Sensus Healthcare, Inc. (SRTS) Earnings Call Transcript & Summary

Good day, and welcome to the Sensus Healthcare Fourth Quarter 2024 Financial Results Conference Call. [Operator Instructions] Please note, this event is being recorded. I would now like to turn the conference over to Tirth Patel, Alliance Advisors IR. Please go ahead.

Good afternoon. This is Tirth Patel with Alliance Advisors IR. Thank you all for joining today's call to discuss Sensus Healthcare's Fourth Quarter and Full Year 2024 Financial Results. Joining me from Sensus are Joe Sardano, Chairman and Chief Executive Officer; Michael Sardano, President and General Counsel; and Javier Rampolla, Chief Financial Officer. As a reminder, some of the matters that will be discussed during today's call contain forward-looking statements within the meaning of federal securities laws. All statements other than historical facts that address activity Sensus Healthcare assumes, plans, expects, believes, intends or anticipates and other similar expressions will, should or may occur in the future are forward-looking statements. The forward-looking statements are management's beliefs based upon currently available information as of the date of this conference call, February 5, 2025. Sensus Healthcare undertakes no obligation to revise or update any forward-looking statements, except as required by law. All forward-looking statements are subject to risks and uncertainties as described in the company's Forms 10-K, 10-Q and other SEC filings. During today's call, references will be made to certain non-GAAP financial measures. Sensus believes these measures provide useful information for investors, yet they should not be considered as a substitute for GAAP nor should they be viewed as a substitute for operating results determined in accordance with GAAP. A reconciliation of non-GAAP to GAAP results is included in today's financial results press release. With that, I'd like to turn the call over to Joe Sardano. Joe?

Thank you, Tirth. Good afternoon, everyone, and thank you for joining us today. Reflecting on our performance over the past year, Sensus Healthcare experienced strong business momentum as we continue to expand our customer base, refine our product offering and reinforce our company's position as a leader in superficial radiotherapy. Top line results demonstrate the market's growing acceptance of our SRT-100 platforms, especially in dermatology practices that value nonsurgical treatment options for non-melanoma skin cancer and keloids. I'd like to start by highlighting our major accomplishments. We've built upon many of the themes I've discussed throughout the year, specifically strong execution of our sales strategy, expansion of our Fair Deal Agreement program and ongoing enhancements to our research and development pipeline. The Fair Deal Agreement or FDA initiative has gained significant traction over the past year and is evolving into an important strategic growth driver, particularly for large dermatology groups and private equity-backed practices looking for both clinical value and financial flexibility. During our sales calls, we emphasized the importance of delivering solutions that align with customer goals, and we continue to see heightened enthusiasm for agreements with attractive economics. Overall, our focused strategy and ongoing innovations are driving the results we're reporting today. I'm proud of our team's execution and look forward to capitalizing on new opportunities in 2025. From a financial perspective, I'm pleased to report that our fourth quarter performance capped an outstanding year. We recorded revenue of $13.1 million for the quarter and $41.8 million for the year, which is up 71% compared to 2023. These results reflect higher unit sales of our flagship SRT-100 systems driven by expanding clinical awareness and broadening reimbursement for superficial radiation therapy. We delivered a quarterly record of 39 systems in the fourth quarter and 115 for the full year, increases of 18% and 74%, respectively. It's important to note that within these shipments, five were to international customers in the quarter and 10 were shipped internationally during the year, advancing the approach we outlined in our Q2 call. We continue to deepen relationships with established distributors and prospective partners across multiple geographies where there remains significant unmet need for noninvasive treatment options. Profitability remains central to our strategy, and I'm proud to share that we achieved our fifth consecutive quarter of profitability with net income of $1.4 million for the quarter. We also ended the year with $22.1 million in cash and cash equivalents with no debt, reflecting our ability to maintain a strong capital position. We believe this level of liquidity provides the flexibility to support ongoing R&D, fund potential partnership opportunities and further invest in sales and marketing initiatives that will drive the company's next phase of growth. I would like now to turn the call over to Michael to discuss the growth trajectory for our FDA program and other upcoming strategic goals. Michael?

