Pro Medicus Limited (PME) Earnings Call Transcript & Summary

Ladies and gentlemen, good morning. On behalf of my fellow Directors, I'd like to welcome you to the Annual General Meeting of Pro Medicus Limited and thank you for taking the time to be with us. My name is Peter Kempen and I'm the Chairman of the Board and will be Chairman of this meeting. We are meeting in Hawthorn, a suburb of Melbourne, and I'd like to acknowledge the traditional owners of the land, the Wurundjeri people of the Kulin nation. As indicated in the Notice of Meeting, this AGM will be a hybrid meeting with physical attendance here at Leonda and online through Link Market Services facility. I'm delighted that many shareholders have decided to join us today both in-person -- in-person, and I would like to welcome all shareholders to this meeting. There will be an opportunity to ask questions and to vote during the course of the meeting, either in-person or online, and I'll go through the process later in the meeting. I'd now like to acknowledge and introduce my fellow directors, who will stand hopefully when their names mentioned. Ms. Deena Shiff, who is the Non-Executive Director and Chair of the People and Culture Committee; Ms. Alice Williams, who is Non-Executive Director and Chair of the Audit and Risk Committee. I won't ask Dr. Sam Hupert, the Joint Founder and CEO and Executive Director to stand, because you can hopefully see him on screen. Mr. Anthony Hall, Joint Founder and Executive Director; Mr. Tony Glenning, Non-Executive Director; and Dr. Leigh Farrell, Non-Executive Director. We're also accompanied by Mr. Clayton Hatch, the Chief Financial Officer; and Ms. Danny English, the Company Secretary. Also joining us is Ms. Andrea Steacy of Ernst & Young, the company's auditor. You don't have to stand. Who is available to answer any questions in relation to the financial statements and her report to the shareholders. It's also very important to mention the following key personnel, who in addition to the Executive Directors have provided excellent leadership during the year, Malte Westerhoff, who's the General Manager, Europe and Global Chief Technology Officer; Sean Lambright, Global Head of Sales; Teri Gschwind, Global Head of Customer Service; Danny Tauber, who's General Manager of Australia; Brad Levin, General Manager, North America and Global Head of Marketing; Clayton Hatch, we've mentioned; and Sharni Redenbach, who's Director, People and Culture. Each of those is depicted on Page 9 of the Annual Report, which will give you a little more background of their contribution to the company. Before we deal with the formal business of the meeting, I'll provide my report to you, which will be followed by a report from Dr. Sam Hupert, the CEO. So mentioned earlier, there will be opportunities to ask questions during the course of the meeting and following the formal business. And now to my Chairman's Report. You may be tired of me saying this, but I'll do it anyway. The company's enjoyed another very successful year, both from an operational and financial point of view. The success of the company in the markets that we serve continues to be due to the quality of our leading technology, the quality of our management team and the passion, enthusiasm and dedication of all our staff, and not to put too finer point on it, but the robustness of our business model. The company continued to deliver the highest level of service to our clients and in turn to their patients. The company is fortunate to have a group of highly skilled professionals led by Dr. Sam Hupert and the management team. The majority of our staff have been with the company for many years and the core management team well over a decade. As a consequence, the company has continued to deliver long-term, profitable and sustainable financial result by delivering on milestones in accordance with the company's strategic plan. The group continues to invest in our best of breed suite of innovative products to maintain our market leadership, which we believe is fundamental to your company's success. We also continue to invest in our management and staff, which is growing in line with our strategic objectives. Dr. Hupert will provide further commentary in relation to the company's personnel in his presentation. New contract wins and renewals. During fiscal '24, the company announced 9 new contract wins in North America, including our largest contract to date, Baylor Scott & White, which as of mid-September of this year is fully live, along with many others implemented during the year. Dr. Hupert again will go through the details of these contracts in his presentation. Since 1st July 2024, the company has announced 2 significant client renewals, one in North America and one in Australia, both at increased fee levels. Despite the number of new additions to our client base, new opportunities continue to present themselves and as a result, our pipeline remains very strong. Financial results. Fiscal '24 was another record year for the company with revenue increasing by 29.3% to $161.5 million and net profit after tax increasing by 36.5% to $82.8 million. The company continued to be cash flow positive with retained cash and liquid investments increasing from $121.5 million to $155.4 million after AUD 2.77 buyback of shares in February-March, a USD 5 million, which is about AUD 7.5 million investment in Cardiac CT AI company Elucid and of course, paying increased dividends. The Board anticipates fiscal '25 will be another very strong year. The budget for the current financial year has been determined recognizing anticipated continuing strong growth from both existing and new clients. I'm pleased to advise that the results to date are ahead of our budget on a constant currency basis and an Australian dollar basis, despite some volatility in currency markets during the period since 1st of July. We anticipate the second half of the financial year will be stronger than the first half as is traditionally the case. Surplus cash and M&A. As I indicated earlier, our cash and other financial instruments have continued to grow during the year. These funds are maintained to allow the company to continue to invest in the development of our product suite, including AI, to meet our dividend obligations and to take advantage of acquisition opportunities that might arise. During fiscal '24, the company announced a strategic investment in Boston-based Elucid Bioimaging Inc. It's a company specializing in Cardiac CT AI with the aim of further bolstering our Visage 7 cardiology imaging product offering. The Board has also considered a small number of acquisition opportunities during the course of the year which met our criteria, but to date have not given rise to a transaction. Dividend policy. The Board was pleased to increase dividend payments for the 2024 financial year to $0.40 per share fully franked. This represents an increase of 33% over the previous year and a payout ratio of approximately 50%. The dividends, as in the past, were funded from the company's internally generated cash flow. The Board anticipates that future dividends will continue to be fully franked. The Board will continue to determine an appropriate level of dividends having regard to the profitability of the business, the need for our ongoing investment and the necessity to retain sufficient funds to pursue other growth opportunities. Environmental, social and governance, generally known as ESG. The company's ongoing success has given a rise to a growing demand for the company's shares, which in turn has significantly increased its market value. I don't wish to comment on the share price per se, but rather note that the increase in market value has brought greater visibility to the company and in turn greater focus on the disclosure of ESG and other reporting obligations. I want to assure our shareholders that the Board appreciates the greater interest in the company and is taking all reasonable steps to meet investors' expectations in this regard. In closing, on your behalf, I'd again like to thank all our dedicated staff in Australia, North America and Europe for their contribution to the company during what has been another very successful year. I'd also like to thank my fellow directors who have also worked tirelessly and diligently to ensure that the company reaches its ultimate goals. That ends my report and I'd now like to hand over -- and there will be opportunity to ask questions after Sam's report, but I'd now like to hand over to Dr. Sam Hupert to give you an overview for the performance of the company over the last year and provide an update on the company's current activities. Sam?

