Vapotherm Reports Fourth Quarter and Fiscal Year 2023 Financial Results

EXETER, N.H., Feb. 22, 2024 /PRNewswire/ -- Vapotherm, Inc. (OTCQX: VAPO), ("Vapotherm" or the "Company"), today announced fourth quarter and fiscal year 2023 financial results and related highlights.

Fourth Quarter 2023 Financial Results and Related Highlights

    --  Net revenue for the fourth quarter of 2023 was $19.7 million, an
        increase of 5.7% as compared to the fourth quarter of 2022
        --  Disposables revenue increased by 10.4% as compared to the fourth
            quarter of 2022
    --  Gross margin in the fourth quarter of 2023 was 46.6% as compared to
        27.5% in the fourth quarter of 2022 and 39.6% in the third quarter of
        2023
    --  For the fourth quarter of 2023, GAAP operating expenses were $14.2
        million and non-GAAP cash operating expenses were $11.9 million. Both
        decreased compared to the prior year period and third quarter of 2023 as
        a result of the Company's Path to Profitability initiatives:
        --  GAAP operating expenses decreased by $8.6 million from the fourth
            quarter of 2022 and by $2.1 million from the third quarter of 2023
        --  Non-GAAP cash operating expenses decreased by $6.1 million from the
            fourth quarter of 2022 and by $0.4 million from the third quarter of
            2023
    --  Adjusted EBITDA loss in the fourth quarter of 2023 was $2.0 million as
        compared to an Adjusted EBITDA loss of $12.0 million in the fourth
        quarter of 2022 and an Adjusted EBITDA loss of $6.1 million in the third
        quarter of 2023
    --  The Company's unrestricted cash and cash equivalents was $9.7 million at
        the end of the fourth quarter of 2023
    --  The HYPERACT clinical trial results were presented at the Society of
        Critical Care Medicine Conference on January 23, 2024, which concluded
        that our therapy was as effective as the current gold standard at
        reducing CO(2), improving pH and reducing dyspnea in moderate to severe
        hypercapnic COPD patients. Additionally, this study showed high velocity
        therapy to have superior patient tolerance than the current gold
        standard

Fiscal Year 2023 Financial Results and Related Highlights

    --  Total revenue for 2023 was $68.7 million, an increase of 2.8% as
        compared to 2022
        --  Non-GAAP net revenue excluding the Vapotherm Access call center
            business, which the Company exited in the fourth quarter of 2022,
            increased by 7.2% as compared to 2022
        --  Non-GAAP net revenue excluding the Vapotherm Access call center
            business increased by 17.2% over the last three quarters of 2023 as
            compared to the last three quarters of 2022
        --  Disposables revenue increased by 8.0% as compared to 2022
    --  Gross margin in 2023 was 41.2%, an increase from 25.8% in 2022
    --  GAAP operating expenses in 2023 were $67.4 million and non-GAAP cash
        operating expenses were $54.8 million. Both decreased compared to the
        prior year period as a result of the Company's Path to Profitability
        initiatives:
        --  GAAP operating expenses decreased by $50.3 million from 2022
        --  Non-GAAP cash operating expenses decreased by $28.8 million from
            2022

"We made significant progress on our Path to Profitability Initiatives in 2023," said Joseph Army, President and CEO. "We saw good improvement in our gross margin, reduced our inventory balances and cash burn, and our Adjusted EBITDA loss in the fourth quarter of 2023 was the lowest it's been since 2018. Despite the large reductions we made in Non-GAAP cash operating expenses in 2023 we continued to invest in future growth drivers such as HVT 2.0, clinical studies and the home ventilation platform. Our HVT 2.0 installed base is growing nicely and is showing increased disposables utilization versus our workhorse Precision Flow product. I'm excited that we were able to share the results of the HYPERACT clinical trial in late January. We believe the combination of the HVT 2.0 platform with these clinical results will allow us to become the standard of care for patients in respiratory distress who present in the emergency department. I'd like to thank our entire team for all of their contributions in executing on our Path to Profitability Initiatives in 2023 and I look forward to building on this in 2024 and getting ready for our launch into the home market in early 2025."

