Hi, everyone. This is Rachel Vatnsdal from the Life Science Tools & Diagnostics team. I'm joined by Stanley Bergman and Ronald N. South, CEO and CFO of Henry Schein. Today this session's gonna be 40 minutes. It's really gonna be more of a fireside chat style, so it's gonna be Q&A the entire time. For those of you listening online via the webcast, feel free to submit a question via the Q&A function. For those of you that are in person, feel free to raise a hand. We have mic runners throughout the room, so they will hand you a mic to ask a question. For that Stanley, if you could just kinda walk us through the story for those of us new to this. spend a few minutes talking about the business, how 2022 has gone so far, and how Henry Schein has come out of the pandemic a stronger company. Thank you, Rachel. It's good to be back here live. Been doing this for almost 30 years, and to see live people again is terrific. Henry Schein, we are the largest provider of products and related services to office-based healthcare practitioners. That's dentists, healthcare practitioners outside of the acute care setting, although today many hospitals own, or IDNs own our customers, essentially we're focused in the alternate care market. We provide practically every product that a practitioner may need, from consumables, to equipment, to pharmaceutical, to med-surg products, equipment, dental, medical. Huge part of the medical is diagnostics, various kinds of services. We're the largest provider of dental practice management services in the world, I believe. Of course, the practice management system is important, but really it's the electronic medical record which is very much customized to the needs of dentists, and the integration in an interoperable way between our software and devices and other related services. Of course, services such as management of billing, revenue cycle management, as it's called, demand generation tools, website management, and in recent years, cybersecurity services are all services that we provide. We're today quite a significant manufacturer of dental specialty products where we have our own brands. We do quite a bit of R&D in that space. We have a rapidly growing oral surgery business, which is the implants and the bone regeneration products. We have today a rapidly growing, and I believe significant endodontic business, brands, generics, and a small but rapidly growing orthodontic and aligner business that's wires and brackets and aligners. Our strategy, of course, is to help practitioners operate a more efficient practice so that our customers can provide better clinical care. That's what we do. For the smaller practitioners, we have field sales consultants that work with these practitioners in helping to optimize the practice from a profit point of view or efficiency point of view, but also from a clinical point of view, and that goes all the way up. We work with the largest DSOs in the United States and abroad, where we help these DSOs with their inventory management and other expense control procedures and management tools. Equipment service, by the way, is a key service that we offer. I believe today we are the largest provider, excuse me, of dental equipment in the world. More important, the service we have, I believe they are an outstanding clinical workflow, helping practitioners connect the clinical aspects of their practice to the practice management system. Rachel, I can go on and on talking, but you asked within your question, how did 2022 go? It's been a very good year for us, and what is very important in understanding Henry Schein's numbers is to take out the noise from PPE and test kits. We had significant sales in these products in 2020, 2021, and 2022. We provided specifics in our quarterly calls on the amount of sales related to these products. If you take these out, and of course we're in our quiet period now, but if you look at our numbers through the end of the third quarter, you will see pretty good growth in our business, excluding PPE and test kits. The strategy is to advance each of our businesses, our distribution, dental, medical, and our medical, by the way, is a rapidly growing business as well as our dental in many parts of the world. To make these businesses more efficient and much more user-friendly from a digital point of view, where we're investing significantly in digital capabilities to connect with our customers. Our goal is to advance our distribution businesses, our specialty businesses from a product point of view, and our services businesses, while at the same time, driving sales increase share of wallet between these businesses. We're able to provide customers that are buying from one side of the business with a very good deal on products that are coming out of another part of the business. This helps drive up our sales and our margin. I don't wanna monopolize the time because we have our CFO here, and Ron perhaps has something you would like to add. No, I do. I think you touched on a lot of the major points there, Stanley. I think that in 2022, we did face some headwinds with decreasing PPE revenues, decreasing COVID test kit revenues. The core business really grew well and helped keep us in a growth mode. I think that we haven't provided guidance on 2023 yet. We'll do that next month when we release our Q4 earnings. We did indicate in past communication that we do expect some of those headwinds to continue into 2023. There are some pricing headwinds with gloves, which is our primary product. When we talk about ppe the primary product there is gloves. There continues to be kind of a some market conditions that are