Integrum AB (publ)

and welcome to today's webcast with Integrum, where CEO Richard Brodermark, CFO Jörgen Svanström, and US President Jeff Rezani will present a report. After the presentation, there will be a Q&A, so if you have any questions to the company, you can send them in via the form to the right. And with that said, I hand over the word to you guys.

Thank you very much, and welcome everyone to Integrum's company presentation, the first quarter of this fiscal year. Next slide, please. so we go directly to the introduction and and so it's the i'm rick deborah one of my accountants founder and ceo and to my left here i have you're looking at monster and on the other side of the pond we have zani u.s president so we we start with a quick recapitulate recapitulation of the company you know we have been uh the real pioneer in bone anchored prosthetics and also into the neuromuscular integrated prosthetics. Our core product is the O-brain implant system, and it is still the only FDA-approved osteointegrated prosthesis for amputees, and currently the approved indication is for above-knee amputees. We have since 2020 had an annual revenue growth of about plus 30%. We have had increasing profitability and we have been trying to scale up the company. We also have a growing pipeline of new products and new indications, such as not only above the knee, also above the elbow, amputations with prosthesis, and we are also working on what we call EO, that is brain control smart prosthesis. We think that we now are well positioned to capitalize on the larger growing global market for advanced perspectives and it's estimated that the market size currently is about 8 billion US dollars. I think we have a proven track record of clinical excellence, scientific innovations and commercial success. We've been in this field for more than 20 years and there are now more than 700 treated patients worldwide. Next slide, please. So here are some of the milestones. We started in 1998. We went to the U.S. first in 2015, where we had a limited FDA Google Humanitarian Device exam. And then end of 2020, we got the full or pre-market approval, or PMA, so we can really start to scale up the business in the US. And last fiscal year, our annual revenue surpassed 100 million Swedish crowns. Next slide, please. So our key market, that is the US. That's the most important medtech market in the world. We've got the PMA in 2020. We have our subsidiary that is run by Jeff. We have our internal sales force that is now strengthened. We work with different distribution partners that Jeff will also talk about. There is a substantial market size. In Europe, we sales force, distribution partners, and it is a smaller market, but still a substantial market, about $2 billion. We have some of the most prestigious institutions in the world that we collaborate with on the experimental side, primarily MIT, Massachusetts Institute of Technology, and on the clinical side, for instance, Johns Hopkins and the Mayo Clinic. Next slide please. So what is the core product OURA? So this is in the field of amputations, but not all amputations. This is towards the subpopulation of persons living with amputation due to trauma, accident, war-related injuries, or cancer-associated amputations. So that is what we are targeting today with the indication. And only with that limited subpopulation, we have this substantial total addressable market. So in the U.S. right now, we are only approved for above-knee amputations. But there is a very, very significant additional market if we can move into below-knee amputations. And we have publicly stated that we are initiating clinical studies funded by, actually in the the Reed National Military Medical Center, that is the major military hospital in the US. So that means that over time, we will be able to expand the total addressable market substantially. So Oprah, what is it really? What is the difference compared to standard prosthesis? The standard prosthesis is a socket-based prosthesis. And the socket sits on the outside of the amputated stomach. And there are certain mechanical constraints to that solution because it's not really anchored to the skeleton. So you get mobility problems, You get infections, a part of the heel bones because the socket is rubbing towards the skin and you need to change the sockets frequently due to these problems and also because the body is all the time changing in shape. If you add weight or you lose weight, et cetera, over time you lose some of the muscle mass and then you lose volume. The Oprah implant on the other hand is directly connected to the skeleton, then bypassing all other problems related to the impaired mechanical solution with the socket. so that means we eliminate all our socket related problems and we can increase range of motion that's how much you can move the joint and limb strength it's also so that with a direct connection to the skeleton you get a feeling for your prosthesis and it's a combination of proprioception that is a joint position feeling and what we call osteoporception that you can actually feel within that and it's very easy to put on the prosthesis. So what is really the difference here? If you have a socket and you've been taking a shower and you want to put on the socket, it could be very difficult because it needs to dry out. With an implant that is connected to the bone and there's a mechanical connection to the prosthesis, you can just snap it on in a matter of seconds. Next slide, please. So the way we do it, we have a surgical two-step procedure, and that's been shown to be an efficient and now a standardized treatment. We have also added additional features. So the XO2 release system, that is like a ski binding. So if you get an overload, that will reduce the risk for fractures. implant system and also for fractures to the skeleton. We have also since the introduction, actually in the early 90s, added what we call the biohelix surface. That is a novel surface that increases the success rate of the implant and the integration to bone tissue through mechanisms that is making the healing more rapid and the connection between bone tissue implants stronger. And we have now more than 700 users globally. Next slide, please. We have worked extensively with scientific evaluations. So I think we're still the only ones that have published prospective studies is actually the data that paid away for the PMA in the US. We can show that we have increased mechanical function and this sense of self or superception. You take more step counts per day with a prosthesis like that. And in overall, you also increase your mental wellness and quality of life. Next slide. So even though in the US, or today only, knee amputation indication approved. We have outside of the EU has been working with upper arm, lower arm, thumb, index fingers and below knee. What is currently CE marked under MDR, that is the new regulation in Europe, it's the upper arm, it's the above knee and it's the thumb and index fingers. Next slide, please. So let me very briefly talk about EO-Pram at this point. But it's the most advanced control system that is in the scientific evaluation phase. So it's a way to create direct brain control to external prostheses. But we don't do it directly in the brain. We use neuromuscular integration. We use pattern recognition algorithm. artificial intelligence, and we're also adding tactile sensory feedback. And why is that important? Well, you know, an extremity without sensory feedback is not really a real extremity. And we would like to try to make an artificial limb become a true part of your body. Next slide, please. So this is what we call, you know, signal from the brain to move the prosthesis. Sensor signals This is how an intact limb is working. That's what we're trying to recreate. But this is a challenge and it's not something that we can fully develop by ourselves. So for instance, we work with leading institutions and the recent years we've been working a lot with Massachusetts Institute of Technology. Next slide, please. So I'll leave the word to you, Jonathan.

