Vapotherm Reports Fourth Quarter and Fiscal Year 2020 Financial Results

2020 Revenue of $125.7 Million Reflects 161.4% Increase Over Prior Year

Results in Line with Preliminary Revenue of $125.4 Million

Worldwide Installed Base of Precision Flow Hi-VNI® Systems Grew by 72.8% in 2020

EXETER, N.H.--(BUSINESS WIRE)--Vapotherm, Inc. (NYSE: VAPO), (“Vapotherm” or the “Company”), a global medical technology company focused on the development and commercialization of its proprietary Vapotherm high velocity therapy® products, which are used to treat Patients of all ages suffering from respiratory distress, today announced fourth quarter and fiscal year 2020 financial results.

Fourth Quarter 2020 Summary

• Net revenue for the fourth quarter of 2020 was $40.9 million, representing a 214.4% increase over the prior year period
• Gross margin was 50.6% in comparison to gross margin of 45.1% in the fourth quarter of 2019

Fiscal Year 2020 Summary

• Net revenue for 2020 was $125.7 million, 161.4% growth over 2019
• Disposable revenue in 2020 was $56.7 million, 61.8% growth over 2019
• Gross margin was 50.1% in comparison to gross margin of 44.3% in 2019
• Worldwide installed base of Precision Flow Hi-VNI systems grew by 72.8% in 2020

“We are pleased with our progress in 2020, which has positioned us well for continued long-term growth beyond the COVID pandemic. During 2020, we saw increased worldwide awareness of High Velocity Therapy, significant growth in the number of new ED Gold and Silver accounts in the U.S., and 72.8% growth in our worldwide installed base of Precision Flow systems,” said Joe Army, President and CEO of Vapotherm. “In 2021, we will focus on educating our Customers on how to use High Velocity Therapy for Patients experiencing Type II respiratory distress, increasing our worldwide installed base, and launching new products worldwide.”

Results for the Three Months Ended December 31, 2020

The following table reflects the Company’s net revenue for the three months ended December 31, 2020 and 2019:

	Three Months Ended December 31,
	2020					2019					Change
	(in thousands, except percentages)
	Amount		% of Revenue			Amount		% of Revenue			$		%
Revenue
Capital (product & lease revenue)	$	21,582		52.8	%	$	2,920		22.4	%	$	18,662		639.1	%
Disposable		18,074		44.2	%		9,679		74.4	%		8,395		86.7	%
Service and Other		1,251		3.0	%		411		3.2	%		840		204.4	%
Total net revenue	$	40,907		100.0	%	$	13,010		100.0	%	$	27,897		214.4	%

Net revenue for the fourth quarter of 2020 was $40.9 million as compared to $13.0 million for the fourth quarter of 2019, a 214.4% increase over the fourth quarter of 2019. Total capital equipment revenue, including product and lease revenue, increased by $18.7 million or 639.1% over the fourth quarter of 2019. This increase was due to increased sales of our Precision Flow units as a result of demand related to the COVID-19 pandemic and increased average selling prices in the United States. Total disposable revenue increased 86.7% over the fourth quarter of 2019, primarily driven by an increase in the worldwide installed base of Precision Flow units and increased utilization to treat the respiratory distress experienced by many COVID-19 patients and higher average selling prices in the United States.

Revenue information by geography is summarized as follows:

	Three Months Ended December 31,
	2020					2019					Change
	(in thousands, except percentages)
	Amount		% of Revenue			Amount		% of Revenue			$		%
United States	$	33,612		82.2	%	$	9,821		75.5	%	$	23,791		242.2	%
International		7,295		17.8	%		3,189		24.5	%		4,106		128.8	%
Total net revenue	$	40,907		100.0	%	$	13,010		100.0	%	$	27,897		214.4	%

Worldwide revenue growth in the fourth quarter of 2020 was driven by an increase in the number of Precision Flow units sold over the prior year period and to a lesser extent an increase in single-use disposable sales due to higher installed bases of Precision Flow units worldwide.