Does this work? Yes, good. Good morning, everybody, thanks for coming along. As most of you know, we are domiciled in 3 jurisdictions. Melbourne, Australia, which is our corporate office. It's where we do the R&D for the Visage RIS product and where the company was founded. Berlin, where the R&D and support for the Visage 7 product is done, and the U.S., which is our biggest market. We have 2 products, as I mentioned, the RIS, which I'll talk about a little later. Again, developed here, we have 2 of the largest radiology companies in Australia using it, plus a host of others, and Visage 7, which is the product we sell in the U.S. and now represents a large proportion of our revenue. In terms of the results, it was a record year, as Peter said, and it was a record year in terms of a number of metrics. Clearly financially is one and it's important, but we did win a number of contracts and importantly we also implemented a large number of contracts, because we have the reputation of being able to implement seamlessly and quickly, which is a very important part of our strategy in the U.S. market. We made progress with other ologies that I'll talk about and AI, and all the work we did in '24 forms the base for future growth in '25 and beyond. The results they speak, I won't go through them in detail, most of you will have seen them in the full year presentation, but I think it's fair to say that every single financial metric moved in the right direction. We are financially very conservative, as Peter has mentioned, that's our DNA, so growth, start-up type mentality at the front, very old-world conservative when it comes to the finances at the back. So we're a bit of a hybrid, but we're very proud of that, and the fact that we have retained earnings and no debt means that we have a bit of dry powder not only to return to shareholders, but more importantly invest in the businesses as we need to, and look at M&A if anything sort of meets our criteria. In terms of the revenue, I won't go through all the splits, but the pink is the transaction revenue. So as most of you know, when we went into the U.S., we changed the licensing model so that it would be per click or per transaction, and the beauty of that is it forms an annuity style stream, revenue stream, where each new client adds to the base of existing clients. And as Peter mentioned, we renewed 2 long-term clients, one in Australia for the RIS product, and one of our largest clients in the U.S., so that base organically grows, not just with new entrants, but obviously the existing ones where we renew them at a higher price, and in most cases at for equal if not longer-term. The blue is the standard support contracts that we used to do, mainly in Australia. Again, they're recurring revenue, and the green are professional services which are split across the life of the contract. So the vast majority of our revenue not only comes to us, which I'll talk about a little later, but it is recurring in nature. There were a number of highlights in the year, in 2024. You would have seen many of these before. We had a -- without going through each individual opportunity, the beauty is they were in a lot of different markets. There were some academic, like Memorial Sloan Kettering. There were some like South Shore that are regional IDNs. There's CRL down there, which is a reading group, which is interesting. They're a group of radiologists that were reading for one of our clients in Minneapolis called Allina, which we had sold and implemented a number of years ago. They liked the platform so much that they then went and bought it for themselves. So they use it for all the hospitals, non-Allina-based, that they read for outside the Allina contract. So again, in the private space. So the -- we were very pleased that there was a broader range of market segments. There are some children's hospitals, which seems to be a little niche that we've got ourselves into, which is great. And then Moffitt, which was a cancer center. So not only was it a good year in terms of sales opportunities, but it was across a number of market segments and size of opportunity, because as Peter mentioned, we won Baylor Scott & White, which like everything, Texas is big, and it became our biggest contract to date. In terms of the model, we pioneered the operational per transaction model, and it served us very well. It is based on a concept of minimums, so the client will commit to a certain percentage of their previous 12 months volumes, and we use that as the base going forward. So when we announce a contract, the dollar value we announce is always at the minimums, because we're guaranteed that money. Now, the minimums are usually around 80%, because no one wants to commit to 100% of their volume in case there are sort of annual variations. So there's always upside in each of these contracts, and as I mentioned, it does generate an annuity stream, which is very important to us going forward. We do have a lot of operating leverage. All of the revenue that we generate comes directly to us. We don't sell hardware. If they're cloud fees, they are separate to the dollar values we announce for the contracts. Training and installation of what we call professional services, we bill out. They're at consultant rates, so over USD 2,000 ahead a day, but our real growth driver is in the operational model. We do have a contained cost base, and I'll speak about that a little later, and our margins continue to grow as our footprint grows, and they're just a tad under 70% on an EBIT level, which is sort of on the far end of the bell curve. It's about triple our nearest competitor, but we're very proud of that. In terms of our client base, Tier 1 academic medical centers, we now do 11 out of the top 20. Now this list gets reissued every year, and people go in and out of it. The top 5 or 10 are always the same. Mayo Clinic's always #1, but because they are always winning, they now do the list alphabetically. They don't rank them, but we are doing between any 1 year, 10 or 11 of the top 20. And I think that really underpins the fact that the product is very sophisticated, because these institutions, they need the best most advanced tools, because they're at the leading edge of radiology globally, and the fact that we've done so many of them, and we continue to win academic clients, I think underpins the whole concept that the product is not only very fast, which we talk about, but it's very sophisticated. The other footprint is in the IDN space. People know about the academics, but IDNs are actually the biggest section of the market. They're usually regional, sometimes multi-state. The difference between the academics and the larger IDNs, academics are part of a university and have a teaching hospital system, whereas IDNs have got a lot of hospitals, but they don't have a teaching program per se and a university attached. And you'll see on the right a list of the IDNs that we have won over the years. Mercy at the top was one of the renewals. They renewed again for 8 years. The original contract was sort of 6 plus 1, 1 year to put it in, 6 years of full use. The fact that they renewed for 8 shows -- we believe, shows the confidence they had in the technology and the company, because it is a very big commitment financially, very big commitment to their radiologists, so we were very pleased when they re-signed with us just a month or 2 ago. The RIS, as we mentioned, this is an Australian-based product. Anthony was the first programmer for the RIS, the foundational programmer, many, many years ago, which I'll talk about. It has gone on to bigger and better things, and again recently we renewed one of our large clients here for 5 years in a $32 million deal. So what makes Visage 7 so different to everybody else? We think we're #1, we're sure we're #1 in 3 things that really matter to a radiologist or a clinician. Speed, so no matter how large that dataset is, we can visualize it remotely in less than 1 second in 99% of cases, less than 2 seconds in pretty much 100%. So it almost defies physics. It's on demand, regardless of size of system. Functionality, as I mentioned before, is very, very important. Radiology is becoming a lot more sophisticated. It used to be largely 2D, it's now moved more and more into the realm of 3D, and more sophisticated, what we call fusion. So you would have heard of PET scanning, it's where they fused CT and nuclear med together, and there's more and more of that advanced imaging that's being done as a standard around the world. So the functionality is very important. And scalability, because we literally deal with petabytes of client data every year per client, and it has to be able to handle that increasing data load without compromise. So what's driving the market for us? Well, we've talked about many, many years and it continues, a massive explosion in the size of datasets, they're just getting bigger and bigger and bigger. And the traditional systems of compress and send, which is what everybody else does, they take the file from the scanner, they compress it, send it down the network, and the local workstation has to unpack that file and do all its manipulation locally. And that model used to work, but the files are just getting too big. The technology which is unique to us, and the 2 founders of Visage, I'll talk about a little later, developed in-house, is a streaming technology where we don't move the file. So it's fundamentally different, and while people have tried to copy it, it's been in the market some 15 years in the U.S., we don't know of anyone who's been able to crack that code. So it is a very, very different mousetrap, and one that I think sets us apart from the rest of the market. So what's our newest solution? Our solution's based around a streaming platform, which I think I've got a pointer out here, yes, all of that, which is the original streaming viewer. We are now cloud-based, because we think that's the way the market is going, and I'll talk about that a bit more. We have the archive at the bottom, and then off that we have things like research, we have other ologies, so it's the one core technology, the one platform. Now fully cloud-based for the last 4 years, which no one's been able to do, that does everything. So it's not multiple platforms that we're trying to cobble together, it's the one which is fundamental to our success to date, and our go-forward success. As I mentioned before, it's one thing to sell it, it's another thing to put it in. In the past, one of the great disincentives for enterprises, healthcare enterprises, to switch systems was that it would take 2 years plus. We've debunked all of that, changed the whole model, and we're now able to put it in pretty much seamlessly and incredibly quickly. It is a huge advantage for us. At first, prospective clients didn't believe it, but we've done enough of it in the market now that everybody understands that that's one of the key things that make us different. So when we did Baylor Scott & White, our biggest client to date, we signed them in October. We did a lot of the work in background remotely, migrating their data, setting up the cloud environment, testing all the interfaces. We did 3, what I call mini-go-lives. A go-live is they switch off the system Sunday night and start on the new system Monday morning. So we did 3 regions across a number of weeks, and then in September of this year, we did the final big bang go-live. So they switched across in 3 increments plus 1, the entire organization of over 600 radiologists, a few thousand technologists, and millions of exams went from old systems, legacy, to new Visage in cloud. It was that quick. People, we sell our system at a premium. Again, we're very proud to do that because we believe it is a premium product and should attract a premium price. And we believe we give back the biggest return on investment, not just financially, of which we can talk about that if people want later on, but also clinically. We actually move the needle clinically and allow clinicians to do things that previously would take too long or they couldn't do. So here are some quotes verbatim from recent clients that just came on board. The first one, the registration fusion and linking of 2 prior studies at once is mind-blowing. In diving terms, that's degree of difficulty 12 out of 10. In other words, it was never possible to do on the fly, and we enabled this. So this was a neurosurgeon that does this for every single case, and instead of spending 10, 15 minutes, it pretty much opens up like that for him. And he said that's just changed his working day. Again, there's some other things around speed, it's around capability, but I think the message in all of it is it changes the way the radiologists can work, both in terms of efficiency, but also clinical capability. This is now one of the biggest problems facing radiology globally. This is the American College of Radiology released this on its website recently. How will we solve our radiology workforce shortage? And at the bottom, it talks about 1,400 positions that are advertised that are still yet to be filled. And that was in March. It's got much worse since. So people feel that the reason this all occurred was the promise of AI replacing radiologists, and so a lot of young doctors decided not to go into the specialty, but the exact opposite has occurred. It's created a huge worldwide shortage, reduced intake, but the larger data sets means there are more images to read for every case. So you've got more workload, fewer people, a lot of people post-COVID looking for changing work-life mix, working from home, or only working 3 or 4 days a week. So the groups are actually struggling to meet their workload, and in a number of cases, the first time I've ever seen it in 20-plus years, they are refusing new work. They just cannot cope with their own load, yet alone take on new work where 10 years ago there'd be 3 or 4 groups competing for this work they aren't. Why is this so important to us? Because the radiologist shortage conundrum is something we actually address. And the reason we address it is because we can empirically prove that our radiologists using Visage are between 25% to 30% more efficient. Now we had 1 client clock it at 50%. That's on the outside of the bell curve. But 25% to 30%, when you think about it, is huge. And when you think about it financially, the biggest cost for any radiology group, way ahead of any number 2, is the cost of the radiologist. So one, they're expensive, and B, you can't get them. So again, we're seeing increased demand for what we're doing because of the large data sets, but also because of this. There's a squeeze, and we can -- we have a surefire means of addressing, or partially addressing, that squeeze in terms of manpower. Cloud is something that is very important to us. I think our product was intrinsically engineered for cloud, even before cloud became a real thing. And so when cloud, and I mean public cloud, AWS, Microsoft Azure, or Google GCP became available, we were pretty much in the slot ready to go. Yes, there was some engineering, but it was something we anticipated. So we now have large-scale implementations in all 3 public clouds, so we give