Nano-X Imaging Q2 2023 Earnings Call Transcript

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Provided by Quartr
August 17, 2023

There are 6 speakers on the call.

Operator

Good morning, and thank you for standing by. Welcome to the Nanox Second Quarter 2023 Earnings Call. At this time, all participants are in a listen only mode. After the speakers' presentation, there will be a question and answer Please be advised that today's conference is being recorded. I would I'd like now to turn the conference over to Mike Cavanaugh, Investor Relations.

Operator

Please go ahead.

Speaker 1

Good afternoon and thank you for joining us today. Earlier today, Nanox Imaging Limited released financial results for the quarter ended June 30, 2023. The release is currently available on the Investors section of the company's website. Erez Meltzer, Chief Executive Officer and Ron Daniel, Chief Financial Officer, will host this morning's call. Before we get started, I would like to remind everyone that Management will be making statements during this call that include forward looking statements regarding the company's financial results, research and development, manufacturing and commercialization activities, regulatory process operations and other matters.

Speaker 1

These statements are subject to risks, uncertainties and assumptions that are based on management's current expectations as of today and may not be updated in the future. Therefore, these statements should not be relied upon as representing the company's views as of any subsequent date. Factors that may cause such a difference include, but are not limited to, those described in the company's filings with the Securities and Exchange Commission. Management will also refer to certain non GAAP financial measures to provide additional information to investors. A reconciliation of each non GAAP financial measure to the nearest GAAP financial measure is provided in the company's press release filed today.

Speaker 1

The non GAAP financial measures include non GAAP net loss attributable to ordinary shares, non GAAP cost of revenue, non GAAP gross profit, non GAAP gross profit margin, non GAAP research and development expenses, non GAAP sales and marketing expenses, non GAAP general and administrative expenses, non GAAP other expenses and non GAAP gross loss per share. With that, I'd like to turn the call over to Erez Meltzer.

Speaker 2

Thanks, Mike, and welcome all to the Nanox Second Quarter 2023 Earnings Conference Call. Throughout this quarter, we achieved significant advancements across multiple business segments. I would like to highlight that today's call will extend a bit beyond our typical duration as I aim to offer more comprehensive insights. I will delve into specifics, including our strategic approach to the U. S.

Speaker 2

Market, the reinforcement of our manufacturing and supply chain and our regulatory process. During the quarter ended June 30, 2023, we continue to advance our commercialization efforts outside the U. S. Following FDA clearance to market the multi source Nanox Arc. With this clearance, we are now preparing to establish our foothold in the U.

Speaker 2

S. Market, complemented by our ongoing commercialization initiatives outside the U. S. Today, I'm excited to delve into our commercial efforts in both the U. S.

Speaker 2

And the non U. S. Markets. About the U. S.

Speaker 2

Deployment and strategy, obtaining the 510 clearance from the FDA for the multi source Nanox Arc has been a long standing strategic goal for the company and enable us to deploy the Nanox Arc in the U. S. For the indication of use cleared by the FDA. As previously announced, we are in the process of establishing A U. S.

Speaker 2

Demo is part of our strategic approach for our U. S. Commercial activities. We have decided to shift this first unit and are now planning to install the unit in a clinical setting rather than a standalone commercial site. The system is planned to be installed in an East Coast facility and we'll expect to start generate revenues alongside training and demonstrations.

Speaker 2

We believe that this first site will serve a dual purpose. 1st, as a training and demonstration center for the Nanox R, which will provide potential buyers with live demonstration of the technology, which we believe is essential for informed acquisition purposes by healthcare practices, Hospitals and Health Systems. Secondly, we believe the clinical side can raise awareness of the Nanox Arc among key opinion leaders, Radiologists and Hospital System Personnel. The first NanoxOG system was shipped from Israel and arrived in the U. S.