Results for the Three Months Ended December 31, 2023

The following table reflects the Company's net revenue for the three months ended December 31, 2023 and 2022:


                                            
            
        Three Months Ended December 31,


                                                            2023                                              2022             Change


                                                        
           
              (in thousands, except percentages)


                                                 Amount                         % of Revenue                       Amount             % of Revenue     
       
     $ %



     
              Revenue



     Capital (product & lease revenue)  $
      2,733                 13.8                   $
            3,039              16.3 $
           (306)         (10.1)
                                                                     %                                                 %
                                                                                                                                                    %



     Disposables                           15,586                 79.0                            14,113              75.6          1,473            10.4
                                                                     %                                                 %                            %



     Service and other (1)                  1,415                  7.2                             1,511               8.1           (96)          (6.4)
                                                                     %                                                 %
                                                                                                                                                    %



     
              Total net revenue      $
      19,734                100.0                  $
            18,663             100.0 $
           1,071             5.7
                                                                     %                                                 %
                                                                                                                                                    %




     (1) Includes $70,000 in revenue from Vapotherm Access in the fourth
            quarter of 2022

Net revenue for the fourth quarter of 2023 was $19.7 million and increased 5.7% over the fourth quarter of 2022 due to an increase in capital and disposables demand in the International markets and higher average selling prices worldwide. Excluding revenue from Vapotherm Access, which the Company exited in the fourth quarter of 2022, non-GAAP net revenue increased by 6.1% as compared to the fourth quarter of 2022.

Revenue information by geography is summarized as follows:


                                        
              
          Three Months Ended December 31,


                                                          2023                                                  2022                Change


                                                        
           
                (in thousands, except percentages)


                                                 Amount                             % of Revenue                          Amount              % of Revenue        
     
     $ %


      United States (1)              $
       14,686                 74.4                  $
              15,531             83.2       $
         (845)              (5.4)
                                                                   %                                                  %
                                                                                                                                                           %



     International                        5,048                 25.6                               3,132             16.8              1,916                61.2
                                                                   %                                                  %
                                                                                                                                                           %


                   Total net revenue $
       19,734                100.0                  $
              18,663            100.0       $
         1,071                 5.7
                                                                   %                                                  %
                                                                                                                                                           %




     (1) Includes $70,000 in revenue from Vapotherm Access in the fourth
            quarter of 2022

Gross profit and gross margin for the fourth quarter of 2023 was $9.2 million and 46.6%, respectively, as compared to gross profit of $5.1 million and gross margin of 27.5% for the fourth quarter of 2022. The increases in gross profit and gross margin were primarily due to continued benefits from the transition of the Company's manufacturing operations to Mexico, higher revenue and production levels, and inventory reserves and write-offs recorded in 2022 that did not recur in the current year period.

Total operating expenses were $14.2 million in the fourth quarter of 2023, a decrease of $8.6 million as compared to the fourth quarter of 2022. Non-GAAP cash operating expenses, excluding impairment charges, loss on disposal of property and equipment, depreciation and amortization, stock-based compensation expense, termination benefits, and loss from deconsolidation were $11.9 million in the fourth quarter of 2023 compared to $18.0 million in the fourth quarter of 2022 and $12.3 million in the third quarter of 2023. The decreases in operating expenses and non-GAAP cash operating expenses were primarily due to the Company's Path to Profitability initiatives.

Net loss for the fourth quarter of 2023 was $10.2 million, or $1.60 per share, compared to $21.4 million, or $6.28 per share, in the fourth quarter of 2022. Net loss per share was based on 6,366,734 and 3,416,093 weighted average shares outstanding for the fourth quarter of 2023 and 2022, respectively.

Adjusted EBITDA was negative $2.0 million for the fourth quarter of 2023 as compared to negative $12.0 million for the fourth quarter of 2022. The reduction in Adjusted EBITDA loss was primarily due to the Company's Path to Profitability initiatives.

