Surgalign Holdings, Inc.

Surgiline undertakes no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this conference call. In addition, this conference call may include a discussion of non-GAAP financial measures. Please see today's earnings release for further details, including the reconciliation of the GAAP to non-GAAP results. I'll now turn the call over to Terry.

Thanks, Dave, and good afternoon. We continue to make progress on the restructuring program and our outlook has not changed. Product rationalization programs have intensified and will continue throughout both the second and third quarters. And we've been managing distribution carefully to ensure we meet our customers' needs. Along with product rationalization, we right-sized and realigned many areas of our business and we're operating more efficiently, which has enabled us to better manage resources. I'm very proud of our execution on this front, and the team has done a remarkable job. As for the market, conditions remain unchanged since my comments six weeks ago in our earnings call. For the most part, we've seen the market stabilize, similar to what many have been reporting. Domestically, hospitals are still experiencing some staffing shortages and procedural delays, but it hasn't been all that impact on the hardware side of our business. With respect to HoloPortal, we're still seeing a long sales cycle, but discussions with many of the accounts in our pipeline are progressing well, and several are in the final stages of contract negotiations. I'm pleased to report that we currently have two new sites in the onboarding process for our upgraded system with cases scheduled in the coming quarter. We remain focused on commercialization with a goal to expand our reach and drive adoption. The new system upgrades unveiled in March are designed to drive efficiencies in setup and workflow and support a broader range of instruments and procedures. On our last call, we discussed the launch of HoloAI Insights for Spine Imaging, which was a late Q1 event and the prospects of opening up new markets for SurgeLine. HoloAI Insights is another offering in our portfolio. It's for research use only and uses AI to analyze and translate medical imaging into aggregated quantifiable data. We partnered with San Diego Spine Foundation as part of our initial launch and subsequently formed new alliances, one with Dr. Pierce Nunley and the Spine Institute of Louisiana, and the other with Dr. Alexander Vaccaro, one of the top-ranked spine experts in the world. These are invaluable relationships, and we couldn't be happier to be working with such prestigious surgeons in the area of spinal research. Our strategy is to align with the best of the best and gain insights into how AI can be applied in research and ultimately how it can be leveraged in the clinical decision-making process. I'd like to pull one reference from Dr. Vaccaro from our most recent announcement, quote, SurgeLine, in my opinion, is one of the most exciting given the groundbreaking work they are doing with artificial intelligence." The relationships we have in place are all important alliances, and we feel we have a strong foundation to build from. Just last week, we announced the continued evolution of HoloAI Insights with a new research-based solution for use in neurovascular research. This latest addition to our AI portfolio can analyze large sets of cranial MRA images, automatically identify 16 different structures, and aggregates the data into configurable graphical and file formats. We kicked off the launch with a collaboration with Dr. Brian Jankiewicz, a neurosurgery specialist with extensive experience in neurocritical care disorders. This is only the beginning, and as I've mentioned previously, We believe that HoloAI Insights can be leveraged for precision medicine and apply to many different applications in population health, clinical research, and in the future, patient care. Expect to see more news from SurgeLine regarding our HoloPortal commercializations and new technology upgrades. We are working to expand alliances within the medical community for HoloAI Insights for research use, both spine imaging and neurovascular research, with plans to release a clinical product for AI assessment of lumbar spine MRI images in 2024. I'll turn the call over to Dave now to cover our financial results and outlook. Dave? Thank you, Terry.

We reported Q1 2023 revenue of $16.7 million ahead of our prior expectations, breaking it down into key components of our restructuring and taking out CoFlex, and CoFix, which we sold on February 28th, our U.S. hardware business grew by approximately $745,000, or 6.7%, on a sequential basis, which was offset by a decline in international revenue of $667,000. In addition, we captured approximately $1.6 million in revenue from obsoleted products, which continued to contribute revenue in April, and so far in May. As a side note, our COFLEX products generated about $2 million in revenue in Q1 for the months of January and February until it was sold. Non-GAAP gross margin in Q1 was 69.5% on the higher end of our previous guidance range and down slightly sequentially compared to Q4. GAAP gross margin in Q1 was 63.7%. items taken out for non-GAAP purposes were $730,000 of international inventory, which continues to be rationalized, and $235,000 of inventory purchase price adjustments. As for operating expenses, Q1 non-GAAP operating expense was $23 million as compared to $24.6 million in Q4, an improvement of $1.6 million sequentially. We continue to manage our costs diligently and have removed expenses through the restructuring program with a greater impact anticipated in future periods. Excluded from Q1 non-GAAP operating expense was a gain of approximately $1.1 million related to acquisition contingency, asset impairment and abandonment expense of approximately $550,000, severance and restructuring costs of approximately $460,000, transaction and integration expense of approximately $460,000, and $1 million in non-cash stock-based compensation expense. Adjusted EBITDA in Q1 was a loss of $10.8 million as compared to an adjusted EBITDA loss of $9.1 million in Q4. The sequential decline was driven primarily by lower revenue and gross margins somewhat offset by lower operating expense. As for the balance sheet, we had $22.4 million in cash at the end of Q1, compared to $16.3 million at year end. The improvement in our cash position is related to the sale of our CoFlex business in February, which netted $14.8 million in cash to the company. We had guided to approximately $21 million in cash on our last call for Q1, and the improvement versus our plan was driven primarily by continued reduction in operating expenses during the period. Managing cash is critical, and we are looking at all expenses to extend our runway. With that said, we continue to explore all strategic avenues to improve our liquidity position, including additional potential divestitures, mergers, and restructurings. Operator, we're now ready to open up the call for questions.