Speaker 2

For installation in the clinical site, which we expect to open the clinical site during the Q4 of this year. Based on market analysis of the U. S. Market of clinicians, imaging administrators and directors, stakeholders recognize The clinical benefits of the Nanox are and its more affordable approach to advanced imaging techniques. Furthermore, outpatient facilities such as skilled nursing facilities, freestanding emergency clinics And pulmonary clinics showed interest in adopting the Nanox ARCs, specifically because such Facilities typically do not have CT capabilities and we believe such facilities view the NanoxR as the more affordable Outpatient facilities also expressed potential interest in our MSaaS business model, which we believe reduces the risk of an upfront purchase because the cost is based on equipment use.

Speaker 2

We believe that gathering further clinical evidence will strengthen the support of our technology. Our U. S. Go to market strategy is comprised of 3 primary components: Customer targeting, building a sales team and using a hybrid business model. In terms of the customer targeting, We believe several factors impact willingness to adapt to our system, including the type of facility, its current imaging capabilities and imaging volumes and geographic locations, namely rural versus urban.

Speaker 2

Our aim is to strategically engage segments that show early adoption potential such as orthopedic clinics, Skilled Nursing Facility, Freestanding Emergency Departments and Urgent Care Facilities. We intend to continue to build clinical evidence, particularly with the U. S. Market to support the adoption of our system as well as reimbursement mechanisms specifically with commercial payers. We have strategically realigned our focus to enhance our presence in the U.

Speaker 2

S. Market. Our initial efforts in commercialization and deployment within the U. S. Will be concentrated on select states.

Speaker 2

This approach allows us to optimize customer service delivery and support in the near term. To execute our strategy, We have allocated internal sales resources and we are planning to leverage the USA RAD network in order to accelerate our initial penetration in the market. Furthermore, we are in the process of enhancing a U. S.-based Sales and service team that will seek to generate leads, close sales, manage relationships and provide services for the Nanox RX installed base. We are also in the process of engaging an independent service provider to provide service needs in remote geographies and to decrease equipment downtime.

Speaker 2

We expect that the other operating areas such as medical affairs, Regulatory, Billing, Finance and Contracting will be supported by the existing international Nanox Organization. For our business model in the U. S, we intend to use a hybrid approach combining a usage based MSAS model with a CapEx model to help promote adoption based on different segments. We have designed a training program To promote the Nanox Arc, we intend to use a combination of pilot sites, training, sales and marketing efforts to help meet customer needs. These aspects of our business strategy will require us to hire additional experienced healthcare business development professionals, who will be charged with raising awareness of the Nanox Arc among physicians, hospitals, urgent care operators and large health systems throughout the USA.

Speaker 2

To support these important efforts, I intend to increase My personal presence in the U. S. And make myself available for meetings with potential customers as well as investors who would like to have an in-depth conversation about our technology, commercial strategy and future strategic plans. We look forward to providing further details in the upcoming months. With respect to the rest of the world deployments, Turning to our commercialization efforts outside of the U.

Speaker 2

S, we continue to make significant progress in multiple countries, principally in Africa. As we have previously announced, we have an agreement with a distributor in Morocco and are working to accelerate deployments. We have deployed a Nanox Arc system in a prominent hospital in Morocco that is a major healthcare provider in the southern region of the country. The distributor in Morocco received appropriate clearance to conduct certain scans with the Nanox Arc. Subject to the clearance, the Nanox Arc system has generated human images on incoming patients at the hospital, including chest.

Speaker 2

In Nigeria, we have installed the Nanox Arc systems, which we accept will become operational upon receipt Of the necessary regulatory approvals and certification that have been formally submitted to the local authorities, the NNRA, to facilitate clinical activities. We hope to begin generating human images in the very near future. As previously reported, we have already placed the system in Ghana at the U GMC Hospital mainly for training purposes. Meantime, our distributor has submitted the specific NanoxR device for approval to the Ghana Food and Drugs Authority For commercial use, we anticipate receiving an initial response in the Q4 of 2023. And in addition, we have engaged a clinical research organization to potentially hold clinical trials in both Morocco and Ghana subject to local regulatory approvals.

