UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
(Mark One)
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended March 31,September 30, 2022
OR
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from   to
Commission file number 001-40797
PROCEPT BioRobotics Corporation
(Exact name of registrant as specified in its charter)
Delaware26-0199180
(State or other jurisdiction of incorporation or organization)(I.R.S. Employer Identification No.)
900 Island DriveRedwood CityCA94065
(Address of Principal Executive Offices)(Zip Code)
(650) 232-7200
(Registrant's telephone number, including area code)
Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading Symbol(s)Name of each exchange on which registered
Common stock, $0.00001 par value per sharePRCTNasdaq Global Market
Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports); and (2) has been subject to such filing requirements for the past 90 days.    Yes  ☒ No ☐
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).     Yes  ☒   No  ☐ 
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company. See the definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act. (Check one):
Large accelerated filerAccelerated filer
Non-accelerated filer  Smaller reporting company
Emerging growth company
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act).     Yes   ☐     No  ☒

The registrant had outstanding 44,173,32244,720,047 shares of common stock as of April 30,October 31, 2022.



PROCEPT BioRobotics Corporation
Form 10-Q – QUARTERLY REPORT
For the Quarter Ended March 31,September 30, 2022
TABLE OF CONTENTS
Page
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2


CAUTIONARY NOTE REGARDING FORWARD-LOOKING STATEMENTS
This Quarterly Report on Form 10-Q contains forward-looking statements. All statements other than statements of historical facts contained in this Quarterly Report are forward-looking statements. In some cases, you can identify forward-looking statements by terms such as “may,” "can,"“can”, “will,” “would,” “should,” “expect,” “plan,” “anticipate,” “could,” “intend,” “target,” “project,” “contemplate,” “believe,” “estimate,” “predict,” “potential,” or “continue” or the negative of these terms or other similar expressions, although not all forward-looking statements contain these words. All statements other than statements of historical facts contained in this Quarterly Report, including without limitation statements regarding our business model and strategic plans for our products, technologies and business, including our implementation thereof, the impact on our business, financial condition and results of operations from the ongoing and global COVID-19 pandemic, or any other pandemic, epidemic or outbreak of an infectious disease in the United States or worldwide, the timing of and our ability to obtain and maintain regulatory approvals, our commercialization, marketing and manufacturing capabilities and strategy, our expectations about the commercial success and market acceptance of our products, the sufficiency of our cash, cash equivalents and short-term investments, and the plans and objectives of management for future operations and capital expenditures are forward-looking statements.
The forward-looking statements in this Quarterly Report are only predictions and are based largely on our current expectations and projections about future events and trends that we believe may affect our financial condition, results of operations, business strategy, short-term and long-term business operations and objectives, and financial needs. These forward-looking statements speak only as of the date of this Quarterly Report and are subject to a number of known and unknown risks, uncertainties, and assumptions, including those described under the sections in this Quarterly Report entitled “Risk Factors” and “Management’s Discussion and Analysis of Financial Condition and Results of Operations” and elsewhere in this Quarterly Report. Moreover, we operate in a very competitive and rapidly changing environment. New risks emerge from time to time. It is not possible for our management to predict all risks, nor can we assess the impact of all factors on our business or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in any forward-looking statements we may make. In light of these risks, uncertainties, and assumptions, the future events and trends discussed in this Quarterly Report may not occur and actual results could differ materially and adversely from those anticipated or implied in the forward-looking statements.
Because forward-looking statements are inherently subject to risks and uncertainties, some of which cannot be predicted or quantified, you should not rely upon these forward-looking statements as predictions of future events. The events and circumstances reflected in the forward-looking statements may not be achieved or occur. Although we believe that the expectations reflected in the forward-looking statements are reasonable, we cannot guarantee future results, performance, or achievements. Except as required by applicable law, we do not plan to publicly update or revise any forward-looking statements contained herein, whether as a result of any new information, future events, changed circumstances or otherwise. We intend the forward-looking statements contained in this Quarterly Report to be covered by the safe harbor provisions for forward-looking statements contained in Section 27A of the Securities Act of 1933, as amended (the “Securities Act”), and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”).

3




PROCEPT BioRobotics Corporation
CONDENSED CONSOLIDATED BALANCE SHEETS
(in thousands, except per share data)
(unaudited)
March 31,December 31,September 30,December 31,
2022202120222021
AssetsAssetsAssets
Current assets:Current assets:Current assets:
Cash and cash equivalentsCash and cash equivalents$284,288 $304,320 Cash and cash equivalents$249,217 $304,320 
Accounts receivable, netAccounts receivable, net6,992 4,464 Accounts receivable, net12,838 4,464 
InventoryInventory12,629 13,147 Inventory22,358 13,147 
Prepaid expenses and other current assetsPrepaid expenses and other current assets4,070 4,242 Prepaid expenses and other current assets4,519 4,242 
Total current assetsTotal current assets307,979 326,173 Total current assets288,932 326,173 
Restricted cashRestricted cash3,814 777 Restricted cash3,814 777 
Property and equipment, netProperty and equipment, net4,560 5,045 Property and equipment, net5,120 5,045 
Operating lease right-of-use assets, netOperating lease right-of-use assets, net2,877 3,279 Operating lease right-of-use assets, net24,424 3,279 
Intangible assets, netIntangible assets, net1,682 1,750 Intangible assets, net1,545 1,750 
Other assetsOther assets202 — 
Total assetsTotal assets$320,912 $337,024 Total assets$324,037 $337,024 
Liabilities and Stockholders' EquityLiabilities and Stockholders' EquityLiabilities and Stockholders' Equity
Current liabilities:Current liabilities:Current liabilities:
Accounts payableAccounts payable$2,628 $2,029 Accounts payable$6,331 $2,029 
Accrued compensationAccrued compensation4,586 6,475 Accrued compensation10,284 6,475 
Deferred revenueDeferred revenue1,368 1,025 Deferred revenue2,342 1,025 
Operating lease – current portionOperating lease – current portion2,181 2,105 Operating lease – current portion2,473 2,105 
Other current liabilitiesOther current liabilities3,994 4,608 Other current liabilities5,929 4,608 
Total current liabilitiesTotal current liabilities14,757 16,242 Total current liabilities27,359 16,242 
Note payable – non-current portionNote payable – non-current portion50,254 50,004 Note payable – non-current portion50,692 50,004 
Operating lease – non-current portionOperating lease – non-current portion1,418 1,991 Operating lease – non-current portion23,415 1,991 
Loan facility derivative liabilityLoan facility derivative liability1,533 1,496 Loan facility derivative liability1,609 1,496 
Other non-current liabilitiesOther non-current liabilities200 200 Other non-current liabilities200 200 
Total liabilitiesTotal liabilities68,162 69,933 Total liabilities103,275 69,933 
Commitments and contingencies (see Note 9)00
Commitments and contingencies (see Note 11)Commitments and contingencies (see Note 11)
Stockholders’ equity:Stockholders’ equity:Stockholders’ equity:
Preferred stock, $0.00001 par value;Preferred stock, $0.00001 par value;Preferred stock, $0.00001 par value;
Authorized shares: 10,000 at March 31, 2022 and December 31, 2021
Issued and outstanding shares: NaN at March 31, 2022 and December 31, 2021— — 
Authorized shares: 10,000 at September 30, 2022 and December 31, 2021Authorized shares: 10,000 at September 30, 2022 and December 31, 2021
Issued and outstanding shares: none at September 30, 2022 and December 31, 2021Issued and outstanding shares: none at September 30, 2022 and December 31, 2021— — 
Common stock, $0.00001 par value;Common stock, $0.00001 par value;Common stock, $0.00001 par value;
Authorized shares: 300,000 at March 31, 2022 and December 31, 2021
Issued and outstanding shares: 44,077 and 43,676 at March 31, 2022 and December 31, 2021, respectively— — 
Authorized shares: 300,000 at September 30, 2022 and December 31, 2021Authorized shares: 300,000 at September 30, 2022 and December 31, 2021
Issued and outstanding shares: 44,714 and 43,676 at September 30, 2022 and December 31, 2021, respectivelyIssued and outstanding shares: 44,714 and 43,676 at September 30, 2022 and December 31, 2021, respectively— — 
Additional paid-in capitalAdditional paid-in capital531,509 528,666 Additional paid-in capital541,048 528,666 
Accumulated other comprehensive lossAccumulated other comprehensive loss(53)(54)Accumulated other comprehensive loss217 (54)
Accumulated deficitAccumulated deficit(278,706)(261,521)Accumulated deficit(320,503)(261,521)
Total stockholders’ equityTotal stockholders’ equity252,750 267,091 Total stockholders’ equity220,762 267,091 
Total liabilities and stockholders’ equityTotal liabilities and stockholders’ equity$320,912 $337,024 Total liabilities and stockholders’ equity$324,037 $337,024 
The accompanying notes are an integral part of these condensed consolidated financial statements.
4