Results for the Year Ended December 31, 2023

The following table reflects the Company's net revenue for the years ended December 31, 2023 and 2022:


                                                       
              
           Year Ended December 31,


                                                                      2023                                                   2022                Change


                                                                    
            
                (in thousands, except percentages)


                                                            Amount                              % of Revenue                           Amount              % of Revenue        
     
     $ %



     
                Revenue



     Capital Equipment (product & lease revenue) $
     12,766                  18.6                  $
              11,650              17.4       $
         1,116                 9.6
                                                                               %                                                   %
                                                                                                                                                                        %



     Disposable                                     50,100                  73.0                              46,368              69.4              3,732                 8.0
                                                                               %                                                   %
                                                                                                                                                                        %



     Service and Other (1)                           5,803                   8.4                               8,783              13.2            (2,980)             (33.9)
                                                                               %                                                   %
                                                                                                                                                                        %



     
                Net revenue                    $
     68,669                 100.0                  $
              66,801             100.0       $
         1,868                 2.8
                                                                               %                                                   %
                                                                                                                                                                        %




     (1) Includes $2,758,000 in revenue from Vapotherm Access in the year ended
            December 31, 2022

Net revenue for 2023 was $68.7 million and increased 2.8% over 2022 due to an increase in capital and disposables demand and higher average selling prices. These increases were partially offset by our exit from the Vapotherm Access call center business, which the Company exited in the fourth quarter of 2022. Excluding revenue from Vapotherm Access, non-GAAP net revenue increased by 7.2% as compared to 2022.

Revenue information by geography is summarized as follows:


                                   
              
           Year Ended December 31,


                                                  2023                                                   2022                  Change


                                                
            
                (in thousands, except percentages)


                                        Amount                              % of Revenue                           Amount                 % of Revenue        
     
     $ %


     United States (1)        $
     51,023                  74.3                  $
              52,591              78.7       $
          (1,568)              (3.0)
                                                           %                                                   %
                                                                                                                                                       %


     International               17,646                  25.7                              14,210              21.3                 3,436                24.2
                                                           %                                                   %
                                                                                                                                                       %


                  Net Revenue $
     68,669                 100.0                  $
              66,801             100.0         $
          1,868                 2.8
                                                           %                                                   %
                                                                                                                                                       %




     (1) Includes $2,758,000 in revenue from Vapotherm Access in the year ended
            December 31, 2022

Gross profit and gross margin for the year ended December 31, 2023 was $28.3 million and 41.2%, respectively, as compared to gross profit of $17.2 million and gross margin of 25.8% for 2022. The increases in gross profit and gross margin were primarily due to continued benefits from the transition of the Company's manufacturing operations to Mexico, higher revenue and production levels, and inventory reserves and write-offs recorded in 2022 that did not recur in 2023.

Total operating expenses were $67.4 million in 2023, a decrease of $50.3 million as compared to 2022. Non-GAAP cash operating expenses, excluding impairment charges, loss on disposal of property and equipment, depreciation and amortization, stock-based compensation expense, termination benefits, loss from deconsolidation, and change in fair value of contingent consideration were $54.8 million in 2023 compared to $83.6 million in 2022. The decreases in operating expenses and non-GAAP cash operating expenses were primarily due to the Company's Path to Profitability initiatives.

Net loss for the year ended December 31, 2023 was $58.2 million, or $9.64 per share, compared to $113.3 million, or $33.89 per share, in 2022. Net loss per share was based on 6,037,468 and 3,341,617 weighted average shares outstanding in 2023 and 2022, respectively.

Adjusted EBITDA was negative $23.2 million for the year ended December 31, 2023 as compared to negative $65.2 million in 2022. The reduction in Adjusted EBITDA loss was primarily due to the Company's Path to Profitability initiatives.

Cash Position

Unrestricted cash and cash equivalents were $9.7 million as of December 31, 2023 compared to $14.4 million as of September 30, 2023.

Website Information

Vapotherm routinely posts important information for investors on the Investor Relations section of its website, http:// investors.vapotherm.com/. Vapotherm intends to use this website as a means of disclosing material, non-public information and for complying with Vapotherm's disclosure obligations under Regulation FD. Accordingly, investors should monitor the Investor Relations section of Vapotherm's website, in addition to following Vapotherm's press releases, Securities and Exchange Commission ("SEC") filings, public conference calls, presentations and webcasts. The information contained on, or that may be accessed through, Vapotherm's website is not incorporated by reference into, and is not a part of, this document.