Speaker 2

In alignment with our global initiatives and as announced in the past, We established a partnership with Bio Ventures For Global Health, BVGH, a non profit organization dedicated to solving global health issues by forming connections between people, resources and IKEA. We completed the first phase of this program and are excited to begin the 2nd series in just a few weeks, which involved a series of expert led seminars to train Nigerian and other African healthcare professionals on imaging topics. We also regularly host radiologists, distributors, Representatives from hospital systems, investors and analysts at Nanox headquarter in Israel to discuss the Nanox Arc System in detail and conduct live demonstration of the systems on-site, Providing first hand insight into the capabilities of Nanox are. I'm happy to report that these meetings resulted in very positive feedback in writing. All of those efforts constitute just the beginning Our goal to help people achieve better health outcomes.

Speaker 2

Lastly, On this front, as part of our global commercialization, we have started to generate initial revenues from the Medical Imaging Equipment and MSAs. With respect to the OEM, Before I provide an update on the manufacturing and production front, I'd like to share the news that we have entered and Original Equipment Manufacturing OEM relationship with the U. S. Government agency that we have signed and are working to develop. The government agency I referred to has procured Nanox MAM systems for assessment.

Speaker 2

Their interest in our technology is for the purposes of developing next generation security scanning and non The project is scheduled to commence next month. As part of our OEM efforts, We have sent several demo units to industry partners, out of which a leading partner independently examined Nanox Call cathode chip and reported a real technological breakthrough. With respect to the mass production, As we begin to deploy the Nanox Arc and prepare for mass production, I would like to provide updates regarding research and development and Manufacturing. We are currently using chips produced by our Korean fabrication facility in our Nanox Arc System. However, to secure additional chip supply in anticipation Of commercialization, scale up and acceleration of manufacturing activity, we recently entered into an agreement with CSAM, A chipmaker located in Switzerland.

Speaker 2

We have proceeded to Phase 2 lab to fab development, which is expected to manufacture sample chips by the end of this year and provide production of chips in Q1 2024. For the commercial production of our digital X-ray tubes for use in Nanox R, we plan to engage 3rd party manufacturers and suppliers based on among other things cost effectiveness. We are currently developing both ceramic and glass based digital X-ray tubes for use in Nanox R. Our Korean facility is currently our primary manufacturer and supplier for our ceramic digital X-ray tubes. And we are working with a third party for the production of glass based digital X-ray tubes.

Speaker 2

For example, we recently started testing glass Based digital X-ray tubes manufactured by CEI, the testing includes performance integration and radiation testing. Furthermore, we are negotiating with additional third party to produce the digital X-ray Tubes. Along with our existing manufacturing facilities in Israel and Korea, we believe these developments further strengthen our future supply of both ships and tubes, the 2 key components of the Nanox Arc to support the Scaled deployment of the Nanox Arc units. In an additional step towards optimizing our MS Manufacturing capabilities, we have initiated collaboration with Scanray for Nanox Arc Systems Assembly at Scale. Scanray, a medical equipment manufacturer, meets essential standard requirements and serves as a Supplier for prominent global medical entities.

Speaker 2

It is also the parent company of CEI, our Italian provider of glass based digital X-ray tubes. With robust technological manufacturing capabilities in India, We plan to leverage in the coming years of the Nanox R deployment. Regarding regulatory, I'd like to now turn our attention to regulatory and clinical trials update. On April 28, 2023, we obtained a 510 clearance from the FDA to market the Nanox ARC, Including the Nanox Cloud, it's a company cloud based infrastructure. The Nanox Arc is a stationary X-ray system intends to produce Tomographic images of the human MSK system adjunctive to conventional radiology on adult patients.

Speaker 2

The approved device is intended to be used in professional healthcare facilities or radiological environments such as hospital, clinics, Imaging Center and Other Medical Practices by trained radiographers, radiologists and physicians. This version of the Nanox ART has the required capabilities to scan MSK chest and abdomen and to provide 2 d x-ray images conventional radiography subject to local regulatory approvals. We are also continuing to pursue the CE Mark in the European Union with our notified body aiming to submit during Q3 of 2023. In Israel, we are pursuing the Amar clearance, the Israeli medical device listing, The required technical file was completed and submitted in early July 2023, and we expect a decision in the few months. Clinical, as previously discussed, under Helsinki permit, we started to collect clinical sample images of multiple human body anatomies with the Nanox Arc System that was deployed in the Shamir Hospital in Israel.

