinds that impacted us in the fourth quarter alone. Adjusting for that tariff headwind, we actually were really solid earnings growth. From a signings perspective for the year, we signed $2.4 billion of new customer signings. That's well above our billion-dollar goal for the year.
Really proud of our signings and the share gains that we're taking in the marketplace. From the overall guidance perspective as it relates to 2026, we're projecting organic sales growth of 8%-9% year-over-year, and our EBITDA, Adjusted EBITDA will be $3.5 billion-$3.6 billion for next year.
Okay, excellent. Maybe that's a good segue into where I wanted to start. I mean, the growth outlook for fiscal 2026, very impressive, and that's augmented by the $2.4 billion in new signings, which is much above sort of your annualized target. Jim, maybe a good place to start is talking about what sort of drove that? I mean, clearly the company has a natural competitive advantage being able to serve all points of care, but at the same time, we're seeing some shift in the competitive landscape a little bit. I mean, people here have been living with Owens & Minor for the last kinda couple decades. McKesson's made some recent announcements on maybe divesting, not maybe, actually divesting their medical business.
Just maybe give us an assessment for you, the competitive advantages you have on the supply chain side versus a shifting competitive landscape that's maybe driving the share shift, and help us think about the durability of these trends that we're seeing.
Yeah. First, I'd say we might be the only company that wants to be in the business we're in, right? If you just look what's happening in the landscape. We commit to $1 billion of prime vendor signings every year. That's what we believe we can control. That's what we believe is gonna become available in the marketplace. That's kind of our goal that we think we can manage, and then we take advantage of those market conditions that are in place. You mentioned one. Customers are concerned about long-term viability and sustainability of some of the competitors in the marketplace, and they look at us as a resilient, sustainable supply chain provider that can get the right product to the right place at the right time, every time. That's one.
Two, consumers are concerned about cuts in the Affordable Care Act, the OBBBA, lack of reimbursement, and in times of financial crisis or financial strife, we tend to do better because we are the value player in the marketplace. That customer yesterday that was not willing to listen, all of a sudden doesn't have a choice but to listen because they need to drive value today, to really remain financially viable on a go-forward basis, and so we're winning because of that. Third, when you think about how we handled the tariff situation, it was vastly different than the rest of the market. We did not raise a single price until August first. Instead, we chose to kind of wait and actually get to a normalized run rate of what we thought reality was.
We don't react in times of crisis and chaos. If you remember earlier last year, tariffs went from 30% to 145% in China. We were like, "This is not real. We're gonna wait until what we believe will be a normalized run rate. We're gonna understand what reality is. We're gonna focus on internal mitigation efforts of what we can do to mitigate first, and then we're gonna focus on educating the customers on what's happening, why is it happening, and how are we working to actually solve some of the problems." First and foremost, we didn't push price increases till August. That opened doors that historically had been closed. There's many customers who are having kinda challenges, if you will, from a service level perspective.
You can't take care of patients if you have 85% fill rates. When that happens, we tend to win because we have the 99% fill rate service level. Then finally, consolidation in healthcare is speeding up. 90% of the deals we signed last year in acute affiliated were for all classes of trade they own. We are the only supply chain solution provider that serves all points of care, meaning home health, hospice, nursing home, physician office. Anywhere a consumer or patients needs access to medical supplies, Medline has built a solution for that. I mentioned on the earnings call a large faith-based health system that had five distributors across their physician office, their home health, their acute facilities, their lab and diagnostics.
The way they put the RFP to marketplace is they would only accept bids from an organization that could serve every single care setting that they own. We are the only player that can do that. That created an acceleration as well. All the tailwinds I just mentioned are still available in 2026. The $1 billion we think we can control, we're gonna target that, and we're gonna take advantage of those market conditions that I just described.
You know, Jim, you know, you talk about sort of the supply chain efficiency and the advantages that you have and the fill rate advantages that you have. I mean, I think sitting in our seat, you know, working on our Excel models, it's very hard for us to appreciate all the technology investments that, you know, your company has made probably relative to the competition. Could you maybe just touch on that for a minute? I mean, the robotic technology, the Symbotic technology for bulk packaging, the AI-powered solutions you have at the customer sites. Like, I think that kinda gets lost on all of us here.