Non-GAAP Financial Measures

This press release includes non-GAAP financial measures, including non-GAAP net revenue excluding Vapotherm Access, EBITDA, Adjusted EBITDA, non-GAAP operating expenses excluding impairment of goodwill, impairment of long-lived and intangible assets and gain (loss) on disposal of property and equipment, and non-GAAP cash operating expenses excluding additional items, including stock-based compensation expense, depreciation and amortization, termination benefits, loss from deconsolidation, and change in fair value of contingent consideration, which differ from operating expenses calculated in accordance with U.S. generally accepted accounting principles ("GAAP"). Non-GAAP net revenue excluding Vapotherm Access represents net revenue less net revenue of Vapotherm Access, which the Company exited in the fourth quarter of 2022. EBITDA represents net loss less interest expense, net, income tax provision or benefit, and depreciation and amortization, and Adjusted EBITDA represents EBITDA as further adjusted for the impact of foreign currency loss or gain, change in fair value of contingent consideration, stock-based compensation expense, impairment of goodwill, impairment of long-lived and intangible assets, and loss on disposal of property and equipment. The Company has reconciled all historical non-GAAP financial measures with the most directly comparable GAAP financial measures in tables accompanying this release.

These non-GAAP financial measures are presented because the Company believes they are useful indicators of its operating performance. Management uses these non-GAAP financial measures, as measures of the Company's operating performance and for planning purposes, including the preparation of the Company's annual operating budget and financial projections. The Company believes these measures are useful to investors as supplemental information because they are frequently used by analysts, investors and other interested parties to evaluate companies in its industry. The Company believes Adjusted EBITDA is useful to its management and investors as a measure of comparative operating performance from period to period.

These non-GAAP financial measures should not be considered alternatives to, or superior to, net income or loss as a measure of financial performance or cash flows from operations as a measure of liquidity, or any other performance measure derived in accordance with GAAP. They should not be construed to imply that the Company's future results will be unaffected by unusual or non-recurring items. In addition, Adjusted EBITDA is not intended to be a measure of free cash flow for management's discretionary use, as it does not reflect certain cash requirements such as tax payments, debt service requirements, capital expenditures and certain other cash costs that may recur in the future. Adjusted EBITDA contains certain other limitations, including the failure to reflect our capital expenditures, cash requirements for working capital needs and cash costs to replace assets being depreciated and amortized. In evaluating Adjusted EBITDA, you should be aware that in the future the Company may incur expenses that are the same as or similar to some of the adjustments in the Adjusted EBITDA presentation. The Company's presentation of Adjusted EBITDA should not be construed to imply that its future results will be unaffected by any such adjustments. Management compensates for these limitations by primarily relying on the Company's GAAP results in addition to using Adjusted EBITDA and other non-GAAP financial measures on a supplemental basis. The Company's definitions of Adjusted EBITDA, non-GAAP operating expenses and non-GAAP cash operating expenses are not necessarily comparable to other similarly titled captions of other companies due to different methods of calculation.

About Vapotherm

Vapotherm, Inc. (OTCQX: VAPO) is a publicly traded developer and manufacturer of advanced respiratory technology based in Exeter, New Hampshire, USA. The Company develops innovative, comfortable, non-invasive technologies for respiratory support of patients with chronic or acute breathing disorders. Over 4.2 million patients have been treated with the use of Vapotherm high velocity therapy® systems. For more information, visit www.vapotherm.com.

Vapotherm high velocity therapy is mask-free non-invasive respiratory support and is a front-line tool for relieving respiratory distress--including hypercapnia, hypoxemia, and dyspnea. It allows for the fast, safe treatment of undifferentiated respiratory distress with one tool. The HVT 2.0 and Precision Flow systems' mask-free interface delivers optimally conditioned breathing gases, making it comfortable for patients and reducing the risks and care complexities associated with mask therapies. While being treated, patients can talk, eat, drink and take oral medication.