Speaker 2

We have completed 1st phase of clinical sampling and have We are in the final stages of approval of additional clinical sites in Israel And this additional trial aims to utilize the Nanox AARC subject to receiving the final approval from the institutional IRB. This trial will aim to assess The diagnostic capabilities of Nanox ART in detecting chest and lung diseases. Installation of the Nanox ART is expected to be completed within a month from its commensals and the trial itself is scheduled to commence in the Q3. With respect to Nanox AI, I'm excited to share the progress we have made in the ADAPT trial with the National Health Service in the UK. To date, All 5 of the testing sites in the UK have signed the collaboration agreement.

Speaker 2

And in addition, 3 sites Cambridge, Southampton and Bradford have begun sending images to the Nanox Cloud platform And we expect 2 more sites in Nautigam and Cardif to begin sending images very soon. Nanox AI is currently engaged in showcasing the product across a range of platforms to 10 integrated delivery networks in both the United States and in other regions. With that, I'd like to turn the call over to Rand Daniel, Chief Financial Officer to review our financial results.

Speaker 3

Thank you, Evan. We reported a GAAP net loss for the Q2 of 2023 of $17,400,000 compared with a net loss of $19,600,000 in the Q2 of 2022. The decrease was largely due to a goodwill impairment $14,300,000 that was recorded in the comparable period and not in the 3 months ended June 30, 2023, which effect was offset in part by a decrease in the company's earn out liabilities in the amount of 12.8 $1,000,000 in the Q2 of 2022 versus an increase of $100,000 in the Q2 of 2023. Revenues for the Q2 of 2023 were $2,600,000 and the gross loss was $1,700,000 on a GAAP basis. Revenues from the teleradiology services for the same period was 2 point which represents a gross profit margin of approximately 14% on a GAAP basis and 36% On a non GAAP basis, the increase in the company's revenues in the Q2 of 2023 is mainly due to the increase and the number of radiologists that engage in reading during the overnight and weekend shift.

Speaker 3

The decrease in the gross profit margin on a GAAP On a non GAAP basis, it's mainly due to an increase in the cost of the company's radiologists due to the incentive payments, which the company paid to the radiologists to engage in reading during the overnight and weekend shift. Research and development expenses for the Q2 of 2023 were $6,900,000 as compared to $6,500,000 for the comparable period in 2022. The increase of $400,000 in our research and development expenses was mainly due to an increase in the company's cost of labor in the amount of $700,000 mainly due to an increase in the headcount in connection with the development of the Nanox Arc System, which was partially offset in part by a decrease in share based compensation of $300,000 An increase in research and development grants that the company has received in the amount of $100,000 Sales and marketing expenses for the Q2 of 2023 were $380,000 as compared to $1,100,000 for the comparable period in 2022. General and administrative expenses for the Q2 of 2023 were $7,600,000 as compared to $11,200,000 for the comparable period in 2022. The decrease of $3,600,000 in the general and administrative expenses million was mainly due to a decrease in the company's cost of labor in the amount of 0 point $5,000,000 due to a reduction in headcount as part of the company's plan to increase efficiency.

Speaker 3

In addition, we added decrease in our share based compensation in the amount of $2,800,000 and a decrease in the cost of directors and During the Q2 of 2023, we had accrued $700,000 for the future settlement expenses in connection with the SEC investigation. As previously disclosed, the company and Ron Polyakim, our Chairman of the Board of Directors, reached Agreement in principle with the SEC staff to settle the SEC investigation. The agreements are subject to finalization, including any financial remedies, which the company estimates will be approximately of $700,000 in civil penalties from the company. Final resolution of this matter is subject to the preparation and negotiation of the documentation of its authority to all parties, including with respect to the company approval by the company's Board of Directors and in the case of the SEC, authorization by the commission as well as approval by a federal district court. As mentioned above, we incurred an expense of 0.1 We entered into an amendment to the stock purchase agreement with the former stockholders of U.