Thanks, Joe. A significant driver of our expected growth is the Fair Deal Agreement program. The flexibility of these agreements accommodates a wide range of potential customers, yet interest among corporate accounts has been particularly strong, surpassing our expectations and reflecting growing acceptance for a program that we launched almost exactly 1 year ago. These agreements typically include a structured tiered revenue sharing component with no capital outlay by the customer. For Sensus, they create recurring revenue streams once SRT is incorporated into the practice workflow. We expect these agreements to begin contributing meaningfully to our top line in the second half of 2025. The Fair Deal Agreement at its core allows providers to acquire SRT systems through an operating lease-like structure. This alleviates capital purchase barriers, making it easier for practices to implement cutting-edge technology and enhance their competitive position, all without significant upfront cash outlays or the financial impact of entering into a lease. This program offers our customers flexibility and aligns our success with theirs. This shared revenue option also differentiates us from typical equipment financing models in the industry and positions our treatment solutions as more accessible and scalable, which we're seeing in terms of growing demand. Under these programs, it's less about selling a unit and more about forming a lasting partnership. That deeper relationship opens the door to greater service and support interactions, which is not only beneficial for patient outcomes, but also fosters loyalty and long-term growth. At the recent medical conferences, including the 2025 Winter Clinical Dermatology Conference in January, we showcased our SRT systems to a broad audience of dermatologists and health care decision-makers. We plan to continue building on this momentum at the 2025 American Academy of Dermatology Annual Meeting in March, further elevating our brand and introducing our noninvasive treatment solutions to new clinicians and potential partners. I mentioned a moment ago that we've surpassed our expectations for the number of Fair Deal Agreements signed in 2024. Yet with our focus on corporate accounts, which may operate dozens or even hundreds of clinics, the number of Fair Deal Agreements signed is not the key metric for future revenues. What matters is the number of clinics where an SRT is installed and most importantly, the number of patients who are being treated with our SRT technology. We support our largest customers to prioritize the rollout of SRTs within their network by utilizing the extensive data analytics gathered from across our installed base, our vast resources regarding non-melanoma skin cancer and our unmatched experience. Through this partnership, we help ensure customer success with their early SRT experiences. We also aim to ensure that resources are allocated efficiently and that success is evident for the dermatology practice, the corporate entity and for Sensus. SRT is a versatile technology, and we achieved a milestone this past quarter with the sale of an SRT system to a veterinary clinic here in South Florida. This sale demonstrates the long-term potential for SRT in new specialized verticals such as animal health. It's still early in our exploration of the veterinary market, but we see a growing interest from veterinary hospitals seeking noninvasive treatment options for superficial tumors in animals. This diversification underscores the versatility of our platform, a topic we've touched on repeatedly throughout the year, and it fuels our optimism for finding additional niche markets in the future. Lastly, we are making meaningful progress with our product innovation pipeline. After refining our approach in collaboration with regulatory consultants, we are preparing to resubmit our TDI 510(k) application in the first half of 2025. We believe that the enhancements we've made in response to FDA feedback, along with our track record of successful clearances, put us in a stronger position for a successful submission and advances our goal of diversifying the Sensus Healthcare product line and further solidify our footprint in the dermatology market. With that overview, I'd like to turn the call over to Javier Rampolla, who will provide more details on our financial performance. Javier?