Legal Notice Regarding Forward-Looking Statements

This press release contains forward-looking statements under the Private Securities Litigation Reform Act of 1995, including statements about the anticipated continued success of HVT 2.0 and the Company's ability to become the standard of care for patients in respiratory distress who present in the emergency department. In some cases, you can identify forward-looking statements by terms such as "believe," "expect," "continue," "plan," "intend," "will," "outlook," or "typically," or the negative of these terms or other similar expressions, although not all forward-looking statements contain these words, and the use of future dates. Each forward-looking statement is subject to risks and uncertainties that could cause actual results to differ materially from those expressed or implied in such statement. Applicable risks and uncertainties include, but are not limited to the following: Vapotherm's ability to raise additional capital to fund its existing operations and debt service obligations; Vapotherm's ability to comply with its financial covenants, execute on its path to profitability initiative, convert excess inventory into cash and fund its business and otherwise continue as a going concern through 2024; Vapotherm's has incurred losses in the past and may be unable to achieve or sustain profitability in the future; risks associated with its manufacturing operations in Mexico; Vapotherm's dependence on sales generated from its High Velocity Therapy systems, competition from multi-national corporations who have significantly greater resources than Vapotherm and are more established in the respiratory market; the ability for High Velocity Therapy systems to gain increased market acceptance; Vapotherm's inexperience directly marketing and selling its products; the potential loss of one or more suppliers and dependence on its new third party manufacturer; Vapotherm's susceptibility to seasonal fluctuations; Vapotherm's failure to comply with applicable United States and foreign regulatory requirements; the failure to obtain U.S. Food and Drug Administration or other regulatory authorization to market and sell future products or its inability to secure, maintain or enforce patent or other intellectual property protection for its products; the impact of COVID on its business, including its supply chain; risks in holding Vapotherm stock in light of trading on the OTCQX tier of the OTC Markets; and the other risks and uncertainties included under the heading "Risk Factors" in Vapotherm's Annual Report on Form 10-K for the fiscal year ended December 31, 2023, as filed with the SEC on February 22, 2024. The forward-looking statements contained in this press release reflect Vapotherm's views as of the date hereof, and Vapotherm does not assume and specifically disclaims any obligation to update any forward-looking statements whether as a result of new information, future events or otherwise, except as required by law.



             
                
                  Financial Statements:





             VAPOTHERM, INC.



             CONSOLIDATED BALANCE SHEETS



             (In thousands, except share amounts)




                                                                                                              December 31,


                                                                                                       2023                   2022



             
                Assets



             Current assets



             Cash and cash equivalents                                                          $
         9,725           $
          15,738



             Accounts receivable, net of expected credit losses                                       10,672                    9,102
      of $160 and $227, respectively



             Inventories                                                                              22,968                   32,980



             Prepaid expenses and other current assets                                                 3,058                    2,081



             Total current assets                                                                     46,423                   59,901



             Property and equipment, net                                                              23,703                   26,636



             Operating lease right-of-use assets                                                       3,372                    5,805



             Restricted cash                                                                           1,109                    1,109



             Goodwill                                                                                    565                      536



             Intangible assets, net



             Deferred income tax assets                                                                   57                       96



             Other long-term assets                                                                    2,388                    2,112



             Total assets                                                                      $
         77,617           $
          96,195



             
                Liabilities and Stockholders' Deficit



             Current liabilities



             Accounts payable                                                                   $
         5,053            $
          2,739



             Contract liabilities                                                                      1,237                    1,216



             Accrued expenses and other current liabilities                                           12,805                   15,609



             Revolving loan facility



             Total current liabilities                                                                19,095                   19,564



             Long-term loans payable, net                                                            107,059                   96,994



             Other long-term liabilities                                                               6,797                    7,827



             Total liabilities                                                                       132,951                  124,385



             Commitments and contingencies



             Stockholders' deficit



             Preferred stock ($0.001 par value) 25,000,000 shares authorized; no shares issued
      and outstanding as of December 31, 2023 and 2022



             Common stock ($0.001 par value) 21,875,000 shares authorized as of                            6                        4
      December 31, 2023 and 2022, 6,165,806 and 3,564,505 shares
      issued and outstanding as of December 31, 2023 and 2022, respectively (1)



             Additional paid-in capital                                                              492,764                  461,965



             Accumulated other comprehensive income (loss)                                                91                    (157)



             Accumulated deficit                                                                   (548,195)               (490,002)



             Total stockholders' deficit                                                            (55,334)                (28,190)



             Total liabilities and stockholders' deficit                                       $
         77,617           $
          96,195



                (1) On August 18, 2023, the Company effected a 1:8 reverse stock split for each
                 share of common stock issued
     and outstanding. All shares and associated amounts have been retroactively
      restated to reflect the stock split.



             VAPOTHERM, INC.