clients a choice, and we see it as a massive strategic advantage because Clayton and I get on a plane on Thursday to go to the RSNA in Chicago, which is the big conference, and every single stand, I will guarantee you, will have 2 words, AI and cloud. And if you went to that conference, you'd think, my God, how's it possible Pro Medicus could sell anything when everybody does exactly the same thing? But the reality is, we're the only ones that have been able to prove it. Our growth strategy, again, an extension of what we've talked about previously. I think one thing that we haven't talked much about, but is really important, is our existing user base. The industry is growing at about 2% to 3% annually, depending on the year. Our user base is more 8% to 10%, so triple industry average growth that is internal. Now some of its organic, some of its new centers, some of its bolt-on M&A, but the net result is they're growing pretty much triple the industry average. In the U.S., people often ask us, how big is this market? And we've done a lot of work. Unlike Australia, where Medicare tell you one figure and that's it, in the U.S., there's not one source of this information. There's a whole lot that you have to triangulate. We now believe there are around 650 million exams done annually. It's growing, as I said, by about 2% to 3%. That's general market. We believe we can address the market from a product perspective almost 100%. It works for the remote reading, the teleradiology, the private groups. As I mentioned, the sophisticated end, the academics, the large end, like the IDNs, and the people in the middle. But we think realistically 85%, which is a huge section of the market is addressable. And the other 15% is purely around the economics. It's when the deal is too small, because you've still got a contract, you've still got to go through all the normal processes, and that's quite time-consuming. So we think about 85% is addressable, including from both a product and commercial point of view. We now have about 7% of the market, a touch more. Doesn't sound like much, but America is a huge market, and no one has gone from 0% or standing start to 7% as quickly as we have. So we really believe, particularly in the U.S., we have a huge amount of addressable runway ahead of us. The pipeline that Peter talked about, as I mentioned, it's very robust, particularly since COVID -- the end of COVID, we are seeing increasing numbers of inbound RFPs across all market segments and across different market sizes. So the pipeline is not just skewed to one area or one market segment, it's across everything, which is really good, because it just means that you can -- to get to that 85%, you've really got to be able to address a large segment of the market. Things that have occurred that have really helped us a number of years ago, we bought out the Visage Open Archive. This product has been incredibly well accepted and is generating very, very strong revenue for us. It also is an integral part of our cloud strategy, so it makes a whole lot more sense to have everything in the cloud, including the data. And as I mentioned, we're the only ones that can currently do that. The last part of our core stack was workflow, which we introduced a number of years ago. Again, this has been incredibly popular since we've introduced it, and has enabled us to sell what we call full stack, all 3 products out of the gate. So we are -- we just -- the client is only dealing with us. It's all cloud-based, and you would have noticed in our announcements, an increasing number of them now are full stack for these products. We did talk about other ologies. I won't talk too long about it. Happy to answer questions about it. Cardiology being the first one, first cab off the rank, because it's the closest to radiology. Uses the same equipment, ultrasound, CT, MRI, and nuclear. We released the prototype of our cardiology product last year at RSNA. We've had a lot of interest from clients. We haven't got a commercial client just yet, but I believe we're very close, and it will be a big feature of our stand next week at RSNA 2024. AI, the word on everyone's tips, lips rather. I think healthcare was one of the industries that embraced AI very early. It has gone through the excitement phase, the hype phase, which I think generative AI is going through at the moment. It's gone through the disappointment phase, and I think now we're starting to see pockets of reality in the market. It has multiple uses. To date, the biggest use has actually been embedded in equipment. So most of the FDA cleared algorithms have been embedded into equipment. So if a patient moves on the table, it'll try and denoise the image, and if it can't, it'll tell the technologist you need to take another one. So many uses. We have a number of irons in the fire. Our 2 co-founders of the Visage platform, Malte and Detlev, PhDs in exactly this area. So we have internal capability as well as capability through research collaboration with some of our clients. So we think we're very well placed as this starts to become more mainstream to be in the slot to take advantage of it. So as I said, AI-capable platform. We are looking at developing our own algorithms further, co-developing, and also looking at opportunities with third parties, and as Peter mentioned, one of them we've actually made an investment in, which is Elucid, but there are others where we don't need to make an investment but can still partner and bring their algorithms to the platform. So something new since last year, a little bit of the future. As a radiologist called it from the Flintstones to the Jetsons, and it's most probably it. It was the release of Apple's Vision Pro, their immersive goggles, and we were a prerelease partner to that project under strict, strict security. I couldn't tell anybody. I wasn't even allowed to see it because I'd have to fly to Germany where it was locked up in a room before it was released. But very interesting technology. As I said, it was launched on the 5th of February. It allows -- what we currently do is we show 3D models on a 2D plane. This allows you to show a 3D model in a 3D environment so you can literally walk in and around someone's brain. Now, it sounds macabre, but it really, really is quite spectacular. Now it's not normal to wear goggles all day, but the technology, it's hard to believe till you actually witness it yourself. So we think it'll be a very good platform for immersive AI integration. So a lot of the planned uses for things like tumor boards where multiple specialists, radiologists, oncologists, physicians, radiotherapists, get together in a room and they discuss every case, every tumor case. Now a lot of that is all to do around imaging. Is the tumor still there? Are there more of them? Are they bigger? Are they smaller? Now imagine doing this in immersive 3D. It would just change the whole dynamic of it. So we're just starting to see the first use of that in the real world. And here is an article just released about few weeks ago from University of San Diego, which was our launch partner for this. They were the ones that introduced us to Apple for this project, where they got a whole lot of radiologists to use a normal screen and then use the goggles. And they're saying there will be applications for these goggles in radiology. Now subsequent to this article, they've been able to bring out a new version of the operating system where you can actually have a huge panoramic 4K-by-4K view of things. And we've been able to do that with our desktop. So it literally can have someone on the beach with this massive virtual screen in front of them reporting a case, the proverbial radiologist on the beach. So we think there yet to be commercial application for this, but we think it will come, particularly as Apple brings out version 2 of the Vision Pro and version 3. We think it also helps underpin our technical lead because people are going, well, you've just leapfrogged again, which is where we want to be. So going from the future now, I thought we'd go back to the future and back to our past. We talk about it from time to time, but this is a very interesting graphic because it was actually in an internal wall of our stand at RSNA 2022. So our Head of Marketing, Brad, and our Head of Creative decided it would be really good for the staff every day as we walk in and out of the stand to get a little bit of our history and see it. So '83 to '89, I know it looks like Starsky & Hutch. It is actually Anthony and myself many, many years ago. We started just before '83. This was a picture in the old days that was taken in our first office in Fitzroy. In '99, that's when Malte and Detlev started Indeed, which then became Visage. So they started back then. 2008 was the first RSNA we went to. There was Roger and myself, and we were a corner of an Agfa stand. We didn't even have our own stand in 2008. 2009, as many of you may know, in February, we acquired Visage Imaging and had our first stand. 2011 to 2012, various milestones. But the interesting thing, sorry, about -- if you look at what else happened in those years. So Disney buys Lucasfilm's for $4 billion. Facebook IPOs, 2012. Everything was happening around us. And this is what it looked like. So these were our RSNAs in 2010. The stand is nothing like it is today. It was about a 1/10 the size. That was the number of people that turned up. Now you'll notice I'm not in this photo, but I was there. Now, you'll see me in subsequent photos, and the reason is for people that know me. I hate getting up early. And they used to do this first thing in the morning, so I banned it. I said, you've got to wait till I'm here. 2013, '15, '17, '18 and '19 were big growth years for us. We started to talk a lot more about speed. You'll see the stand gets bigger. We started to merge the cultures of Visage and Pro Medicus, which was quite an effort in the early days. And this is what it looked like in terms of numbers. The top is '17. The next one is 2018 RSNA. The stand is getting bigger. The staff numbers are getting bigger. And then '20 was virtual because of COVID. '21, you'll see Bobby Roe on the right there wearing a mask. Australians couldn't go. We weren't allowed out of the country. So it was only parts of Germany, and they were just allowed in a few weeks beforehand. So we weren't sure if even they could go. And then, of course, the Americans, and this wall was done RSNA 2022. Wind forward to last year, and it's a completely different picture. A, I'm in it, if you can spot me in the front. And B, this is the team that we took. You can see that big curved wall, Brad gone mad, as I call it, at the top. It's a big 75-foot video wall that we use. And that was last year's. So if we wind forward -- wind back one more time. It's our people. So this really is to illustrate not only do we have a long heritage and a long history, but we have a great team, as Peter alluded to. So if you really think about it, Visage, Pro Medicus today, is really an amalgamation of 2 co-founded companies. Pro Medicus and Anthony and I co-founded back in '83, and then it's a picture of them in 2021 looking very futuristic. That's Malte, our CTO, and Detlev, who co-founded a company called Indeed that became Visage. So the important thing about all of that is it's been an amalgam. And today, all 4 founders are active in the business. Still, after all these years, which I think has been great. We're a large company, but really, we're actually very small. There's 121 people globally across all 3 jurisdictions. We like to keep it small. But I think some of the stats that we looked through were very interesting, like, 30% of the company have been with us 10 years. So if you're a 10-year-old, you're a newbie. We have 5 that have been with us 20 years, and we have 1, Danny in Melbourne, who's been with us over 30 years. Now remember, this is in a dynamic industry of information technology where people hop in and out of jobs pretty much every second year. The other interesting stat, the one I like the most, is we now have 3 second-gen employees where their parents work for us, and now their children work for us, and the parents are still working for us. So we have [ Andre ] in America, and his daughter, Yulia. We have Teri Gschwind, our Head of Services, and her daughter, Anna. And here in Australia, we have Peter Kiprillis, who's a 20-plus-year, and now his son, Cooper, has started working with us. So I see that as a huge validation that we are a positive and a good place to work. And then the last thing Sharni, our Head of P&C, told us is 1/3 of our new hires come from staff referrals, which I think, again, reinforces the message. So from the past into the future, next week, RSNA 2024. Bigger and better every year, according to Brad. It's 25% bigger stand, 25% bigger cost, of course. But we need the space. So the things that make it different this year, we now have -- it's a bit hard to see, but we have 3 meeting rooms at the back. You can see them there with the black. They're actually covered. We used to have 2. We build our own theatre that can hold 35 people. It's only built for 4 days, so we can actually have big groups that we can show the technology to. And 2 smaller meeting rooms, 1 with a smaller theatre, all the pods, and the white couch in the front. You won't guess what that's for, but I'll help you. It's the Vision Pro, because you don't want people standing up when they first use it, because they can get a bit giddy if they're not used to it. So we have 4 Vision Pros and 4 stations where they can sit and experience the whole new immersive technology. The other thing is that not only is it our people, but we're starting to see a blending of the technology between the 2 camps. So for the first time, we're releasing a new product called -- it's a work in progress called [ Chat ]. It is a joint development between our development team here and Berlin. Initially originated here, so not in Berlin, but now it's going to be global. It will work with both Visage RIS and Visage 7. It allows for things like context sharing, so if you're chatting and you go click, the images that you're looking at both ends will come up simultaneously, so you don't have to navigate to where they are. And we're going to highlight it at RSNA, but it'll come out in Q2 2025. And again, why I show you this, not just because it's something new we bring out. We bring out new things every year. But it's the first time we're trying to bring the teams to do a co-development, and I think this will be the first of many. So where are we? I'm just about to finish. As Peter mentioned, we are ahead of our growth budget, so we anticipate to grow every year and grow strongly. We set our budgets on that basis, and we are ahead of that budget as we sit here today. We've had 2 contract renewals worth at minimums $130 million. We've done 3 major implementations since July. That's MSK, Memorial Sloan Kettering, Baylor that I mentioned, and OHSU, the big academic. We are looking at an increased pipeline across all the opportunities. We think we're well positioned for AI as it becomes mainstream. And as I said next week, RSNA is shaping up to be our biggest and best. Thank you.