PROCEPT BioRobotics Corporation
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS
(in thousands, except per share data)
(unaudited)
Three Months Ended March 31,Three Months Ended September 30,Nine Months Ended September 30,
202220212022202120222021
RevenueRevenue$14,197 $7,192 Revenue$20,349 $8,668 $51,237 $24,335 
Cost of salesCost of sales6,505 3,665 Cost of sales10,118 4,428 24,828 12,986 
Gross profitGross profit7,692 3,527 Gross profit10,231 4,240 26,409 11,349 
Operating expenses:Operating expenses:Operating expenses:
Research and developmentResearch and development5,011 4,522 Research and development7,582 4,919 19,299 13,917 
Selling, general and administrativeSelling, general and administrative18,385 10,349 Selling, general and administrative24,754 12,118 62,794 34,765 
Total operating expensesTotal operating expenses23,396 14,871 Total operating expenses32,336 17,037 82,093 48,682 
Loss from operationsLoss from operations(15,704)(11,344)Loss from operations(22,105)(12,797)(55,684)(37,333)
Interest expenseInterest expense(1,421)(1,464)Interest expense(1,455)(1,469)(4,317)(4,370)
Interest and other income (expense), net(60)(14)
Interest and other income, netInterest and other income, net947 163 1,019 198 
Net lossNet loss$(17,185)$(12,822)Net loss$(22,613)$(14,103)$(58,982)$(41,505)
Net loss per share, basic and dilutedNet loss per share, basic and diluted$(0.39)$(2.65)Net loss per share, basic and diluted$(0.51)$(1.22)$(1.33)$(5.64)
Weighted-average common shares used toWeighted-average common shares used toWeighted-average common shares used to
compute net loss per share attributable tocompute net loss per share attributable tocompute net loss per share attributable to
common shareholders, basic and dilutedcommon shareholders, basic and diluted43,855 4,830 common shareholders, basic and diluted44,640 11,580 44,276 7,361 
Other comprehensive loss:Other comprehensive loss:Other comprehensive loss:
Unrealized gain (loss) on cash equivalentsUnrealized gain (loss) on cash equivalents(16)Unrealized gain (loss) on cash equivalents185 (2)271 (27)
Comprehensive lossComprehensive loss$(17,184)$(12,838)Comprehensive loss$(22,428)$(14,105)$(58,711)$(41,532)
The accompanying notes are an integral part of these condensed consolidated financial statements.
5


PROCEPT BioRobotics Corporation
CONDENSED CONSOLIDATED STATEMENTS OF REDEEMABLE CONVERTIBLE PREFERRED STOCK AND STOCKHOLDERS’ EQUITY (DEFICIT)
(in thousands)
(unaudited)
Redeemable
Convertible
Preferred Stock
Common StockAdditional
Paid-in
Capital
Accumulated
Other
Comprehensive
Loss
Accumulated
Deficit
Total
Stockholders'
Equity
(Deficit)
Redeemable
Convertible
Preferred Stock
Common StockAdditional
Paid-in
Capital
Accumulated
Other
Comprehensive
Loss
Accumulated
Deficit
Total
Stockholders'
Equity
(Deficit)
SharesAmountSharesAmountSharesAmountSharesAmount
Balance at December 31, 2021Balance at December 31, 2021— $— 43,676 $— $528,666 $(54)$(261,521)$267,091 Balance at December 31, 2021— $— 43,676 $— $528,666 $(54)$(261,521)$267,091 
Issuance upon exercise of optionsIssuance upon exercise of options— — 401 — 1,291 — — 1,291 Issuance upon exercise of options— — 401 — 1,291 — — 1,291 
Stock-based compensation expenseStock-based compensation expense— — — — 1,552 — — 1,552 Stock-based compensation expense— — — — 1,552 — — 1,552 
Unrealized loss on cash equivalents— — — — — — 
Unrealized gain on cash equivalentsUnrealized gain on cash equivalents— — — — — — 
Net lossNet loss— — — — — — (17,185)(17,185)Net loss— — — — — — (17,185)(17,185)
Balance at March 31, 2022— — $— 44,077 $— $531,509 $(53)$(278,706)$252,750 
Balance at December 31, 202025,402 $243,854 4,713 $— $18,788 $(14)$(201,668)$(182,894)
Balance at March 31, 2022Balance at March 31, 2022— — 44,077 — 531,509 (53)(278,706)252,750 
Issuance upon exercise of optionsIssuance upon exercise of options— — 400 — 1,572 — — 1,572 
Shares issued under employee stock purchase planShares issued under employee stock purchase plan— — 61 — 1,289 — — 1,289 
Stock-based compensation expenseStock-based compensation expense— — — — 2,676 — — 2,676 
Unrealized gain on cash equivalentsUnrealized gain on cash equivalents— — — — — 85 — 85 
Net lossNet loss— — — — — — (19,184)(19,184)
Balance at June 30, 2022Balance at June 30, 2022— — 44,538 — 537,046 32 (297,890)239,188 
Issuance upon exercise of optionsIssuance upon exercise of options— — 504 — 1,225 — — 1,225 Issuance upon exercise of options— — 176 — 777 — — 777 
Stock-based compensation expenseStock-based compensation expense— — — — 650 — — 650 Stock-based compensation expense— — — — 3,225 — — 3,225 
Unrealized loss on cash equivalents— — — — — (16)— (16)
Unrealized gain on cash equivalentsUnrealized gain on cash equivalents— — — — — 185 — 185 
Net lossNet loss— — — — — — (12,822)(12,822)Net loss— — — — — — (22,613)(22,613)
Balance at March 31, 202125,402 $243,854 5,217 $— $20,663 $(30)$(214,490)$(193,857)
Balance at September 30, 2022Balance at September 30, 2022— $— 44,714 — $541,048 $217 $(320,503)$220,762 
The accompanying notes are an integral part of these condensed consolidated financial statements.

6


PROCEPT BioRobotics Corporation
CONDENSED CONSOLIDATED STATEMENTS OF REDEEMABLE CONVERTIBLE PREFERRED STOCK AND STOCKHOLDERS’ EQUITY (DEFICIT)
(in thousands)
(unaudited)
Redeemable
Convertible
Preferred Stock
Common StockAdditional
Paid-in
Capital
Accumulated
Other
Comprehensive
Loss
Accumulated
Deficit
Total
Stockholders'
Equity
(Deficit)
SharesAmountSharesAmount
Balance at December 31, 202025,402 $243,854 4,713 $— $18,788 $(14)$(201,668)$(182,894)
Issuance upon exercise of options— — 504 — 1,225 — — 1,225 
Stock-based compensation expense— — — — 650 — — 650 
Unrealized loss on cash equivalents— — — — — (16)— (16)
Net loss— — — — — — (12,822)(12,822)
Balance at March 31, 202125,402 243,854 5,217 — 20,663 (30)(214,490)(193,857)
Issuance of preferred stock, net of issuance costs4,448 84,710 — — — — — — 
Issuance upon exercise of options— — 575 — 1,415 — — 1,415 
Stock-based compensation expense— — — — 725 — — 725 
Unrealized loss on cash equivalents— — — — — (9)— (9)
Net loss— — — — — — (14,580)(14,580)
Balance at June 30, 202129,850 328,564 5,792 — 22,803 (39)(229,070)(206,306)
Issuance upon exercise of warrants62 970 — — — — — — 
Issuance of preferred stock, net of issuance costs— — — — — — — — 
Conversion of redeemable convertible preferred stock to common stock upon initial public offering(29,912)(329,534)29,912 — 329,534 — — 329,534 
Issuance common stock upon initial public offering, net of issuance costs— — 7,539 — 172,409 — — 172,409 
Issuance upon exercise of options— — 229 — 855 — — 855 
Stock-based compensation expense— — — — 925 — — 925 
Unrealized loss on cash equivalents— — — — — (2)— (2)
Net loss— — — — — — (14,103)(14,103)
Balance at September 30, 2021— $— 43,472 $— $526,526 $(41)$(243,173)$283,312 
The accompanying notes are an integral part of these condensed consolidated financial statements.
67