             CONSOLIDATED STATEMENTS OF OPERATIONS



             (In thousands, except share and per share amounts)




                                                                                          Three Months Ended                             Year Ended
                                                                                 December 31,                               December 31,


                                                                                2023                          2022                 2023                     2022


                                                                                             (unaudited)



             Net revenue                                                 $
        19,734                   $
         18,663     $
              68,669            $
           66,801



             Cost of revenue                                                   10,536                          13,540                 40,386                     49,558



             Gross profit                                                       9,198                           5,123                 28,283                     17,243



             Operating expenses



             Research and development                                           3,371                           4,561                 14,213                     20,802



             Sales and marketing                                                6,717                           9,476                 32,552                     46,091



             General and administrative                                         4,041                           7,042                 19,260                     27,796



             Impairment of goodwill                                                                                                                           14,701



             Impairment of long-lived and intangible assets                                                    1,501                  1,187                      7,676



             Loss on disposal of property and equipment                            98                             247                    151                        568



             Total operating expenses                                          14,227                          22,827                 67,363                    117,634



             Loss from operations                                             (5,029)                       (17,704)              (39,080)                 (100,391)



             Other (expense) income



             Interest expense                                                 (4,932)                        (3,771)              (18,733)                  (11,643)



             Interest income                                                        8                              26                     78                        139



             Foreign currency loss                                              (158)                           (51)                 (332)                     (239)



             Loss on extinguishment of debt                                                                                                                  (1,114)



             Net loss before income taxes                              $
        (10,111)                $
         (21,500)  $
              (58,067)         $
          (113,248)



             Provision (benefit) for income taxes                                  74                            (63)                   126                         11



             Net loss                                                  $
        (10,185)                $
         (21,437)  $
              (58,193)         $
          (113,259)



             Other comprehensive income (loss):



             Foreign currency translation adjustments                             280                             229                    248                      (183)



             Total other comprehensive income (loss)                              280                             229                    248                      (183)



             Total comprehensive loss                                   $
        (9,905)                $
         (21,208)  $
              (57,945)         $
          (113,442)



             Net loss per share basic and diluted                        $
        (1.60)                  $
         (6.28)    $
              (9.64)           $
          (33.89)



             Weighted-average number of shares used in calculating net      6,366,734                       3,416,093              6,037,468                  3,341,617
      loss per share, basic and diluted (1)




     (1) On August 18, 2023, the Company effected a 1:8 reverse stock split for each share of common stock issued



      and outstanding. All shares and associated amounts have been retroactively restated to reflect the stock split.



             VAPOTHERM, INC.



             CONSOLIDATED STATEMENTS OF CASH FLOWS



             (In thousands)




                                                                                                                      Year Ended December 31,


                                                                                                                   2023                              2022



             
                Cash flows from operating activities



             Net loss                                                                                   $
          (58,193)                $
            (113,259)



             Adjustments to reconcile net loss to net cash used in operating activities



             Stock-based compensation expense                                                                      9,611                              10,385



             Depreciation and amortization                                                                         4,977                               5,180



             Provision for credit losses                                                                            (18)                                224



             Provision for inventory valuation                                                                       744                               3,083



             Non-cash lease expense                                                                                  937                               2,127



             Change in fair value of contingent consideration                                                                                       (3,351)



             Impairment of goodwill                                                                                                                  14,701



             Impairment of long-lived and intangible assets                                                        1,187                               7,676



             Loss on disposal of property and equipment                                                              151                                 568



             Placed unit reserve                                                                                     758                                 646



             Interest paid in-kind                                                                                 9,488



             Amortization of discount on debt                                                                        736                                 686



             Loss from deconsolidation                                                                                                                   35



             Deferred income taxes                                                                                    38                                  11



             Loss on extinguishment of debt                                                                                                           1,114



             Changes in operating assets and liabilities:



             Accounts receivable                                                                                 (1,511)                              1,162



             Inventories                                                                                           9,361                                 449



             Prepaid expenses and other assets                                                                     (913)                            (1,771)



             Accounts payable                                                                                      2,454                             (3,347)



             Contract liabilities                                                                                     21                               (844)



             Accrued expenses and other liabilities                                                              (1,850)                            (3,285)



             Operating lease liabilities, current and long-term                                                  (2,250)                            (2,347)



             Net cash used in operating activities                                                              (24,272)                           (80,157)



             
                Cash flows from investing activities



             Purchases of property and equipment                                                                 (2,994)                           (11,610)



             Net cash used in investing activities                                                               (2,994)                           (11,610)