Well, the only thing Sam doesn't have is the black skivvy, but I think he's done a pretty good job in exciting you all.

Skivvy starts [ indiscernible ].

I just want to make 2 additional comments about what Sam just said before I go to questions. You may have noticed in the annual report that our staff turnover last year was 2.7%, which for those of you who know about staff turnovers, that's a very, very low number and supports and is a statistical support to what Sam was saying about why people or the fact that people join and they stay a very long time. And I think it's a testament to the management team that encourages those people to thrive in the environment that they're working in. The other thing I just want to say, there's a bit of bribery that goes on in relation to the RSNA. As long as Brad provides a first-rate barista for Sam's coffee, he can have the biggest and brightest stand that money will buy. And that seems to be working effectively for both of them at the moment. And the coffee, if you've drunk coffee in America, you know it's not terribly good. So it does attract a lot of interest in our stand in any event. And then that captures them to actually experience the technology. So those 2 things are working in our favor and they're hidden under the radar, but I've now shared them with you.

Now I'll invite shareholders to submit any questions they may have. And we'll initially deal with those questions that are in relation to the comments that myself and Sam made. And then we'll later answer the questions in relation to the formal business. Just to try and bring some order to the nature of the questions, we'll deal with them in the following order. Firstly, those received prior to the meeting. Secondly, questions from those attending in person. Thirdly, from questions from those utilizing the online portal. And finally, any questions from those attending by telephone, if we have any. So shareholders attending online can submit their questions during the meeting by clicking on the Ask a Question button to ensure questions reach us in time. I ask that you submit them now if you haven't already. I have one written question which came through prior to the meeting from a shareholder and I'd like to thank them for taking the trouble to do so. And the question comes from Dr. Andrews from New Zealand. We do have shareholders outside Australia, you'll be pleased to know. But many more globally now than we've ever had. The question is, could you please offer more reflection on the nature of PME's competition and advise more generally on the extent to which PME is ahead of its competitors? What gives the company the confidence that it can sustain its lead over the competition? And I'll hand that question to Sam.

Thanks for that. As I mentioned in my presentation, our technology, our platform is totally different. It was built from the ground up. It wasn't like someone took a toolkit that gets you to 70% or 80% of the way and then you refine the rest. It was built from the ground up by the 2 co-founders of Indeed and Visage, Malte and Detlev. And the majority of the team that were with them when we acquired the company are still with the company today. So it's a unique technology. We don't leave a roadmap of what we did. We talk about the streaming as if that were the only piece of technology in it, but in reality, it's about 15 to 20 unique technologies blended together to give the ultimate client experience. So it's not a simple thing to copy. So we do think we have been ahead. We [ told ] the market 18 to 24 months. Clearly that's based on a number of data points, none of which -- I suppose the main one is no one's been able to replicate it in the market that we know of. And the other thing is we're not standing still. So we're into cloud. We've been in cloud 4 years. We're already moving to the next thing where others are still trying to get into cloud. But does that mean we can be complacent? Absolutely not. So in software there's 2 states, quick and dead, and you don't want to be dead. So we are always reinvesting in the platform. So whilst our R&D we don't break down what we do, in which part we put it into, the bulk of it goes into the core platform to make sure that it is always marching ahead of the competition. So we see 2 -- in the last bit of the question we see 2 buckets of competitors. The traditional ones, the equipment makers, the guys that used to make film, we don't see as much from them anymore. I think they've sort of stopped innovating to a degree as a group. We see people like us, pure software plays. There are a number of them. I think most of them are based on old technology. And of course, as you'd expect in such a big market, we're seeing new entrants, "born in the cloud," which they would be. But they have other challenges, like to get the feature functionality to match us will take years, and to harden it so that they can do large complex clients will also take years. But is it impossible to do? Absolutely not, because we did it. But as we sit here today, we always monitor what's going on in the industry. We'll know more next week, because anyone that has anything to show will be at the RSNA. And then we'll reset our data points. But as we sit here today, we think the technology is unique, it's novel, it's proven, and we keep investing in it.

Thank you, Sam. I'll now move to any questions from the floor. Are there any questions? Sir? Just a moment.

Stewart Burn from the Australian Shareholders Association. I'd like to congratulate the Board and the company on the clear annual report you produced this year, and also for increasing the number of independent directors that you have. We're very pleased that that has occurred over the past few years. We just have one request for the annual report, and that would be that a director matrix, skill matrix be included in the annual report. We have asked this for many companies, and we hope that Pro Medicus will include this in the future years. I also have a question regarding one of the directors. Do you want that now, or do you want it later?

No, we'll take that when we deal with the business, if that's all right with you. I think we have a composite skill matrix, but not an individual skill matrix in the annual report. We'll take that question on notice and consider that for next year's annual report. Thank you. Are there any other questions? Sir? Sorry, just a moment. Mr Porter.