driving down the prices of gloves, and we do expect that to continue for a while. Having said that, we were very happy with the growth that we're experiencing in our specialty products. We're really excited about the opportunities and the growth we're seeing with some of the software products that we're offering from our technology business. We go into 23 with some optimism. Great. Maybe just following up on that comment regarding 2022. During 3Q, you revised your guidance down to 1.5%-2.5% sales growth from that 3%-6% prior to reflect the strengthening of the US dollar and then lower PE sales. Can you walk through how much of that difference came from the PP&E versus the FX? Can you walk us through what you're seeing on PP&E that led you to that lower side of the expectations? I think for... In terms of FX, and that's kind of the easier one 'cause that's the math, right? I think that what our expectations then were that we would have about a 2.5-3 point headwind from FX, if I recall. The combined effect of PPE and COVID test kits would also be in that kinda 2-3 point range in terms of a headwind for us on revenue. That was being offset by some pricing favorability we got in the inflationary environment, as well as a little bit of volume growth. We also had the benefit of 2022 was a 53-week year for us. About every six or seven years, we have that 53rd week. 2022 was a 53rd week, and we estimate that that provides about 1 point of growth. We got a little bit of a tailwind there, as well as from the acquisitions. Our acquisitions, we probably ended up with about 1.5 points of acquisition growth when you those headwinds and tailwinds kinda largely offset and you end up with this little bit of incremental growth that comes from volumes and a little bit of market share. Helpful. You mentioned driving down the price of gloves. Could you just walk through, was that some certain competitor? Was it an online retailer like Amazon, or what really triggered some of that glove price decline, and how do you think about that pricing moving forward for the PPE? It's largely commodity based, right? What happened was, if you go back to 2019, which seems like centuries ago now, right? In 2019, we had PPE revenues of about $450 million. That's a round number, but about $450 million. Obviously we had no COVID test kit revenues in 2019. Glove pricing then was probably in the neighborhood of, call it $0.065 per unit. What happened with the pandemic was that there was a significant increase, and because of the demand, there was significant increases in costs of the gloves, which were largely imported. A lot of the gloves come from China, Vietnam, Malaysia. Those costs approached $0.16, $0.17, $0.18 in some cases as we went. Pricing went up with those costs. Things more or less peaked, call it summer of 2021. We've seen declines in net pricing since then. Our pricing has come down with that. Our margins have stayed relatively consistent during that period of time. Just order of magnitude, and these are disclosed numbers. Like I said, we did about $450 million in PPE revenues in 2019. In 2020, PPE plus COVID test kits combined, we did about $1.2 billion. $1.25 billion. In 2022, that number was over $1.7 billion. This year we've our latest guidance indicated we expect about a 30% decline in that number from 2021 to 2022 we've kinda have reached that peak, and now we're starting to come back down. I think the landing point will be something that, as a run rate, will continue to be well north of the $450 million we did in 2019. Obviously, we're gonna come off those levels that we had in 2020 and 2021. Helpful. Maybe just since you flagged the margin. On a total co basis for margins, you expect 2022 operating margin expansion of 20 to 25 bits over the prior year. What are the key margin drivers there?, looking into 2023, what's your framework for driving margin expansion? Yeah 2022, we've benefited somewhat from a little bit of change in mix in our revenue, right? As our distribution revenue becomes a smaller piece of the pie because of the decline in COVID test kits and PPE, we see a greater part of that mix coming from the specialty business which have grown quite well in 2022, and those are higher margin businesses for us. Those are providing us with with some gross margin expansion, which is a lot of which is falling to the bottom line for us. For us to continue to grow margins to that extent, we would have to continue to follow that formula. At the same time, we wanna be sure that we continue to invest in the business. I think you're aware of our global e-commerce platform, which we'll be launching a pilot of that in the UK in the early part of this year, and then in the US, in the later part of this year in 2023. I do think that we wanna be able to continue to invest in the business that type of investment can put some pressure on margins, but we feel very good about the long-term operating margin expansion opportunities that we have. Helpful. I think we had a question here. Yeah. I was gonna ask, what is the changing relationships- Oh, sir, one sec. Can you just wait for the microphone? Thank you. I was gonna ask what the changing relationships with dental buyers groups and in particular role private equity roll-ups of dental practices. You wanna start with that? I didn't quite hear the question. Dental roll-ups of private equity practices. The private equity roll-ups of dental practices. What about dental- Well, we've seen private equity roll-ups of dental practices that are trying to negotiate part of the gestalt of putting 500 or 1,000 dental practices together is that they can leverage