PROCEPT BioRobotics Corporation
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(in thousands)
(unaudited)
Three Months Ended March 31,Nine Months Ended September 30,
2022202120222021
Cash flows from operating activities:Cash flows from operating activities:Cash flows from operating activities:
Net lossNet loss$(17,185)$(12,822)Net loss$(58,982)$(41,505)
Adjustments to reconcile net loss to cash used in operating activities:Adjustments to reconcile net loss to cash used in operating activities:Adjustments to reconcile net loss to cash used in operating activities:
Depreciation and amortizationDepreciation and amortization758 915 Depreciation and amortization2,178 2,561 
Stock-based compensation expenseStock-based compensation expense1,552 650 Stock-based compensation expense7,452 2,300 
Change in fair value of redeemable convertible preferred stock warrants and derivative liabilityChange in fair value of redeemable convertible preferred stock warrants and derivative liability37 (280)Change in fair value of redeemable convertible preferred stock warrants and derivative liability113 (235)
Non-cash lease adjustmentNon-cash lease adjustment(97)(79)Non-cash lease adjustment645 (249)
Inventory write-downInventory write-down87 537 
Changes in operating assets and liabilities:Changes in operating assets and liabilities:Changes in operating assets and liabilities:
Accounts receivable, netAccounts receivable, net(2,529)(2,584)Accounts receivable, net(8,375)(4,804)
InventoryInventory517 (926)Inventory(9,502)(3,580)
Prepaid expenses and other current assetsPrepaid expenses and other current assets177 (420)Prepaid expenses and other current assets(2)(606)
Other assetsOther assets(202)— 
Accounts payableAccounts payable448 701 Accounts payable4,243 2,362 
Accrued compensationAccrued compensation(1,889)(815)Accrued compensation3,810 235 
Accrued interest expenseAccrued interest expense250 (92)Accrued interest expense688 804 
Deferred revenueDeferred revenue343 173 Deferred revenue1,318 615 
Other liabilitiesOther liabilities(613)381 Other liabilities1,321 707 
Net cash used in operating activitiesNet cash used in operating activities(18,231)(15,198)Net cash used in operating activities(55,208)(40,858)
Cash flows from investing activities:Cash flows from investing activities:Cash flows from investing activities:
Purchases of property and equipmentPurchases of property and equipment(55)(39)Purchases of property and equipment(1,787)(260)
Net cash used in investing activitiesNet cash used in investing activities(55)(39)Net cash used in investing activities(1,787)(260)
Cash flows from financing activities:Cash flows from financing activities:Cash flows from financing activities:
Proceeds from issuance of Series G preferred stock, net of issuance costsProceeds from issuance of Series G preferred stock, net of issuance costs— 84,710 
Proceeds from issuance of common stock under employee stock purchase planProceeds from issuance of common stock under employee stock purchase plan1,289 — 
Proceeds from issuance of common stock from the exercise of stock optionsProceeds from issuance of common stock from the exercise of stock options1,291 1,225 Proceeds from issuance of common stock from the exercise of stock options3,641 3,495 
Proceeds from the exercise of redeemable convertible preferred stock warrantsProceeds from the exercise of redeemable convertible preferred stock warrants— 858 
Proceeds from issuance of common stock from the initial public offering, net of underwriting discounts, commissions and offering expensesProceeds from issuance of common stock from the initial public offering, net of underwriting discounts, commissions and offering expenses— 172,409 
Net cash provided by financing activitiesNet cash provided by financing activities1,291 1,225 Net cash provided by financing activities4,930 261,472 
Net decrease in cash, cash equivalents and restricted cash(16,995)(14,012)
Net (decrease) increase in cash, cash equivalents and restricted cashNet (decrease) increase in cash, cash equivalents and restricted cash(52,065)220,354 
Cash, cash equivalents and restricted cashCash, cash equivalents and restricted cashCash, cash equivalents and restricted cash
Beginning of the periodBeginning of the period305,097 100,907 Beginning of the period305,096 100,907 
End of the periodEnd of the period$288,102 $86,895 End of the period$253,031 $321,261 
Reconciliation of cash, cash equivalents and restricted cash to balance sheets:Reconciliation of cash, cash equivalents and restricted cash to balance sheets:Reconciliation of cash, cash equivalents and restricted cash to balance sheets:
Cash and cash equivalentsCash and cash equivalents$284,288 $86,118 Cash and cash equivalents$249,217 $320,484 
Restricted cashRestricted cash3,814 777 Restricted cash3,814 777 
Cash, cash equivalents and restricted cash in balance sheetsCash, cash equivalents and restricted cash in balance sheets$288,102 $86,895 Cash, cash equivalents and restricted cash in balance sheets$253,031 $321,261 
Supplemental cash flow informationSupplemental cash flow informationSupplemental cash flow information
Interest paidInterest paid$1,171 $1,171 Interest paid$3,573 $3,566 
Non-cash investing and financing activitiesNon-cash investing and financing activitiesNon-cash investing and financing activities
Transfer of evaluation units from inventory to property and equipment, netTransfer of evaluation units from inventory to property and equipment, net$— $(190)Transfer of evaluation units from inventory to property and equipment, net$203 $(1,227)
Property and equipment included in accounts payable and accrued expenses$351 $200 
Property and equipment included in accounts payable and other current liabilitiesProperty and equipment included in accounts payable and other current liabilities$200 $200 
Deferred offering costs included in accounts payable and other current liabilitiesDeferred offering costs included in accounts payable and other current liabilities$— $819 
Right-of-use assets obtained in exchange for operating lease liabilitiesRight-of-use assets obtained in exchange for operating lease liabilities$22,668 $— 
The accompanying notes are an integral part of these condensed consolidated financial statements.
78