Gross profit for the fourth quarter of 2020 was $20.7 million, an increase of $14.8 million over the fourth quarter of 2019. Gross margin was 50.6% in the fourth quarter of 2020 compared to 45.1% in the fourth quarter of 2019. Gross margin was positively impacted by improved overhead absorption due to higher production volumes and a higher mix of U.S. revenue.

Operating expenses were $33.0 million in the fourth quarter of 2020, an increase of $14.4 million as compared to $18.6 million in the same period last year. The increase in operating expenses was primarily due to higher sales and marketing expenses as a result of an increase in sales commissions, and increased sales and marketing headcount, and to a lesser extent increased general and administrative expenses as well as research and development expenses.

Net loss for the fourth quarter of 2020 was $17.2 million, or $0.67 per share, compared to net loss of $12.5 million, or $0.60 per share, in the fourth quarter of 2019. Net loss for the fourth quarter of 2020 includes a loss on debt extinguishment of $4.2 million recorded as a result of the Company’s debt refinancing. Net loss per share was based on 25,682,098 and 20,830,169 weighted average shares outstanding for the fourth quarter of 2020 and 2019, respectively.

Adjusted EBITDA was negative $9.1 million for the fourth quarter of 2020 as compared to negative $10.8 million for the fourth quarter of 2019. The $1.7 million improvement in Adjusted EBITDA in the fourth quarter of 2020 was primarily due to higher revenue and gross profit, partially offset by increased operating expenses resulting from higher levels of sales and marketing expenses, primarily sales commissions and increased headcount. Reconciliations of all historical non-GAAP financial measures used in this release to the most comparable GAAP measures can be found in the attached financial tables.

Results for the Twelve Months Ended December 31, 2020

The following table reflects the Company’s net revenue for the twelve months ended December 31, 2020 and 2019:

	Year Ended December 31,
	2020					2019					Change
	(in thousands, except percentages)
	Amount		% of Revenue			Amount		% of Revenue			$		%
Revenue
Capital (product & lease revenue)	$	65,964		52.5	%	$	11,045		22.9	%	$	54,919		497.2	%
Disposable		56,711		45.1	%		35,055		72.9	%		21,656		61.8	%
Service and Other		3,058		2.4	%		2,004		4.2	%		1,054		52.6	%
Total net revenue	$	125,733		100.0	%	$	48,104		100.0	%	$	77,629		161.4	%

Net revenue for 2020 was $125.7 million, representing a 161.4% increase over 2019. Total capital equipment revenue, including product and lease revenue, increased 497.2% year over year. This increase was due to increased sales of our Precision Flow units as a result of demand related to the COVID-19 pandemic and increased average selling prices in the United States. Total disposable revenue increased 61.8% year over year, primarily driven by an increase in the worldwide installed base of Precision Flow units and increased utilization to treat the respiratory distress experienced by many COVID-19 patients and higher average selling prices in the United States.

Revenue information by geography is summarized as follows:

	Year Ended December 31,
	2020					2019					Change
	(in thousands, except percentages)
	Amount		% of Revenue			Amount		% of Revenue			$		%
United States	$	99,161		78.9	%	$	36,583		76.0	%	$	62,578		171.1	%
International		26,572		21.1	%		11,521		24.0	%		15,051		130.6	%
Total net revenue	$	125,733		100.0	%	$	48,104		100.0	%	$	77,629		161.4	%

Worldwide revenue growth in 2020 was driven by an increase in the number of Precision Flow units sold year over year and to a lesser extent an increase in single-use disposable sales due to higher installed bases of Precision Flow units.

Gross profit for the twelve months of 2020 was $63.0 million, an increase of $41.7 million over 2019. Gross margin was 50.1% in comparison to 44.3% in 2019. Gross margin was positively impacted by improved overhead absorption due to higher production volumes and a higher mix of U.S. revenue partially offset by higher labor costs, increased supplier freight and expediting fees to meet the rapid increase in production capacity.

Operating expenses were $106.1 million for the year ended December 31, 2020, an increase of $36.6 million as compared to $69.5 million in 2019. The increase in operating expenses was primarily due to higher sales and marketing expenses as a result of an increase in sales commissions and increased sales and marketing headcount and, to a lesser extent, general and administrative expenses as well as research and development costs.

