Sanara MedTech Inc. Q1 FY2024 Earnings Call

Thank you, and good morning, everyone. I'd like to welcome you to Sanara MedTech's Earnings Conference Call for the quarter ended March 31, 2024. We issued our earnings release yesterday morning, and I would like to highlight that we have posted today's deck on the Investor Relations page of our website. This supplemental deck as well as a copy of the earnings release and the Form 10-Q for the quarter ended March 31, 2024, are also available on this page. We will reference this information in our remarks today. With us today are Ron Nixon, our Executive Chairman and CEO; Mike McNeil, our Chief Financial Officer; and Seth Yon, our President, Commercial. Please note that certain statements in this conference call and our press release and in our supplemental deck include forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. For more information about the risks and uncertainties involving forward-looking statements and factors that could cause actual results to differ materially from those projected or implied by forward-looking statements, please see the risk factors set forth in our most recent annual report on Form 10-K, supplemented by the risk factors in our most recent quarterly report on Form 10-Q. Also, this conference call, our earnings release, and supplemental deck reference certain non-GAAP measures. In that regard, I direct you to the reconciliation of these measures in the earnings materials that are available on our website. Now I'd like to turn the call over to Ron.

Thank you, Callon, and good morning, everyone. As we mentioned in our press release yesterday, our former CEO, Zach Fleming, resigned on Friday. We're in the process of finalizing a separation agreement with Zach, and I've been appointed CEO by the company's Board of Directors. As a result of Zach's departure, the company will no longer be presenting the proposal for the election of a ninth Director on our Board of Directors at the Annual Meeting of Shareholders in June. As many of you know, I've been intimately involved with the leadership team in developing and executing Sanara's strategic vision since the inception of Sanara MedTech. I'm looking forward to working with Sanara's leadership team now on a daily basis to continue that execution. Turning to our first quarter results, the first quarter of 2024 marks the company's tenth consecutive record quarter. The company generated $18.5 million in revenue in Q1 over the course of 2023. We made significant advancements in data analytics, sales force optimization, and sales processes. As I've told many of you before, when you're in a high-growth business, you need to be able to build infrastructure, data analytics, and details around these processes in order to be able to improve and continue that growth. We believe that that's been implemented and that will pay dividends going forward. These improvements and the momentum we've achieved in the fourth quarter helped us to exceed our forecast for the first quarter, and we believe position us to continue to build upon the success the teams achieved in previous periods. For the three months ended March 31, 2024, we reported a net loss of $1.8 million while we generated positive adjusted EBITDA of $300,000 over the same period. I'd like to provide a brief update on our partnership with InfuSystem. We continue to invest in this partnership and are focused on three potential areas of opportunity. The first initiative for the partnership is to distribute Sanara's advanced wound care products, including BIAKO¯S and HYCOL, as well as negative pressure wound therapy products into long-term care skilled nursing facilities and wound centers. Building upon the strategic objectives, we're also exploring emerging opportunities for InfuSystem to distribute our advanced wound care products outside of this channel. We also agree that our partnership will play a key role in Tissue Health Plus, our value-based care strategy that you've heard about many times before, which is planned to include standardized wound prevention and treatment plans utilizing Sanara's wound care products. As these opportunities continue to develop, we will provide additional updates. As I mentioned in our last call, we're having discussions with potential partners participating in the execution of the Tissue Health Plus strategy. During this process, we're continuing to invest in the technology, capabilities, and infrastructure that we believe are required to commercialize this well-designed strategy, but we do not anticipate this will be continued spending by us alone in 2024. We hope to have our partnerships in place so that we can execute, and these partners we're looking for are not just financial partners; they are strategic partners. We're also continuing our focus on expanding the existing surgical product offering. Lastly, we've made significant progress in the area of intellectual property and manufacturing processes for the Cellerate product line itself. We believe that this has been something we've discussed multiple times and we see a significant capability to obtain more IP around the product as we continue to advance this through various specialties. I'd like to now introduce you to Seth Yon, our President of Commercial. Seth has been with the company since 2018 and has been promoted multiple times to roles of increasing responsibility. In his current position as President of Commercial, he leads our national sales team and multiple internal teams, including marketing, customer support, national accounts, and business operations. He's been instrumental in building out our sales team and infrastructure at Sanara, and I'm looking forward to working closely with him on the execution of our strategy. Seth, I'll now turn it over to you to discuss our surgical sales results in more detail.