PROCEPT BioRobotics Corporation
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(unaudited)
1.    Organization
Description of Business
PROCEPT BioRobotics Corporation (the “Company”) is a surgical robotics company focused on advancing patient care by developing transformative solutions in urology. It develops, manufactures and sells the AquaBeam Robotic System, an advanced, image-guided, surgical robotic system for use in minimally invasive urologic surgery, with an initial focus on treating benign prostatic hyperplasia, or BPH. BPH is the most common prostate disease and impacts approximately 40 million men in the United States. The AquaBeam Robotic System employs a single-use disposable handpiece to deliver the Company’s proprietary Aquablation therapy, which combines real-time, multi-dimensional imaging, personalized treatment planning, automated robotics and heat-free waterjet ablation for targeted and rapid removal of prostate tissue. The Company designed its AquaBeam Robotic System to enable consistent and reproducible BPH surgery outcomes. The Company received U.S. Food and Drug Administration clearance in December 2017 to market its AquaBeam Robotic System.
Liquidity
As of March 31,September 30, 2022, and December 31, 2021, the Company had cash and cash equivalents of $284.3$249.2 million, and $304.3 million, respectively, and an accumulated deficit of $278.7 million and $261.5 million, respectively.$320.5 million. In September 2021, the Company completed its initial public offering (“IPO”) for net proceeds of approximately $172.4 million, after deducting underwriting discounts and commissions and offering expenses. Since its inception, the Company has financed its operations with a combination of debt and equity financing arrangements. The Company expects its cash, and cash equivalents, revenue and available debt financing arrangementsanticipated revenue will be sufficient to meet its capital requirements and fund its operations through at least the next twelve months from the issuance date of these financial statements. The Company has not achieved positive cashflowcash flow from operations to date and expects to continue incurring losses for the foreseeable future as it focuses on growing its business.
The COVID-19 pandemic and the resulting economic downturn are affecting business conditions in the industry in which the Company operates. In response to the pandemic, many state and local governments in the United States issued orders that temporarily precluded elective medical procedures in order to conserve scarce health system resources. The Company has taken necessary precautions to safeguard its employees, patients, customers, and other stakeholders from the COVID-19 pandemic, while maintaining business continuity to support its patients, customers and employees. The timing, extent and continuation of any increase in procedures, and any corresponding increase in sales of the Company’s products, and whether there could be a future decrease in the current level of procedures as a result of the COVID-19 pandemic or otherwise, remain uncertain and are subject to a variety of factors.
2.    Summary of Significant Accounting Policies
Basis of PreparationPresentation
The condensed consolidated financial statements have been preparedpresented in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) and pursuant to the rules and regulations of the United States Securities and Exchange Commission (“SEC”). These condensed consolidated financial statements include the accounts of the Company and its consolidated subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation. The Company operates as one reportable segment.
Unaudited Interim Financial Statements
The accompanying balance sheet as of September 30, 2022, the statements of operations and comprehensive loss for the three and nine months ended September 30, 2022 and 2021, the statements of cash flows for the nine months ended September 30, 2022 and 2021, and the statements of redeemable convertible preferred stock and stockholders’ equity (deficit) as of September 30, 2022 and 2021, are unaudited. The financial data and other information disclosed in these notes to the financial statements related to September 30, 2022, and the three and nine
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months ended September 30, 2022 and 2021, are also unaudited. The accompanying balance sheet as of December 31, 2021 have been derived from the audited consolidated financial statements included in the Company’s Annual Report on Form 10-K (“Annual Report”) filed with the Securities and Exchange Commission.
The unaudited interim financial statements have been prepared on the same basis as the annual financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary to a fair statement of the Company’s financial position as of September 30, 2022, and the results of its operations and cash flows for the three and nine months ended September 30, 2022 and 2021. The results for the three and nine months ended September 30, 2022, are not necessarily indicative of results to be expected for the year ending December 31, 2022, or for any other interim period or for any future year and should be read in conjunction with the annual consolidated financial statements included in the Company’s Annual Report.
Use of Estimates
The preparation of condensed consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the amounts and disclosures reported in the condensed consolidated financial statements. Management uses significant judgment when making estimates related to its common stock valuation in periods before the Company’s IPO and related stock-based compensation expense, right-of-use lease asset, lease liability, the valuations of the redeemable convertible preferred stock warrant liability and
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loan facility derivative liability, as well as certain accrued liabilities. Management bases its estimates on historical experience and on various other assumptions that are believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities. Actual results could differ from those estimates.
Initial Public Offering (IPO)
In September 2021, the Company completed its IPO by issuing 6,556,000 shares of common stock, and the exercise of the underwriters option for 983,400 shares, at an offering price of $25.00 per share, for total net proceeds of approximately $172.4 million, after deducting underwriting discounts and commissions of $13.2 million and offering expenses of $2.9 million. Offering costs are capitalized, and consist of fees and expenses incurred in connection with the sale of common stock in its IPO, including legal, accounting, printing and other IPO-related costs. Upon completion of its IPO, these deferred offering costs were reclassified to stockholders’ equity and recorded against the proceeds from the offering. In addition, all 29,912,264 shares of its then-outstanding redeemable convertible preferred stock automatically converted into 29,912,264 shares of common stock and it reclassified $329.5 million of redeemable convertible preferred stock to additional paid-in capital on its condensed consolidated balance sheet.
Unaudited Interim Financial Statements
The accompanying balance sheet as of March 31, 2022, the statements of operations and comprehensive loss and cash flows for the three months ended March 31, 2022 and 2021, and the statements of redeemable convertible preferred stock and stockholders’ equity (deficit) as of March 31, 2022 and 2021, are unaudited. The financial data and other information disclosed in these notes to the financial statements related to March 31, 2022, and the three months ended March 31, 2022 and 2021, are also unaudited. The accompanying balance sheet as of December 31, 2021 have been derived from the audited consolidated financial statements included in the Company’s Annual Report on Form 10-K (“Annual Report”) filed with the Securities and Exchange Commission.
The unaudited interim financial statements have been prepared on the same basis as the annual financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary to a fair statement of the Company’s financial position as of March 31, 2022, and the results of its operations and cash flows for the three months ended March 31, 2022 and 2021. The results for the three months ended March 31, 2022, are not necessarily indicative of results to be expected for the year ending December 31, 2022, or for any other interim period or for any future year and should be read in conjunction with the annual consolidated financial statements included in the Company’s Annual Report.
Cash, Cash Equivalents and Restricted Cash
Cash and cash equivalents consist of cash in banks and highly liquid securities, which are readily convertible to cash, that mature within 90 days or less from the original date of purchase, to be cash equivalents, which include money market funds and treasury securities.
Cash equivalents are considered available-for-sale marketable securities and are recorded at fair value, based on quoted market prices. Unrealized gains and losses are recorded in other comprehensive income (loss) and included as a separate component of stockholders’ equity (deficit).
Restricted cash is primarily related to the Company’s letter of credit for the lease of its new corporate headquarters.
Fair Value of Financial Instruments
The Company measures certain financial assets and liabilities at fair value on a recurring basis, including cash and cash equivalents, and accounts receivable, accounts payable and accrued liabilities, which approximate fair value due to their relatively short maturities as well as the redeemable convertible preferred stock warrant liability and loan facility derivative liability. Fair value is an exit price, representing the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. As such, fair value is
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a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or a liability. A three-tier fair value hierarchy is established as a basis for considering such assumptions and for inputs used in the valuation methodologies in measuring fair value:
Level 1-Observable inputs such as quoted prices (unadjusted) for identical assets or liabilities in active markets.
Level 2-Other inputs that are based Also, upon quoted prices for similar instruments in active markets, quoted prices for identical or similar instruments in markets that are not active and model-based valuation techniques for which all significant inputs are observable in the market or can be derived from observable market data.
Level 3-Unobservable inputs that are supported by little or no market activities, which would require the Company to develop its own assumptions.
The fair value hierarchy also requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value.
The following is a summary of assets and liabilities measured at fair value on a recurring basis (in thousands):
March 31, 2022December 31, 2021
Level 1Level 2Level 3TotalLevel 1Level 2Level 3Total
Cash and cash equivalents:
Cash$8,558 $— $— $8,558 $13,621 $— $— $13,621 
Cash equivalents275,730 — — 275,730 290,699 — — 290,699 
Total cash and cash equivalents$284,288 $— $— $284,288 $304,320 $— $— $304,320 
Loan facility derivative liability$— $— $1,533 $1,533 $— $— $1,496 $1,496 
Cash equivalents consist primarily of money market funds and treasury securities.
There were no transfers in and out of Level 3 during the three months ended March 31, 2022 and year ended December 31, 2021.
Loan facility derivative liability
In connection with the Company’s loan facility, the Company is obligated to pay a fee upon the earlier occurrence of a defined liquidity event, including but not limited to, a merger or sale of our assets or voting stock, or achieving a $200.0 million trailing twelve months revenue target, in each case, by September 2029. The fee is calculated at the time of the liquidity event occurrence to be $1.0 million if only the first installment has been drawn, $2.0 million if the first two installments have been drawn, $2.4 million if the first three installments have been drawn, or $3.0 million if all four installments have been drawn, in each case, upon the occurrence of the liquidity event. As of March 31, 2022, the Company has drawn on the first two installments. The Company has determined this fee is a freestanding derivative instrument. The $1.4 million fair value of this loan facility derivative was recorded as a debt discount and liability on the date of issuance in connection with obtaining additional financing as applicable and will be revalued every reporting period until the earlier occurrence of a defined liquidity event or achieving a revenue target by September 2029 or termination of such fee arrangement.
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The following table sets forth a summary of the changes in the estimated fair value of the Company’s loan facility derivative liability, classified as Level 3 (in thousands):
Three Months Ended March 31,
20222021
Beginning of the period$1,496 $1,782 
Issued— — 
Change in fair value37 43 
Payment of success fee— — 
End of the period$1,533 $1,825 
The fair value of the loan facility derivative liability was determined using a discounted cash flow calculation discounted at 10%.
Concentration of Credit Risk
Financial instruments, which potentially subject the Company to concentrations of credit risk, consist principally of cash and cash equivalents and, to a lesser extent, accounts receivable. The Company believes that credit risk in its accounts receivable is mitigated by its credit evaluation process, relatively short collection terms and diversity of its customer base. The Company generally does not require collateral and losses on accounts receivable have historically been within management’s expectations.
The Company’s investment policy limits investments to certain types of debt securities issued by the U.S. government, its agencies, and institutions with investment-grade credit ratings, as well as corporate debt or commercial paper issued by the highest quality financial and non-financial companies, and places restrictions on maturities and concentration by type and issuer. The Company is exposed to credit risk in the event of a default by the financial institutions holding its cash and cash equivalents and issuers of investments to the extent recorded on the balance sheets. The Company has limited its credit risk associated with cash and cash equivalents by placing its investments with banks it believes are highly creditworthy and with highly rated investments.
Allowance for Doubtful Accounts
The Company provides for uncollectible accounts receivable by recording an allowance for doubtful accounts for balances deemed uncollectible. The Company evaluates the collectability of its accounts receivable based on known collection risks and historical experience. In circumstances where the Company is aware of a specific customer’s inability to meet its financial obligations to the Company (e.g., bankruptcy filings, substantial downgrading of credit ratings), the Company records a specific allowance for bad debts against amounts due to reduce the carrying amount of accounts receivable to the amount it reasonably believes will be collected. The Company has not experienced any significant collection issues and the allowance for doubtful accounts has not been material.
Inventory
Inventories are valued at the lower of cost, computed on a first-in, first-out basis, or net realizable value. The allocation of production overhead to inventory costs is based on normal production capacity. Abnormal amounts of idle facility expense, freight, handling costs, and consumption are expensed as incurred, and not included in overhead. The Company maintains provisions for excess and obsolete inventory based on management’s estimates of forecasted demand and, where applicable, product expiration. In 2021, the Company had initiated a voluntary recall for a limited number of handpieces due to certain issues related to supply chain and manufacturing processes, of which the provision recognized was not material.
Property and Equipment and Intangible Assets
Property and equipment and intangible assets are stated at cost, less accumulated depreciation and amortization. Depreciation and amortization for property and equipment are determined using the straight-line method over the
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estimated useful lives of the respective assets, generally three to five years. The Company reclassifies inventory used at customer sites for evaluation purposes to property and equipment due to a limited history of sales of evaluation units. Amortization of intangible assets are determined using the straight-line method over the estimated useful lives, generally through the patent expiration date. Leasehold improvements are amortized on a straight-line basis over the shorter of their estimated useful lives or the term of the lease. Maintenance and repairs are charged to operating expenses as incurred.
Impairment of Long-Lived Assets
Long-lived assets consist primarily of property and equipment and intangible assets, net, and are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. If circumstances require that a long-lived asset be tested for possible impairment, the Company compares the undiscounted cash flows expected to be generated by the asset group to the carrying amount of the asset group. If the carrying amount of the long-lived asset is not recoverable on an undiscounted cash flow basis, an impairment is recognized to the extent that the carrying amount exceeds its fair value. The Company determines fair value using the income approach based on the present value of expected future cash flows or other appropriate measures of estimated fair value. The Company’s cash flow assumptions consider historical and forecasted revenue and operating costs and other relevant factors. During the three months ended March 31, 2022 and 2021, the Company has not recorded impairment charges on its long-lived assets.
Deferred Revenue
The timing of revenue recognition may differ from the timing of invoicing to customers. The Company records deferred revenue when revenue will be recognized subsequent to invoicing. Service agreements are generally invoiced annually at the beginning of each coverage period and recorded as deferred revenue and recognized as revenue ratably over the coverage period. Deferred revenue that will be recognized during the twelve months following the balance sheet date is recorded as the current portion of deferred revenue, and the remaining portion, if any, would be recorded as non-current.
Redeemable Convertible Preferred Stock
The Company records redeemable convertible preferred stock at fair value on the date of issuance, net of issuance costs. The redeemable convertible preferred stock is recorded outside of permanent equity because it contains liquidation features that are not solely within the Company’s control. The Company determined that the carrying values of the redeemable convertible preferred stock should not be adjusted to the liquidation preferences because it is uncertain whether or when an event would occur that would obligate the Company to pay the liquidation preferences to holders of shares of redeemable convertible preferred stock. Subsequent adjustments to the carrying values of the redeemable convertible preferred stock to the liquidation preferences will be made only when it is probable that the redeemable convertible preferred stock will become redeemable. Upon the completion of the Company’s IPO, in September 2021, all 29,912,264 shares of its then-outstandingthe Company’s 62,454 redeemable convertible preferred stock automatically converted into 29,912,264 shares of common stockwarrants were exercised and it reclassified $329.5 million of redeemable convertible preferred stock to additional paid-in capital on its condensed consolidated balance sheet.
Loan Facility Derivative Liability
The Company has determined that its obligation to pay success fees to a lender upon a successful liquidation event or achieving a revenue target represents freestanding financial instruments. The instruments are classified as a non-current liability in the consolidated balance sheets and are subject to remeasurement at each financial reporting date. Any change in fair value was recognized through other income (expense) in the condensed consolidated statements of operations and comprehensive loss.
Leases
For agreements with a term of more than twelve months, the Company determines if an agreement contains a lease at inception. Operating lease liabilities represent an obligation to make lease payments arising from the lease agreement. Operating lease liabilities are recognized at the lease commencement date based on the present value of
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lease payments over the remaining lease term. In determining the present value of lease payments, the Company estimates its incremental borrowing rate as the rate of interest that the Company would have to pay to borrow on a collateralized basis over a similar term, of an amount equal to the lease payments in a similar economic environment. Operating lease liabilities are included in the Company’s consolidated balance sheet. Right-of-use assets represent our right to use an underlying asset for the lease term and are classified as non-current assets. Lease expense is recognized on a straight-line basis over the expected lease term in the Company’s consolidated statements of operations and comprehensive loss.
The Company has not elected to separate lease and non-lease components for any leases within its existing classes of assets and, as a result, records a right-of-use asset and lease liability based on the present value of the future minimum lease payments over the term at commencement date. Variable lease payments are expensed as incurred. The Company has also elected to not apply the recognition requirement to any leases within its existing classes of assets with a term of twelve months or less and does not include an option to purchase the underlying asset that the Company is reasonably certain to exercise.
The Company has lessor arrangements with customers for a fixed monthly fee with no non-lease components, typically for three-twelve months. These arrangements are accounted for as an operating lease in accordance with ASC 842. These arrangements and related revenue are immaterial to the periods presented.
Revenue Recognition
Revenue is derived primarily from the sales of the AquaBeam® Robotic Systems, and handpieces that are for one-time use during each surgery using the AquaBeam Robotic System. The AquaBeam Robotic System contains both software and non-software components that are delivered together as a single product and generally contain a one-year warranty.
To determine revenue recognition for arrangements that the Company determines are within the scope of ASC Topic 606, Revenue from Contracts with Customers (“ASC 606”), the Company performs the following five steps: (i) identify the contract with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when, or as, the Company satisfies the performance obligations. The Company only applies the five-step model to contracts when it is probable that the Company will collect the consideration it is entitled to in exchange for the goods or services it transfers to the customer. At contract inception, once the contract is determined to be within the scope of ASC 606, the Company assesses the goods or services promised within each contract and determines those that are performance obligations and assesses whether each promised good or service is distinct based on the contract.
The contracts are typically in the form of an agreement and a purchase order from the customer. The Company’s AquaBeam Robotic System sales generally contain multiple products and services and can include a combination of the following performance obligations: robotic system, handpieces and consumables, and service.
The Company determines the transaction price it expects to be entitled to in exchange for transferring the promised product to the customer, which is based on the invoiced price for the products. All prices are at fixed amounts per the sales agreement with the customer and there are generally no discounts, rebates or other price concessions or a right of return, once the agreement is signed.
For multiple-element arrangements, revenue is allocated to each performance obligation based on its relative standalone selling price. Standalone selling prices are based on observable prices at which the Company separately sells the products or services. If a standalone selling price is not directly observable, then the Company estimates the standalone selling price considering market conditions and entity-specific factors including, but not limited to, features and functionality of the products and services, geographies, and type of customer. The Company regularly reviews standalone selling prices and updates these estimates as necessary.
The Company recognizes revenue as the performance obligations are satisfied by transferring control of the product or service to a customer. The Company generally recognizes revenue for the performance obligations at the following points in time:
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AquaBeam Robotic Systems - For systems (including system components and system accessories) sold directly to end customers, revenue is recognized when the Company transfers control to the customer, which is generally at the time of delivery. Systems rented for a fixed monthly fee during an evaluation period, typically three-twelve months, are recognized as revenue straight-line during the lease term, in accordance with ASC 842, and are not material. For systems sold following an evaluation period, revenue is recognized generally once sales terms are mutually agreed (as the system is already installed at the customer site). For systems sold through distributors, revenue is recognized generally at the time of delivery. The Company’s system arrangements generally do not provide a right of return. The systems are generally covered by a one-year service agreement included in the warranty. The service agreements have a stand alone selling price and are typically recognized as deferred revenue and amortized over the one-year service period.
Hand pieces and other consumables - Revenue from sales of handpieces and other consumables is recognized when control is transferred to the customers, which generally occurs at the time of shipment but also occurs at the time of delivery.
Service - Service revenue, inclusive of the amounts associated with the AquaBeam Robotic System warranties, is recognized over the term of the service period, as the customer benefits from the services throughout the service period.
The Company has determined that certain promises in the multiple-element arrangements, such as installation, training and certain ancillary products, are immaterial, and/or do not represent separate performance obligations for which transaction price is allocated.
The timing of revenue recognition may differ from the timing of invoicing to customers. The Company records deferred revenue when revenue is recognized subsequent to invoicing, such as service contracts, which are recognized ratably as revenue over the performance period.
The Company’s typical payment terms are between approximately 30 to 90 days. The Company expenses shipping and handling costs as incurred and includes them in the cost of sales. In those cases where shipping and handling costs are billed to customers, the Company classifies the amounts billed as a component of revenue. Taxes collected from customers and remitted to governmental authorities are excluded from revenue. The Company expenses any incremental costs of obtaining a contract, including but not limited to, sales commissions, as and when incurred as the expected amortization period of the incremental costs would have been less than one year and are reported in selling, general and administrative expense in the statements of operations and comprehensive loss.
The following table presents revenue disaggregated by type and geography (in thousands):
Three Months Ended March 31,
20222021
U.S.
System sales and rentals$7,754 $4,559 
Handpieces and other consumables4,444 1,622 
Service359 72 
Total U.S. revenue12,557 6,253 
Outside of U.S.
System sales and rentals742 272 
Handpieces and other consumables745 603 
Service153 64 
Total outside of U.S. revenue1,640 939 
Total revenue$14,197 $7,192 
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Cost of Sales
Cost of sales consists primarily of material costs, direct labor and manufacturing overhead costs, including stock-based compensation. A significant portion of the Company’s cost of sales currently consists of manufacturing overhead costs. These overhead costs include the cost of quality assurance, material procurement, inventory control, facilities, equipment and operations supervision and management. Cost of sales also includes depreciation expense for production equipment, warranty, including any recalls, and field service costs, and purchased intangibles and certain direct costs such as shipping costs.
Research and Development
Research and development costs are expensed as incurred. Research and development costs consist primarily of engineering, product development, and regulatory affairs, consulting services, materials, depreciation and other costs associated with products and technologies being developed, including employee and non-employee compensation, stock-based compensation, supplies, quality assurance expenses, related travel expenses and facilities expenses.
Stock-Based Compensation
The Company maintains an equity incentive plan to provide long-term incentives for employees, consultants and members of the board of directors. The plan allows for the issuance of non-statutory and incentive stock options and restricted stock units to employees and non-employee directors, and non-statutory stock options to consultants.
The Company is required to determine the fair value of equity incentive awards and recognize compensation expense for all equity incentive awards made to employees and directors, including employee stock options and restricted stock units. Stock-based compensation expense is recognized over the requisite service period in the statements of operations and comprehensive loss. The Company uses the straight-line method for expense attribution.
The valuation model used for calculating the fair value of awards for stock-based compensation expense is the Black-Scholes option-pricing model (the “Black-Scholes model”). The Black-Scholes model requires the Company to make assumptions and judgments about the variables used in the calculation, including the fair value of the Company’s common stock, the expected term (weighted-average period of time that the options granted are expected to be outstanding), the expected volatility of common stock, an assumed risk-free interest rate and an expected dividend rate.
Prior to the Company’s IPO, the fair value of the Company’s common stock underlying the stock options was determined by the Company’s board of directors (“Board”). Because there was no public market for the Company’s common stock, the Board determined the fair value of the Company’s common stock at the time of grant of the option by considering a number of objective and subjective factors, including valuations of comparable companies, sales of the Company’s redeemable convertible preferred stock, operating and financial performance and the general and industry-specific economic outlook. The Company uses the “simplified method” to determine the expected term of the stock option. Expected volatility is based on an average of the historical volatilities of the common stock of publicly-traded companies with characteristics similar to those of the Company. The risk-free rate is based on the U.S. Treasury yield curve in effect at the time of grant for periods corresponding with the expected term of the option. The Company has elected to account for forfeitures when they occur.
Common Stock Valuation
The Company’s intent has been to grant all options with an exercise price not less than the fair value of its common stock underlying those options on the date of grant. Prior to its IPO, the Company has determined the estimated fair value of its common stock at each valuation date in accordance with the guidelines outlined in the American Institute of Certified Public Accountants Practice Aid, Valuation of Privately-Held-Company Equity Securities Issued as Compensation (the “Practice Aid”). The Company’s board of directors, with the assistance of
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management, developed these valuations using significant judgment and taking into account numerous factors, including:
valuations of its common stock with the assistance of independent third-party valuation specialists;
the stage of development and business strategy, including the status of research and development efforts, of its products and product candidates, and the material risks related to its business and industry;
the results of operations and financial position, including its levels of available capital resources;
the valuation of publicly traded companies in the life sciences and medical device sectors, as well as recently completed mergers and acquisitions of peer companies;
the prices of its redeemable convertible preferred stock sold to investors in arm’s length transactions and the rights, preferences, and privileges of its redeemable convertible preferred stock relative to those of its common stock;
the likelihood of achieving a liquidity event for the holders of its common stock, such as an initial public offering or a sale of the Company given prevailing market conditions;
the inability of the Company’s stockholders to freely trade its common stock in the public markets, resulting in a discount to reflect the lack of marketability of the Company’s common stock based on the weighted-average expected time to liquidity.
trends and developments in its industry; and
external market conditions affecting the life sciences and medical device industry sectors.
The Company’s board of directors determined the fair value of its common stock by first determining the enterprise value of the Company’s business using the market approach, income approach or from the value implied by the latest round of equity financing, and then allocating the value among the various classes of its equity securities to derive a per share value of its common stock. The Practice Aid identifies various available methods for allocating enterprise value across classes and series of capital stock to determine the estimated fair value of common stock at each valuation date.
For all options granted prior to the Company’s IPO in September 2021, the Board allocated the enterprise value based on the option pricing method (“OPM”). OPM treats the rights of the holders of preferred and common stock as equivalent to call options on any value of the enterprise above certain break points of value based upon the liquidation preferences of the holders of preferred stock, as well as their rights to participation and conversion. Thus, the estimated value of the common stock can be determined by estimating the value of its portion of each of these call option rights. When valuing options granted around the time of an equity financing that is considered arms-length, OPM derived the Company’s equity value of a company from the price of the securities issued by the Company in the equity financing. Following the completion of the Company’s IPO in September 2021, the fair value of the Company’s common stock is determined based on the closing price of its common stock on The Nasdaq Global Market.
Advertising Expenses
The Company expenses the costs of advertising, including promotional expenses, as incurred. Advertising expenses were not significant.
Defined Contribution Plan
The Company has a defined contribution retirement savings plan under Section 401(k) of the Internal Revenue Code. This plan allows eligible employees to defer a portion of their annual compensation on a pre-tax basis. The Company is authorized to make matching contributions but has not made such contributions for the three months ended March 31, 2022 and 2021.
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Income Taxes
The Company accounts for income taxes under the asset and liability method. Under this method, deferred tax assets and liabilities are determined based on the differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax rates that will be in effect when the differences are expected to reverse. Valuation allowances against deferred tax assets are established when necessary to reduce deferred tax assets to the amounts expected to be realized. Currently, the Company has recorded a full valuation allowance against its deferred tax assets and there is no provision for income taxes, as the Company has incurred operating losses to-date. The Company’s policy is to record interest and penalties expense related to uncertain tax positions as a component of income tax expense in the statement of operations. To date, there have been no interest or penalties charged in relation to the unrecognized tax benefits.
Net Loss Per Share
Basic net loss per share is computed by dividing the net loss by the weighted-average number of shares of common stock outstanding during the period. Diluted net loss per share is computed by dividing the net loss by the weighted-average number of shares of common stock and common stock equivalent shares from dilutive stock options and common stockunexercised warrants outstanding during the period. Because the Company has reported a net loss for all periods presented, diluted net loss per share is the same as basic net loss per share for those periods as all potentially dilutive securities were antidilutive in those periods.
The Company allocates no loss to participating securities because they have no contractual obligation to share in the losses of the Company. The shares of the Company’s redeemable convertible preferred stock participated in any dividends declared by the Company and were therefore considered to be participating securities.
Upon the completion of the Company’s IPO in September 2021, all 29,912,264 shares of its then-outstanding redeemable convertible preferred stock automatically converted into 29,912,264 shares of common stock.
Net loss per share was determined as follows (in thousands, except per share amounts):
Three Months Ended March 31,
20222021
Net loss$(17,185)$(12,822)
Weighted-average common stock outstanding43,855 4,830 
Net loss per share, basic and diluted$(0.39)$(2.65)
The following potentially dilutive securities outstanding have been excluded from the computations of weighted-average shares outstanding because such securities have an antidilutive impact due to losses reported (in common stock equivalent shares, in thousands):
March 31,
20222021
Redeemable convertible preferred stock outstanding— 25,402 
Redeemable convertible preferred stock warrants— 72 
Common stock options6,023 6,445 
Restricted stock units198 — 
Employee stock purchase plan193 — 
Total6,414 31,919 
Comprehensive Loss
Comprehensive loss consists of net loss and changes in unrealized gains and losses on cash equivalents and available-for-sale marketable securities. Accumulated other comprehensive income (loss) is presented in the accompanying balance sheets, when applicable.
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Segment, Geographical and Customer Concentration
The Company operates as a single operating segment. The Company’s chief operating decision maker, its Chief Executive Officer, reviews financial information on an aggregate basis for the purposes of allocating resources and evaluating financial performance. The Company’s assets are primarily based in the United States.
No customers accounted for more than 10% of revenue during the three months ended March 31, 2022. Two customers accounted for 11% and 10% of revenue during the three months ended March 31, 2021.
One customer accounted for 11% of accounts receivable at March 31, 2022 and December 31, 2021.expired.
JOBS Act Accounting Election
The Company is an emerging growth company, as defined in the JOBS Act. Under the JOBS Act, emerging growth companies can delay adopting new or revised accounting standards issued subsequent to the enactment of the JOBS Act until such time as those standards apply to private companies. The Company has elected to avail itself of this exemption and, therefore, for new or revised accounting standards applicable to public companies, the Company will be subject to an extended transition period until those standards would otherwise apply to private companies.
RecentRecently Issued Accounting Pronouncements
In March 2020, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2020-4, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting (“ASU 2020-4”). The amendments in ASU 2020-4 provide optional expedients and exceptions for applying GAAP to contracts, hedging relationships, and other transactions affected by reference rate reform if certain criteria are met. These amendments apply only to contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued because of reference rate reform. The expedients and exceptions provided do not apply to contract modifications made and hedging relationships entered into or evaluated after December 31, 2022, except for hedging relationships existing as of December 31, 2022, that an entity has elected certain optional expedients for and that are retained through the end of the hedging relationship.
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These amendments are effective for all entities as of March 12, 2020 through December 31, 2022. The Company is currently evaluating the impact of the adoption of this ASU 2020-4 on its consolidated financial statements.
In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments—Credit Losses (Topic 326) Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”), which requires an entity to utilize a new impairment model known as the current expected credit loss (“CECL”) model to estimate its lifetime “expected credit loss” and record an allowance that, when deducted from the amortized cost basis of the financial assets and certain other instruments, including but not limited to available-for-sale debt securities. Credit losses relating to available-for-sale debt securities will be recorded through an allowance for credit losses rather than as a direct write-down to the security. ASU 2016-13 requires a cumulative effect adjustment to the balance sheet as of the beginning of the first reporting period in which the guidance is effective. In November 2019, the FASB issued ASU 2019-10, Financial Instruments—Credit Losses (Topic 326), Derivatives and Hedging (Topic 815) and Leases (Topic 842): Effective Dates, which defers the effective date of ASU 2016-13 to fiscal years beginning after December 15, 2022 for all entities except SEC reporting companies that are not smaller reporting companies. ASU 2016-13 will be effective for the Company beginning January 1, 2023. The Company is currently evaluating the impact of the adoption of this ASU 2016-13 on its consolidated financial statements.
Significant Accounting Policies
Property and Equipment
Property and equipment are stated at cost, less accumulated depreciation and amortization. Depreciation and amortization for property and equipment are determined using the straight-line method over the estimated useful lives of the respective assets, generally three to five years. As of June 30, 2022, the Company no longer reclassifies inventory used at customer sites for evaluation purposes to property and equipment due to change in customary business practices.
Income Taxes
On August 16, 2022, President Biden signed the Inflation Reduction Act of 2022 ( the Inflation Act) into law. The Inflation Act contains certain tax measures, including a corporate alternative minimum tax of 15% on some large corporations and an excise tax of 1% on corporate stock buy-backs. The Company expects the various provisions of the Inflation Act to not have a material impact on the Company’s condensed consolidated financial statements and related notes.
During the three months ended September 30, 2022, there have been no material changes to the Company’s significant accounting policies as described in its 2021 Annual Report or the first quarter 2022 Quarterly Report that could have had a material impact on the Company’s condensed consolidated financial statements and related notes.