against you. Absolutely. I wanna understand how that relationship is panning out now. Yes, there has been quite a bit of consolidation at the upper end. These are very large DSOs in the United States, abroad. I think maybe I heard from Australia. Australia and New Zealand, there are a couple of very large ones. We do business with most of these. Maybe there's one or two. There's one maybe or two that we don't do business with at the top end. These businesses generate very good income for us, but also we provide tremendous services to them, and they buy a lot of our own brands. They can be more clear with their practitioners to focus on our own brands and our own manufactured, specifically, specialty products. A lot of them are customers of our software business. When you take everything into account, these are quite profitable accounts. We don't obviously pay the commission, et cetera. Their pricing may be lower, but at the end of the day, the profit isn't bad. It's quite good. It adds relative to our investment. These orders are generally taken totally digitally. The orders come right from the customer right into our warehouse. The cost of doing business with these accounts is quite low. Of course, this is not only the case in dentistry, but the same with the IDNs in medicine on the human medical side. These are a big part of today's Henry Schein business, and at the end of the day, is quite profitable business. They have software, et cetera, I understand your cost to serve would be considerably lower, straight through ordering, et cetera. It's that, and we don't pay commission. Right. And, uh- The flip side is how much do they save? How much lower is their pricing? I'm thinking of it from the perspective of the private equity group rather than from your perspective. Yeah. It's different for every customer. Depends entirely on the mix of products they buy from us, whether we can work with a specific manufacturer who wishes to provide a particular chargeback for that customer. It's very, very customized. At the end, I believe we provide the best supply chain alternative for any of these large customers, dental or medical. We've been at this business for about 25 years. First one of these dental customers was in 1992. On the medical side, even before that. We're the largest player in this combined business. We provide, I think, outstanding service to our customers. I provide very good pricing. I can't give you the specifics. I don't think we have the specific average discount. No, but I do think, and I understand the purpose of your question, but I think often when we get questions about DSOs, they're kind of... they're framed in a sense that the DSOs are a threat to us. Actually, we see the DSOs as an opportunity. Our relationship isn't as Stanley said, it's not just transactional. It's not who can sell cotton balls cheaper than somebody else. It is very much a strategic relationship. What can we do to help the DSOs grow their practices faster than the market? That's a... I think it's a very healthy relationship that we have with them. Yes, they do get better pricing, and they do get better gross margins. As Stanley said, it opens up a lot of opportunities for us with our specialty products, with our software. Having that common platform, having that practice management system, which is common across the practices, is a very attractive proposition for the DSOs, and it's one that we can offer, we think, better than anybody else. Just to add to what Ron said, it's not only about the price of the cotton ball, nor is it simply about the practice management accounting system. The value we bring to these DSOs is enormous when it comes to practice management. We have, I think, the most advanced AI capabilities when it comes to managing a practice. They're able to adopt these AI capabilities much better than the smaller practice because they have professionals that are in the IT space, for example, that can connect with us. It's practice management and clinical management and quality of care that I think we can bring a lot to these practices. Helpful. Maybe shifting over to a few questions on dental here. Could you spend a few minutes speaking about dental instruments and what really drove the strength this year? Do you think this was simply catch up from not reinvesting over the course of COVID, or do you think this was an underlying market shift? When you say instruments, are you referring to equipment? Yes, equipment. Apologies. I wouldn't say it was a catch-up, per se. There has been a very strong demand for traditional equipment. Dentists have some pressure to modernize their practice. It's in that connection that our traditional business has been quite strong. In fact, the demand outstripped the capacity of the manufacturers. That's starting to get better now. At the same time, there's a strong demand for digitalization and products relating to digitalization of the practice. I would say the demand is strong. It has been strong. We've mentioned this in our calls. There has been quite a bit of price deflation in that area, like with any digital product or service, and that balances out. I would say the demand for modernizing the practice combined with the desire to digitalize the practice and the prosthetic application in particular, not only in the dental practice, but communicating that impression to the lab and the digitalization of the manufacturing, the crown and bridge chairside, but in the lab, have all been drivers. Today we are, you may know this, I think you probably do, the largest provider of dental laboratory products as well, where there's been a significant