[ Michael Porter from Economic Concepts ], but I'm a retired economics professor who's been bedazzled by the performance of this company, coming out of looking at the economics of medical care, which is a shambles in America, but the technology's the best. My question is this. 3 countries is not many, but the booming business seems to be one, that doesn't get tied up in foreign languages because the language is computer-based. Why is it so difficult? Or why haven't Pro Medicus really proceeded in other countries?

I'll take the first part of that question, and then Sam will get into the detail. The main reason is our strategic focus, and given, as you -- as we -- as Sam covered before, our market share in the U.S. is about 7%, we think. We could easily be distracted and chase other markets. When we've got one right in front of us, we know the territory, we know the competition, we know who's -- who the potential customers are. And as we said earlier, the margins are very attractive, more attractive probably than most other countries. So for those reasons, the Board has made a decision to stay focused strategically to follow. At the moment, it's not a forever decision, but we do want the management team to stay focused on the immediate and very lucrative potential market. Sam will talk about the language [ of ] question, and maybe something else.

You're right. There is no barrier to selling it anywhere in the world. It is multilingual already, so we sell it in Germany. It's been translated into Italian. It's very simple to translate. And most of the medical community globally, particularly in radiology, English is the default language, but yes, we could put it in Spanish elsewhere. I think there are 2 countries where, even if we wanted to at this point in time, there would be a step that we would have to take. One is Japan, because you'd have to go through a regulatory process. Now that should be fairly straightforward because we have FDA, TGA, CE, but you still have to go through the Japanese process. There's language, but then there's also a completely different cultural sort of situational environment there that we are not adept at at this point. The second place is China. And I think there are reasons for that that everybody understands. To us, it's a black box and would represent a possible danger. But anywhere else in the world is fair game. Now we do sell elsewhere. So we have 2 of the biggest hospitals in Germany. We have Charité, we have LMU. It's just that in Europe, the opportunities are much more divided. They're nowhere near as big and they're a lot more bureaucratic because the one thing Europe has in common is actually a negative. It's all government-funded health. So you have to go through this massive bureaucratic layer. So the cost of sale is huge. And it's exactly for that reason that we don't bid for public hospital work here in Australia because the cost of doing it for the reward, it's just not balanced. So we tend not to do it. But if there was an opportunity in somewhere in the Middle East or Singapore or Hong Kong, there's absolutely no reason we couldn't put it in. And because we're follow the sun support, so San Diego hands over to Australia, hands over to Berlin, there's always someone awake 24/7 in our network. So support would fit in equally well. So I think in summary, it's really market opportunity. Something does come up and it's opportunistic, yes, we'll certainly look at it. There's no reason why we wouldn't. But as Peter said, U.S. is the main prize. The statistic is around $0.60 in every $1 spent globally on healthcare is spent in the U.S. So that gives you the reason why it stacks up well for us.

Thank you, Sam. I did say -- just further to that, I did say a stat the other day, which sort of supports the 60%. I think in most developed countries, the spend per head of population is about AUD 6,000 around that figure. In the U.S., it's $12,000. And that gap exists. And that's why we want to be in the U.S. primarily at the moment. Once we've saturated the U.S. market, we'll move on. We'll probably do that next year. Okay. Are there any other questions from the floor before I go to any? Stella, you promised not to ask a question.

I'm not really here only for the food, Anthony. I was joking. The first time I came to this company's AGM was well over 10 years ago. And it's so pleasing to see so many more investors came to the conference and asked interesting questions. So I wouldn't be the only one. Only one question this year. Regarding the AI front, you've got your first in-house built product breast density classification on the market for about 2 years in trial. What's the latest progress on that? And in terms of the commercialization from your AI accelerator, you mentioned many irons in the fire, but what we should as expect as the first round of commercialization that comes out of all the irons?

Thanks, Stella.

Well, you're correct. We did do the breast density one, and we are in the throes of commercializing it, pricing it. We are 100% confident about its accuracy. It has been used by a number of clients, and it's more accurate than a human on average. So it's purely a matter of how we package it and commercialize it. And to be honest, too many other things have gotten in the way, but we will get there very soon. In terms of some of our collaborative work, we have already had stuff that you would not have seen that we've built into the program. So things that we've done with Mayo Clinic that help with segmentation and other bits. We're not going to sell separately. We're going to put it in under the bonnet, which answers that question, how do we keep ahead of competitors? That's a perfect way of doing it. There are some other projects. I can't tell you what they are. Where there is a co-development, and they are progressed, they are progressed. So these things take a while, because not only do you have to do the algorithm, you have to prove it clinically, and you have to prove it in multiple sort of trials and areas. It's not a thing you can just drag and drop like a new app for social media. So we are making good progress. You haven't seen it. It's all been under the hood. Could we do it quicker? I'd love everything to be quicker, but we are making progress, and I don't believe we've lost any opportunity in the market. If anything, I think the market's now starting to come to us because a lot of the third parties that have their own AI algorithms, usually born out of a university or a university hospital, they do a project, they commercialize it, then they think they're going to sell it in the U.S., and it'll all be really quick and easy. It takes 2 years to get into a hospital. It's a really long process, and I think they're starting to see that. So we are seeing more third parties coming to us. And as I said, Elucid was just one of them, but there are a fair number. But again, we have to be very careful to make sure that you partner with the right people because your reputation is at stake, even if it's their algorithm. So a fair bit of work being done. You will see more work being done, and some of that will be a lot more visible in the coming year.

Thank you, Sam. Are there any other questions from the floor? Just back to the microphone.

First, congratulations. This year, the share price increased so much, but I'm very curious that definitely it bring a lot of challenge and risk for the company also. So my question is, what is the largest challenge for you? And how are you going to handle about it?

As my family who are here know, to me it's like a treadmill. You wake up in the morning and you hear a sound, it's gone up 1 degree. We don't control the share price. I think we've been consistent in telling the story. Some of it builds in an expectation. I don't think there's anything we can do about that. So I think we try, and not only try, but we do run the business and try and divorce ourselves from that particular thing because we can't control it more than it has. Is it better going up than down? Yes. Is it fun when it's volatile? No, but we don't have a choice. But in terms, I think, Peter, you'll agree, the way the Board thinks, it really hasn't changed.

Well, as many know, and some have commented, I've been around this company for quite some time. And that's never been the mantra to pump the share price. It's all about driving the business and growing the business. And the 2 founders always had the view to reinvest in the business for the long-term. And that focus hasn't changed. In relation to the other part of your question, though, the main issue for us, we've got a fantastic staff, very stable, and so on, but what's the future? And succession is on our minds. It's something we've been thinking about and looking at and developing plans. We don't have anything to announce at the moment, but if there's something that the Board's focused on that's a challenge, it's that challenge of maintaining the momentum with the current staff and the future. Are there any other questions from the floor? Sir.

[ indiscernible ]

The man's getting very fit there.

Look, I just want to -- Jeff Newman's my name. I just want to congratulate you because I used to attend these meetings a long time ago, and this is a good indication of the growth and success of your company in that there used to be 20 people, and the share price was $0.30 to $1, and haven't things changed. Congratulations.

Thank you. Thank you very much. We're very heartened that so many people have come today, but there is another challenge for us. We may need to increase the size of the venue again if we keep going, because as you would recall, we met in a fairly small room previously. So we'll take that on as a to-do -- put it on our to-do list. Okay, let's move to -- if there are no other questions, sorry.

Sorry, one more question. My name's Tony, I'm just a retail holder. Again, congratulations to the Board and staff for an amazing year, and it's been a great story to follow. I had a 2-part question. The first one was, as you mentioned, this company's all about speed, and that's one of the main criteria, the fact that you guys are so much faster on bringing those images down to the radiologists. And with images getting larger and larger over the years, I think they're up to 2 to 7 terabytes now, which is enormous, and that will only continue as they look at the brain and the heart and all those kind of organs. Does that mean that Pro Medicus must also look at their render servers and the AI technology, and work out ways on how to stay ahead of the curve and increase their speed? And if so, how do you sort of do that at a high level? Is it to do with the render servers and improving that technology, or is it a combination of a few things? And the second quick question I had was that as the share price keeps going higher and higher, and probably will continue to do so as you garner more market share, would you ever in the future consider a split of the share to make it more affordable for smaller holders?

I'll answer the last part of the question. I'll leave the technology to Sam. It has been raised before, and it's been on my mind, particularly in recent times. The Board hasn't discussed it, but it's something that I think we should consider. So I take your point there, because there aren't too many companies on the exchange that have a hundred multiples of hundreds in their share price. So it is worth considering so that we can allow retail shareholders in particular to participate. But -- So that one we will take on note. And in relation to the question about technology.