20
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3.    CompositionFair Value Measurements
The following is a summary of Certain Consolidated Financial Statement Items
Inventoryassets and liabilities measured at fair value on a recurring basis (in thousands):
March 31,December 31,
20222021
Raw materials$5,401 $6,740 
Work-in-process323 905 
Finished goods6,905 5,502 
Total inventory$12,629 $13,147 
September 30, 2022
Level 1Level 2Level 3Total
Cash and cash equivalents:
Cash$12,077 $— $— $12,077 
Cash equivalents237,140 — — $237,140 
Total cash and cash equivalents$249,217 $— $— $249,217 
Loan facility derivative liability$— $— $1,609 $1,609 
Prepaid Expenses
December 31, 2021
Level 1Level 2Level 3Total
Cash and cash equivalents:
Cash$13,621 $— $— $13,621 
Cash equivalents290,699 — — 290,699 
Total cash and cash equivalents$304,320 $— $— $304,320 
Loan facility derivative liability$— $— $1,496 $1,496 
Cash equivalents consist primarily of money market funds and Other Current Assetstreasury securities.
There were no transfers in and out of Level 3 during the three and nine months ended September 30, 2022 and year ended December 31, 2021.
The fair value of the loan facility derivative liability was determined using a discounted cash flow calculation discounted at 10%.
The following table sets forth a summary of the changes in the estimated fair value of the Company’s loan facility derivative liability, classified as Level 3 (in thousands):
March 31,December 31,
20222021
Insurance$1,901 $2,333 
Inventory539 830 
Software683 428 
Rent252 253 
Other695 398 
Total prepaid expenses and other current assets$4,070 $4,242 
Property and Equipment, Net (in thousands):
March 31,December 31,
20222021
Laboratory, manufacturing and computer equipment, and furniture and fixtures$3,080 $2,874 
Rental equipment984 1,082 
Leasehold improvements4,941 4,941 
Evaluation units2,841 2,842 
Total property and equipment11,846 11,739 
Less: accumulated depreciation and amortization(7,286)(6,694)
Total property and equipment, net$4,560 $5,045 
Other Current Liabilities (in thousands):
March 31,December 31,
20222021
Accrued purchases$219 $1,105 
Customer and supplier deposits1,035 741 
Professional services542 600 
Sales and other taxes684 515 
Interest403 405 
Travel expenses305 281 
Clinical trial expenses127 183 
Other679 778 
Total other current liabilities$3,994 $4,608 
As of March 31, 2022 and December 31, 2021, other non-current liabilities consisted of an asset retirement obligation for the facility lease.
Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
Beginning of the period$1,570 $1,787 $1,496 $1,782 
Change in fair value39 (177)113 (172)
End of the period$1,609 $1,610 $1,609 $1,610 
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Interest and Other Income (Expense), net4.    Inventory
Inventory consists of the following (in thousands):
Three Months Ended March 31,
20222021
Interest income$36 $14 
Decrease (increase) in fair value of preferred stock warrants— 24 
Decrease (increase) in fair value of loan facility derivative liability(37)(43)
Other(59)(9)
Total interest and other income (expense), net$(60)$(14)
September 30,December 31,
20222021
Raw materials$11,757 $6,740 
Work-in-process1,890 905 
Finished goods8,711 5,502 
Total inventory$22,358 $13,147 

