SANUWAVE Health, Inc. ($SNWV)

Hello, and welcome, everyone joining today's SANUWAVE's earnings call. [Operator Instructions] Please note, this call is being recorded. [Operator Instructions] It is now my pleasure to turn the meeting over to CEO, Morgan Frank.

Thank you very much. Good morning, everyone. Welcome to the SANUWAVE Fourth Quarter and Year-end 2025 Earnings Call. Our Form 10-K was filed with the SEC last night, along with our earnings release, and our updated presentation was made available on our website in the Investors section. Please refer to that during the presentation. So joining me on the call is Peter Sorensen, our CFO. And after the presentation, we will open the call to Q&A. So let me begin with the OLS popular forward-looking statements and other disclosures. This call may contain forward-looking statements such as statements relating to future financial results, production expectations, plans for future business development opportunities and expectations regarding the impact of changes in tariff rates. Investors are cautioned that any such forward-looking statements are not guarantees of future performance and involve risks and uncertainties, many of which are beyond the company's ability to control. Description of these risks and uncertainties and other factors that could affect our financial results included in our SEC filings. Actual results may differ materially from those projected in forward-looking statements. The company undertakes no obligation to update any forward-looking statements. Certain percentages discussed in this call are calculated on the underlying hold dollar amounts, and therefore, may not recalculate from the rounded numbers used for disclosure purposes. As a reminder, our discussion today will include non-GAAP numbers. Reconciliations between our GAAP and non-GAAP results can be found in our recently filed 10-K for the period ended December 31, 2025. Okay. So this prefaced, let's dig into what was a slightly complicated quarter. Q4 was an all-time record for SANUWAVE with revenues of $13.4 million, up 30% versus the same quarter last year and adjusted EBITDA of $4.8 million, up from $3.7 million in the prior year and comprising 36% of revenues. Our revs for the year were $44.1 million, up 35% versus 2024, and full year adjusted EBITDA rose to $13.6 million, up 89% versus $7.2 million the year before. We sold 624 UltraMIST systems in the year as compared to 374 in the prior year and the 255 number in Q4 was by far the highest number in company history, beating our prior record, which was in Q3 by 100 systems. We sunset the Derma pace and profile product lines in Q4 and this, along with taking a reserve for sales and use taxes to certain customers resulted in some charges in Q4 that increased cost of goods sold and OpEx, which Peter will walk you through in a bit. Okay. So that was 2025. Let's address the packer and the parlor, which is -- so what about 2026. Obviously, the changes in CMS reimbursement for skin subs and for allografts have had some pretty wide-ranging effects. And I'm sure many of you have heard a number of the other companies in this space speak to that seen the changes in estimates and the results they've announced. As we've discussed in the past, none of those changes to reimbursement pertain to UltraMIST or to the 97610 code which got a small, like a couple of dollar bump up from 2026. But no companies in Ireland and anything that affects the practitioners in this space affect everyone. There seems to be a fair bit of confusion about exactly how this winds up impacting SANUWAVE. So let me say I can provide a little clarity here. The reduction in reimbursement price for skin substitutes to around $127 a square centimeter was a 90% to 95% price cut in an approximately $15 billion category. Adding to that, the new CMS policy of you can only build what you apply, waste is just not covered. Just to put even more pressure on the modality. And as I'm sure you can imagine, very few wounds are perfectly rectangular. So piled on top of this, CMS adopted a very aggressive stance on audits for predictions using skin substitutes, seeking out in proper building over use or use of products that were priced beyond what they deem to have been medical necessity. A lot of the practitioners that use these products are also our customers. So UltraMIST is a useful treatment in conjunction with allograft. So long and short of this is it put a lot of very intense pressure on the space. we've seen individual wound care providers get hit with 9-figure clawbacks on skin substituents. And yes, really 9 figures. As these pressures intensified, it took a fair few companies out of the space altogether. And it left even those who were doing business and who we're doing everything right in fear of kind of ongoing audit and revenue loss even if only from an inefficiency of documentation rather than a misuse of anything or any sort of misbehavior. So this has affected both our overall customer count and the patient count within a number of our customers. We saw this in Q4 to clean in Q1, and this has affected our growth rate. Like this is the tide going out that we kind of discussed in the press release. I mean, internally, we've been discussing it as living a fishpond or some of this great fishing. But honestly, I think a lot of the industry underestimated how sharp this shock would be and how deep these audits would go. So I mean, this obviously as sort of the question of so what's the tide coming in? And that's tide is this, right? The patients didn't go away, right? The wounds didn't go away. -- and sort of life after the grenade is finding a way as many of the other wound companies have said, it looks like Q1 is sort of a shock bottom and from our own personal experience kind of amongst the upheaval there's starting to be some real green shoots and some