movement towards digitalization. Perfect. Just since you commented on pricing pressure there, you noted recently at a conference that there's been some intraoral scanner pricing pressure. You talked about seeing some prices coming in, from players now at the $12,000 range versus $20,000-$25,000 historically. How are these prices bringing the average or getting to the average market price? What do you think will happen with volumes given this price change? I think we're moving towards an environment driven by COVID, I think, and the desire of an increase in by the public in customer satisfaction to move away from the manual impression to the digital impression. The demand is very, very strong, and I think we're moving, or if we haven't gotten there yet, we're gonna be soon to a standard of care where the scanner is gonna be assumed to be the standard of care. The price between the different products that we offer has come down significantly, and the features have gone up. I wouldn't wanna talk about a specific price because there's no average price given the fact that there's such a wide variety of devices available and lots of different software. The price has come down, though, generally per unit, and I think we can expect that to continue, whereas the offerings from different manufacturers have increased, and at the same time, a significant increase in demand. Wonderful. Maybe shifting over to Europe. Europe equipment sales came in below expectations during 3Q. But also you've publicly been very optimistic about this market. Can you just walk us through what really gives you confidence that the macro environment in Europe won't crush our dental CapEx spend? I'm not sure we dealt with Europe, Rachel, per se. We dealt with our international business. Our international business equipment is quite strong. It has been that way for a while. I think there is a demand for traditional equipment, but the digitalization demand is quite strong outside of the United States. We remain optimistic about the short, medium, and long-term growth of our international dental equipment business. Perfect. Then can you walk us through the longer-term outlook for dental consumable sales and whether that business can ultimately return to the level of growth seen before the last economic downturn? I think we are quite bullish about the future of dentistry. There's been many studies that have been published in the last decade, but I would say particularly in the last six or seven years, showing a direct correlation between good oral care and good healthcare. There's also a movement towards closer collaboration between dentists and physicians in the holistic approach of wellness and prevention. I think that many of the payers are starting to understand this. I would say that not everyone, but there is a strong demand for, we believe, for oral care going forward. Of course, within the product offering of oral care, there's a mix, and a different emphasis could be placed on different parts of that mix. Generally, I think there is a growing demand for oral care products in the developed world and specifically in the developing world, where oral care is viewed in a growing way as important part of the consumer spend. Wonderful. Question from the audience. Hi. Yes, I wanted to follow up on, the consumable sales there. If you see a recession in the back half of 23, and maybe some of your DSOs start to kind of tighten their self-financing arrangements, do you have any outlook on could consumable growth stay positive, or is there a risk that people start to defer annual checkups? I think there's two questions in yours, one related to DSOs and one related to general consumable demand. I think, and Ron is quite a proponent of this concept, he should mention it himself, that it very much relates to the unemployment rate. If we have a recession and employment and maybe Ron, you can talk to that. And employment remains strong, I think we have much more of a cushion and less elasticity. If it goes down, it doesn't... Our experience has been it hasn't gone down for long, maybe a quarter or two, and then it's bounced back. Maybe Ron can talk a little bit more to that. As it relates to the DSOs, I think some of the DSOs are leveraged very highly, and the increase in interest rates could impact their desire or ability to invest heavily in the practice or certainly open new practices. That could slow down. I'm not sure that's the case with the mid-size regional DSOs. I don't think the interest rates, certainly at these levels, is playing a big role in slowing down investment by smaller practitioners because they can borrow based on their credit. Perhaps there's a challenge with the very large DSOs. Ron, maybe your thoughts on unemployment and historical trends. yeah a very important kinda just general variable to our business is the public's access to care. At least in the U.S., much of our access to care comes through the insurance that we have through our employer. We do look at the unemployment rates very closely. If you wanna flash back to the 2008, 2009 kinda recessionary period, we were looking at unemployment rates of 10% or higher. We're currently still trending below 4%. Now, there are some out there who think that could tick up. I know Amazon just laid off, I think 18,000 people. There have been other kind of relatively large layoffs announced recently. I think if we can keep that at a fairly moderate level, it does help us. As long as people maintain that access to care, that's very good for us. Since 2008 as well with the passage of the ACA, even people to the extent they can afford it, will still have