Thank you. And as you've seen in the report, We have net sales of 18.5 million Swedish kronor for the quarter, in comparison to 20.4 million in the corresponding quarter last year. And this leaves year-on-year growth of minus 9.5%. The operating profit for the quarter was minus 12 million in comparison to minus 2.9 in the corresponding quarter previous year. And of course, both of these operating profits lead to negative EBIT margins. But I also want to note that we are still at above 100 million for the last 12 months in net sales. And our annual growth rate is 33.4%. And if you look at the quarterly revenue, you can see historically, it's been a bumpy ride. It's not exactly a linear curve pointing just one way. And I guess you can say that it's the same thing for the operating profits. If we compare the currency effect on the revenue, we had minus 9.6. So the currency effect is not quarter. Of course, if you exclude the currency effects, they were negative. So the direct currency effects, you have an EBIT of minus 10.6. So more or less minus 1.4 in currency effect for the quarter. Looking at the operating costs, they are, as you can see, higher than last year. I want to point out that there are one-off effects of 1.2 million and also that we are more active, which leads to more professional services and also that we use more consultancy services. If we look at it regionally, the United States had net sales or revenue of 13.7 million Swedish, in comparison to the corresponding quarter last year of 15.2 million, and this leads to a minus 9.8% growth. I guess a highlight is the Hanger Agreement, which we signed in the quarter. Jeff will talk more about that later on in the presentation. From my point of view, I want to point out that we secured a trade-term loan agreement. I suppose that you can say that it's almost like a factoring deal, but it means that we can actually finance on our purchase order instead of selling the invoices, which is much, much better for us because it means that we can finance at an earlier stage. The agreement is specifically made for the US, but we are currently negotiating to include the rest of the world as well. So that will come in quarter two. Looking at the rest of the world, the revenue was 4.8 million in comparison to 5.2, which meant minus 8.5% in year-on-year growth. I think it's worth pointing out that in the quarter, we got the market approval in Israel, which means that the certification is out of the way. I also want to highlight or emphasize that We talk about the inventory build-up, and it's quite an effect actually when starting out in a new market. So I think this is something important to understand. The UK adopted the MDR regulations, so they use the same regulations, which means that We actually fulfill the demands, but they still need to go through the administrative process of approving it. And this is what we are waiting for in the UK before, or at least we did in the quarter before we can start operating. Yeah, and also, a comment on EOPRA. We are also in a memorandum of understanding with COAD to further develop EOPRA. I now hand over to Jeff for the U.S.