Net loss for the year ended December 31, 2020 was $51.5 million or $2.16 per share compared to a net loss of $51.1 million or $2.74 per share in 2019. Net loss for 2020 includes a loss on debt extinguishment of $4.2 million recorded as a result of the Company’s debt refinancing in the fourth quarter of 2020. Net loss per share was based on 23,818,447 and 18,604,707 weighted average shares outstanding for the year ended December 31, 2020 and 2019, respectively.

Adjusted EBITDA was negative $31.8 million for the year ended December 31, 2020 as compared to negative $41.3 million for 2019. The improvement in Adjusted EBITDA in 2020 was primarily due to higher revenue and gross profit, partially offset by increased operating expenses resulting from higher levels of sales and marketing expenses, primarily sales commissions and increased headcount, and to a lesser extent general and administrative expenses and research and development costs.

Cash Position

Cash and cash equivalents were $113.7 million as of December 31, 2020 compared to $139.0 million as of September 30, 2020 and $71.7 million as of December 31, 2019.

Fiscal 2021 Outlook

COVID-19 has driven dramatic increases in our installed base and awareness of the benefits our technology, which will enable us to produce long-term growth post pandemic. Due to the significant and rapid changes in COVID-19 related hospitalizations, forecasting the demand for both our capital and disposables in the near term remains challenging. From an overall business standpoint, we are addressing this variability by positioning ourselves to respond quickly to changes in demand. This was a significant focus during 2020, and we believe we are positioned well to respond quickly to COVID-19 driven increases or decreases in demand. From a financial outlook standpoint, we are providing a range of outcomes based on a set of assumptions derived from the best information available to us at this time.

To start 2021, we saw near peak COVID-19 related hospitalizations across the U.S. and Europe resulting in demand for our capital and disposables at levels we experienced in late 2020. Beginning in mid-January of 2021, we saw a decrease in U.S. hospitalizations from the peak experienced in early January and reduced COVID-19 related demand for our products. In addition, we have not seen meaningful flu related cases or hospitalizations in the U.S. quarter to date which is a trend we expect to continue throughout 2021. Typically, U.S. disposable utilization rates are the highest in the first quarter each year due to the impact of the flu.

Beginning in the second quarter of 2021, we expect that there will be very limited budget dollars available for capital equipment and, as a result, we expect capital sales to decrease significantly year over year given the COVID-19 driven demand we experienced in 2020. In addition, our current expectations are that vaccination efforts will be successful and will result in a declining number of COVID-19 cases and hospitalizations over the last three quarters of the year thereby reducing COVID-19 related demand for our disposables as well. Despite this, we expect that disposables will show year over year growth in the U.S due to an increased installed base and greater awareness of our ability to treat the symptoms of respiratory distress in all patients, including those in Type II respiratory distress. Lastly, given the significant expected year over year decrease in sales and production volumes, especially related to capital equipment, we expect gross margins to decrease in 2021 before improving again in 2022 to levels above 2020.

For fiscal 2021, we expect revenue in the range of $82 million to $88 million, which represents a two-year compound annual growth rate of 33% at the mid-point of this range.

For the first quarter of 2021, we expect revenue in the range of $30 million to $33 million.

For fiscal 2021, we expect gross margin to be in the range of 46% and 48%.

For fiscal 2021, we expect operating expenses to be in the range of $97 million to $99 million.

We are still in a highly dynamic environment given the impact of COVID-19 and should our expectations regarding COVID-19 or other aspects of our operating results not play out as anticipated, it could result in materially different financial results than what we are currently expecting.

Conference Call

Management will host a conference call at 4:30 p.m. Eastern Time on February 24^th to discuss the results of the quarter and the year with a question and answer session. To listen to the conference call on your telephone, please dial [phone] for U.S. callers, or [phone] for international callers, approximately ten minutes prior to the start time and reference conference code 5693622. To listen to a live webcast, please visit the Investors section of the Vapotherm website at: http://investors.vapotherm.com/events-and-presentations/events . The webcast replay will be available on the Vapotherm website for 12 months following completion of the call. A replay of this conference call will be available by telephone through March 3, 2021 by dialing [phone] in the U.S. or [phone] outside of the U.S. The replay access code is 5693622.