Thank you. If you have a question, please press star 1 on your telephone keypad at this time. If at any time your question has been answered, you can remove yourself from the queue by pressing 1. Again, ladies and gentlemen, if you do have a question or comment, please press star 1 on your telephone keypad at this time. One moment while we poll for questions. And our first question is from HC Wainwright, please go ahead.

Thanks. This is RK from HC Wainwright. Good afternoon, Terry and Dave. Hey, RK. Yeah, so starting off from the restructuring program, you know, you divested CoFlex, but you're also saying that you're still continuing to do product rationalization and will continue not only in this quarter but also next quarter which is third quarter so um i'm just trying to think uh how what sort of products are we talking about and how does it you know when we think about year on year um how how would it impact um the the uh the revenues for the second quarter, third quarter in relationship to what happened in 2021?

Yeah, I think the easiest way to look at this, RK, is to kind of look at Q1 and take out COFLEX and COFIX, which we generated revenue of $2 million in that Q1 number of 16.7. That brings you down to $14.7 for the first quarter. And then take out an additional $1.6 million of the products that we obsoleted in Q1 that actually still generated revenue for us. You know, once we obsoleted those products, you know, at some point we expect that revenue to ramp down. We've been very fortunate, though, that that revenue has continued into Q1 and now even into Q2, so it's a little harder to predict what those obsoleted products revenue contribution will be. But if you take out those numbers and say, you know, looking out into the future, what would that look like, you know, you're talking about a number that's down to the $13 million a quarter range, just taking Q1 as a proxy.

Okay. Thanks for that, Dave. In terms of the HoloPortal, Terry, you were saying that the sales cycle continues to be long. Can you add some additional commentary around it in terms of what do you mean by long? You had a certain number of centers that you would be able to achieve by the end of the year. What is the target now in terms of installation base for end of 2023?

Yeah, sure. So, R.K., we didn't provide a target, but, you know, and part of that is because it's been long. You know, the sales cycle for all capital, you know, out there has been, you know, very long now, regardless of the model they view it all as capital. And so it has been You know, long could be, you know, we've got a couple accounts that, you know, are getting, you know, hopefully close to coming on now that have been, you know, in the funnel for over a year. So it has been, you know, a long path on, you know, a lot of these. The typical capital sales cycle just in broadly in the industry is anywhere from six to 18 months. So it's about getting the funnel full and pulling them through and, And so we've got a very full funnel now and so, you know, are looking to get more units placed.

And then of the units that are already there, what is your – what commentary are you hearing from the surgeons that are actually using the system as of now?

Yeah, so look, we're getting, you know, very positive feedback about how easy the system is to use and how the enhanced visualization with the AR, and it's really enhanced because of the segmentation that we use AI to generate, you know, how much easier it makes things for them because they can identify the anatomy so quickly. So it's been very positive feedback. And now that we're rolling out the new instruments to be able to do more types of procedures as well, I believe this will have a very positive impact also.

Thank you. I think I will step back and thanks for taking the questions.

Thanks, RK. Our next question is from Matt Hewitt. Please go ahead.

Hi, this is Jack. I'm from Matt. We've heard from larger players like HCA and Tenet, the budgets and hiring trends have been getting better and therefore helping their procedure volumes. We were curious if you're seeing that trickle down on your end at all.

Yeah, I'm not sure if we have any Tenet accounts we're working on, but yes, we do have HCA accounts and they did move through pretty nicely there.

Okay, and then final question, could you remind us how many sites are up and running using the Holo platform currently?

Yeah, there are five active, and we're in the process of bringing up two more.

Okay, thank you for taking my questions.

Thank you.

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