It's a very interesting question. So when Visage was first started, the words NVIDIA and AI were never in one sentence. NVIDIA used boards, or the boards were used for the gaming community. And Detlev and Malte saw that as a big plus, because Visage has always, from day dot, been based on NVIDIA GPUs. And it was the gaming industry that fueled the speed of those boards. Now it's the AI industry. So we don't need to do any R&D in that. The boards just get bigger and faster naturally. But on top of that, we're always looking at not only optimization of the technology stack, but is there something that we can build into it with an emerging technology that will make it even quicker again? Because you're right, these data sets are just going to keep growing and growing and growing. So at the moment, the fact that the world has gone mad about AI and NVIDIA, you just need to look at every data set that's being built. That works in our favor, because each board that comes out is faster, bigger, better than the one before. But that doesn't mean we're complacent and just relying on that. We are looking at -- now, I'm not the one to ask, because I'm not that deep and technical, but clearly the guys back in Berlin are looking at what's the next new thing and can that be somehow integrated either as the hardware we run on or somehow the software in the platform.

Thank you. Another question.

My name's Angelo. I'm actually a practicing emergency physician at a public hospital. And I sympathize I can understand your reluctance to get involved with government organizations, because there are many layers there. But I actually bought some shares 20 years ago at about $0.98, and my social and professional cohort think I'm the equivalent of Warren Buffett, thanks to you, so thanks. But I'd like to ask a question. All the cloud-based stuff, could you -- presumably all this stuff is secure on there? Yes, look, I'm sure it is, but could you reassure us that -- yes, it is.

That's a very good question. So when we first started back in the $0.98 days, all of our implementations were on-premise. But they weren't our premises, not in our data centers. We don't have data centers. So it was the clients, they would buy hardware that we specified, they put it inside their own operating environments, and we would run Visage as an enclave. We did not store the data. When you moved to cloud about 5 years ago or 6 years ago, you'd go to a healthcare enterprise, you guys should look at cloud, they just look at you blankly and go, are you nuts? We're not giving our data to a third party. It's just not going to happen, because in America there are very severe penalties about protected health information, which is patient data, the names, demographics, and of course we keep some of the health information as well. But the likes of Google and Microsoft used to go to these hospitals and say, look, we have 2,500 propeller heads back in Palo Alto, and all they do, all they do is secure our cloud. The minute any patch comes out, it's instantly applied. We monitor, we pen test, we do everything. Hospital X, how many have you got? And the answer was none. So I think the whole thing flipped on its ear. So there are 2 things driving cloud. The first is what you mentioned, security. I think people now realize it's far more secure in cloud than it is in a data center. The second is people are realizing that this whole idea of just the 5-year depreciated cost of hardware and that's how much it costs me to run a data center is actually not correct. That's the cheapest part of it. And so people are now saying, look, we are in a health delivery networks, we're healthcare enterprises, we deliver patient care, we don't manage data centers, so let's give it all to someone else. So we have seen a complete swing, complete 180 to cloud, and I don't think we have a single RFP in our stack at the moment that either doesn't mention cloud or mandates cloud.

Just on that point of security, I think there are 2 aspects to that. The -- one is the fact that if you look at the AWS facility, they actually duplicate the information that you're giving them and so that -- and it's separate. So if one part did go down, they can switch over so that the hospital in real time continues to operate. That's unlikely to happen as easily with an on-site facility. The other issue is that if the hospital doubles or the -- takes on another hospital, that's more easily taken into the cloud because they have the flex -- the cloud providers have the flexibility to provide that without the hospital having to rush out and get more hardware. So there's a couple of really attractive things from the customer's point of view, just outside of the fact that they don't have it right at the servers and so on under their nose. It's quite impressive when you actually if you -- I did see a presentation by AWS and it was very, very impressive the way they go about it. So are there any other questions in the room? So we might go to the online questions. Danny, do we have any online questions?

Yes, certainly. We've got a few. First question for Dr. Hupert, the 5 most valuable U.S. big tech stocks, Microsoft, Apple, Amazon, Alphabet, NVIDIA, are together worth more than $20 trillion, largely because they have enormous pricing power and are overcharging customers the world over. Could the CEO comment on which of the big global technology companies we are most reliant on and what would we do if they suddenly put their prices up by 30%? This question comes from Stephen Maine.

At least he started off with an easy one. We -- as I mentioned in my presentation, we deal with all 3. So we're not behoven to one. And the reason we do that is A, our clients may have an enterprise agreement with AWS and they want to use that agreement, because most of the agreements you pre-commit to spend a certain amount of money. And so for those people, they want to use that commitment and we allow them to use that. So it's what we call we use their tenant. So the cloud fees go directly between the cloud provider and them. The second model we have is where we pay for the cloud fees and the client pays us. Now in that model, A, there's a buffer and a margin, but B, in our contracts, we actually have it that if the cloud provider increases their fees, then we can increase our fees. So we don't have a fixed cost on one side and a variable cost that can work against us on the other. So we're not behoven to any one. We play nicely with all 3. And the beauty is each one looks at the other 2 and goes, you shouldn't go with them, you should go with us. And so they become very competitive because it is big bucks for them. Healthcare is the biggest market in the world and healthcare produces a huge amount of data and that's what they want, that volume of data. So at the moment, and I think for the foreseeable future, it actually works in our favor, not against us.

Dr. Hupert, you mentioned briefly that Pro Medicus is doing well in the children's hospital niche. And I recall a story a few years ago about how the software once helped a radiologist diagnose a difficult problem very quickly, potentially saving a child's life. Is Visage's high performance a largely driving demand from children's hospitals or are there other reasons explaining the success in that niche?

Well, I think it is very well suited. Now the children's hospitals are very similar to adult hospitals in terms of the radiology need. The radiologists, yes, they just specialize in children. But the thing that makes them different, interestingly, is around security and actually getting into them. Because of all the issues, even in an adult hospital, you have to go through certain questionnaires and everything else. But in the children's hospital, it's near impossible. And one of the things we've been able to do is actually do all the implementation and all the training 100% remotely, if that makes sense for them. So A, it's very well suited to children's hospitals, the technology. And B, if they have this policy where they don't want anyone in the hospital, then that's not a problem for us. And children's hospitals are like a niche market. They're all radiologists, they all know each other's [ radio ] each other, but inside pediatric radiology, it's a sort of a much smaller clique so that all the children's hospitals will know each other. And when you're successful in one, it helps in others.

Next question from [ Adam Jakich ]. With the markers penetration achieved in the U.S., is a network effect occurring that significantly disadvantages hospitals that do not have the Pro Medicus platform? If so, what is stopping the Pro Medicus platform from becoming the standard of care in the same way Microsoft is to computing operating systems?

I wish we were Microsoft. And I'm flattered by the analogy. But I think we feel we've raised the bar. We know we have. But if you come to the RSNA next week, as I mentioned, every single stand will pretty much pertain to do everything we do. And you'd go, how could you ever sell a system? The 150 companies all doing the same thing. Now that noise is the same in the industry. So we have competitors 100% say that they're in cloud. But when the client comes to install it in cloud, it's sort of cloud, or it's half cloud, whatever that is. So you'd be surprised how people can be, I suppose, can be convinced that some of these things exist when they don't. So don't think everybody just knocks on our door and goes, we want you, there's no one else. Every single sale is a battle, particularly when we're more expensive. But we are seeing a network effect because clients talk to each other. So one, Baylor Scott & White, the Head Radiologist, he said, Sam, you don't need to tell me that this works. And I go, why? He goes, I trained at Mass General Brigham. So I went there and started reading on the system for 2 weeks. So he used it before he even rang me. It's that sort of thing that helps us. But did it make it easy? No. It took a year with Baylor just arguing about price, 1 year. So it's not -- we do have that momentum, no question. We are winning the bulk of what we bid for. We won't win every one. We sometimes even get people that don't buy us first time around, come back 3 years later and they do, not everybody, but a few. But it's not this simple network effect where all of a sudden everybody just comes to you and there's no one else.

Next question is from [ Mary Curran ]. Congratulations on a fabulous year. Looking forward to say 5 to 10 years, where do you see revenue by percentage of new customers, current customers with the same service and current customers using extra services?

That's a real crystal ball question. I hope the answer is in all of the above. So we spend a huge amount of time engaging with our clients because in our industry in particular, you're only as good as your last support call. So we have dedicated people that have clients, they're clinical people that they have to be in contact with. They have to make sure they're the system properly. They have to tell them about every single update. The really big ones we have quarterly or half yearly meetings with. Next week in RSNA I'll see most probably every single chair of every major client that's coming to the conference. And the first question I ask them is, how's it going? And if they go, great, I know all the rest. It's just small detail on what's coming out next. And so one, we hope we keep all the clients in touchwood to date we have. Two, we hope to continue getting new clients, touchwood we have. And three, we're bringing out new product like AI and other ologies to sell back to the existing base. Because some of these technologies, the cost of sale are so high that if you had to do it just in its own right, like AI or just cardiology, it wouldn't be worth it. But the fact that we're there, we've got a loyal client, the fact that it makes sense, gives us a bit of a leg up in that area. So hopefully in 3 years or 5 years, it'll be all of those things combined, which it is today. But obviously we want to keep expanding that product offering and expanding the user base.