Yeah.
You know, in our day-to-day analytical work, it really makes a difference and is translating into customer wins. Maybe just, you know, 30 seconds on that advantage that you have.
Yeah. We were the first installation of a robotic technology called AutoStore. We installed our first installation 15 years ago. Today, we have 2,100 robots across our network. It leverages AI automation and robots to increase throughput, quality, and value for our customers. It decreases the labor burden, it decreases the footprint in the building, so it gives you excess capacity in your existing network. It's been an extremely successful throughput for less than case. Think about not pallet goods, but either each's or boxes, which 70% of our lines are less than case. It decreases the labor to pick that by about 75%, so you're decreasing cost, increases the throughput by 2x, and decreases the footprint in the building by about 66%. Think about taking your existing asset infrastructure and getting 66% capacity back.
That decreases your need to add additional buildings, allows you to get more from your existing asset infrastructure and push it through, and do it in a much more efficient, effective way. You mentioned Symbotic. Symbotic is a new technology. We're about to do our first pilot. Walmart has a pretty robust installation of it, but it does the same thing that AutoStore does for less than case for bulk picking. In a warehouse, the largest real estate owner is bulk picking pallet goods. One of the challenges I gave our head of supply chain is. How do we shrink the internal footprint in our 29 million sq ft and make it act like and perform like 32 million sq ft without adding an additional building? What you do is you shrink the internal footprint.
Symbotic will do the same thing for pallet goods, leveraging AI, robotic technology, reduce labor by about 50% and actually increase capacity in a building roughly 40%, which we think is gonna be pretty amazing. Decrease in G&A, increasing throughput, decreasing labor burden, especially with the labor-challenging environment we have in really the warehouse space. This is a great way to create a job that a warehouse worker wants to be there for. Then finally, you mentioned the AI kinda Empower program that we're launching for our customers, where we're partnering with Microsoft to build a technology that will completely change the dynamics of how both demand replenishment and really cycle counts happen in healthcare. There'll be a camera in the room in the future.
The brain of that camera will be Copilot. It will decrement the inventory. It'll create both demand and replenishment signals. We have real-time visibility to total inventory on hand. It'll change really the footprint of how caregivers have access to goods to bring it closer to the patient. We'll have real-time data to understand kinda what's happening in the environment. How do we create channel optimization? How do we streamline standardization? From raw materials all the way to that supply room, we'll be able to predict challenges and get in front of a challenge. We'll say, "Hey, there's a hurricane going through Asheville, North Carolina. We might have some issues with fluids. We should probably do some backup ordering from one of the competitors," so we get in front of any supply chain challenges.
We're pretty excited about it.
Hey, Jim, in your initial statement, you were sort of talking about the fact that Medline is a manufacturer and then a distributor. The Medline brand gets so much attention on the street, and I think it's obviously because maybe the margin differential on the Medline brand is significantly higher than the third-party products that you distribute. Can you just remind everyone where you are in terms of penetration? What maybe the goals and aspirations could be? Within that context, you got the $2.4 billion of new signings. Could you talk about when you bring new customers on, maybe how you grow that Medline brand product within that new sort of customer?
Yeah. In a traditional acute care facility, up to 60% of their medical surgical budget has a Medline brand equivalent that we can convert to our brand. It drives significant value to our customer. Day one, when we sign a new prime vendor deal, we take it from a competitor. 90% of that product is in other people's products because the competitive landscape distributes about $1.2 billion of our brand through their channel. 10% is already in our brand. In the lifecycle of a deal, in the first year, we normally double the penetration rate from 10% to 20%. Over the life of the deal, we aspire to convert 3%-4% additional conversions to our brand. That is something we learned through many years of trials and tribulations.
Sometimes you go too fast, the pace of change can be challenging for the clinical team. When you go too slow, you don't drive incremental value at a pace of change that actually yields the savings value they need. 10%, so doubling the penetration the first year and increasing 3%-4% the following years drives incremental value on a consistent basis. We've worked with our customers to build a playbook that we're all aligned on. This quarter, we're gonna do exam gloves and underpads. This quarter, we're gonna do custom trays and drapes and gowns. It's built in a way that always drives incremental value, so you never get to that, "What have you done for me lately?" relationship with your customer.