market update. Great. Thank you, Jorgen. Next slide. I'd like to share with you some focus points First is ecosystem and how we're executing. The second is I'll give you a highlight, as Jorgen and Ricard have said, on our strategic partnerships and an opportunity that we found that will help us speed. Some of the partnerships with key facilities and how we're working with hospitals as well as prosthetists and clinics. A plan of building out the U.S. commercial team. And then one of the most important pieces, the voice of the customer. Next slide. In January of 2024, we launched the ecosystem approach, really learning how to properly put together a plan to execute against our budget. We currently have three reps covering the United States. We call them regional business development reps in the market. We're really establishing what works well, how do we come up with the proper plan, and how do we expand that when we find exactly what works so that we can build growth and replicate it across the country? The ecosystem model is working. What we've realized is that we need additional resources, and I'm going to get into that on the next few slides. Next slide, please. So I've shared with you the ecosystem model before and what it takes to generate patient production in the periphery of this ecosystem to send those patients to the center of the nucleus, which we see as hospitals and the surgeon. The key is the prosthetist. The key is the prosthetist because they're the ones that have the relationship with our targeted customer. They are the ones that will drive the patients to the facilities. And what we needed to find is a way to get to more prosthetists faster versus having three regional business development managers moving around the country, along with a smaller organization, executive organization with three additional people in a support system. Next slide. So in June 10th, we entered into a strategic partnership with Hanger. Hanger has 925 and growing clinics across the U.S. with employed prosthetists. This gives us an opportunity to partner with Hanger to train their trainers, to train their regional vice president of business developments across the country in an effort to stand up patients and identify patients that are OI candidates. Additionally, Hanger has a distribution channel that will help distribute the X or two to the market and create a channel for awareness to the prosthetists and our technology. Next slide, please. By having this strategic partnership with Hanger, as well as SPS, it enables us to focus in on what you're seeing here referenced, the step one, which is connect and qualify. We now have not only our direct Salesforce, but we now have and are building to Hanger and SPS's Salesforce, helping us identify candidates for osseointegration and utilizing our technology as a differentiated platform for their channel. What that'll help us do is move through the steps much faster than we have before and generate more patients in step one in getting them to the surgery center for S1 production. Next slide. So as I said, we only have three regional business managers working in the United States right now. With our capital injection, it's gonna allow us to take what we've learned the model that has been proven and expand our team and expand our footprint. We're also developing an onboarding and training program so that we can hire new, pick up new hires and speed, get them to speed quickly. With this increased focus, we're going to hire a sales team that's strictly calling on prosthetists and helping with our strategic partners in generating new patient production. We also in June launched this collaborative agreement with this additional partner called SPS. SPS is an independent distribution channel that will also operate very similar to Hanger in the sense that they have regional business managers that we are also partnering with. So we can leverage our current ecosystems that we've had partnerships with and establish better harmonization between Hanger, SPS, other strategic partners, and the context that we've had. And lastly, really qualifying and driving patient referrals. Design a capture process for these newly identified patients to the current ecosystems we work with so that there's a good inbound program, and then create a concierge service between the CPO and Integrum to walk this patient through the journey. So as we develop this and we fine tune it, we'll expand our market. And I'm gonna share with you in the next slide, if you could advance to the next slide, our initial phasing here of the strategic partnership. We decided that we wanted to stay laser focused with this partnership that we just executed. We've established relationships with four centers for excellence or ecosystems across the US. And this is our primary focus in creating good collaboration and execution with the partnership. Next slide. Lastly, this deeper focus will create stronger relationships. It creates strong relationships with the surgeons, our strategic partners, as well as Integra referenced individuals, RBDs and resources. We're able to conduct faster penetration with field-based cadaver trainings, bringing surgeons to get the best clinical training with our technology. And lastly, which we're really happy about and excited to share, is that we were able in June to bring together the top 16 osteointegration surgeons in the US to what we refer to as a master's course. These surgeons came on their own time and spent time with each other, sharing best practices for osteointegration, true testimony to the support that we have from our surgical side of the business with Integrum. And lastly, this new strategic partnership has created focus. This focus will create an opportunity to call on prosthetic centers across the U.S. and build out a sales team to support the reflection of capturing more patients. Next slide. I'll go back to Ricard.