of the -- where some of the customers are pulling back. We've seen others expanding to fill the spaces and the others left. -- like a significant number of mobile wound providers dissolve, but we're now seeing a number of new ones reform. And this has added a new customer category, kind of our internal taxonomy, which we're describing as the baby elephants. -- like we're seeing these new groups coalesce kind of off and out of providers from multiple former groups. And we're working with them to get them their first UltraMIST systems, build mistreatment into their patient treatment plans, end of their practice flow? Like many of them are starting small, light they're doing like 3 to 5 practitioners but have eyes on to quote 1 of them, adding a 0 to that by year-end, hence the sort of baby elephant descriptor. With the period of high-priced skin subs behind us, many of them feel a lot safer about 2026 billings than they did in 2025. Like the sort of industry disruption that we've seen has created what looks to be a really significant jump ball. And as I said, the patients and the wounds are still with us. And there is a land grab going on to see who gets to serve them. Land grabs are speed moves. And the best way to -- the best way to adapt to this opportunity is to expand rapidly. So we have engaged with a number of resellers kind of add to our feet on the street count and go get after this current opportunity. So what does that look like? The partners who've chosen to have compete and care expertise, they have the strong customer relationships. They're very much the sort of folks that we have long and interested in working with but who really -- who were too focused on the skin sub space to really be it and partnering. So we've been highly selective. We're working only with those who we see as being strong, long-term partners who have excellent customer service culture and a real sort of presence purchasing sales strategy. And our goal is to gear up here, move very quickly and engage with the newly available white space in this industry, and nothing does that like adding feet on the street. Most of these partners are acting as resellers or stocking distributors. So you will see that in the ASP figures as we sell products to them at a wholesale price rather than paying them a commission and selling at retail. Like this actually worked out well for SANUWAVE. These sales don't carry any sales force costs for us, and they actually wind up being a bit higher in terms of operating margin than our W2 sales. So obviously, these sorts of systems always create this potential for inventory and channel issues. And that's something we've been really heavily focused on keeping manageable. We're trying to keep channel inventory down in the range of kind of 8 to 10 weeks. And that should decline as resellers ramp up with their selling effectiveness. We'll aim to drive that lower through kind of smaller frequent re-ups, particularly as we get our ERP systems better synced with the resellers. 32% of revenues in Q4 came through outside resellers and distributors. That was up from 26% in the prior quarter but still a little below the 2024 full year average of 36%. It's just worth noting back in 2024, those were all commission-driven distributors, not resellers. So the wholesale pricing, which began in Q3 is new. One of the effects of this channel shift to stocking distributors and resellers, is that it causes the units in the field number that we have been providing to kind of lose resolution, right? Like that number is how many systems have been shipped to people out in the field. But when you ship a system to a reseller, I may have not yet resold it to an end customer. Now it's kind of sitting on their shelf, right? And so it's no longer really a good metric for determining usage rates. So in combination with the disruption to our customer base, that's been going on during the last sort of quarter. This seems like a good time to have like a hard first principles rethink on really how we think about that number and to clean it up. And so the number we've arrived at, we're calling active systems. And this is defined as systems owned by customers who have ordered applicators within the last 6 months, or within their expected ordering time frame. There are some customers who, for whatever reason, like to make bulk orders sort of annually. We then ramp through this and called all the customers we know to have shut down. And we removed them and their systems from the count even if they had ordered within the last 6 months. as that just seemed like good housekeeping and the most accurate way to look at the data. This resulted in an active system count of 1,292 for the end of this really doesn't map that well to the systems in the field figure, which we've used in recent quarters. To give you some perspective, using this methodology in Q3 of 2025 would have resulted in 1,236 active systems. So the active system count for end of was up 56 systems or about 5% from the end of Q3. We took 168 systems out of that number during Q4. has discontinued, which gives you a sense of kind of the magnitude of the challenges in the wound care space right now. So all in all, like here we are, a lot of times gone out, a new ties coming in. And Ultimately, the idea of wound care moving to both evidence and cost-effectiveness based standards, looks like a good thing for Sauve, right? UltraMIST is a great product, real efficacy, clinical data and value for money from a payer standpoint. Helios is a lot less expensive than living with them. And despite -- or I mean, honestly, maybe because of the current disruption, this market is pending in a direction that looks extremely favorable to us in sort of the medium and long term. So with that, I'll turn you over to Peter Sorensen, our CFO, who can walk you through the financials in some detail.