Thanks, Michael, and good afternoon, everyone. As Joe mentioned, our revenues for the fourth quarter totaled $13.1 million, up from $12.6 million a year ago, driven by an increase in the number of SRT units sold. Gross profit came in at $7.1 million or 54.4% of revenues, down from $7.8 million or 62.3% of revenues in the prior year quarter. Most of that decline was due to a onetime discount to a new large group customer and higher service costs. On operating expenses, general and administrative expenses increased to $2.4 million compared with $0.9 million last year, mainly because of higher compensation and professional fees. Selling and marketing expenses were $1.4 million in the quarter, up from $0.6 million last year, mostly reflecting higher commissions. This was offset by lower marketing and trade show spending. Research and development expenses rose to $1.6 million from $0.7 million a year ago, driven by a higher compensation and ongoing product development costs. Other income, which is largely interest income, was $0.2 million both this quarter and the same quarter last year. Net income for Q4 2024 was $1.5 million, or $0.09 per diluted share compared with $4.2 million, or $0.26 per diluted share a year ago. Adjusted EBITDA, which excludes interest, taxes, depreciation, amortization and stock compensation expense was $1.9 million compared with $5.7 million in the fourth quarter of 2023. The difference between the 2 quarters is attributable to higher net income and income tax expense in the 2023 period. For the full year, revenues came in at $41.8 million, a sizable 71% increase from $24.4 million in 2023. That reflects a higher number of SRT units sold partly because some customers deferred purchases in 2023 given the macro environment and also because sales to a large customer in 2024. Gross profit for 2024 rose to $24.4 million or 58.6% of revenues, up from $14.1 million or 57.8% of revenue in 2023. Looking at operating expenses for the year. General and administrative expenses increased to $7.1 million from $5.2 million, which is partly due to higher compensation, professional fees and some bad debt expense, balanced by a reduction in bank fees and insurance costs. Selling and marketing expenses decreased to $5 million from $5.6 million, mainly due to lower agency fees, travel and payroll. Research and development expenses were $4.2 million, up from $3.7 million a year ago, driven mostly by compensation and product development, although we did have a decrease in expenses tied to a drug delivery project. Other income net, which again is primarily interest income, was $0.9 million in 2024 versus $1 million in 2023. As a result of all these factors, we reported a net income for 2024 of $6.6 million or $0.41 per diluted share compared with a net income of $0.5 million or $0.03 per diluted share for 2023. Adjusted EBITDA was $8.7 million in 2024 compared with $0.3 million in 2023, which represents a very strong improvement on that metric. Moving to our balance sheet. We ended 2024 with $22.1 million in cash and cash equivalents compared with $23.1 million at the end of 2023, and we had no outstanding borrowings under our revolving credit line at either year-end. Inventories totaled $10.1 million as of December 31, down from $11.9 million a year ago and prepaid inventory was $3.3 million, up slightly from $3 million. From a cash perspective, we continue to spend prudently and focus on investments that will drive our long-term growth. Our balance sheet remains healthy, which positions us to pursue strategic opportunities as they arise, whether that's through partnerships, expanded R&D or other initiatives we believe can accelerate our business in the coming quarters and years. Please see the table in the news release we issued earlier today for a reconciliation of GAAP to non-GAAP measures. As a final comment, as mentioned in this afternoon's earnings news release, the first and the third quarters are our seasonally softest, and 3 of this year's 4 largest medical conferences are in the first quarter. These events impact sales as prospective customers and their staff are out of the office and also they impact expenses as we leverage these important opportunities. Regarding sales, we expect that first quarter 2025 sales could be considerably lower than the first quarter of 2024 sales, with full year sales growth in 2025 versus 2024. I'd also like to point out that the first quarter of 2024 is a tough sales comp as various factors contributed to a particularly strong quarter. With that, I'll turn the call back to Joe.

Thanks, Javier and Michael, for those updates. We remain particularly encouraged by the opportunities to deepen ties with large medical practices. These organizations value comprehensive, cost-effective solutions that enhance patient care without requiring significant upfront capital, which is exactly what our Fair Deal Agreement model delivers. At the same time, we are broadening our international footprint, exploring specialized markets like veterinary medicine and delivering SRT in new ways, each of which holds promise for further diversification. We look forward to engaging with more clinicians and health care leaders at the important AAD Annual Meeting in March, where we plan to highlight clinical outcomes, share best practices for implementing SRT in high-volume settings and discuss how flexible our financial models can empower more practices to adopt noninvasive therapies. I'd like to conclude by reiterating how proud we are of the progress we've made over the course of 2024 as both Sensus and our customers adapted to the macroeconomic environment. The highlights we've shared today, including a record number of units shipped, ongoing profitability, new FDA agreements, added veterinary applications and steps towards the TDI resubmission, all underscore our momentum and set the stage for what we anticipate to be another productive and rewarding year ahead. We have concluded a great Q4 in 2024. We continue to direct many potential customers from an outright sale to the Fair Deal Agreement, which will, as we have said repeatedly, provide significant revenue in the second half of 2025. We will continue this trend throughout the first half of this year. Our largest customer continues to grow as they provided us with the PO for 50 units, of which 25 were delivered in Q4 with the next 25 slated for delivery in 2025. We expect this trend to continue as we work together in bringing our market the very best noninvasive technology or IG-SRT for non-melanoma skin cancer. While we aren't providing formal financial guidance for 2025 at this time, we remain optimistic about our growth trajectory. We anticipate continued momentum from both direct system sales and our Fair Deal Agreement pipeline. Our objective remains to drive sustainable profitable growth while bringing beneficial technology to patients in need of effective treatment alternatives. As we look ahead, we believe we have the right team, the right strategy and the right products to achieve these goals. We appreciate your continued support and look forward to reporting on our progress throughout 2025. Thank you for joining us today, and now we'd be happy to take your questions. Operator?