             
                Cash flows from financing activities



             Proceeds from issuance of common stock and pre-funded warrants and                                   20,943
      accompanying warrants in private placement, net of issuance costs



             Proceeds from loans, net of discount                                                                                                    99,094



             Repayment of loans                                                                                                                    (40,000)



             Payments of debt extinguishment costs                                                                                                    (817)



             Payment of debt issuance costs                                                                                                         (1,567)



             Repayments on revolving loan facility                                                                                                  (6,608)



             Payment of contingent consideration                                                                                                      (135)



             Proceeds from issuance of common stock in connection with at-the-market offerings, net                                                   1,064



             Proceeds from exercise of warrants                                                                        2



             Proceeds from issuance of common stock under Employee Stock Purchase Plan                                93                                 228



             Proceeds from exercise of stock options                                                                                                     65



             Net cash provided by financing activities                                                            21,038                              51,324



             Effect of exchange rate changes on cash, cash equivalents and restricted cash                           215                                (34)



             Net decrease in cash, cash equivalents and restricted cash                                          (6,013)                           (40,477)



             
                Cash, cash equivalents and restricted cash



             Beginning of period                                                                                  16,847                              57,324



             End of period                                                                                $
          10,834                    $
            16,847



             
                Supplemental disclosures of cash flow information



             Interest paid during the period                                                               $
          5,857                     $
            8,834



             Property and equipment purchases in accounts payable and accrued expenses                       $
          809                       $
            702



             Issuance of common stock to satisfy contingent consideration                           
     $                                     $
            5,630



             Issuance of common stock warrants in conjunction with long term debt                            $
          152                     $
            1,201



             Issuance of common stock for services                                                           $
          232                       $
            360



             Issuance of common stock upon vesting of restricted stock units                        
     $                                        $
            12

Non-GAAP Financial Measures

The following tables contains a reconciliation of GAAP net revenue to Non-GAAP net revenue excluding Vapotherm Access for the three months and years ended December 31, 2023 and 2022, respectively, and the growth of such GAAP net revenue and Non-GAAP net revenue excluding Vapotherm Access over the prior year period.


                                                               Three Months Ended December 31,                           Change


                                                         2023                                2022            
           
        $               %



     (Unaudited)                                                               (in thousands, except percentages)



     GAAP net revenue                                $
     19,734                    $
              18,663              $
      1,071          5.7
                                                                                                                                     %



     Vapotherm Access net revenue                                                              (70)                    70      (100.0)

                                                                                                                                     %



     Non-GAAP net revenue excluding Vapotherm Access $
     19,734                    $
              18,593              $
      1,141          6.1
                                                                                                                                     %


                                                                Year Ended December 31,                                Change


                                                         2023                             2022            
              
          $            %



     (Unaudited)                                                               (in thousands, except percentages)



     GAAP net revenue                                $
     68,669                 $
              66,801                 $
        1,868       2.8

                                                                                                                                    %



     Vapotherm Access net revenue                                                        (2,758)                      2,758   (100.0)

                                                                                                                                    %



     Non-GAAP net revenue excluding Vapotherm Access $
     68,669                 $
              64,043                 $
        4,626       7.2

                                                                                                                                    %

The following table contains a reconciliation of net loss to Adjusted EBITDA for the three months and years ended December 31, 2023 and 2022, respectively.


                                                                       Three Months Ended                                     Year Ended
                                                              December 31,                                        December 31,


                                                             2023                          2022                         2023                 2022



     (Unaudited)                                                            
              
           (in thousands)



     Net loss                                         $
      (10,185)                $
         (21,437)             $
           (58,193)         $
      (113,259)



     Interest expense, net                                   4,924                           3,745                         18,655                 11,504



     Provision (benefit) for income taxes                       74                            (63)                           126                     11



     Depreciation and amortization                             971                           1,174                          4,977                  5,180



     EBITDA                                            $
      (4,216)                $
         (16,581)             $
           (34,435)          $
      (96,564)



     Foreign currency                                          158                              51                            332                    239



     Loss on extinguishment of debt                                                                                                             1,114



     Change in fair value of contingent consideration                                                                                         (3,351)



     Stock-based compensation                                1,986                           2,760                          9,611                 10,385



     Impairment of goodwill                                                                                                                    14,701



     Impairment of long-lived and intangible assets                                         1,501                          1,187                  7,676



     Loss on disposal of property and equipment                 98                             247                            151                    568



     Adjusted EBITDA                                   $
      (1,974)                $
         (12,022)             $
           (23,154)          $
      (65,232)

The following table contains a reconciliation of operating expenses to Non-GAAP operating expenses and Non-GAAP cash operating expenses for the three months ended December 31, 2023, September 30, 2023 and December 31, 2022, respectively.