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 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 of EBITDA and Adjusted EBITDA, which differ from financial measures calculated in accordance with U.S. generally accepted accounting principles (“GAAP”). EBITDA in this press release represents net loss less interest expense, net, taxes and depreciation and amortization. Adjusted EBITDA in this release represents EBITDA as adjusted for the impact of foreign currency loss or gain, stock-based compensation expense, loss on debt extinguishment and gain on legal settlement. 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 Adjusted EBITDA principally as a measure 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 this measure is useful to investors as supplemental information because it is 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 as 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 this 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 definition of Adjusted EBITDA is not necessarily comparable to other similarly titled captions of other companies due to different methods of calculation.

About Vapotherm

Vapotherm, Inc. 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 2.6 million patients have been treated with Vapotherm high velocity therapy. High velocity therapy is mask-free noninvasive ventilatory support for spontaneously breathing patients 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 Precision Flow system’s mask-free interface delivers optimally conditioned breathing gases, making it comfortable for patients and reducing the risks associated with mask therapies. While being treated, patients can talk, eat, drink and take oral medication. For more information, visit www.vapotherm.com.

Legal Notice Regarding Forward-Looking Statements

This press release contains forward-looking statements, including statements about our ability to grow our installed base, our ability to educate new customers on the use of Vapotherm’s High Velocity Therapy, especially on hypercapnic patients, increasing our production and our installed base, expanding the limited release of our Oxygen Assist Module, improving our gross margins and expected revenue for the first quarter of 2021 and expected revenue, gross margin and operating expenses for fiscal year 2021. In some cases, you can identify forward-looking statements by terms such as ‘‘expect,’’ “guide” or “typically” or the negative of these terms or other similar expressions, although not all forward-looking statements contain these words. 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 has incurred losses in the past and may be unable to achieve or sustain profitability in the future, Vapotherm may need to raise additional capital to fund its existing commercial operations, develop and commercialize new products, and expand its operations, Vapotherm’s dependence on sales generated from its Precision Flow systems, competition from multi-national corporations who have significantly greater resources than Vapotherm and are more established in the respiratory market, the ability for Precision Flow systems to gain increased market acceptance, its inexperience directly marketing and selling its products, the potential loss of one or more suppliers, 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 the COVID-19 pandemic on its business, including its supply chain, 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, 2020, as filed with the Securities and Exchange Commission on February 24, 2021, and in any subsequent filings with the Securities and Exchange Commission. 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,
	2020			2019
Assets
Current assets
Cash and cash equivalents	$	113,683		$	71,655
Accounts receivable, net		23,488			8,243
Inventories		19,873			9,137
Prepaid expenses and other current assets		5,041			4,066
Total current assets		162,085			93,101
Property and equipment, net		20,573			15,086
Operating lease right-of-use assets		8,260			-
Restricted cash		1,853			1,852
Goodwill		16,226			588
Intangible assets, net		5,694			353
Deferred income tax assets		-			66
Other long-term assets		967			844
Total assets	$	215,658		$	111,890
Liabilities and Stockholders’ Equity
Current liabilities
Accounts payable	$	4,967		$	3,375
Contract liabilities		459			137
Accrued expenses and other liabilities		36,551			9,187
Short-term line of credit		-			3,491
Total current liabilities		41,977			16,190
Long-term loans payable, net		39,653			41,787
Revolving loan facility		4,888			-
Deferred income tax liabilities		6			-
Other long-term liabilities		15,229			174
Total liabilities		101,753			58,151
Commitments and contingencies
Stockholders' equity
Preferred stock ($.001 par value) 25,000,000 shares authorized; no shares issued and outstanding as of December 31, 2020 and 2019		-			-
Common stock ($.001 par value) 175,000,000 shares authorized as of December 31, 2020 and 2019; 25,722,984 and 20,851,531 shares issued and outstanding as of December 31, 2020 and 2019, respectively		26			21
Additional paid-in capital		430,781			319,115
Accumulated other comprehensive income		41			44
Accumulated deficit		(316,943	)		(265,441	)
Total stockholders' equity		113,905			53,739
Total liabilities and stockholders’ equity	$	215,658		$	111,890