4.5.    Intangible Assets
In March 2019, the Company entered into a license agreement with HydroCision, Inc. This agreement grants the Company an exclusive, perpetual, irrevocable, worldwide, fully paid-up license to develop, manufacture and commercialize products in the field of urology using the patented technology and know-how controlled by HydroCision as of the effective date and as well as new patented technology developed by HydroCision that cover certain activities and improvements that relate to the use of fluid jet technology in connection with the licensed products during the period commencing on the effective date and ending on the earlier of the date that the Company ceases to use HydroCision’s existing contract manufacturers and the third anniversary of the effective date. Also included is the right to utilize HydroCision’s contract manufacturers, if desired. The consideration paid was a one-time upfront payment of $2.5 million, as well as allowing HydroCision (a reciprocal license) to use any new patented technology and know-how developed by the Company relating to the HydroCision patented technology and know-how in the field of urology for HydroCision use outside the field of urology. HydroCision will pay for any patent maintenance fees on HydroCision’s licensed patents. As of March 31,September 30, 2022 and December 31, 2021, accumulated amortization was $0.9$1.0 million and $0.8 million, respectively, and the net carrying amount is expected to be amortized at a rate of $0.3 million per year until fully amortized.
Amortization expense for intangible assets was $0.1 million and $0.2 million for each of the three and nine months ended March 31,September 30, 2022 and 2021.
5.6.    Loan Facility and Derivative Liability
In September 2019, the Company entered into a loan facility for up to $75.0 million available in 4four installments. The Company borrowed $25.0 million in September 2019. An additional $25.0 million was borrowed in March 2020. The third installment of $10.0 million was originally available for draw through March 31, 2021 contingent upon achieving $20.0 million in trailing six months revenue. In January 2021, the third installment was amended to be available for draw through June 30, 2021 contingent upon achieving $6.4 million trailing six months revenue. The remaining $15.0 million was originally available for draw through June 30, 2021 and is contingent upon achieving $25.0 million in trailing six months revenue. In January 2021, this installment was amended to be available for draw through June 30, 2022. The facility bears an interest rate of 9.37%, which is 7.17% plus the greater of 2.2% or 30-day(i) 9.37% and (ii) 7.17% plus 30 day LIBOR. The initial term of the facility is 60 months with interest-only payments each month for 24 months followed by 36 months amortization of principal and interest. In January 2021, the interest-only period was amended to 36 months followed by 24 months amortization (principal and interest) beginning October 1, 2022 since the amended trailing six months target revenue of $6.4 million was achieved, and accordingly, the current portion of the amount due was reclassified to non-current. Upon drawing the final $15.0 million tranche, the interest-only period iswas extended 12 months followed by 24 months amortization of principal and interest. Upon the completion of the Company raising over $50.0 million in its IPO in September 2021, interest-only payments were extended an additional 12 months followed by 12 months amortization of principal and interest. Substantially all assets of the Company are pledged as collateral. Commencing with the earlier of June 30, 2021 and the month following the funding of either the third or final installment, the Company is required to achieve revenues for the previous six months ended equal to the greater of (1) 70% of the forecast for the commensurate period, (2) $15.0 million if
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neither third or final installments have been drawn, (3) $20.0 million if the third but not final installment has been drawn and (4) $25.0 million if both the third and final installments have been drawn.
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The loan facility includes certain fees payable to the lender recorded as a loan discount that are accrued and amortized to interest expense during the loan term. A 6% final payment fee of each funded tranche is payable at the earlier of prepayment or loan maturity and a 0.25% facility fee paid at each funded tranche. A prepayment fee was originally payable if the loan is paid before maturity in the amount of 3% of loans outstanding if paid in full during first 12 months, 2% if loan is paid in full during second twelve months, or 1% if loan is paid in full thereafter before maturity. In January 2021, the prepayment fee was removed as part of the amendments. In addition, the Company shouldwould pay the lender’s loan initiation fees and a fee upon the earlier occurrence of a defined liquidity event, including but not limited to, a merger or sale of the Company’s assets or voting stock, or achieving a $200 million trailing twelve months revenue target, in each case, by September 2029. The success fees are calculated at the time of the liquidity event occurrence to be $1.0 million if only the first installment has been drawn, $2.0 million if the first two installments have been drawn, $2.4 million if the first three installments have been drawn, or $3.0 million if all four installments have been drawn, in each case, upon the occurrence of the defined liquidity event. As of March 31,September 30, 2022, the Company has drawn on the first two installments. The Company determined that this obligation to pay success fees represents freestanding financial instruments.
The amendments in January 2021 were accounted for as a debt modification under ASC 470-50-40 as the changes in the debt terms are not considered substantial, and thus no gain or loss was recorded and a new effective interest rate was established based on the carrying value of the loan and the revised cash flows.
6.    Redeemable Convertible Preferred Stock Warrants
In June 2017,connection with the Company’s loan facility, the Company is obligated to pay a fee upon the earlier occurrence of a defined liquidity event, including but not limited to, a merger or sale of its assets or voting stock, or achieving a $200.0 million trailing twelve months revenue target, in each case, by September 2029. The fee is calculated at the time of the liquidity event occurrence to be $1.0 million if only the first installment has been drawn, $2.0 million if the first two installments have been drawn, $2.4 million if the first three installments have been drawn, or $3.0 million if all four installments have been drawn, in each case, upon the occurrence of the liquidity event. As of September 30, 2022, the Company has drawn on the first two installments. The Company has determined this fee is a freestanding derivative instrument. The initial $1.4 million fair value of this loan facility derivative was recorded as a debt discount and liability on the date of issuance in connection with obtaining additional financing as applicable and will be revalued every reporting period until the issuanceearlier occurrence of convertible notes,a defined liquidity event or achieving a revenue target by September 2029 or termination of such fee arrangement.
Subsequent to September 30, 2022, the Company issued 108,145 redeemable convertible preferred stock warrants that were exercisable into Series E orpaid the next round of redeemable convertible preferred stock. During the three months ended March 31, 2021, no warrants were exercised,loan facility and 71,705 were outstanding at March 31, 2021. Upon the completion of the Company’s IPOrelated fees in September 2021, 62,454 warrants were exercised and the remaining unexercised warrants expired.full. See Note 12 for further information.