Thank you, Jeff. Thanks for the update. So next slide, please. In principle, the rest of the world is following a lot of what Jeff already described. We're focusing on the CPOs, certified prosthetists and orthopedists. Orthopedic prosthetists. To help them and also combine that with what the rest of the world call excellence centers that is very similar to the ecosystem. So how can we execute that in the rest of the world? Well, compared to Jeff's present organization, the organization in Europe has been very small. And in principle, we have a sales and marketing manager and a training and education and a key point manager or clinical coordinator, and then a marketing and events coordinator. And now you can see here we're expanding with clear indication with a C mark, the rest of the word. Business development coordinator to follow up the KPIs. A sales support assistant to support the sales and marketing manager. A clinical sales rep towards the prosthetist, which is similar to what Jeff is doing, and he will start in Germany. And another clinical support expert, a prosthetist, to work with the lower extremity And that will be primarily initially on the UK market. Next slide, please. So if we have a brief snapshot here, UK, a distributor that we just started. In Germany and associated countries, we go direct and we focus on three excellent centers. In Italy, we're going to go direct, and then we're targeting the Rizzoli Institute. That is one of the top five orthopedic hospitals in the world. In Ukraine, you can say we have more of a hybrid model. So right now, it's direct to some extent, but you also know from our press releases that we have been able to sell an inventory. Over time, we see that this will change more to a distributed We work with distributors, and Israel is also starting out with distributors. You see all the distributors starting right now. That's also reflecting on what Jörgen said about inventory. If needed, we can come back to that. Next slide, please. So what is the way forward? Next slide, please. focus growth and how we will be able to execute that. We continue to work with the ecosystem strategy in the US. The hangar is a very, very important part to be able to scale this rapidly over time, not this quarter. We would use a specialized sales force within the ecosystem targeting on prosthetics. key markets with the direct sales model and via distributors. Next slide, please. So we have been growing from just a few employees to now, I think we have about 35 globally. And everything is happening and we need to make sure that we can continue to grow. So we're working to align the organization to this continued growth. We're going from a small company now passing 100 million in revenue. We feel we need to upgrade certain key roles. And we also need to improve the efficiency by adding key systems to our headquarters and US office. And what do we mean by that? you know, we cannot trust that I would check every x-ray. So we're setting up system And you say, oh, is that important? Well, at this point, we are evaluating every single patient manually because we need to have a very high quality to get great success rates. But this is something that we are now moving on to a more streamlined system. And if you're interested, I'm sure that Jeff can fill you in on that later. Next slide. So how can we get to operational excellence? We need to drive economic value to the key customer, our core constituents. We need to establish the right salesforce productivity. We continue to develop new products and launch new products to the market. is something that will help our working capital challenges when we continue to grow. Let me stop there and go to the next slide. This is what we do. We are changing people's lives forever. thank you very much for your attention and let us now turn over to any questions you might have

Thank you so much for the presentation here. And we received a large number of questions. I think we'll go straight ahead here. Can you tell us more about the status of the study on below the knee? Is it one or two operations per patient? And have you started receiving income linked to the study?

So the study protocol is approved by FDA and FDA requires it to be a student. The protocol has received clearance from FDA, which is called an IDE, Investigation and Device Exam. But the study has not started to include any patients yet, and so there is still no revenue.

Thank you. Why is Europe so weak versus Q4?

