Butterfly Network, Inc.

Hello and welcome to Butterfly Network's first quarter 2022 earnings call. My name is Alex and I'll be coordinating the call today. If you'd like to ask a question at the end of the presentation, you can press star one on your telephone keypad. If you'd like to withdraw your question, you may press star two. I'll now hand over to your host, Agnes Lee, Vice President of Investor Relations. Over to you, Agnes.

Good morning and thank you for joining us today. Earlier this morning, Butterfly released financial results for the first quarter ended March 31, 2022, and provided a business update. The release and earnings presentation, which include a reconciliation of management's use of non-GAAP financial measures compared to the most applicable GAAP measures, are currently available on the Investors section of the company's website at ir.butterflynetwork.com. Dr. Todd Fuckerman, Butterfly's President and Chief Executive Officer, will host this morning's call. During today's call, we will be making certain forward-looking statements. These statements may include statements regarding, among other things, expectations with respect to financial results, future performance, development and commercialization of products and services, potential regulatory approval, the size and potential growth of current or future markets for our products and services, and the impact of the COVID-19 pandemic on our business. These forward-looking statements are based on current information, assumptions, and expectations that are subject to change and involve a number of risks and uncertainties that may cause actual results to differ materially from those contained in the forward-looking statements. These and other risks are described in our filings made with the Securities and Exchange Commission. You are cautioned not to place undue reliance on these forward-looking statements and the company disclaims any obligation to update such statements. During this call, we will refer to non-GAAP financial measures, including adjusted gross margin, adjusted gross profit, and adjusted EBITDA. These financial measures are not prepared in accordance with U.S. generally accepted accounting principles or GAAP. These non-GAAP financial measures are not intended to be considered in isolation or to substitute the results prepared in accordance with GAAP. The definitions and reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures and the discussion of why we present these non-GAAP financial measures are included in today's press release and at the end of the slide presentation. As a reminder, this call is being webcast live and recorded, and we will be referencing a slide presentation in conjunction with our remarks. Because there is a short delay between the live telephone audio and the presentation being shown on the webcast, for the best experience, please use either the webcast for both the audio and video content, or if you dialed in by telephone, download the slides from our website and advance them yourself. To access the webcast, please visit the event section in the investor section of our website, and a replay of the event will be available following the call. I would now like to turn the call over to Dr. Seckerman.

Thank you, Agnes, and good morning, everyone. I'd like to start off by sharing that I'm joined by Heather Getz, our new Executive Vice President and Chief Financial Officer. While she will not be participating in today's call, I did want to briefly introduce her. Heather is a proven CFO with deep experience in delivering results and value creation. She brings 25 years of corporate finance and operating experience from both public and private companies, as well as a strong background in the digital health and medical device space. Heather spent 12 years at BioTelemetry, a publicly traded remote medical technology company where she served as Executive Vice President and Chief Financial and Administrative Officer. Before this, Heather held various leadership positions at companies including Alita Pharmaceuticals, Bias Healthcare, and Sunoco. I have no doubt Heather will be a strong partner as we continue to execute our strategy and introduce unique value for the healthcare ecosystem and our shareholders. Now to set the stage for our first quarter results. I want to highlight the important progress we are making in building a mission-aligned culture throughout Butterfly. Our team has come together to not only realize, but to accelerate the vision of Dr. Jonathan Rothberg and Butterfly's early trailblazing scientists who set out to make healthcare more effective, more accessible, more equitable, and more affordable by enabling clinicians to accelerate diagnosis and care and to improve patient wellness and convenience. In today's discussion, you will not only hear how we are catalyzing care transformation across health systems, but also how we are enabling maternal imaging in Africa, facilitating emergency care in Ukraine, providing EMS teams with imaging capabilities, and empowering veterinarians across the country to more quickly assess and address animal health needs. We are unified by a belief that our technology will dramatically elevate care across use cases and care continuums. And we are investing heavily in our people and product development to meaningfully capture our first mover advantage. From a revenue perspective, we opened the year with $15.6 million in quarterly revenues. a 25% increase versus the first quarter of 2021. This was an excellent