Thank you, Morgan. We delivered a strong fourth quarter with revenue reaching a new Ashim quarterly high and growing 30% year-over-year -- this performance reflects continued execution of our commercial strategy and increase in demand for UltraMIST, particularly driven by higher consumable utilization and continued system placements. For the full year, revenue grew 35% to $44.1 million, supported by a 24% increase in consumables volume and a 67% increase in system sales. We also saw modest pricing strength in consumables, while system pricing reflected a higher mix of reseller-driven placements, which we view as an important lever to accelerate expansion of our installed base as Morgan reference. Gross margins expanded year-over-year to 77%, driven by pricing improvements in consumables and continued reductions in system cost of revenue, partially offset by mix and pricing dynamics on the system side. Before turning to the financials in more detail, I want to briefly address the restatement reflected in our Form 10-K. The restatement has been completed and primarily related to previously unrecognized sales tax liabilities identified through a third-party excess studies. -- as well as an error in the allocation of revenue for certain extended warranty arrangements. From a quantitative standpoint, the revenue impact was not material totaling approximately $300,000 across the first 3 quarters of 2025. The more significant impact was related to sales tax resulted in approximately $1.6 million of additional general and administrative expense and $0.1 million of interest expense in 2024. We -- in 2025, we recognized approximately $1.6 million of incremental general and administrative expenses and roughly $0.3 million of interest expense associated with these items. As moving to the first quarter, we may incur some additional sales tax-related expense as we complete remediation activities at the state and local level. We are actively working with third-party tax advisers to strengthen our processes and controls and ensure full compliance going forward. As we look ahead, our focus remains on driving sustainable profitable growth, while continuing to invest in key strategic priorities and expanding our active system base. With that, let's take a closer look at the financial results for the quarter. Revenue for the 3 months ended December 31, 2025, totaled $13.4 million, an increase of 30% as compared to $10.3 million for the same period of 2024. This growth was in line with our guidance for the quarter of $13 million to $14 million. Gross margin as a percentage of revenue for the 3 months ended December 31, 2025, came in at 74.7%, a decrease of 320 basis points year-over-year driven by a $486,000 write-off of pace inventory associated with the sunset of that product line. Absent this change, gross margin would have been 78.3%, which would have been an increase of 40 basis points year-over-year. For the 3 months ended December 31, 2025, operating income totaled $2 million, which is flat compared to the same period last year. Excluding the previously mentioned inventory write-off as well as a sales tax expense of $479,000, operating income would have been $3 million. Operating expenses for the 3 months ended December 31, 2025, amounted to $8 million compared to $6 million for the same period last year, an increase of $2 million. The change in operating expenses was driven by several key factors. First, the reversal of directors fees accruals and the shift from cash to stock-based compensation resulted in a net $1 million impact with $943,000 reducing expense in 2024 on the accrual reversals and $103,000 increase in expense in 2025 from the stock-based comp. Payroll and related headcount expenses were $358,000 higher in 2025 compared to 2024 due to increased headcount. In R&D, nonpersonnel expenses increased by $483,000 reflecting investments in ongoing product development initiatives. Despite these expense increases, we remain focused on disciplined cost management and expect operating leverage to improve as revenue scales in the coming quarters. Net income for the 3 months ended December 31, 2025, was $7.7 million compared to a net loss of $13.3 million for the same period in 2024, an increase of $21 million. The increase in net income was primarily driven by the change in fair value of derivative liabilities, which resulted in a noncash gain of $5.9 million in Q4 2025 versus a $13.8 million loss in Q4 2024, representing a $19.7 million in year-over-year variance. With the majority of our warrants now exercise exchange or expired, we should see limited impact of the noncash swing in the fair value of derivative liabilities going forward. We also had lower interest expense of $2.1 million in Q4 2025, primarily due to lower interest expense on our senior debt that was refinanced at the end of Q3 2025 with JPMorgan. The 3 months ended December 31, 2025, was $8.7 million. Adjusted EBITDA was $4.8 million versus $3.7 million for the same period last year, an improvement of $1.1 million year-over-year. Total current assets amounted to $24.6 million as of December 31, 2025, versus $18.4 million as of December 31, 2024. Cash and cash equivalents totaled $12 million as of December 31, 2025. We're grateful for the continued trust and support of our stakeholders. Q4 2025 was a strong finish to the year for Sanui, and we're pleased with the progress we've made across our business. As we move into 2026, we remain focused on executing the discipline, driving sustainable growth and building a solid foundation for long-term value creation. With that, I'll turn the call back over to Morgan.