Next good question from [ Paul Crossing ]. What would be Sam's intentions if you were to receive a ridiculously high offer for the company?

What do you call ridiculously high? I don't know if I can answer that question. Obviously, we as a Board would have to consider anything that's come. I often get asked. No one has ever offered to buy the company, not at its share price under $1 and not now. So it's not a question we consider often. As a Board, yes, we're in a public space. We're in a more international space. A lot more of our shareholders are offshore. And we obviously have to discuss things like that. But it's really moot at this point because no one's come.

Okay. Last question from [ Nigel Beale ]. Is there any progress with contracts with the U.S. Veterans Health Administration or the military health service now that the new U.S. financial year is under way?

Yes. Well, the Veterans Affairs there financial year I think starts or ends in October. Don't ask me why. The government's very slow moving. So Department of Defense is 100% government. It's active duty and also the veterans. Unlike here in America, the veterans health care services are very developed, very extensive, and it's a big market. So we are seeing interest. We are seeing a move to cloud. They did put out a very high level RFI at the end of last year. They did have an Information Day about 3 weeks ago, which we attended. They are talking about an RFP towards the end of next calendar year. But you're dealing with the government. So that could either come out then, it could come out in 2 years, it could not come out at all. So it's really hard to tell. But we do have a thing for those that aren't aware, we have a thing called FedRAMP. So FedRAMP is a sort of special clearance to work in a hyper secure cloud that is for government. And there are only 2 cloud providers that have this. It's AWS and Microsoft Azure. So for Department of Defense and the VISNs, you can't put them in normal cloud. Even if it's with those vendors, it has to be in this hyper secure enclave and you have to get this special -- they've done all these tests and everything else, special security clearance where we're one of the few that have it. So we're sitting there on the starting line. Does it mean we'll get a whole lot of work? We just don't know, but at least we're in a position where if it does come our way, we'll be able to do it. So let's watch this space.

That's it.

Thank you. We have another question from the floor, just for a moment.

Sorry, Peter Cameron. Just one quick question. Does being an Australian domiciled company affect you with U.S. contracts, government contracts?

No. No, we haven't noticed anything. Not with our clients, not with any of our large healthcare enterprises. And we do have one of the VISNs, so we do have clearance, we have people which are a subset of our support team that have to get fingerprinted every year. I mean, it's like something out of a draconian movie, but so no, the answer in short is no. I don't think that would work against us. And if you think about it, even with equipment, there's only GE. All the other companies, Siemens, Philips, they're all European. So no, we haven't noticed that.

Thanks Sam. I hesitate to mention Donald Trump, though. Hopefully nothing happens. We're done for the moment. Right. Business of the meeting, we'll move to, to consider the formal business of the meeting as set out in the notice paper. And with your permission, I will take the notice of meeting as read, because it's quite extensive, and I'm sure you don't want me to read it out. Minutes of the previous Annual General Meeting, the Board reviewed those minutes of the meeting held on the 20th of November, 2023, and I've signed those minutes as a true and accurate record of the meeting. The company secretary has a copy, if any shareholder would like to refer to them, but with your permission, we will note those minutes as a true and accurate record of proceedings. I'd now like to refer to the process of shareholders' questions and voting on the resolutions before the meeting. Those present at this meeting may, again, ask questions at each point, as each resolution comes up. Those attending virtually online may -- virtually may ask questions and vote using the portal. And just to go through it again, shareholders can submit written questions during the meeting by clicking the Ask Question button to ensure questions reach us in time. I ask that you submit now, if you haven't already. Again, any general shareholder questions submitted online during the meeting will be addressed after the formal business is completed. If we aren't able to get through all of them today, or there are any specific questions that would be better addressed on an individual basis, we'll respond to them after the meeting. If we receive multiple questions that are similar, we'll try to amalgamate them into one, or choose to answer the broadest question, which will cover off the others. So voting on the resolutions will be conducted by way of poll. Those voting in person can do so by submitting their votes to the returning officer, who I'll identify in a moment. Those who are attending online can do so by using the electronic voting card you should receive after clicking the get a voting card button. Pro Medicus share registry provider, Link Market Service, will conduct the poll, the voting by way of poll, and Mr. Jim Kompogiorgas, I always stumble, of Link, will act as the returning officer. Jim is just sitting over there on my right. Votes will be counted after the end of the meeting, and results published on the ASX and the Pro Medicus Limited's website. Shareholders can cast their vote using the electronic voting card received after validating online registration. To validate registration, you'll be asked to enter your security holder reference number, or holder identification number, which most of you know as SRN or HRIN, plus a postcode if you're in Australia, or country if you're outside Australia. To then cast your vote, click the get voting card button. If you're intending to vote, you'll be able to finalize and submit votes up until 5 minutes after the meeting ends, and I'll remind you at the end of the meeting. Final results of each resolution will be posted on the ASX later today. Proxies. The proxy votes that have been submitted will be set out on the slide shown for each resolution. For some context, the current number of Pro Medicus shares on issue is approximately 104 million, and I ask you to try and remember that if you can as we go through the -- when you see the proxy votes. A number of shareholders have appointed the Chair of today's meeting, myself, as their proxy. As indicated on the proxy form and in the Notice of Meeting, my intention as Chair is to vote all discretionary or undirected proxies held by me in favor of each resolution. So moving to the business itself, accounts and reports. To receive and consider the financial statements of the company for the year ended 30th June 2024, and the related director's report, director's declaration, and the auditor's report. Whilst no vote is required on this item, I would call for any questions shareholders may have in relation to the financial statements. Are there any questions from the floor? None. Are there any questions online?

Yes, we have a couple of questions online. So when it comes to professional directors who have made it big from a soaring stock, few in Australia have done better than Peter Kempen at Pro Medicus. The skin in the game alignment is enormous relative to other ASX 200 chairs. However, after 16 years on the Board and the last 14 as a Chair, the box tickers might argue Peter is no longer independent, something you are still asserting. Could Peter comment as to whether he is friends with our 2 Founders and also whether this will be his last term or could run again in 2027?

I think that's a question for my friend [ Stephen Mayne ], actually.

You are correct.

Stephen and I know each other too, which is a bit disappointing. He's right to make some of those observations. I think there were 2 parts to the question. Do -- how friendly am I with Sam and Anthony? We don't socialize together. We have enjoyed the odd lunch together, mainly for business. I've been to Anthony's house once, which was to celebrate his 60th birthday, and I haven't set foot in Sam's house. So I wouldn't regard us as friends, but certainly close professional colleagues. In relation to my tenure, yes, I have been here a long time, and I've enjoyed all of the time that I've been a member of this Board and had the privilege to be Chairman of a company that has shown such a fantastic success. So, is it something I intend to leave soon? I don't have any specific timeframe, but obviously, just to look at me, you know I won't be here forever. I think I'll stop there while I'm ahead.

Did any of the 5 main proxy advisors, ACSI, Ownership Matters, Glass Lewis, ISS and ACA, recommend a vote against any of today's resolutions, including this remuneration report item? If so, what reasons did they give and did this cause any material protest votes?

The answer's no, I think that was a...

Yes, absolutely right.

No. Well, to be more -- we don't see every proxy advisor's reports, but those who are kind enough to share them with us have indicated they are supporting or recommending support for all of the motions that we're putting today.

Those are all the questions.

Got out of that lightly. Sam's telling me to keep moving and he's the one who took most of the time for the voting. So there's no questions at all on the accounts themselves. So we'll move on to the next item, the Remuneration Report. To adopt the remuneration report, which is contained within the annual report on Pages 30 to 38, for those of you who've looked at our annual report, for the year ended 30th of June, 2034. Whilst the vote in relation to this item is not immediately binding on the company, we naturally take seriously the views of our shareholders and for those of you who were here last year, you might remember I was a bit shocked at the vote that we received last year and we did track that down to a particular proxy advisor and we've had discussions with that group and I think we both understand each other's position in relation to remuneration and you might see that reflected in the proxy votes that you'll see shortly. That partly answers Stephen's question again. But before putting the motion, I do just want to allow anyone to ask questions on the remuneration report if there are any. If there are none, I'll now put the motion and for those of you who haven't cast your vote yet, if you could do so now and we'll refer to the proxy votes, please. If we can get those up. So I think that supports my answer to the question previously and I think that's a clear majority of shareholders and so I will declare that resolution carried. And thank all those who supported the company's remuneration policies. Re-election of directors. 2 directors are to be considered for re-election, Alice Williams, who's Chair of the Audit and Risk Committee and myself. 3.1, the motion reads that Ms. Alice Williams, being a Director, who's retiring in accordance with the Company's Constitution and Listing Rule 14.4 and being eligible, offers herself for re-election, be re-elected as a Director of the company. Details of Alice's background and experience are outlined in the Explanatory Memorandum, which is attached to the Notice of Meeting. I will now invite Alice to address the meeting prior to putting the motion.