Yes, to some extent, I think we tried to explain that when we do an inventory build-up, we get the revenue when we do the inventory build-up. And I think that the most typical example here would be Ukraine. So NLQ2 reported that they bought inventory for 3.5 million Swedish crowns. and of course that will be affecting revenue because they use the end inventory that were already sold so that is I think a key mechanism but it's also so that if you go check you know the quarters we have a volatility quarter from quarter so that can also affect and that's because we have fairly low volumes there thank you what are you doing differently now compared to 12 months ago Well, I think that the big difference is not really what we do now. I think it's more related to what we're going to execute forward. And I don't know if you want to add something yet, but you know, the Hanging Deal will change a lot what you will be doing and how you will focus your team going forward. And this is not just for this quarter or next quarter. This is a plan for long-term growth. Jeff, do you have anything to add?

I do. We have a fantastic surgeon-based foundation. We have clinicians and surgeons that are eager to use our technology, want to use our technology, stand with us on our technology. What we need now, and this is why the focus has shifted, to not just securing more surgeons, it's not what we need. What we need is patients for the surgeons. And the way we get those patients is hyper-focused in on the prosthetist, because they're the ones that hold the relationship with the current amputees. So as we move forward, our target now is not just on the ecosystem, it is at the top tier of the ecosystem and calling on prosthetists and expanding our sales force to prosthetists to generate more patient production.

Thank you. Is the financial performance in Q1 an outliner compared to the last couple of quarterly reports?

Yes, to some extent you can say that, but it's also so that these have been our best quarters ever. So what is an outlier that can maybe be discussed? As I was trying to explain with a couple of new distributors coming on board during those quarters as compared to no new distributor coming on board this quarter. of course also affect. But you know, we're not going to sit here and have no growth for this company. So that's not the plan. So of course we feel that the figures that we did last year and we reached 100 million, that's still just a part of our journey.

I think also Relating to the previous question of what we're doing differently. I mean, 12 months ago, we didn't have any distributors like we have now. So of course, in the short perspective, the inventory buildup will lead to an immediate revenue stream. But I mean, the major revenue streams from the distributor partnerships will come in the future and not from selling the first inventory.

Thank you. Does Integrum have to actively participate in selling its products in the promoted medical centers?

I'm not sure I really understand the question, but you know, we sell in the US and you can feel it also Jeff, you know, we sell our implant system directly to the hospitals. but the actual additional prosthetic components that's sewn to the prosthetics.

Thank you. Martin, could you just repeat that question, please?

Yeah, of course. Also, does Integrum have to actively participating in selling its product in the promoted medical centers? Or to add some more color, does the centers not promote the product as a part of their service on ongoing basis?

Let me try to answer that question. So on the surgical side, to Ricard's point, here in the United States, we go through the standard orthopedic implant process, which is called VAC approval. So the product gets submitted to the hospital. It goes through approval committee and then gets access to the surgeon at that facility or ecosystem. From a promotional standpoint, what's been really interesting to watch here in the US is that as we've gotten deeper relationships through the ecosystem approach and started working and collaborating with the institutions, we're finding these institutions utilizing their own resources to market and share that they are now an osseointegration site. So they're using it as a differentiator for competitor hospitals.

Thank you.

what are the remaining steps to complete the hanger agreement and what is the expected time frame so um you know hanger is a big entity and we have a good rapport good relationship there's two pieces to that um that agreement one is the hanger side which owns prosthetists as well as clinic clinics and then there's the sps side which is more of the distribution side but they all they both fall under the hanger umbrella It's a big organization and they're excited to be working with us as a differentiated technology. We've already done some collaboration out in the field with these co-branded opportunities of bringing patients together and collaborating and identifying new opportunities for OI. I think it's a slow moving ship. I think it's going certainly in the right direction. The relationship is extremely strong and is starting to roll out. You know, again, reflecting on one of my slides, we have essentially three business development managers here that are running the United States in all of our centers. So as we start to expand our sales staff and our resources, I think we'll be able to speed opportunity, but right now it's going at a very good pace where we're identifying and harmonizing and teaching their teachers, so train the trainer mentality on our technology. So we'll have more sellers out there now in this collaboration.