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7.    Redeemable Convertible Preferred StockStock-Based Compensation
A summaryStock Options
The Company had 4.4 million shares available for grant as of the Company’s redeemable convertible preferred stock are as follows:
March 31, 2021
SeriesShares
Authorized
Shares
Issued and Outstanding
Carrying
Value
(in thousands)
A1,243,223 1,104,728 $2,781 
B1,841,805 1,543,804 5,404 
C1,564,851 1,564,851 7,073 
D8,245,295 7,547,542 36,879 
E8,825,653 8,414,496 115,229 
F5,263,157 5,226,981 76,488 
Total26,983,984 25,402,402 $243,854 
Upon the completion of the Company’s IPO in September 2021, all 29,912,264 shares of its then-outstanding redeemable convertible preferred stock automatically converted into 29,912,264 shares of common stock and it reclassified $329.5 million of redeemable convertible preferred stock to additional paid-in capital on our condensed consolidated balance sheet.
8.    Stockholder’s Equity
2021 Equity Incentive Award Plan
In September 2021, the Company adopted30, 2022 under the 2021 Equity Incentive Award Plan (the “2021 Plan”), which allows for the granting of stock options and stock purchase rights to the employees, members of the board of directors, and consultants of the Company. A total of 3,303,910 shares of common stock were initially reserved for
23