[Operator Instructions] And our first question comes from Jeremy Pearlman with Maxim Group.

Congrats on a great quarter and a great year. So just a couple of questions from our team. Firstly, on the -- I don't know, did you give a -- provide a breakout, I didn't see it in the press release of the number of units that were shipped in the fourth quarter? How many of those were part of the Fair Deal Agreement? And then just to piggyback off that, looking at 2025 and as you're dealing with new customers, what percentage do you think are more inclined to sign up for the Fair Deal Agreement as opposed to some of your -- the traditional sales or the lease program that you had? And is there one track that you as a company prefer? I guess, maybe whether -- just -- yes, sorry, I know those are three questions.

That's all right. Good questions. What I'm going to do is I'll ask Javier to go over the -- and reflect upon the different products that were sold to who and when, and then I'll provide a comment afterwards, but they're good questions.

All right. So Jeremy, the number of units shipped in Q4 was 39. None of that is a Fair Deal Agreement. We don't include that count in the 39 that we shipped in Q4. And yes, so that's the answer there.

The comment that I have, Jeremy, is that it's a delicate transfer of opinion in a lot of cases. We have a lot of customers and prospects that are deciding between purchasing and/or the Fair Deal Agreement. And as we direct customers towards the Fair Deal Agreement, if you look at the number of units that we applied to the Fair Deal Agreement versus the sale, if we didn't have the Fair Deal Agreement, our revenues would probably be a lot higher. But for the sake of driving the Fair Deal Agreement for the long-term benefits of the company, we're gaining a lot of access to these contracts and putting in a lot of installations because of the Fair Deal Agreement. Michael, do you have a comment?

Yes. I was just going to say, I just want to make sure we clarify here. Of the 39, Javier is absolutely correct that we did not account for the FDAs or the Fair Deal Agreements in that number. It's not to say that we did not ship out any Fair Deal Agreements. However, we're getting away from that number, as you may have heard me say in my statement, it's not about how many contracts signed on the Fair Deal Agreement. It's about how many patients are actually put through in a live setting once those operations tick up. So we wanted to get away from setting expectations with just how many Visions went out under the Fair Deal Agreement because that's actually not a good way to track revenue. Does that make sense, Jeremy?

Yes. No, 100% I understand. Yes. So just actually segueing from that another one of my questions was, as you move into 2025, I know you mentioned towards the back half of the year, the Fair Deal Agreement placements are going to start contributing to the top line. Is there, from your perspective, from the company perspective, the metric you hope to -- that like that's the average utilization of the placements? Are you going to be -- how are you going to be monitoring that? And at what point do you say, let's say, an underperforming unit would have to get either pulled back into the company and then -- or moved to another clinic?

Yes, that's a great question. Go ahead, Joe.

Well, let me answer that because that is a very good question. First of all, I can tell you that the customers that were installing these first units or these first bunch of units are customers that are looking at the same types of volumes that we want to have, and that's high volumes. So we're targeting all of the higher volume installations first so that we can gain -- hit the ground running here. So we're expecting a good start to this. I think everybody wants to be able to make money with this. So they're looking for those volumes to continue to grow each and every month. The initial installations that we have, we're showing increased revenues from each and every month. And once we have a significant amount or numbers that are significant enough that we'll be able to demonstrate and show you what those revenues are, which will be accumulated and put together for the second half of the year. We just don't have enough sample right now that's going to give us enough revenue that's going to be significant. But we feel as these installations grow and the volumes continue to grow each and every month, I think we're going to have significant revenue growth for the second half of the year, which everybody will understand.