Thanks, Ron. In the first quarter of 2024, our products were sold in over 1,080 facilities across 34 states and the District of Columbia. We continue to focus on increasing the use of our products in new and existing territories, expanding usage into new specialties, and increasing our current facility sales. Our products were approved to be sold in more than 3,000 facilities as of March 31, 2024. Subsequent to the end of the quarter, a new contract with a large GPO went into effect, which has had a significant impact on the number of facilities in which our products are approved to be sold. Sales of our soft tissue products grew from $12.9 million in the first quarter of 2023 to $16.1 million in the first quarter of 2024. Sales of bone fusion products decreased slightly from $2.6 million in 2023 to $2.5 million in 2024. This was due to a slower-than-expected adoption of ALLOCYTE Plus as well as a larger-than-normal order from a facility in Q1 of 2023 of BiFORM, which subsequently returned to previous levels in subsequent quarters. I will now turn it over to Mike McNeil to discuss the details of our recent loan agreement with CRG, as well as our most recent financial results. Mike?

Thank you, Seth. I'd like to discuss the new debt facility we recently announced with CRG. This transaction helped us strengthen our cash position and provided access to growth and acquisition capital in a way that was nondilutive to equity holders. The facility allows for flexibility in the event of a transaction we believe would be accretive, given the company has the ability to draw additional capital beyond the initial $15 million at our option. We're currently in discussions with the commercial bank for an additional $10 million revolver, as permitted under the CRG facility, which could provide us access to what we expect will be lower-cost capital for immediate needs. The term loan is structured as a senior secured loan with a 5-year term and up to $55 million in aggregate potential proceeds. In addition to the $15 million drawn at close, we can draw up to an additional $40 million before June 30, 2025. I'll now go into more detail about our most recent financial results for the three months ended March 31, 2024. Sanara generated net revenue of $18.5 million compared to $15.5 million for the first quarter of 2023, representing a 19% increase over the prior year period. Higher revenue in 2024 was due to increased sales of our soft tissue repair products, including CellerateRX, resulting from increased market penetration, geographic expansion, and our continuing strategy to expand our independent distribution network in both new and existing U.S. markets. SG&A expenses for the first quarter of 2024 were $16.2 million, compared to $13 million for the same period in 2023. The higher SG&A expenses in the first quarter of 2024 were primarily due to higher direct sales and marketing expenses, which accounted for approximately $2.2 million or 69% of the increase compared to the prior year period. Higher direct sales and marketing expenses were mostly attributable to an increase in sales commissions of $1.6 million as a result of higher product sales and $0.6 million of increased costs due to sales force expansion and operational support. R&D expenses for the three months ended March 31 were $0.9 million compared to $1.3 million for the same period in 2023. The lower R&D expenses in 2024 were primarily due to reduced costs associated with the Precision Healing Diagnostic Imager and LFA. Sanara had a first-quarter net loss of $1.8 million compared to a net loss of $1.2 million during the same period in 2023. A higher net loss in 2024 was due to higher SG&A costs and increased amortization of our acquired intangible assets, partially offset by higher gross profit and lower R&D expenses. Our cash on hand at the end of the quarter was $2.8 million.

Thanks, Mike. We're pleased with our progress in the first quarter, continued growth, and the results we achieved in that quarter. We are striving to achieve profitability. This is not a revenue play; this is a focus on building a sustainable business for the long term, and we plan to do so. Related to our surgical business, we've had multiple opportunities to review that complement our existing product offering, as well as to expand our products into other specialties and hospitals. You know how many hospitals we are currently in, and we want to continue to advance that across the U.S. This concludes our remarks, and we look forward to answering any questions you may have. Operator, we're ready to open the call for questions.

Ron, I just had one question and I'll jump back in the queue. My question was regarding the recent CEO transition. Has that transition disrupted the sales momentum you've shown for Q1?

Not at all. I would tell you, Ian, that the team is stronger than it's ever been. Seth Yon has been driving this for a long period of time. And while we're sorry to see him go, quite frankly, there's zero disruption.

Okay. A follow-up question for Seth. I noticed that the bone fusion products have been somewhat flat year-over-year. I was wondering if you could speak to that, considering I believe the supply disruption kind of became abated in Q4.