Thank you. Can the lower U.S. sales be explained by any surgeons moving hospitals during the quarter resulting in a stop of surgeries that would otherwise have been carried out?

So as Ricard had said, we're not a high-utilized product. We have a potential, but we're not a high-volume product just yet. So when you have a surgeon that shifts or moves facilities, it does hurt you, right? It does make impact. And the good thing is that we have had a couple surgeons relocate to new facilities, and the surgeons that have moved is generally a surgeon that will pick up that facility from the departure and become the new leader of osteointegration for that facility. But then when that surgeon lands at his new opportunity or their new opportunity, it does take time to stand up a new program. And that can make some impact.

Thank you. Is there a continuous work with Hanger or any other products that will take focus away from increasing sales in the shorter term, meaning the next quarter and forward? Or should we expect a continuous depressed sales development into Q2 and Q3 as well?

So I remain very, very confident in our ability to grow this organization. And I think with this new strategic partnership, it's going to allow us to generate more patients Again, we need to ramp up our team and increase our sales team. We have eight people here in the US covering the United States, three regional field people, so my expectation is certainly positive for the future, and I think this is going to help us in the long term. Thank you.

You previously announced a reversed profit warning when your sales were higher than market expectations. Why did you not announce a profit warning for the low Q1 sales?

So we have checked this with our legal advisors and certified advisors how we should handle this and we have followed their advice.

Thank you. Considering the low Q1 sales is there a particularly high demand for your surge in Q2 that could propel sales back to the anticipated higher levels? you repeat that question yeah of course considering the low q1 sales is there a particularly high demand for your surgeries in q2 that could propel sales back to the anticipated higher levels ricardo i don't know how you how you like me to answer that um no i can i can start maybe with you know uh the rest of the world so uh today we had a lower

revenue than expected, but we don't share any further details. And then I'm trying to indicate that we still have surges going on that we don't get any revenue from because they've already been sold to that inventory. So that can be one mechanism in the rest of the world. I think you're primarily talking about the US and what we are trying to do now is a fairly big shift to make sure that the hanger collaboration is working. But it's also so, and we haven't really talked about that, you know, we did a capital injection and that would give Jeff also additional resources to be able to expand the work outside hanger, because I think that's where we had maybe a primary weakness. So maybe you can expand around that, Jeff.

Yeah, you know, we originally had stayed focused in on these ecosystems, which again, were the periphery of the diagram that you saw. So we had a small organization calling on PM&R, surgeons, distributors, prosthetists, all the above. And now with this focused mechanism calling on prosthetists to generate patients, we feel as though it's going to be much more impactful. And now that we have this collaboration with strategic partners, we will have many others that are indirect sales essentially calling on prosthetists to generate opportunity for us. Thank you so much.

Can you tell us about your expectations on the Hanger Agreement in more concrete terms for the fiscal year? What would be good sale contribution and what would be below your expectations?

Well, let me first say, you know, we don't give any prognosis. So we cannot say anything about the figures. We stated in the report that we expect that the hanging collaboration will have effect this fiscal year. So I think unfortunately we have to leave it with that. But let me just give you an example to get a feeling for the magnitude of the opportunities. It's up to you, Jeff, to fix it. But you know, Anglia is sitting on about a third of the amputee population in the US. And our targeted indication is about say 180 to make it easy, 150,000 patients. So that means that if they have a third, they have about 150,000 transfemoral amputees that could maybe fit our treatment. So even if yes, short term, can only get a small fraction of that. It's a very, very important opportunity. And if over time that can be a good part of that, that's why we feel that this hanger setup is a very, very important way for us to rapidly meet a big part of our potential patient population. Yes, we want to expand on that.

No, I actually think you covered it perfectly. It's an opportunity for us to get to the market much faster, and quite frankly, with a partner that's interested and excited about this technology. They won't represent any technology that's not approved. We are certainly FDA approved here in the United States, and they are excited to have us as part of their portfolio.

Thank you so much. Have Hanger started building its XO2 inventory yet?