Thank you, Chairman, and good morning. I've been a non-executive director of Pro Medicus for the past 3 years. My background is founded on an accounting and economics degree from Melbourne University and I have postgraduate investment qualifications as a Charter Financial Analyst and have undertaken studies in cybersecurity governance at NYU and Harvard University. During my executive career, I have worked as an accountant with a number of domestic and international financial institutions. I've also had extensive experience managing institutional funds as a fund manager at JPMorgan and as a non-executive director of Mercer and Victorian Funds Management. Over the past 25 years, I've worked as both a consultant and a non-executive director. My other Board appointments are on listed companies in the financial services, telecommunications and defense sectors. I typically Chair audit and risk committees for these entities. As an independent consultant, I have also worked with a range of domestic and international corporations and the Australian federal government, assisting with corporate strategy development, capital fundraising, government regulatory and competition policy and foreign investment views. It has been a privilege and a pleasure working with the Board and management team at Pro Medicus. My experience enables me to assist in the financial oversight of your company, the development of corporate strategy and risk management activities. I would be pleased to be reappointed by shareholders and to continue assisting in the governance and the oversight of your company as it continues to grow. Thank you.

Thank you, Alice. Are there any questions in relation to Alice's resolution?

Stewart Burn from the ASA again. The ASA has concerns about workloads of directors and we know that Ms. Williams has a significant workload associated with directorships of other companies. Can she assure the Board and also the shareholders that she will have sufficient time to adequately represent the shareholders of Pro Medicus?

Thank you. I'll just make 2 points and I will ask Alice to reassure you. One is that she has just recently stood down from one of her listed companies, Djerriwarrh. You may have noted that. And the other comment I'd make is she has always turned up to every meeting without fail and always been very well prepared to meet her responsibilities as Director of this company. So personally, I don't have any concerns about her workload and she does bring insights from other boards naturally, which is also helpful to the Board as a whole. But Alice, you may wish to just comment further.

Thanks, Chairman. Yes, look, I did recently retire from a listed company Board in the financial services sector and that was in recognition of the need to have enough capacity for the Boards that I'm working with. I also take my obligations and responsibilities very seriously and make sure that I'm fully prepared for the requirements of the Board. And as I think the Chairman has highlighted, chairing audit and risk committees, there's strong thematics between each of the companies in terms of new and emerging disclosure requirements and ASX and AASB requirements in terms of how those financial statements are prepared. And so working across companies, which do have some similarities I might add, telecommunications and defense have a lot of the same sort of issues in terms of risk management as healthcare does. And so working across different jurisdictions and industry sectors, it's actually beneficial in terms of what I'm seeing in terms of trends, particularly with things such as national security.

Thank you, Alice. Are there any other questions before I put the motion? For those of you who haven't voted, could you please cast your vote now and we'll refer to the proxies. And currently with a 94%, nearly 95% approval rating, I think I can safely say that Alice has been reelected and I congratulate her on her reappointment to the Board. Item 3.2 reads that Mr. Peter Kempen, being a Director, who is retiring in accordance with the Company's Constitution and Listing Rule 14.4, and being eligible offers himself for re-election to be re-elected as Director of the company. Details of my background and experience are outlined in the Explanatory Memorandum attached to the Notice of Meeting. As this motion is in relation to me, I'll ask Sam Hupert to assume the Chair for the conduct of this item of business.

Are there any questions before I put the motion? Any questions of Peter?

I do have one online. Mr. Kempen, you've been a major contributor to good corporate governance for many years, and you are well aligned with shareholders, giving you purchase shares with your own money many years ago. It would be nice to have you stay on as a Chair for as long as possible, but who do you think should succeed you as a Chair when the time comes, and do you discuss that much with the founders?

I think that question probably comes from the same source. And I think I've answered it already. But succession is an issue for the company as a whole, and we certainly are discussing that quite regularly at our Board meetings. So when the time comes, no doubt someone will succeed me.

There's another question from the floor.

Stewart Burn from the ASA again. We recognize Mr. Kempen has brought significant skills to the company, and we also recognize his longevity. We also recognize the directors of his reputation brings a significant amount of skills to the company. Can we ask that he be recognized as a non-independent director in the next annual report rather than as an independent?

I probably shouldn't answer this question, but the Board does regularly look at that question. And with me not voting, the other directors decide that I am independent, probably for the reasons that I mentioned earlier. But it's something that's continually looked at, as it should be.

Any other questions for Peter? I'll now put the motion, and in doing so, note the Board supports Peter's re-election. Would you please cast your vote if you haven't already? And can we refer to the proxy votes, please? They're already there. So congratulations, Peter, for 95%. Thank you.

This feels like going to the football club when nobody else wants the voluntary job, but rest assured that I'm still as enthused in this company as I was as many have pointed out when I bought shares. I actually bought shares before I joined the Board because I had confidence in particularly the founders at that time. And then I obviously bought more shares when I became more intimately involved, so. But I still get great pleasure out of the success of the company. I love watching the pipeline. I like seeing the companies that are coming to us as they move through the pipeline, which is incredibly slow, I must say, because it takes so long, as Sam was saying, to start from an RFP through to signing of a contract. It's not as simple as we might make it look. But I really get pleasure out of that, and I do take great pride in what we're doing for patients, and effectively many patients around the world, which I think there's not many other true callings that allow that. Doctors probably are the ones who are closest to that, but we're sort of next in line. So it is a wonderful company to be involved in, and the people, as we've said before, are all highly dedicated and do support the company as best they can. So thank you, but thank you for your ongoing support. I do really appreciate it. Now, Item 4 on the agenda, which is the last item, and I know we're between you and a cup of tea, but is the approval to issue securities under the Pro Medicus limited long-term incentive plan. As indicated in the Explanatory Memorandum attached in the Notice of Meeting, this item's required to be approved every 3 years, and is largely, or we thought, largely procedural. It aims to provide the company with the ability to continue to issue up to 10 million performance rights under the LTI plan, consistent with the approval granted by shareholders in 2021. It has been pointed out recently that a number of performance rights granted in the last 3 years is a very small fraction of the number being sought for approval. And just to remind you, if you haven't got the Notice of Meeting in front of you, in September 2022, the first year of our prior approval, 23,026 performance rights were issued. In September '23, it was 74,000, and in September '24, it was 47,930. So it's a long way from 10 million. But I do want to assure you that the Board is not intending to materially change the granting of performance rights under the plan, and we expect to be issuing a similar level of rights during the next 3 years. And I think next time this comes up, we'll probably look to revise the request to something closer to reality. It wasn't intentional. It was just we thought we were continuing on what had been approved in the past. So we didn't -- it was too late to pull the resolution, but rest assured there won't be significant changes we don't expect in relation, and certainly not any changes in the LTI, and therefore there won't be significant changes. In fact, just to be even more specific, as the share price rises, the number of shares that we or performance rights that we issue under the scheme goes down, doesn't go up. So -- because it's based on a dollar value that's then converted into performance rights, and ultimately into shares. It's a long-winded explanation, but I thought I'd give it anyway, so that everybody hopefully understands our intention rather than exactly what's written on the resolution. Are there any questions before I put the motion? If not, if you haven't cast your vote already, please do so now. And we'll refer to the proxies on resolution 4. And again, I thank everybody for their support in relation to that. Now I just wanted to go back to the 104 million shares. If you look at the resolutions, in that particular case, 84 million or 85 million votes were cast, which I'm not sure, I haven't done a poll on other companies, but I think it's really heartening to see so many shareholders participating in the meeting by voting, and I do appreciate that level of support, even if some vote against the resolution, at least they're voting and expressing their view. And it gives the Board a great deal of confidence to know that that support comes off a very large voter complement. So thank you all for taking the trouble to vote, because it is very much appreciated. Other business. I don't have any other business, but I invite you to ask any further questions that you may have before we adjourn the meeting. We've exhausted you all. All right. Before closing, I'd like to remind particularly those online that you will have 5 minutes after the conclusion of the meeting to cast your vote on any of the resolutions. And if you would pass your voting, those who are here who haven't voted yet, if you can pass your voting paper to Jim to collect before you leave the meeting so that we can record -- oh, sorry. The box is up behind. Jim's casually sitting there resting. The box is up behind you if you would like to place your votes in that for us to count. So thank you very much. And ladies and gentlemen, I'd like to thank you all for attending the meeting, both in-person and online. And I look forward to joining those in the room for refreshments post the meeting. So thank you again for your attendance. And I look forward to seeing you next year.