Vapotherm, Inc.
UNAUDITED CONSOLIDATED STATEMENTS OF OPERATIONS
(In thousands, except share and per share amounts)
	Three Months Ended December 31,
	2020			2019
Net revenue	$	40,907		$	13,010
Cost of goods sold		20,196			7,147
Gross profit		20,711			5,863
Operating expenses
Research and development		4,954			3,656
Sales and marketing		20,958			9,903
General and administrative		7,114			5,021
Total operating expenses		33,026			18,580
Loss from operations		(12,315	)		(12,717	)
Other (expense) income
Foreign currency gain		77			81
Interest income		30			202
Gain on litigation settlement		-			1,151
Interest expense		(813	)		(1,313	)
Loss on extinguishment of debt		(4,163	)		-
Net loss before income taxes	$	(17,184	)	$	(12,596	)
Benefit for income taxes		-			(146	)
Net loss	$	(17,184	)	$	(12,450	)
Other comprehensive income
Foreign currency translation adjustments		38			114
Total other comprehensive income	$	38			114
Total comprehensive loss	$	(17,146	)	$	(12,336	)
Net loss per share - basic and diluted	$	(0.67	)	$	(0.60	)
Weighted-average number of shares used in calculating net loss per share, basic and diluted		25,682,098			20,830,169

Vapotherm, Inc.
CONSOLIDATED STATEMENTS OF OPERATIONS
(In thousands, except share and per share amounts)
	Year Ended December 31,
	2020			2019
Net revenue	$	125,733		$	48,104
Cost of revenue		62,687			26,793
Gross profit		63,046			21,311
Operating expenses
Research and development		16,956			13,376
Sales and marketing		65,065			37,689
General and administrative		24,039			18,410
Total operating expenses		106,060			69,475
Loss from operations		(43,014	)		(48,164	)
Other (expense) income
Foreign currency gain		114			44
Interest income		257			860
Gain on litigation settlement		15			1,151
Interest expense		(4,711	)		(5,096	)
Loss on extinguishment of debt		(4,163	)		-
Net loss before income taxes		(51,502	)		(51,205	)
Benefit for income taxes		-			(146	)
Net loss		(51,502	)		(51,059	)
Other comprehensive income (loss)
Foreign currency translation adjustments		(3	)		44
Total other comprehensive income (loss)		(3	)		44
Total comprehensive loss	$	(51,505	)	$	(51,015	)
Net loss per share - basic and diluted	$	(2.16	)	$	(2.74	)
Weighted-average number of shares used in calculating net loss per share, basic and diluted		23,818,447			18,604,707