                                                        
              
            Three Months Ended


                                                               December 31,                     September 30,            December 31,
                                                         2023                          2023                   2022



     (Unaudited)                                         
              
            (in thousands)



     GAAP operating expenses                        $
      14,227              $
              16,284        $
             22,827



     Impairment of goodwill



     Impairment of long-lived and intangible assets                                     (755)                 (1,501)



     Loss on disposal of property and equipment           (98)                                                  (247)



     Non-GAAP operating expenses                        14,129                          15,529                   21,079



     Stock-based compensation                          (1,967)                        (2,161)                 (2,663)



     Depreciation and amortization                       (286)                          (754)                   (342)



     Termination benefits                                                               (312)                    (30)



     Loss from deconsolidation                                                                                   (35)



     Non-GAAP cash operating expenses               $
      11,876              $
              12,302        $
             18,009

The following table contains a reconciliation of operating expenses to Non-GAAP operating expenses and Non-GAAP cash operating expenses for the years ended December 31, 2023 and 2022, respectively.


                                                                  Year Ended December 31,


                                                           2023                            2022



     (Unaudited)                                                      (in thousands)



     GAAP operating expenses                          $
      67,363                 $
            117,634



     Impairment of goodwill                                                              (14,701)



     Impairment of long-lived and intangible assets      (1,187)                          (7,676)



     Loss on disposal of property and equipment            (151)                            (568)



     Non-GAAP operating expenses                          66,025                            94,689



     Stock-based compensation                            (9,435)                          (9,668)



     Depreciation and amortization                       (1,195)                          (1,709)



     Termination benefits                                  (754)                          (3,060)



     Loss from deconsolidation                               119                              (35)



     Change in fair value of contingent consideration                                       3,351



     Non-GAAP cash operating expenses                 $
      54,760                  $
            83,568

Supplemental Operating Metrics


                                                                              December 31,


                                                                     2023               2022                         Change


                                                                            Amount                            Amount                Amount %



     
                HVT 2.0 and precision flow units installed base



     United States                                                  24,617               24,327             290                1.2

                                                                                                                               %



     International                                                  12,892               12,439             453                3.6

                                                                                                                               %



     Total                                                          37,509               36,766             743                2.0

                                                                                                                               %




                                                                            Three Months Ended December
                                                                                    31,


                                                                     2023               2022                         Change


                                                                            Amount                            Amount                Amount %



     
                HVT 2.0 and precision flow units sold and leased



     United States                                                     178                  239            (61)            (25.5)

                                                                                                                               %



     International                                                      88                   75              13               17.3

                                                                                                                               %



     Total                                                             266                  314            (48)            (15.3)

                                                                                                                               %





     
                Disposable patient circuits sold



     United States                                                  98,749              104,302         (5,553)             (5.3)

                                                                                                                               %



     International                                                  45,137               24,551          20,586               83.8

                                                                                                                               %



     Total                                                         143,886              128,853          15,033               11.7

                                                                                                                               %




                                                                            Year Ended December 31,


                                                                     2023               2022                         Change


                                                                            Amount                            Amount                Amount %



     
                HVT 2.0 and precision flow units sold and leased



     United States                                                     874                  813              61                7.5

                                                                                                                               %



     International                                                     489                  531            (42)             (7.9)

                                                                                                                               %



     Total                                                           1,363                1,344              19                1.4

                                                                                                                               %





     
                Disposable patient circuits sold



     United States                                                 319,641              331,044        (11,403)             (3.4)

                                                                                                                               %



     International                                                 153,396              118,226          35,170               29.7

                                                                                                                               %



     Total                                                         473,037              449,270          23,767                5.3

                                                                                                                               %

Investor Relations Contacts:
John Landry, SVP & CFO, ir@vtherm.com, +1 (603) 658-0011

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SOURCE Vapotherm, Inc.