start to the year and in line with our expectations. I'm immensely proud of our butterfly team for their work this past quarter and throughout the pandemic, which has been a challenging and chaotic period in healthcare delivery. The commitment of our people to transform care by providing valuable clinical insights earlier in the pathway has never wavered. We endeavor to work as hard as clinicians and technicians have over the past several years and look forward to continuing to work alongside them in partnership to help them deliver the best possible care to all patients. I'd now like to touch on some overarching market activity that is validating the transformational role of butterfly. In Q1, at the American Institute of Ultrasound and Medicine annual meeting, Dr. Abraham Bergesi of Stanford University called out in a keynote speech that it was his hope that recent advancements in ultrasound technology would bring new life to the bedside exam and help foster greater connection between the doctor and the patient. Further, the Institute's president, Dr. Mazarian, supported this sentiment by saying, resist the trend of commoditizing ultrasounds as just another study that we read while seated in a dark room understand the importance of getting up scanning and interacting with patients this is what butterfly makes possible it's about establishing connections with patients and being present with them at the bedside and obtaining a window into the body to see and at times to even show what's happening It's about using ultrasound information to inform clinical decisions rather than confirm them. This is a paradigm shift from how ultrasound has historically been used. We believe this shift has the potential to transform healthcare, to improve the patient-doctor relationship, and in time to unlock multiple economic efficiencies and gains. With that, I'd like to shift to our business update. Our team continues to make progress against our core principles of making butterfly easy, everywhere, and economical. Let's start with an example of our principle of ease. In a landmark study published March 28th in the New England Journal of Medicine Evidence, butterfly was found to be an effective tool to estimate fetal gestational age just as accurately as a trained sonographer using a standard ultrasound machine. Dr. Joni Price at UNC, who led the study, said, armed with a pocket-sized butterfly probe and a smartphone, a Zambian midwife with no prior training in sonography can assess gestational age as accurately as a certified sonographer using an expensive machine. This has the potential to revolutionize the delivery of obstetric care in settings like Zambia. The results of this study offer hope to millions of mothers when it comes to determining risk and ensuring good quality maternal care. Access to low-cost imaging devices and the expertise to perform scans has historically presented challenging hurdles to overcome in low-resource care settings around the world. Additionally, ultrasound as part of routine care can demonstrate the benefits whether it be a greater willingness to seek out appropriate prenatal care or to pursue proper vaccinations. This study reinforces the ease in which butterflies can enter the equation and drive positive impact and reinforces our belief that all levels of practitioners, when armed with the right tools, can meaningfully advance the standard of care. In addition to such external validation, we continue to strengthen and differentiate our educational curriculum, in-app guidance, and associated services to take the burden off the user while increasing their confidence in scanning with a butterfly. Fifth, alongside our team's ongoing development of AI to enable and simplify bedside ultrasound for those not traditionally trained in it, it's core to making butterfly adaptable at scale. Now let's talk about our second core principle, everywhere. We believe Butterfly can be as ubiquitous as a stethoscope and can find a home in every practitioner's pocket and used for every patient, every time. Our belief is materializing. The American Academy of Family Physicians is now recommending that family medicine residents be trained in point of care ultrasound. In curriculum guidelines, AAFP called out that point-of-care ultrasound will transform family physicians' ability to arrive at a rapid diagnosis for patients. This is a meaningful recommendation, with one in eight U.S. medical graduates entering family medicine residencies each year. It's this type of catalyst that our clinical education and commercial teams are prepared to quickly activate around and already have. Also this past quarter, I was reminded of the importance of our everywhere principle as our team worked to arm caregivers who are aiding in the humanitarian crisis in and around Ukraine. True to our mission, we were able to equip care teams on the front lines of this crisis with Butterfly, and we're already hearing of the value it's bringing to this distressing situation. The use of Butterfly in such a backdrop reinforces people everywhere get the care they need. It's moments like these that emphasize the great impact and utility of butterfly and drive our team. If you take a quick look at our third principle, economical, one area where butterfly is increasingly seen as becoming a standard of care is with diagnostic assessment of the lungs. In Q1, the Journal of Ultrasound and Medicine featured a retrospective multi-center study of 479 patients that found point-of-care ultrasound to bring