access to affordable insurance even if they lose their job. We think that is a positive market condition for us in terms of a recession various surveys out there with dentists have shown what types of procedures may be under more pressure if discretionary spending gets pulled back a little bit. , the one procedure that is seen as the least vulnerable is the general maintenance, when you go in for your cleaning with the dentist, et cetera, right? The most vulnerable being implants or and oral surgery because of there is a larger out-of-pocket element to that. It is something we're watching closely. Having said that, I think the implant market is largely under-penetrated. I think that's a market that can still grow significantly. We're seeing very good growth from our value implant manufacturer that we have in Europe. We don't think it's cannibalizing business from our premium implant manufacturer there. We do think there's... globally, there's still an opportunity for really, really, significant greater penetration in that implant market, which will help subside a little bit the effects of a recession. Yeah, kind of one last thought on recession we're, we feel like we're the market leader. I've said if there's a recession, I don't see us going on defense and pulling back and trying to wrap ourselves in bubble wrap, so to speak, right? We have to stay on offense. We're gonna continue to invest in our global e-commerce platform. We're gonna continue to aggressively pursue good merger and acquisition candidates. We have to stay on offense so that when the recession ends, and they all eventually do end, that we have that momentum and that we can, as opposed to then trying to gear back up and get that traction, we have that momentum coming out of the recession, and we'll be able to grow even faster at that point. Just to add a little bit to what Ron said, there is a growing tendency for government expenditure in this area. The overall Medicaid programs in aggregate have spent more money, I don't see that going back. In the United States, there is a movement towards government funding of aspects of oral care. Of course, this is quite extensive outside of the U.S. Great. Maybe shifting gears but still sticking with dental, can you just walk us through how you're thinking about the clear aligner market? Acknowledge this is a smaller portion of the business, but how is this holding up versus brackets and wires? Generally in ortho, can you talk about some of the areas where you could increase your penetration in that market? Okay. We're a tiny player in the orthodontics arena. Essentially, we're not a player in going to the general dentist to sell orthodontic products. We essentially provide orthodontic products to some of our close DSO customers, both in terms of brackets and wires and in terms of aligners. We have a very good aligner product. We believe it's one of the best. Our clinicians that work with us think it's outstanding. What we were missing was the right kind of software, which we launched at the beginning of last year, it makes it much easier for the practitioner to use our software. We have a small aligner business. It's doing quite well. It's growing significantly, but it's still largely DSOs. We just announced an investment that we hope to close in the next month or two or three in a French business that sells implants. I believe they're the number one implant company in France, and aligners. That business has tremendous software for aligners and for implants, clinical software. The business in itself is a good business when we look at the products, and we expect it to do well for Henry Schein from a bottom-line point of view. It's the software that we would integrate with our software that we believe will give us a pretty good edge when connected to the Henry Schein One practice management software, give us a significant edge in the aligner field. We have no interest in going to the consumer directly, but only working with practitioners. A caution, it's a small business for us today, and if it grows at a multiple, it will not impact $13 billion of Henry Schein sales. There are others that are more leveraged when it comes to orthodontics that you should probably direct that question at. Fair enough. I'm happy to answer it. Fair enough. Maybe just going back to some of the DSO comments, some of your peers have called out DSO softness related to supply chain issues that they're having as they continue to build out and open. Can you talk about if you've been seeing this as well? Then, typically Henry Schein and other distributors have typically shined in de novo areas as they help pull together complete office portfolios are you seeing any delays in that part of the segment as well? In all modesty, Henry Schein does not have any supply chain issues. Well, I know there are brands that are not available, if a DSO calls us up and they wanna open up an office tomorrow, we can do that. We have methodologies for bringing together everything so that all the products, consumables, equipment, service, so that a DSO can open up an office tomorrow. I think we do that better than anyone else. We have more service technicians in the United States and globally than anyone else. We do the servicing very well, supply chain is not the issue. Of course, during COVID, we had some challenges. We had lots of challenges, PP&E, perhaps more than others because we were very careful only to sell regulated product and product that went through our quality control. Supply chain is really not a big issue for Henry Schein. Of course, we can't install every unit ordered right away for our entire