Speaker 3

S. RUB. Under this amendment, The company paid an aggregate amount of approximately $300,000 in cash And 45,392 ordinary shares to the former stockholders of U. S. ROD in consideration for the shipment of certain milestones in connection with the first earn out period as defined in the U.

Speaker 3

S. Large stock purchase agreement. In addition, we paid an aggregate of $500,000 in cash and 210,000 Ordinary shares to the former stockholders of U. S. R.

Speaker 3

A. D. As consideration for the remainder of the milestones and applicable announced under the U. S. Rodstock Purchase Agreement.

Speaker 3

Turning to our balance sheet. As of June 30, 2023, We had cash, cash equivalents with restricted cash and marketable securities of approximately $80,300,000 And add 3,400,000 loans from banks. We ended the quarter with a property and equipment of $45,200,000 As of June 30, 2023, we had approximately 55,500,000 shares outstanding as compared to 52,100,000 shares outstanding as of December 31, 2022. The increase was mainly due to the issuance of approximately 200 55,000 ordinary shares to the former stockholders of U. S.

Speaker 3

ROTH under the amendment to the U. S. ROTH Stock Purchase Agreement previously discussed. On July 26, 2023, we raised $30,000,000 in a registered direct offering by selling approximately 2 1,000,000 shares and warrants to purchase up to 2,100,000 shares. The net proceeds of the raise are intended to be used to further development, manufacturing and commercial deployment of our systems.

Speaker 3

With that, I'll hand the call back over to Eric.

Speaker 2

Once again, I want to thank you all for being here today and for being with Nanox on our multiyear journey to make medical imaging more We have made tremendous strides in realizing our vision this year and I'm proud of what our team has done to bring our company to the doorstep of commercializing the Arc System at scale. Before we end the call, I want to announce that we will be hosting an Investor Day to be held in New York City at the end of September or the beginning of October 2023. And if you would like to attend either in person or virtually, Please contact our Investor Relations partners at ICR Westwicke. Have a great day. Operator, please open the call for questions.

Operator

Please standby while we compile the Q and A roster. The first question will come from Ross Osborne with Cantor Fitzgerald, your line is open.

Speaker 4

Hi, congrats on the progress Thank you for taking our questions. So starting off, would you discuss the level to which your system in Nigeria is operating in terms of scans per day?

Speaker 2

I think it was indicated that the one in Nigeria Right now, it's operating without the approval of getting scans per patient or for human, And we're waiting for the final NNRA approval for the scans in human or to getting the human images.

Speaker 4

Apologies, I may have mispelled it. So is Ghana operating on human scans or is that also waiting?

Speaker 2

Ghana is waiting for the final approval for commercial use.

Speaker 4

Okay, understood. And then following up with

Speaker 2

the The one in Morocco is operating with human scans with images Like it's in a full operation at the hospital.

Speaker 4

Okay, great. Would you be

Speaker 2

able to provide With all the Yes. I beg your pardon?

Speaker 4

Would you be able to provide the level to which it's operating in terms of scans per day?

Speaker 2

Right now, we don't disclose what's the numbers of spends per day. But I think that In the next call or probably even earlier in the Investors Day, we will provide the initial indication for the scans per day In all the units that we have installed.

Speaker 4

Okay, understood. And then following up on this, When can we expect for you to deliver more systems to your commercialized operating countries? I believe Nigeria calls for 1,000, Ghana for 3.50 and Morocco for seventy systems.

Speaker 2

1st of all, as soon as we get the final approvals, but this basically will start In the next two quarters, for sure.

Speaker 4

Okay. And then turning to the Could you just walk us through the rationale for the delay in the training center operating? I believe it was previously calling for this summer.

Speaker 2

The one thing that we've had an early indication is that we're going to send the first systems. We are waiting for the Approval of the demo center itself, but in the meanwhile, we have decided, As mentioned in the in my preliminary in the What I said actually earlier today that we wanted to we preferred to have the first system To be installed in a clinical site and to make it commercial earlier than the original plan. Since we have already a few clinical locations or clinics that are willing to So the systems, even before, we have the full operating U. S. Operation system U.