radiation-free, affordable, and equivalent diagnostic accuracy to lung assessment as compared to chest x-ray. Given the magnitude and regularity of patients who present with respiratory distress, we're encouraged that Butterfly is being increasingly used by and adding value with a wide range of clinicians to inform decision-making and in turn to expedite treatment. Studies like this one demonstrate Butterfly's momentum in challenging healthcare's traditional point-of-care toolkit and workflow. As you have just heard, we have made progress in the first quarter in reinforcing the vision of being easy everywhere and economical. I will now provide some updates in line with each of our four strategic pillars. Let's start with hospitals and health systems. We are pleased with our Q1 year-over-year growth in the hospital and health system space, which benefited from solid momentum in software sales and from deeper penetration with current clients. Looking ahead, we believe the industry's growing interest to educate and train practitioners to incorporate ultrasound information into the clinical workflow across the enterprise will help drive continued growth in our Blueprint offering. In Q1, we began a number of installations in top hospitals across the country. We anticipate announcing additional partnerships in the near future. Our first enterprise-wide deployment with Rochester is the embodiment of our Blueprint solution, utilizing Butterfly to advance care delivery, medical education, and clinical research. This project is fully on track, and we expect our device deployment to begin in Q2 of this year. Let's move on to our international pillar. We continue to make progress in markets outside of the U.S. I'm happy to share that in Q1, we solidified a distribution partnership with Novalog, a leading healthcare services group in Israel. This will enable us to bring Butterfly into Israel and introduce its value as part of primary care. Additionally, we have made a number of segment penetrating deals. One of these comes from the UK, where we've begun working with East of England Ambulance Trust, which provides accident and emergency services covering an area made up of around 6.2 million people. This will allow us to further demonstrate the value of butterflies in the hands of EMS teams, which represents a substantial opportunity for butterflies in many markets. Also, as we previously announced, the Bill and Melinda Gates Foundation provided a $5 million grant to help bring butterflies to South Saharan Africa to improve maternal and fetal health. This grant enables our teams to arm 1,000 healthcare workers with Butterfly IQ+. 500 probes will be given to mid-level practitioners in Kenya, and 500 probes will be distributed to healthcare workers in South Africa later this year. This work represents an important step towards improving worldwide access to medical imaging and advancing our commitment to global health equity. I look forward to sharing more progress on future calls as we roll out this initiative later in the year. Our third pillar is home-based care. In addition to the clinical evidence supporting butterflies, the increasing prevalence of chronic diseases is spurring interest and use cases in in-home care. This presents us with a market opportunity as butterflies can enable improved of some diseases. As part of our clinical program, we are launching multiple studies to evaluate the use of butterfly for bladder scanning, heart failure, and dialysis. These are just a few of the scenarios where butterfly could be meaningfully used for home health assessment. We believe this will reduce hospital visits, better manage conditions, and in some instances, replace a more expensive workflow or device. And finally, as I've covered on past calls, we are exploring markets adjacent to healthcare. One such market is veterinary medicine. I'm pleased to announce that we are welcoming Petco to Butterfly's customer ecosystem. Beginning this year, Butterfly IQ Plus beds will be deployed and become standard across 200 Petco clinic locations in the United States. We are proud to be the first and only U.S. imaging provider to collaborate with Petco nationwide and to lead the largest deployment of ultrasound into a practice group in veterinary medicine. Whether used as part of routine exams for early detection or for intervention, Butterfly IQ Plus Vet will expand the services offered to Petco pet owners. and more importantly, will deliver valuable insights to veterinarians, elevating the care delivered in Petco examiners. This partnership is driven by an aligned vision and a mission with Petco, a health and wellness company focused on creating a better world for animals and the people who love and need them. our team maintained focus on deploying butterfly iq plus vet to the more than 250 000 veterinarians and vet techs globally who could benefit from having butterfly in their pocket i'm excited about the progress we have made and will continue to make in the veterinarian market as we evolve and expand our footprint i hope this recap illustrates the progress of our journey As we stated at the beginning of the year, we believe that butterfly can be as ubiquitous as the stethoscope across all specialties, species, and care settings. Over the past year, we've empowered the use of ultrasound where ultrasound is not traditionally utilized and where ultrasound expertise is not traditionally found. As we introduce more caregivers to the benefit of seeing inside the body, at the bedside, And as