Sure. As I mentioned earlier, we did experience a little bit of softening as we returned with ALLOCYTE Plus. I believe a lot of that is related to timing. As you can imagine, when there is an issue with inventory, it can lead to complications at the facility level that need replacing. Therefore, we had to initiate that cycle again to re-engage with our distributors, and this process took longer than we had expected.

There were no other questions from the lines at this time. Okay. We did have Ian Cassel coming with a follow-up.

When we think about the Tissue Health Plus and partnering on that, is that something you expect hopefully to happen by the end of '24—being able to have some partnerships with that?

Yes, that is what we anticipate. Ian, what we have done is designed a thoroughly thought-out strategy for addressing value-based wound care. No one has ever done this before. It's complicated because it involves payers, providers, products, and patients throughout the continuum of care. We have to consider where we provide care for these patients since they are in home settings, home care, skilled nursing facilities (SNFs), and long-term acute care hospitals (LTACHs). All these factors require careful thought about how we engage patients throughout their care journey. We need to develop a platform that enables continuous patient monitoring alongside care coordination and navigation. Therefore, we're seeking partners who will participate with us—those who provide strategic value as well as financial support.

Okay. A follow-up. You're now the CEO of the company. Do you view this as a temporary role, or do you plan to stay here permanently?

It was initially a temporary assignment when I started and spent 2.5 years in the seat. I'm engaged every day, speaking with someone from Sanara. From my perspective, this creates better lines of communication for me with the entire team. I'm looking forward to this journey and have no plans to exit the role anytime soon. As I navigate through this chapter, I aim to avoid any unforeseen challenges. I'm excited about the potential of this role. This was my original vision for our company, and we've accomplished remarkable things. It's due to our passionate and highly capable team. I don't see anyone lacking that passion as we work towards executing our strategy.

Recently, you announced adding two more individuals to the management team. Can you discuss the reasons for bringing them on board and your experience working with them?

Absolutely. We have a strong team, but as we anticipate higher growth, we need additional personnel in key roles. We felt it was essential to add a dedicated Corporate Development role with strategic expertise, which is Tyler Palmer, who has extensive experience in wound care. We also needed to enhance our operational focus with someone possessing financial acuity. That's Jake Waldrop, who has worked with me for many years and has shifted from being a Chief Financial Officer to a Chief Operating Officer. We're thrilled to have them on board. Additionally, we are continuous hiring new talents to support our sales efforts. The new trainees contributing to our sales side impress me greatly. We're laser-focusing on our evolving requirements, and high performers are attracted to our robust strategy and growing company. I'm optimistic about our trajectory and confident in the depth of our team. The journey of growth not only entails moving up but also requires building infrastructure. It's a continuous process to achieve greatness.

While we wait for any other questions, we have received a couple from the web. Can you speak to profitability in relation to increasing revenue, decreasing R&D, but experiencing a setback in profitability? Also, can you provide some context regarding the SG&A increase matching or exceeding revenue growth quarter-over-quarter?

Yes, I will start by addressing the variability in our costs. Our expenses fluctuate based on our hiring and sales progression. Notably, direct sales commissions significantly impact SG&A costs, correlating closely with increased sales. I'll let Mike elaborate further. Regarding our business, profitability is our goal. We achieved a slight level of profitability, but it's not satisfactory yet. We must strike a balance when pursuing opportunities we believe can provide long-term shareholder value; maintaining adequate capital to invest in those opportunities is crucial. This could lead us to forgo short-term profitability in favor of long-term investment returns. However, operational efficiency, sales efficacy, and profitability remain paramount.

Yes, Ron. I would like to add that 2023 included a couple of benefits to the P&L, such as changes in fair value of earn-out liabilities. We had a significant credit last year that we do not have this year. Additionally, amortization of our intangibles increased significantly, contributing to the higher net loss in 2024.

There are no other questions in the queue at this time. I would now like to hand the call back to Ron Nixon for closing remarks.

Okay. Thank you very much. We thank all our shareholders for being on the call today. Beyond our dedicated team members, our shareholders are incredibly important. We greatly appreciate your ongoing support during this transition. While we do not expect disruption from this change, many of you have expressed confidence in our firm, and we sincerely thank you for that. We look forward to engaging with our shareholders in the near term. Take care.

Thank you. This concludes today's conference. You may disconnect your lines at this time. Thank you for your participation.