Thanks, Peter. Okay. So moving on to guidance, which I know has been sort of the bugbear of the space all earnings period. As we stated in our press release, we're guiding to $9.6 million to $10.3 million in Q1 revenues. This is up 3% to 10% from the prior year, largely suppressed as a result of the sort of stutter step of industry impact from CMS changes and the tide going out. But we expect this to get better going forward as the new tide keeps coming in and are, as a result, providing a preliminary 2025 estimate range of 16% to 25% revenue growth for the year 2025 versus 2024. We're still in the early days of this new paradigm. And obviously, we're still collecting dots through which to draw meaningful lines. But we are already seeing a larger amount of inbound interest from customers and partners than at any time in the company's history. And the always useful kind of how big is the inbound resume pile indicator is currently well off the charts. So we'll keep that revenue estimate updated as the year goes on. After [indiscernible] especially and as ever, I want to express my gratitude to the SANUWAVE for all of the hard work and for the commitment and the trust like companies exist. -- downstream in their culture and culturalize downstream of the people, that's what lets you adapt and thrive in interesting times like these. So well done folks, and thank you all. So with that, we will open it up for questions.

[Operator Instructions] We'll take our first question from Carl Byrnes with Northland.

You noted that you're seeing significant inbound interest and also a number of inbound resumes as well. But with respect to the former, can you speak a little bit in terms of your anticipation in terms of the selling cycle for those new bound interests? I know that they're going to fall in different buckets. But any sort of color you can give there would be great. And then I have a follow-up.

Yes. No, it's a good question. The -- I mean, it seems like the industry has been -- I mean, January -- particularly January and then to a great extent in February, there just seemed like there was a certain amount of kind of shock in the industry. I just think there were a fair few people who really didn't think that this price change was going to stick and so you've had some concern around that. I think it has stretched selling cycle a little bit. The -- we're starting to see some of that break loose. The -- some of it also always -- it's always really a function of what channel -- to what channel are you selling? The smaller practitioners tend to buy more rapidly, like ramping up with hospitals, IDNs, larger chains tends to take longer -- so I think we've definitely seen some stretch in the sales cycle, but it seems like perhaps that's starting to get better. It's a little early to say anything like too definitive.

Got it. That's helpful. And then can you provide sort of any feel for what we can expect in terms of -- even if it's a range for adjusted EBITDA for '26.

We really haven't provided that guidance at this point. And I think, trying to do it off the cuff on the call seems unwise. So I think we've provided we've provided some sort of guideposts in the past where it looks like incremental revenue would probably drop something on the order of 50% to the EBITDA line. So I think that's still a fairly good kind of rule of thumb.

[Operator Instructions] We will move next with Kyle Bauser with ROTH Capital.

Great. Maybe just on guidance. So for Q1, 3% to 10% increase. And then for the full year, 16% to 25%. I guess, how should we think about the growth rate over the kind of balance of the year after Q1. I mean, the full year number in terms of growth is a decent amount above Q1. So when would we expect things to kind of flip and start trending towards or above that full year range to kind of get to that since the Q1 is below it?

Yes. I mean, well, so -- I mean, obviously, as you've intuited from those numbers, we're expecting the rest of the year to be a balance to be better than Q1. I think at this point, it's a little premature for us to start kind of trying to break it down by quarter. But I think the -- like many in the industry, I mean, it just seems like there's going to be -- I mean the back half of this year looks like it's going to be very promising exactly where this hockey stick is. I mean hockey stick maybe too aggressive a term. But where the inflection lies is sort of like will -- I think we'll have a lot better ability to speak to that when we report Q1 -- like it just -- it feels like there's a lot going on, like right at this moment. And so I just -- I think it's a little early for us to make that statement.