Vapotherm, Inc.
CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)
	Year Ended December 31,
	2020			2019
Cash flows from operating activities
Net loss	$	(51,502	)	$	(51,059	)
Adjustments to reconcile net loss to net cash used in operating activities
Stock-based compensation expense		6,430			3,836
Depreciation and amortization		4,769			3,078
Loss on extinguishment of debt		4,163			-
Non-cash lease expense		1,140			-
Loss on disposal of property and equipment		250			101
Amortization of discount on debt		222			234
Provision for bad debts		72			104
Deferred income taxes		70			(147	)
Provision for inventory valuation		(534	)		(543	)
Gain on litigation settlement		-			(1,151	)
Changes in operating assets and liabilities:
Accounts receivable		(14,810	)		(833	)
Inventories		(10,157	)		5,606
Prepaid expenses and other assets		(483	)		(1,218	)
Accounts payable		1,461			720
Contract liabilities		322			58
Accrued expenses and other liabilities		20,273			1,552
Operating lease liabilities, current and long-term		(1,154	)		-
Net cash used in operating activities		(39,468	)		(39,662	)
Cash flows from investing activities
Purchases of property and equipment		(9,797	)		(4,747	)
Acquisition of business, net of cash acquired		(8,372	)		(1,560	)
Net cash used in investing activities		(18,169	)		(6,307	)
Cash flows from financing activities
Proceeds from issuance of common stock in connection with public offering, net		94,155			48,669
Proceeds from issuance of common stock in connection with at-the-market offering, net		9,927			-
Proceeds from issuance of common stock under Employee Stock Purchase Plan		824			-
Proceeds from exercise of stock options and purchase of restricted stock awards		593			386
Common stock offering costs		(471	)		(393	)
Proceeds from loans		40,000			10,500
Repayment of loans		(42,500	)		-
Payments of debt extinguishment costs		(3,765	)		-
Debt issuance costs		(475	)		(29	)
Proceeds from short-term line of credit and revolving loan facility		5,883			7,500
Repayments on short-term line of credit		(4,495	)		(7,184	)
Net cash provided by financing activities		99,676			59,449
Effect of exchange rate changes on cash, cash equivalents and restricted cash		(10	)		5
Net increase in cash, cash equivalents, and restricted cash		42,029			13,485
Cash, cash equivalents and restricted cash
Beginning of year		73,507			60,022
End of year	$	115,536		$	73,507
Supplemental disclosures of cash flow information
Interest paid during the period	$	4,439		$	4,793
Property and equipment purchases in accrued expenses	$	145		$	135
Issuance of common stock upon vesting of restricted stock units and awards	$	213		$	402
Issuance of warrants in conjunction with debt draw down	$	-		$	293

Non-GAAP Financial Measures

The following tables contain a reconciliation of net loss to Adjusted EBITDA for the three and twelve months ended December 31, 2020 and 2019, respectively.

	Three Months Ended December 31,
	Amount
	2020			2019
	(in thousands)
Net loss	$	(17,184	)	$	(12,450	)
Interest expense, net		783			1,111
Benefit for income taxes		-			(146	)
Depreciation and amortization		1,398			859
EBITDA	$	(15,003	)	$	(10,626	)
Foreign currency		(77	)		(81	)
Loss on extinguishment of debt		4,163			-
Gain on litigation settlement		-			(1,151	)
Stock-based compensation		1,850			1,081
Adjusted EBITDA	$	(9,067	)	$	(10,777	)

	Year Ended December 31,
	Amount
	2020			2019
	(in thousands)
Net loss	$	(51,502	)	$	(51,059	)
Interest expense, net		4,454			4,236
Benefit for income taxes		-			(146	)
Depreciation and amortization		4,769			3,078
EBITDA	$	(42,279	)	$	(43,891	)
Foreign currency		(114	)		(44	)
Loss on extinguishment of debt		4,163			-
Gain on litigation settlement		(15	)		(1,151	)
Stock based compensation		6,430			3,836
Adjusted EBITDA	$	(31,815	)	$	(41,250	)

Supplemental Operating Metrics

	December 31,
	2020		2019		Change
	Amount		Amount		Amount		%
Precision Flow Units Installed Base
United States		19,884		11,882		8,002		67.3	%
International		8,766		4,698		4,068		86.6	%
Total		28,650		16,580		12,070		72.8	%

	Three Months Ended December 31,
	2020		2019		Change
	Amount		Amount		Amount		%
Precision Flow Units Sold and Leased
United States		2,406		353		2,053		581.6	%
International		1,114		251		863		343.8	%
Total		3,520		604		2,916		482.8	%
Disposable Patient Circuits Sold
United States		136,106		73,276		62,830		85.7	%
International		40,386		22,975		17,411		75.8	%
Total		176,492		96,251		80,241		83.4	%
	Twelve Months Ended December 31,
	2020		2019		Change
	Amount		Amount		Amount		%
Precision Flow Units Sold and Leased
United States		7,706		1,311		6,395		487.8	%
International		3,475		843		2,632		312.2	%
Total		11,181		2,154		9,027		419.1	%
Disposable Patient Circuits Sold
United States		414,068		263,092		150,976		57.4	%
International		157,173		88,944		68,229		76.7	%
Total		571,241		352,036		219,205		62.3	%