In a non-acute setting, in skilled nursing facilities and nursing homes, up to 80% of what they buy is in our brand. It's mainly incontinence, DME, advanced wound care, and enterals and feedings. We happen to be market leaders in all of those, and that convert and curve happens much, much faster. Within the first 90 days of signing the deal, it's all Medline brand. And that's something we take advantage of, both from a value prop to our customers and a margin gain. When you compare the margin profile, it's 5% EBITDA margins on the supply chain solutions business and 24% on Medline brand. Every time you flip it over the edge, you're going margin extremely high, if you will.
What's interesting is you're also creating dilution in your revenue because you're saving 5%-10% every single time. It's kind of an earnings increase and a revenue decrease.
Hey, Mike, can you talk about the impact that has on the margin and as a natural sort of tailwind as that Medline brand increases?
If you think about the overall business, right? The total EBITDA margins are in the 12% range overall. If we sign a new prime vendor customer, that margin percent is under pressure obviously because we're signing it at 5% margins, 90% of it at 5% margins. To Jim's point, over time, as we convert to Medline Brand, it grows our overall margin of the business. The reality is that we drive margin improvement and margin dollar growth. That's really what we're focused on. We focus our business on growing earnings at or greater than sales over time, and we do that by leveraging our sourcing relationships, leveraging our manufacturing footprint, driving growth in our overall sales volumes, and ultimately delivering operating leverage to ourselves.
Hey, Mike, maybe just sticking with you for a second. Investors have become very concerned about the macro all of a sudden, right? Heading into 2026, I think there was a view that the consumer was strengthening due to the anticipated tax refunds. Then obviously, you know, the AI sort of movement has sort of manifested itself in some corporate layoffs, and so people are sort of worried about things on the utilization front. Now, let's put the conflict in yet another Middle Eastern conflict in yet another basket to sort of damage sentiment. On the most recent call, I think you sort of talked about a moderate slowdown in utilization. You know, does all the sort of confluence of events sort of impact your thinking at all as we sit here in sort of 1Q?
Maybe could you just elaborate a little bit?
Yeah.
On those comments you made on the conference call?
Yeah. When we gave our organic growth guide of 8%-9% for the year, which we feel is obviously very strong, we did highlight the fact that if you think about our overall model, our algorithm's very simple. We generate both new signings, new customer signings that generates revenue, plus our same-store sales growth. The combination of the two leads to strong organic growth. On the same-store sales side, we've seen really solid growth in 2025, driven by the demand levels in our customers, both from utilization perspective and procedure volumes. While we expect that to remain strong, we do expect it to moderate a bit. If you look at what our customers are saying, and we talk to our customers every day, they're telling us that they expect to see some moderation in that because of the ACA reforms, because of the OBBBA.
If you look at the enrollment levels in the ACA, now it's a little bit down from where it was previously. We are expecting some moderation, albeit still strong overall same-store sales growth.
Okay, while we're on the topic of financials, can we talk about the tariff impact? Could you just remind people how much that impacted you in 2025 and then 2026, so we can think about the year-over-year impact?
I always say it wouldn't be a meeting if we didn't talk about tariffs, right? Tariffs for us have been a headwind, as we all talked about. The overall impact to the business is $490 million in totality. We saw $290 million of impact in 2025, and we expect an incremental $200 million in 2026. Now, that is based upon the old tariff regime. That is not based upon the Supreme Court ruling that recently announced that the IEEPA tariffs are not valid. We are holding our guidance for now as we continue to evaluate what's gonna happen in the future. As we all know, they put Section 122s in place at 10%, and those only can last about 150 days.
We expect at the end of that, they'll put out 232s and 301s, which we also expect to be back to where we were today previously. Ultimately, we are kind of maintaining our guidance as being net neutral for the year. Now we're. As Jim mentioned this earlier, we are a company that does not react in times of crisis. We'll continue to study and evaluate the situation, do what's best for our customers first, and then share with you our overall impact to our business.
Jim, maybe the natural follow-up. Are you having any conversation with customers over the Supreme Court decision? I mean, are they expecting any sort of refunds back? Are you expecting any refunds back, or you think you sort of take a wait and see approach before making any next moves? Like, how do you think about the evolution of what we've seen here in the last sort of 60 days?