Speaker 2

S. Operation, Then we decided that the first system will be installed in the next few weeks in one of these locations and would start both, First of all, to generate to scan patients and to generate revenues.

Speaker 4

Got it. And then last one for us and we'll jump back in the queue. Would you discuss the size of your U. S. Contract you announced today?

Speaker 4

And just So we're on the same page. Did the OEM sign on for your comprehensive system? Or are you now selling your chips on a standalone basis?

Speaker 2

You mean the OEM agreement?

Speaker 1

Yes.

Speaker 2

Okay. The OEM We have a few OEM arrangements and collaboration. The one that was mentioned, it's for the chip only. The others are aimed to either chip or chip and tube. In addition, we are in the process Of having a full demo, not only the tube itself that We'll be tested in the next, I would say, 6 months.

Speaker 4

Okay. And then are you able to disclose the size of the contract with the U. S. Government agency?

Speaker 2

We are not allowed to.

Speaker 1

Okay. Thanks for taking

Speaker 4

our questions. We'll jump back in the queue.

Operator

Please standby for the next question. The next question comes from Jeff Cohen with Ladenburg. Your line is now open.

Speaker 5

Hi, Erez and Rand. Thank you so much for taking our questions. This is actually Destiny on for Jeff. I will start by kind of continuing on the last group of questions. And I'm curious how are you determining the initial physicians that will be welcomed into your demo site?

Speaker 5

And is this going to be more of a group demonstration? Or is this going to be on a kind of one to one basis?

Speaker 2

First of all, right now, as we have shared, it's actually, it's a full range. So we have individuals that are coming to see the systems and will be coming to see the system. We have some delegations. One of them was even like 10 or 15 people. We are Willing and will be willing to host any size of group that will be able to see what we do.

Speaker 5

Got it. Okay. And there could be multiple people from a single site, I would assume. So that makes sense. Thank you.

Speaker 5

Absolutely. Got it. Okay. And then you mentioned the sales team, a direct sales force in the U. S.

Speaker 5

I'm wondering about the size of that sales team, the timing The onboarding of your initial sales reps and then how we should be thinking about the impact to sales and marketing expense going forward for modeling purposes?

Speaker 2

Okay. Let's start with the first question. So as I've indicated, we are building the team as we speak. We mentioned in the past that we are in the final process of Conclude and complete the full action plan or execution plan of the deployment in the U. S.

Speaker 2

Part of what of this, I've shared with earlier today. And the full, I would say, a more detailed plan, including numbers and further indications We'll be presented in the Investors Day that we're planning to the end of September. By that by then, we are going to have probably most of the team already ready To do the work, we are planning the kickoff early October in the U. S. A few of the people have already engaged and working in the U.

Speaker 2

S. So I think that more of this you will be able to hear. We are talking, by the way, On the September 22 at the NASDAQ to have the Investors Day That we're planning and more details to come on this.

Speaker 5

Excellent. Looking forward to that Investor Day. And then lastly for us, you're collecting a lot of clinical and some real world data. I'm wondering if you'll create some kind of registry to kind of for all of that?

Speaker 2

The answer is yes. Part of it will be shown and presented in our websites. Everything is based on what is allowed, what we can. It will be based on regulation related to the this disclosure. We are also in the process of preparing the all the Clinical data collected and prepared the paper that we're going to Release.

Speaker 2

So this is actually at the same time that we do all the Commercial deployment, we're going to make a lot of efforts and emphasize the clinical side of what we're doing. I think that I've shared a little bit today that, as you know, in the U. S, we are allowed right now to do the MSK, but in the rest of the world, We do chest, abdomen and other anatomies. So both in Israel And in Morocco, we have already tested and scanned human in the other anatomies I'm used so basically this is the plan that we move forward In order to enhance our ability to do the clinical to provide the clinical data and explore the opportunities for the future intended use.

Speaker 5

Okay, got it. Thank you so much for taking our questions. I'll hop back in the queue.

Operator

Thank you. This is all the time we have for questions. Thank you for your participation in today's conference. You may now disconnect. Have a great day.

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