the industry's understanding of the value of imaging to inform first confirmed care decisions continues to grow, Butterfly is proving itself. And with that, I will now turn to the financial results. Revenue for Q1 2022 was $15.6 million, a 25% increase versus the prior year period and in line with our expectations. Product revenue was $11 million, an increase of 15% versus Q1 2021. This increase was driven by higher average selling prices and volume in both our U.S. and international healthcare channels, as well as in the vet market. Partially offsetting this increase was a reduction in e-commerce or direct-to-user sales as our business model is evolving to enterprise sales across health systems. Subscription revenue was $4.6 billion in the first quarter, growing by approximately 60% over the prior year period. Subscription mix of 29.3% of revenue increased by approximately 6 percentage points versus Q1 2021. This increase was due to a higher installed base of products with accompanying subscription software as well as increased renewals. turning now to adjusted gross profit. Please note that a reconciliation of our adjusted numbers to GAAP can be found in today's press release and at the end of the slide presentation. Adjusted gross profit was $8.8 million in Q1 2022, compared to $5.9 million in the prior year period. This increase was primarily due to product mix. reflecting a higher proportion of subscription revenues in addition to higher device prices and volume, also contributing to the increased margin with higher manufacturing productivity, partially offset by the increased cost of manufacturing materials. Adjusted gross profit margin was 56.3% for the first quarter, which compares to 47.8% in Q1 2021, reflecting the positive mix, higher product ASPs, and manufacturing efficiencies. For the first quarter of 2022, adjusted EBITDA was a loss of $40 million compared with a loss of $26.5 million in 2021. The increase in adjusted EBITDA loss of $13.5 million was driven by investments in our commercial and R&D functions as we build out our commercial operations and products, as well as investments in future revenue streams. These investments were partially offset by increased adjusted gross margin dollars driven by the aforementioned positive product mix ASPs, and volume. Moving to our capital resources, as of March 31, 2022, cash and cash equivalents were $359.9 million. In addition to our operating expenses, our Q1 cash position was impacted by fiscal 2021 annual bonus payouts. capital expenditures for the build out of our headquarters in Burlington, Massachusetts, and the annual renewal of insurance premiums. We have a solid cash position and we plan to continue to invest in 2022 to maintain our momentum and continue to capitalize on this attractive market opportunity. Looking at our 2022 guidance, given the strong start to the year, we are reaffirming the previously issued annual revenue guidance of $83 to $88 million and the adjusted EBITDA guidance for a loss of $175 to $195 million. As a reminder, we expected about 40 to 45 percent of 2022 revenue in the first half of the year and 55 to 60 percent in the second half. This translates to approximately 25 to 30 percent growth in the first half and approximately 45 percent growth the second half the increased growth in the second half is due to strength in our international channel in addition to the evolution of our business model from e-commerce sales to institutional purchases and deployments this evolution will be driven by the industry's building awareness of and appreciation for butterfly's practical application of ultrasound In time, we believe this shift will not only accelerate our growth, but will also allow for more predictable growth expectations. For some additional color, as mentioned, we are expecting 25 to 30 percent growth in the first half of the year and approximately 45 percent growth in the second half. we expect our gross margin percentage will fluctuate quarterly along with the change in mix between product and software subscription sets. The first quarter tends to be the lightest in terms of product sales. As such, we anticipate it will be our highest in terms of subscription sales as a percentage of revenue and gross margin percentage. We do, however, anticipate that our subscription sales as a percentage of revenue and gross margin percentage to increase for the full year 2022 versus 2021. For operating expenses, please remember we are doing two things simultaneously. We are building a domestic and international commercial organization to support our current revenue base. And two, we are investing in R&D resources to create future revenue streams. Because we are investing significantly for the future and expecting operating leverage on these investments in subsequent years, we believe at this time adjusted gross margins are the best predictor of our future profitability. In closing, time and time again, Butterfly's unique ability to surface valuable clinical information quickly and easily where it otherwise does not exist is winning the hearts and minds of practitioners and leaders across healthcare. Butterfly is the practical application of ultrasound information in the clinical workflow. This is not about doing more ultrasound, but about using the valuable information from ultrasound to better inform care decisions everywhere. Thank you for joining today's call, and thank you to the Butterfly team for the amazing and important work you continue to do. Now we'll open up for Q&A.