Yeah. Well, first off, there has to be a refund in order to give anything back to anyone.
Yeah.
Let's see if that actually happens, right? No, we'll see. We're gonna be in line with everyone else to see if that does. The truth of the matter is we are having conversations. To Mike's point, we think what's gonna happen with Sections 232 and 301, you're gonna end up net neutral with what the administration wants is to get back to the same revenue that we're generating. We don't think there's gonna be much of a change. We are having conversations with our customers. What's interesting about the way Medline had it, the vast majority of the tariffs we either mitigated or we absorbed. We had a modest increase we pushed through on 8/1.
If we had to give some kind of refund, which if we got a refund, we would give a refund back to our customers. It would be small relative scale to the macro number. It'd be an overall net positive from a reimbursement perspective and from an income perspective. If that comes to fruition, it'll be good for our customers, it'll be good for us. If is the biggest number, the biggest word in that.
Yeah. Okay. Can we maybe talk about some of your other businesses that maybe get less attention? The labs and diagnostics business, right, maybe flies under the radar screen over $1 billion in revenues now. I mean, you know, grew 9% last year. I mean, do you think we on The Street should be paying more attention to that? I mean, I feel like we don't talk about that enough. I mean, is that something or anything else like that on your radar screen that you'd like to sort of highlight or?
Yeah. I think of the new markets we're in, this is the market I'm most excited. It's a $25 billion market that we do $1 billion in, and the market dynamics are changing. It's a business we've been in for about 10 years. Over the last five years, we started really earning our stripes. Now, players or customers see us as a player in the game. What's also happened is it used to medical surgical distribution, so the medical facilities, physician office, surgery center, home health hospice, acute, was under one supply chain leader, and lab was under someone else. Now they're actually pulling the lab supply chain under the same supply chain leader and going back to the continuum of care. They're looking for one source of truth for everything they actually manage.
That's a tailwind for Medline because we're the only ones that can do that. That's what happened with a large healthcare system I mentioned on the earnings call. They actually brought lab under the supply chain leader, and she included that in the RFP. That's one. Two, the wheels on the truck that deliver medical surgical supplies are the exact same wheels on the truck that deliver lab supplies. The incremental cost of distribution to us and the customer is almost zero. Our ability to drive cost savings and value to the customer from a, from a supply chain is pretty robust as compared to the competition. Three, when you look at our supply chain, the robustness, the customization that we can actually deliver is not even close to what the current lab distributors do.
We can deliver refrigerated supplies in a differentiated manner. We can deliver their consumables in less than case, which is different than their current provider. The experience they get is completely different. Then finally, I would tell you that 30% of the lab and diagnostics today is convertible to Medline brands. We're doing the same playbook we did in Med Surg, but we're offering the Medline brand at a value, offering them a more robust, less costly supply chain solution. We're taking share at a pretty decent pace, and last year was our largest year ever of lab presence.
Jim, just to follow up on that, I mean, the company is starting to stretch its core competency a little bit, and, you know, you're starting to dabble in animal health, you're starting to dabble in dental. I feel like we, on The Street, we've sort of seen this a couple times, right? Henry Schein aggregated dental, medical, animal health. You know, Covetrus was in the animal health business, now is kinda getting out. Henry Schein sorta, you know, got out of the animal health business. How do you think about the synergies between these businesses, or is that something that the company's trying to better understand? Maybe the follow-up question to that is because we're starting to run low on time. The international segment is something that you highlighted as well.
That feels like yet another big investment that kinda needs to be made. How do we think about you stretching your core competencies into these other areas and geographies?
We're not actually merging animal health and dental to your point, but they're separate entities. Animal health for Medline, we have no interest in being a distributor. We don't wanna be a dog food flea collar distributor. That's not. We have no aspirations of that. What we wanna sell is medical products into that space. It's a $4 billion market. Same exam gloves used in a physician office are the same exam gloves they use in a vet office, the same gauze, same tongue depressors. Think about that as a brand business only, where we're leveraging MWI, Covetrus, and VetCor for access through a distribution channel, but our brand stands on its own. Think about it as a brand business.