Our next question comes from [ Arsalan Kamran ] with ROTH Capital Partners.

My name is Arsalan, I'm on for Jason Wittes from ROTH Capital Partners. I had a couple of questions. Before that, congrats on the quarter. My questions are, are there any new competitors emerging in the space? Have any competitors dropped out as well as how quickly do you anticipate new FDA sites to be able to get up and running? And how long to reach full capacity? And what is the average expected full capacity? And my last question is for these larger centers, can you provide some color on what customers are more likely to go with the FDA versus purchase?

Michael?

Yes, sure. So as far as your first question again, I apologize, it was cutting in and out.

Sure. Are there any new competitors emerging into the space, any competitors dropping out?

Got it. So no, it's the same competitors that have always been in. And really the main competitor in the dermatology market has always been really Mohs surgery. That's the alternative. Again, with 6 million new skin cancers a year in the United States, which is 4x larger than all other cancers combined, unfortunately, there's enough cancer to go around. So when you talk about competitors, SRT is a very, very unique way of treatment, and it's in dermatology and it's here to stay. So there's not much competitive nature there. I know competitors have dropped out either, if that's your question. And then you touched on Fair Deal Agreement large groups. I think that the -- like we've been saying, the private equity-backed roll-up groups, this program that we have, the Fair Deal Agreement is really geared for them. It allows these large roll-ups to utilize their cash in buying more practices. And that's what their goal is. That's what the private equity backed roll-ups goal is, is to get more practices under their entire geography and expand that way. So this -- it targets them, and we're always in discussions with that. We're really excited about 2025 in getting more interest from those types of groups. Joe, do you want anything to add?

Regarding the interest in the installations, again, each center, each group is evaluating where they would put these placements because they want to maximize their revenues as well. So based on the analytics that we're able to provide them along with the analytics that they have for themselves and for each one of their sites, we're able to calculate where the best place is to start, and we've already begun that process in installing some of these sites based on those analytics. So again, I think that the volumes are going to take care of themselves, and I think it's going to provide significant revenue again for our second half of the year.

Just a follow-up. What percent of sales came from your largest customer? And do you anticipate them continuing to purchase in 2025? And would it be at a similar pace?

Let me answer just real quick. We had 39 units delivered. 25 came from our largest customer. They continue to buy. We expect them to continue to buy throughout the year. And so we look forward to, again, another successful year.

Our next question comes from Ben Haynor with Lake Street Capital Markets.

First off for me, I was wondering on the interest level that you've seen from these private equity groups or large kind of customers. Can you provide a little bit more color on how advanced some of these discussions have gotten? Anything that might be -- might help investors gauge on how many clinics to kind of pencil in for the future?

Sure. Joe, you want that one or you want me to take it?

Yes. Let me give you an overview, Ben, and thanks for being on the call, and thanks for the question. There's between 12 and 15 major private equity-backed roll-ups that are out there. They currently represent or closing in on about 20% of the overall clinics that belong to dermatology. That's about 9,000 clinics, and those clinics keep growing every day. There's new clinics being opened up every day. And so if you're looking at 20% of that, that's 1,800 clinics. And so -- and the progression is looked at being over the next 2 to 3 years, growing to 25% of the overall number of clinics that exist out there. So you can see that the market is vast. It's large, it's long. And so we feel that the product that we have best suits their needs. And we think that it's going to accelerate during the course of 2025. We have several of these customers that are now considering the Fair Deal Agreement. And so hopefully, we'll be able to see some progress as the year continues to progress, and we'll be able to talk about gaining access to a lot of those private equity-backed groups and gaining access to the number of installations that they have. But as Michael previously mentioned, the most important thing here is how many patients can we process. We want to try to focus on the patients that are being treated by SRT within those customers, and we'll start focusing on that because in the end, that's what produces the most money for both sides, and that's going to be what's most important.