So, Hanger is a distributor and yes, they have acquired and continue to acquire stock of Axor inventory for distribution.

Thank you. A question to you Richard. In Kyiv, what is the maximum number of operations that can be conducted per week in the current setup?

Well, it's not a normal setup. They are at war and they work a lot. And this hospital is not just focused on our implant system. But if we can switch more, so say that they at maximum do one or two surgeries, which is maybe a half day or a day's I mean, we can do more, but I think that's not the plan. We have created one center of excellence and that's the way how you, I think in the best way you enter a market. And this is not our model. This is actually, if you go back to dental implants, that's how you enter the global market and then now you replace millions of implants. You create a center of excellence and you use that as a training vehicle for others and then they will be centers of excellence in their regions, and then they train others. This is a cascade effect that's been used effectively, I think not only for dental implants, but for many other implant systems also. So that's why we feel that this is not the limitation what they can do in Ukraine, and hopefully it is not, because the volume of amputees is predicted to, at the end of this year, bypass 100,000.

Thank you. Could you provide more detail on distribution of sales during the quarter? Did you face issues in the first half or the second half of Q1? Secondly, how far off were these Q1 results from your own expectations?

Okay, do we know if this is towards the US or the rest of the world?

It doesn't mention in the question.

Well, so primarily distribution as we And I think we said here that, you know, we have signed up the distribution agreements. But in principle, it's only the hybrid thing in Ukraine that's already up and running for where the UK is not approved. We have approval in Israel, but we haven't started surgeries there yet. So that's still in the works, but we have inventory placed. thank you how many new surgeons has gone through education in the quarter and are now ready to do surgery by themselves yeah yes maybe maybe you and i can talk about that because you know we discussed that previously that that's not the limiting factor i don't know how many surgeons you have that and we're more focusing on on you know this ecosystem model and going to work with that together with hanger to have you know where do you have the right density of hanging clinics around it etc um and in in the rest of the world we also have trained enough so that's not the limiting factor and frankly and i think that is that is a key message here and that was yet was trying to say that The surgery is not the limiting factor right now. It's to make sure that we have patient awareness and that we have the right value proposition to the prosthetist. So Jeff, do you want to add?

Yeah, 100%. So the surgeons are, again, extremely supportive of our technology and they want to do more cases. What is the challenge now is to get the patient to... surgeon what's really interesting is we reflect upon the master's program we brought those top tier surgeons together we think about some of the centers that we work with and i can tell you that all the big academic centers the mayos of the world the hopkins of the worlds were in attendance at that master's meeting so it's not the surgeon standpoint the hospital standpoint that is a factor It is now going after the prosthetist, creating a value message to the prosthetist to generate that patient production.

Thank you so much. Moving on to the last question here. Could you please describe the situation in Ukraine? Do they have the financing in place to continue to buy your products? Do you see Ukraine growing from here?

Yeah, I think that's a very good question and it's also a bit challenging to answer it. They're at war. The center has been moving forward with negotiations with the government to get this treatment in the curriculum to be a standard of care for the niche patient population we are targeting in the uk which is still a very big patient with the what we call the short stumps from the tourniquet syndrome you know you're a soldier you have your A harness, you go in, you get hurt, you are bleeding from your arm, you activate the tourniquet, a medic will see you and say, okay, you need to be sent back to the lines. It takes many, many hours. And when you have someone that can really take care of the trauma, you know, a surgeon and so on, you have had this tourniquet on for so long, so the arm is dead and you have to do a short-stun amputation. So that is what we are focusing on right now in Ukraine to get into the government. But it's also so that there is a lot of international money floating into Ukraine and support the current business we have. So short term, we cannot say anything about what's happening with the war. enough money floating in to support our growth longer term and I don't really know what that is because you know negotiations with governments might take time but we feel that this will be a standard of care for the very selective patients at least and they are still enough to support a long-term business opportunity in Ukraine.

Thank you so much for presenting here today and answering our questions. And thank you all for tuning in. I wish you a pleasant weekend.

Thank you very much. Thank you. Thank you.