It's a $4 billion TAM that is growing every day as we enter into new products that look and feel just like the medical surgical business. Brand alone. Dental looks and feels potentially no different than physician office. I don't wanna be a distributor only. I wanna be a manufacturer that distributes. We bought Sinclair Dental in the Canadian market to test it, kind of like a Petri dish. What our 28 Medline Brands business are creating Medline Brand alternatives in the dental space. We now have Medline Brand versions of blades, Medline Brand toothpaste, Medline Brand floss, Medline. Think about all the items in the dental space. Can we do the same playbook we've done in traditional med-surg in healthcare?
I can tell you we're pretty optimistic that we're significantly outperforming the deal model, and it's looking like something we think we can deploy in the States that won't be dilutive to our earnings because it'll look very, very similar to a physician office in the States. International is about $1.8 billion, about 7% of our total revenue. It's a $200 billion TAM. 85% of that business is either in Canada or in Europe. We do have a LatAm and an Asia Pac business, but they're pretty small. If you go to Canada, we're on the verge of signing our first, this doesn't exist. The prime vendor model doesn't exist in Canada.
We're on the verge of signing the first prime vendor model in the Canadian market, which will completely change the dynamics of that market and create an acceleration in growth very, very similar to what happened in the U.S. We're pretty excited about that. You think about Europe, only 1/3 of our products have CE marks, and most of what we're selling in the European market is in the surgical markets, the custom trays, drapes and gowns, surgical gloves, and is not a distribution business. Prime vendor model doesn't exist in Europe. Think about it as a brand business. Our leader is currently working on expanding the CE mark. We're expanding the breadth of our sales forces currently calling on the acute care market.
She's also building a bag to call on the non-acute market, going back to what we talked about earlier in incontinence, advanced wound care, DME, and the enterals and feedings. If we can get CE marks on that and build a sales team, we can grow for double digits for many years to come, and it's a business we're pretty excited about.
Hey, Mike, maybe just a couple of quick financial questions before we wrap. Just to remind everyone, the revenue guidance 8%-9% this year, and EBITDA will be slightly up in 2026 versus 2025, but that mainly reflects the tariff impact. Could you just remind people, you highlighted on the conference call a couple things that could push us above, below, within that range, and I think you cited utilization, implementation of sort of new customer wins. How do you think about, you know, flexing within that range?
Our organic growth guide of 8%-9% is can be within that range, can be driven by a couple things. One, it could be driven by, again, the same-store sales growth if we see higher demand or lower demand. Two, would be based upon, timing of implementations of existing signings, or it could be timing of implementations of new signings that we sign in 2026. From an EBITDA perspective, things that can move the needle, one way or another could be obviously the tariff impact overall, what happens with tariffs. It could also be, certain other inflationary matters as we see happening in the marketplace today, as well as our ability to continue to generate operating leverage in our business.
Anything you wanna call out with respect to the cadence in 2026?
Yeah. From a cadence perspective, the only thing I would call out is the tariffs. From a tariff perspective, we said we are calling out $200 million of tariff headwinds incremental to 2025. That incremental impact will be primarily showing up in the first half of the year and bleeding into the third quarter. By the end of the fourth quarter, which we should be having tariffs normalized into our base.
Well, listen, Jim and Mike, we're out of time, but I wanna push it back to you guys and give you guys the last word. I don't know if there's anything else that you were hoping to cover we didn't cover. Any message you wanna leave with the investors, anything you think is important to sort of share. I'll flip it back to you guys for the last word.
Yeah, the only thing. People ask me what keeps you up at night. What keeps me up at night is making sure we protect the culture that got us where we are. We have a healthy sense of paranoia. We recognize you have to treat existing customers as if they're more important than new customers because you can't grow if you don't retain your business. That's why we have a 99% fill rate. We're relentless customer focus. Every day we have to earn our spot on the team and earn the right to serve our customers. We have an extreme ownership and empowerment model in the company where every single human that has a job is 100% responsible for that and actually can elevate all the way to me. Me, Mike, and Karen are the only people that you will ever see.
The rest of the people are gonna be focused on growing the business. That's where we are, and thank you very much.
Well, Jim Boyle, Mike Drazin, and Karen King, thank you guys very much.
Yep. Thank you.
Congrats again on everything.
Thank you.