Yes. And Ben, just to add around the edges to that answer, Joe is absolutely right. If you remember in November, we announced that we already signed a large group. So that -- we do have a large group that's signed. And I can happily tell you that they've already started rolling some of the products out there. We're in plans to roll a few sites out. So that's exciting for all of us. In addition, we've given 3 or 4 major presentations to CEOs and medical advisory boards of other very large dermatology private equity-backed roll-up groups. So that's where we're at as far as progression. I think that with the fact that 3 out of our 4 largest shows in dermatology happened to be in Q1, it really, really is and could be a slingshot approach like we typically see with our sales from a history standpoint, our capital sales. I think the FDA has -- I run sales, so I'm looking at it, and it's been an easier sales process when convincing physicians and private equity-backed groups to sign on to the Fair Deal Agreement.

Okay. That's exactly what I was looking for and very helpful. And you mentioned the number of agreements signed is not the right metric. Do you plan on, in the future, giving sort of a patients-treated metric or anything like that?

I think that's what we want to do. Once we have significant numbers to be able to show the progress of it, I think that's very, very important. I think we'll get there.

Okay. Got it. And then you mentioned, how the ones that you have gotten out there, the volumes have ramped month over month over month. Do you have a sense yet of kind of where those level out at? Or do they continue to ramp? And I would imagine that if folks are ready to treat patients in high volume, they already believe that SRT is the solution for these patients. But is there kind of a waiting around like let's do X number of patients and see how they do and then do another X -- or how does that kind of...

I think it's a proven technology. They know that it works. I think the biggest factor is the analysis and the time it takes to work together with these organizations. And keep in mind, they're big organizations. They don't want to make any mistakes. So the valuation of the data and the analytics allows for us to really target the right centers to kick things off so that everything is productive and cost effective as well as profitable right off the bat. Nobody wants to make a mistake, especially them. They're very, very good at what they do. They're very well-managed organizations. And so we're very appreciative of the process that they've implemented. Now is it as fast as we want it to go? No, it's never as fast. We want things installed yesterday. But I'd rather have the right units installed at the beginning so that we don't have to think about replacing anything. And I think that's the way we're going. I think we're going to have a real good receptivity for the sites that they're going into. So we're going to have real good success right off the bat.

Yes. And two things just to add, if I may, Joe. I want to remind everyone about our inventory. We have well over 50 paid for units ready to go as far as Visions, just including Visions. So that gives us a leg up from a Fair Deal Agreement standpoint. We can immediately get those units out there. And then just to remind everyone as far as the process, we've been doing this 15 years. The capital equipment side of things, it's the same process in setting up the site from training to state regulatory. It takes up to about 8 weeks from the time they sign to the time that unit is installed and trained and everyone is ready to go. And then in addition to that, now that we're receiving 50% of all of the revenues from the sites, right, from an insurance standpoint, it takes another 45 to 60 days from first patient treatment to collect the money. So that's -- I want to set the expectations, that's where you're going to start seeing the revenues. From go live on the first day of patient treating to collection, it's 45 to 60 days. And that's very normal in the industry from an insurance standpoint.

So build in 3 months once it's signed, effectively to see the dollars in the door.

Exactly. And so that's the delay in seeing some of the revenues.

Okay. That's perfect. And then lastly for me, I can't leave Javier out of this. Can you quantify how much the step-up in kind of professional fees and compensation impacting G&A was more onetime-ish in nature? Or is this kind of a new higher level run rate?

No. On the professional fees, it's a onetime, different projects that we were doing during the Q4. On the compensation, it was also a onetime adjustment. And I expect G&A to increase a little bit in 2025, but not as much as we saw in Q4.

Congrats on the progress.

No further questions. This concludes our question-and-answer session. I would like to turn the conference back over to Joe Sardano for any closing remarks.

Well, great. Listen, thank you, everyone, for joining us today. Again, we're very proud of the performance that we've had for the last quarter and for the entire year 2024. We look forward to updating you on our progress in the coming quarters. And if you have any additional questions, don't hesitate to reach out to our Investor Relations team headed up by Tirth at Alliance Partners. And so thank you again for joining us today and for continued support of Sensus Healthcare. Operator?

Thank you. The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.