customer base, but our customers generally get very good service, and if they need something right away, they'll get it. Acknowledge that you guys haven't really had supply chain issues on your front, but I was referring more to the supply chain issues as DSOs are physically building their buildings, having employees, having wood and everything to actually build their facilities. Yes. So, so- Yes. Sorry for not clarifying that. No, no, that is a big issue. Yeah. can you talk about that dynamic- Yes. just the delay more at your customer as the DSO, and then being able to offset them? Right. I don't wanna get into any kind of FD issues here. Mm-hmm. Generally, and you can read the newspaper, it is still a problem to get a building fixed, renovated. Mm-hmm. The locks, the hinges, the doors, and dentistry is not immune from that. That is a big issue. Just like if you wanna rebuild your house. Yeah. Yeah. It's not an FD issue. I wanna be careful. I'm not pre-announcing anything on equipment sales or anything, I will say that dentistry and our medical customers are not immune from the general construction supply chain issues that we're experiencing in this country, and I might, I might add, in a magnified way in Europe. Helpful. Maybe if we shift over to some comments around the medical side of the business now. That's been growing high single digits. Can you walk us through how much of that was market driven share gains versus how much has really been driving Henry Schein's outpaced growth there? Yeah, I think our medical business is really,. A big part of our medical business is the IDN. I think a lot of our growth is deeper penetration to our existing IDN customers, which includes the ambulatory surgical centers. I think the ASCs are probably amongst the fastest growing in the medical industry in terms of volumes of procedures, and that being our kind of. A big part of our core customer base has helped us. We're also seeing some market gains with the independent physicians as well. I think there's been some good programs in place to kinda. That really have focused on expanding that market for us. It's been successful. That team has executed really, really well in that area from a product perspective, I think the medical business has also benefited from increased demand for point of care diagnostic kits. I mean, we talk a lot about COVID test kits, in addition to COVID test kits, before COVID test kits were there were flu diagnostic kits, there were strep diagnostic kits, there were others that we've really seen a resurgence in demand for those products, kinda back to pre-COVID, if not higher than pre-COVID levels. That's also been a big part of the growth of the business there. Helpful. A question from online here, relating to more accounting issues. Does Henry Schein have any plans on switching to report cash EPS ex deal amortization in the future? What we've we've been asked this question in the past, and we have looked at our amortization expense and the effect on EPS relative to our EPS growth as well. There has never really been a significant divergence in that pattern of growth. What we've said, and I'll continue to say it, is that if in fact we believe that that pattern will begin to change, which would be the result of transactions which have a higher degree of intangible assets associated with them when doing that purchase price allocation, then that might be the time for us to consider adding back amortization expense when reporting our non-GAAP EPS. It is something that we are always evaluating, and when we believe the time is right to do that, we will do so. Helpful. Shifting back to medical, can you just give us a refresh of which are the largest parts of the medical business and each's growth algorithm?, where are areas that you focus on in terms of market expansion in medical? Is it orthopedics, something else? Just walking through that for us. Well, can you say the first part of the question again, Rachel? Just kinda walking through what the largest drivers are of the medical business and the growth algorithms of those segments. Well, yeah. I mean, I think that like I said before, I think the growth in the ASCs is very helpful for us. especially we may have had a little bit of benefit early in the year, I think, of some pent-up demand. A lot of people who may be put off voluntary procedures that weren't urgent during the pandemic, then decided to go in and have these procedures done. I think there was very good demand at the ASCs, but we've seen that continue throughout the year. I think as more and more procedures are shifting from the acute care setting in a hospital to an asc we're getting some benefit from that. That's just that much more churn of product that is happening in that environment. I'm sorry. Then the H2 of the question was? I think you actually covered it on that piece, so that was good. Can I just respond quickly? Yeah. The orthopedic part. Mm. of our business is very important for us as it relates specifically to the ASC. Mm-hmm. We wanna invest heavily in the orthopedic area. We've had a team on board now for four years that has been exploring this, hopefully no deal is done until it's done. Hopefully, we'll have expansion in that area in 2023. At the same time, we have announced that our customers, specifically the IDNs, would like larger home care support from us. We invested in two businesses, and we hope to expand that investment in 2023. Perfect. Following the patient. Great. Helpful. With that, we are out of time. Thank you so much for joining us. Thank you, Rachel. Thank you, guys. Thank you very much. Thanks, Rachel. Thank you.