Yes. No, that's fair enough. And can you talk a little bit about kind of the latest commercial organization head count numbers. You talked about resellers and distributors contributing 32%. What does the commercial organization look like? And then how many I don't know, relationships or 1099 do you have associated with the non-W2?

Yes. So I think we're at 14 or 15 on internal sales force. Honestly, I'd have to check and see exactly who said, yes, just some -- who said yes to some hiring. We might be a little -- be a little above that. we're definitely we're pushing the internal sales force a little larger and starting to fill it out with things like sales managers and adding some more kind of key national account reps as well as folks to manage the resellers. We have not published a how many resellers are you working with number. It's certainly significantly more than we were in Q3. Part of the more so than the number of -- more so than the number of resellers is sort of the size of the resellers. And whereas we've been working with people who were smaller groups and had a few reps like some of the groups that we begun to work with have kind of 50, 60, 70 people under them and that as you get that ramped up, like that adds a lot of potential, like exactly how long it takes these things to get. We've seen some promising early behavior from some of them. it's exactly what the cycle is to get these folks kind of ramped up, fully trained, firing on all cylinders and then for them to be able to work through the sales cycle within their own networks is still something we're mapping like we're getting it. We're getting it figured out, but it's 1 of those kind of -- it's 1 of those sort of learned by doing things.

Yes. Okay. I appreciate that. And then you talked a little bit about the operating margin associated with those sales coming from resellers and distributors. How does that kind of -- like how does that compare with you selling internally in the direct sales force?

Yes. So obviously, when you're selling to someone at the wholesale price, right? That's going to affect ASPs. So the wholesale price for the wholesale price for a system or for a case of applicators will be lower than the retail price, right, because the resellers are -- the resellers are making their money on the markup. The -- however, there are no further costs below the line, right? So what we used to do is sell through distributors at retail and then pay a commission rate on the on the sales? Like this is -- the new system is pretty closely equivalent to that. And obviously, because we're not carrying the sales force costs of the reseller not paying for plane tickets and lunches or whatever the net effect on the operating line is actually -- it's actually a higher fall-through margin -- does that makes sense?

Okay. Got it. Yes. I mean is it a big effect? Or is it pretty similar to at the end of the day. I mean we really -- I don't want to get into quantifying it here. Yes. Okay. Got it. And then just lastly, any updates on pipeline, how you're thinking about potentially adding in new products, et cetera?

Yes. I mean as you probably noticed, you saw some uptick in R&D. We're definitely working on some stuff. I think we'll probably have more to say about that on the Q1 call. be from a kind of a sales pipeline standpoint, the pipeline is interesting right now. Like there are we've had a lot of inbound interest. There's -- it's really -- there's really an educational sale going on where it's kind of like old talk to me about this? Like does it really work? How can we -- how would we build this into our practice flow? How would it work? Where is the benefit for our patients, like counter practitioners, how hard is this for our practitioners to learn. And so we have like the -- we have a huge top of the pipeline right now. It's just -- it's a little -- it's made a little complicated by the made a little complicated by the fact that, obviously, certain sectors of the wound care space are having are still grappling with the kind of clawbacks and CMS issues. Others, I mean we're seeing a lot of interest out of wound centers, hospitals, surgical and postsurgical we're actually exploring a couple of non-wound applications that are potentially interesting but really, really early. So we don't really -- I wouldn't try to hang my hat on that just yet.

We will move next with Ian Cassel with IFCM.

Yes, I just have a couple of questions. The first one, I mean, you sold 255 systems in Q4, which is just a huge number. Can you give us a sense of kind of where those systems were placed? Was it a couple of pigs in the python to use a phrase that you like to use? Or what really drove that number?

Yes. So obviously, like kind of complicated quarter, right? You sell -- we sell 255 systems. The actual active systems in the field rise by about 5%, right? It's about 56% because we pulled 168 systems out due to things not going well with certain customers, certain customers' businesses, and so from that, I think you can kind of into it like where things went from a channel standpoint. From an individual customer standpoint, like there wasn't really like -- there wasn't really a pig in the python here, right? There wasn't like an order that drove it. It was -- there were a number there were an unusually large number of kind of midsized orders. Does that make sense?

Yes. No, that's helpful. Another question I had was in previous calls, you spoke about, I believe, setting up a new manufacturing line for the applicators and that had the potential to increase gross margins, a few hundred basis points. Is there an update on that?

Yes. So there are 2 updates on that. One, our existing manufacturer has very, very graciously managed to reduce their prices as well. So they're -- they've taken -- so we're now experiencing better pricing on applicators starting the beginning of Q1. We do this on a pool basis. So it's -- we basically -- we use a blended average of our inventory. So -- and we keep 6 to 9 months of applicators on hand. So it will take a while for this to -- it will trickle through gradually rather than be kind of a step function. With regard to the new line, there were some delays in qualifying the mold. It's just I -- everybody is sort of looking at this and saying, wow, I've just never seen a mold this persnickety but we seem to have it -- we seem to be on top of it, and I think we're making progress. I am hopeful to see that ramp. And I'm hopeful to see that hit in the next hopefully see it start producing product in the next couple of months, but it's -- given the delays there, I'm just hesitant to put to form a stake in the ground right now and say, this is the definitive timing. Thank you.

[Operator Instructions] We will move next with Albert Hanser with Kestrel.

A nice job communicating change in landscape and all the cross currents. So well done on this turnaround. My question is simple. And just as you kind of look to define yourself in a changing landscape and play offense by placing units, are there any kind of key industry events, trade shows, conferences that we should put in our calendar to either attend or kind of watch as you plan to flag and get out there more locally with the customers.

Yes. Well, I mean, obviously, 1 of the -- and we'll be at a lot of shows. The sales force does like to get around. You -- obviously, one of the industry bigs is SAWC. That's kicking off in Charlotte, April 9. So if you're looking for something to do in the next couple of weeks, that's a great wound show.

We will move next with Ethan Star, private investor.

So the slide presentation noted that 168 UltraMIST systems were determined to be discontinued in the fourth quarter. And I'm just wondering, aside from customers to shut down, what do you know about why these systems were discontinued?

My -- a lot of -- essentially, we pulled most of the -- so there are 2 ways that would have gone up in that bucket, right? The first is that a customer that we would have expected to order hadn't ordered for 6 months. Second is if we made a determination that the customer who owns the systems was no longer operating the business.

Okay. So generally, there are -- but among those people who didn't order, I mean, just they stopped using them or you don't even know.

It's -- I mean maybe the -- it's difficult to say, right? I mean people don't call you up and tell you why. I expect that in many -- there's a certain -- there's a certain kind of low level of churn kind of nothing like we've experienced in the last quarter or so. The -- I suspect that it's -- I suspect it's financial distress for a lot of folks. Like the -- I mean, you put yourself in the position of you've done a large amount of sort of allografting and then you get a clawback 9 months later for 90% of it. How many of the -- how many folks had the cash on hand to handle that? Like that seems like it's been sort of the media that people have been getting hit with.

Okay. So this -- so Q4 is an unusually high number of discontinued systems for that reason, it sounds like?

Correct.

Okay. Would it be at all feasible to acquire -- try to acquire the discontinued Ultimate systems, recondition them and sell them?

It's -- possibly. I don't want to -- given some things going on, I don't want to talk in too much specificity about that. But we've certainly had a similar thought.

Okay. That's helpful. Aside from the external factors mentioned in the press release, do customers tend to go through Alteris consumables at a fairly steady rate? Or do they increase? Do you see them increasing uses of consumables as they become more familiar with the ULTRMIS system?

That sounds like one of those questions is going to have a simple answer, but the reality is it depends a great deal on the customer type, right? So if you sell a system to a mobile wound care provider who handles long-term care facilities, they will generally ramp up almost immediately, right? They'll take it on their rounds, they'll start doing treatments. You go from 0.60, nothing flat. If you sell it into a podiatry office, it tends to be a slower ramp as they kind of build the -- they do their marketing or kind of build a book of business that gets the -- that gets the product into more usage, like sell it into a nursing home or an assisted living facility and you tend to get an early bolus as they run around and treat everyone who's got -- everyone in the facility who's got wounds. And then it sort of backs off to a steady state once you get the wounds in the facility more under control. And so hospitals have a tendency to sort of start using and then ramp up over time as kind of word gets around and people say, "Hey, this worked really well on our thing, you should try it on your thing. And so Yes. The answer to that question is really complicated.

And at this time, there are no further questions in queue. I will now turn the meeting back to Mr. Frank for closing comments.

Well, thank you, guys. I appreciate everyone being here first thing on Friday morning, and we'll speak to you soon when we report Q1. Thanks again.

This brings us to the end of today's meeting. We appreciate your time and participation. You may now disconnect.