issuance under the 2021 Plan. Options granted under the 2021 Plan may be either incentive stock options (“ISOs”) or nonqualified stock options (“NSOs”). ISOs may be granted only to the Company’s employees, including officers and directors who are also employees. NSOs may be granted to employees and consultants.
Options under the 2021 Plan may be granted for periods of up to 10 years and at prices no less than 100% of the estimated fair value of the shares on the date of grant as determined by the board of directors, provided, however, that the exercise price of an ISO and NSO granted to a 10% shareholder shall not be less than 110% of the estimated fair value of the shares on the date of grant.
Granted options for newly hired employees usually vest over four years monthly with a one-year cliff vesting, and follow-on options vest monthly over four years with no cliff vesting. Granted restricted stock units for newly hired employees and follow-on restricted stock units usually vest over 4 years annually. Options granted to consultants have various vesting schedules depending on the underlying consulting arrangement and anticipated period of service. As of March 31, 2022, 2.8 million shares are available for grant and 0.5 million awards outstanding under the 2021 Plan.
2008 Stock Plan
The Company ceased making awards under the 2008 Stock Plan upon the effective date of the Company’s IPO. In 2008, the Company adopted the 2008 Stock Plan (the “2008 Plan”), which allows for the granting of stock options and stock purchase rights to the employees, members of the board of directors, and consultants of the Company. Options granted under the 2008 Plan may be either incentive stock options (“ISOs”) or nonqualified stock options (“NSOs”). ISOs may be granted only to the Company’s employees, including officers and directors who are also employees. NSOs may be granted to employees and consultants. Options granted under the 2008 Plan will start expiring in August 2021. Options outstanding under the 2008 Plan will expire upon forfeiture. As of March 31, 2022, 5.7 million options were outstanding under the 2008 Plan.
A summary of the Company’s stock option activity and related information are as follows (options(shares in thousands):
Three Months EndedNine Months Ended
March 31, 2022September 30, 2022
OptionsPriceNumber of SharesWeighted Average Exercise Price
Outstanding, beginning of periodOutstanding, beginning of period6,365 $5.34 Outstanding, beginning of period6,365 $5.34 
GrantedGranted186 34.99 Granted254 35.58 
ExercisedExercised(401)3.21 Exercised(978)3.72 
ForfeitedForfeited(127)5.51 Forfeited(224)7.75 
Outstanding, end of periodOutstanding, end of period6,023 6.40 Outstanding, end of period5,417 6.95 
Vested and expected to vestVested and expected to vest6,023 6.40 Vested and expected to vest5,417 6.95 
ExercisableExercisable3,092 4.39 Exercisable3,142 5.27 
As of March 31,September 30, 2022 and December 31, 2021, the aggregate pre-tax intrinsic value of options outstanding and exercisable was $94.6$113.7 million and $64.3 million, respectively, and the aggregate pre-tax intrinsic value options outstanding were $172.4$187.0 million and $125.7 million, respectively. The aggregate pre-tax intrinsic value of options exercised was $8.7$27.9 million and $1.5$5.1 million during the nine months ended September 30, 2022 and 2021, respectively.
As of September 30, 2022, there was a total of $9.7 million of unrecognized stock-based compensation expense related to stock options.
There were no stock options granted for the three months ended March 31, 2022 and 2021, respectively. The aggregate pre-tax intrinsic value was calculated as the difference between the exercise prices of the underlying options and the estimated fair value of the common stock on the date of exercise. The total fair value of options vested was $1.0 million and $1.1 million during the three months ended March 31, 2022 and 2021, respectively.
A summary of the Company’s restricted stock unit activity and related information are as follows (restricted stock units in thousands):
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Three Months Ended
March 31, 2022
OptionsPrice
Outstanding, beginning of period35 $34.78 
Awarded164 29.65 
Forfeited(1)18.96 
Outstanding, end of period198 30.61 
As of March 31, 2022 and December 31, 2021, the aggregate pre-tax intrinsic value of restricted stock units outstanding was $6.9 million and $0.9 million, respectively, calculated based on the closing price of the Company’s common stock at the end of the period, and the weighted-average remaining contractual term was 3.8 years and 3.6 years, respectively.
2021 Employee Stock Purchase Plan
In September 2021, the Company adopted the 2021 Employee Stock Purchase Plan (the “2021 ESPP”). The 2021 ESPP became effective on the effective date of the IPO. A total of 412,988 shares were initially reserved for issuance under the 2021 ESPP. Additionally, the number of shares of common stock reserved for issuance under the 2021 ESPP will increase automatically each year, beginning on January 1, 2022, and continuing through and including January 1, 2031, by the lesser of (1) 1% of the total number of shares of common stock outstanding on December 31 of the preceding calendar year; or (2) such lesser number as determined by the Company’s board of directors. The number of shares that may be issued under the 2021 ESPP shall not exceed a total of 10,526,315 shares. In November 2021, the Company implemented the 2021 ESPP. As of March 31, 2022, no shares have been issued under the 2021 ESPP.
The Company estimates the fair value of stock-based compensation on the date of grant using the Black-Scholes option-pricing model. The Black-Scholes model determines the fair value of stock-based awards based on the fair market value of the Company’s common stock on the date of grant and is affected by assumptions regarding a number of highly complex and subjective variables. These variables include, but are not limited to, the fair market value of the Company’s common stock, volatility over the expected term of the awards and actual and projected employee stock option exercise behaviors. The Company has opted to use the “simplified method” for estimating the expected term of options, whereby the expected term equals the arithmetic average of the vesting term and the original contractual term of the option. Due to the Company’s limited operating history and a lack of company specific historical and implied volatility data, the Company has based its estimate of expected volatility on the historical volatility of a group of similar companies that are publicly traded. When selecting these public companies on which it has based its expected stock price volatility, the Company generally selected companies with comparable characteristics to it, including enterprise value, stages of clinical development, risk profiles, position within the industry and with historical share price information sufficient to meet the expected life of the stock-based awards. The historical volatility data was computed using the daily closing prices for the selected companies’ shares during the equivalent period of the calculated expected term of the share-based payments. The Company will continue to analyze the historical stock price volatility and expected term assumptions as more historical data for the Company’s common stock becomes available. The risk-free rate assumption is based on the U.S. Treasury instruments with maturities similar to the expected term of the Company’s stock options. The expected dividend assumption is based on the Company’s history of not paying dividends and its expectation that it will not declare dividends for the foreseeable future.
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Total stock-based compensation recognized, before taxes, are as follows (in thousands):
Three Months Ended March 31,
20222021
Cost of sales$124 $23 
Research and development299 152 
Sales, general and administrative1,129 475 
Total stock-based compensation$1,552 $650 
The amount of unearned stock-based compensation related to unvested employee stock-based payment awards as of March 31, 2022 and December 31, 2021 is $18.7 million and $10.6 million, respectively. The weighted-average period over which the unearned stock-based compensation is expected to be recognized as of March 31, 2022 and December 31, 2021 is 3.1 years and 2.8 years, respectively.
30, 2022. The fair value of the options granted to employees or directors was estimated as of the grant date using the Black-Scholes model assuming the weighted-average assumptions listed in the following table:
Three Months Ended March 31,Three Months Ended September 30,Nine Months Ended September 30,
202220212022202120222021
Expected life (years)Expected life (years)6.06.0Expected life (years)0.05.95.96.0
Expected volatilityExpected volatility64 %45 %Expected volatility— %53 %55 %50 %
Risk-free interest rateRisk-free interest rate2.4 %1.1 %Risk-free interest rate— %0.9 %2.5 %1.0 %
Expected dividend rateExpected dividend rate— %— %Expected dividend rate— %— %— %— %
Weighted-average fair valueWeighted-average fair value$20.87 $2.38 Weighted-average fair value$— $7.00 $19.15 $3.88��
Restricted Stock Units
A summary of the Company’s restricted stock unit (“RSU”) activity and related information are as follows (restricted stock units in thousands):
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Nine Months Ended
September 30, 2022
Number of SharesWeighted Average Grant Date Fair Value
Outstanding, beginning of period35 $34.78 
Awarded630 34.42 
Forfeited(29)33.76 
Outstanding, end of period636 34.47 
As of September 30, 2022, there was a total of $19.1 million of unrecognized stock-based compensation expense related to RSUs.
Employee Stock Purchase Plan
As of September 30, 2022, there was approximately $0.3 million of unrecognized cost related to employee stock purchases under the Employee Stock Purchase Plan (“ESPP”). This cost is expected to be recognized over a weighted average period of 0.5 years. As of September 30, 2022, a total of 0.8 million shares were available for issuance under the ESPP.
The fair value of the optionsawards granted under the 2021 ESPP for the nine months ended September 30, 2022 to employees was estimated as of the grant date using the Black-Scholes model assuming the weighted-average assumptions listed in the following table:
ThreeNine Months Ended March 31,September 30,
2022
Expected life (years)0.90.8
Expected volatility5057 %
Risk-free interest rate0.11.8 %
Expected dividend rate— %
Weighted-average fair value$8.4412.25 
Total stock-based compensation recognized, before taxes, are as follows (in thousands):
Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
Cost of sales$337 $62 $712 $135 
Research and development678 174 1,531 482 
Sales, general and administrative2,210 689 5,209 1,683 
Total stock-based compensation$3,225 $925 $7,452 $2,300 


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8.    Net Loss Per Share
Upon the completion of the Company’s IPO in September 2021, all 29,912,264 shares of its then-outstanding redeemable convertible preferred stock automatically converted into 29,912,264 shares of common stock.
Net loss per share was determined as follows (in thousands):
Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
Net loss$(22,613)$(14,103)$(58,982)$(41,505)
Weighted-average common stock outstanding44,640 11,580 44,276 7,361 
Net loss per share, basic and diluted$(0.51)$(1.22)$(1.33)$(5.64)
The following potentially dilutive securities outstanding have been excluded from the computations of weighted-average shares outstanding because such securities have an antidilutive impact due to losses reported (in common stock equivalent shares, in thousands):
As of September 30,
20222021
Common stock options5,417 6,607 
Restricted stock units636 — 
Employee stock purchase plan61 — 
Total6,114 6,607 

9.    Revenue
The following table presents revenue disaggregated by type and geography (in thousands):
Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
U.S.
System sales and rentals$9,811 $5,038 $26,081 $14,368 
Handpieces and other consumables8,015 2,184 18,182 5,458 
Service812 169 1,741 378 
Total U.S. revenue18,638 7,391 46,004 20,204 
Outside of U.S.
System sales and rentals743 481 2,353 1,725 
Handpieces and other consumables791 666 2,369 2,159 
Service177 130 511 247 
Total outside of U.S. revenue1,711 1,277 5,233 4,131 
Total revenue$20,349 $8,668 $51,237 $24,335 


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10.    Segment, Geographical, and Customer Concentration
The Company operates as a single operating segment. The Company’s chief operating decision maker, its Chief Executive Officer, reviews financial information on an aggregate basis for the purposes of allocating resources and evaluating financial performance. The Company’s long-lived assets are primarily based in the United States.
No customers accounted for more than 10% of revenue during the three and nine months ended September 30, 2022 and 2021.
No customers accounted for more than 10% of accounts receivable at September 30, 2022. One customer accounted for 11% of accounts receivable at December 31, 2021.
The Company’s revenue by geographical location is as follows:
Three Months Ended September 30,Nine Months Ended September 30,
 2022 2021 2022 2021
United States92 %85 %90 %83 %
Outside the United States%15 %10 %17 %

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11.    Commitments and Contingencies
Guarantees and Indemnifications
In the normal course of business, the Company enters into agreements that contain a variety of representations and provide for general indemnification. The Company’s exposure under these agreements is unknown because it involves claims that may be made against the Company in the future. To date, the Company has not paid any claims or been required to defend any action related to its indemnification obligations. As of March 31,September 30, 2022 and December 31, 2021, the Company does not have any material indemnification claims that were probable or reasonably possible and consequently has not recorded related liabilities.
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Facility Lease
In July 2013, the Company entered into a lease agreement for its current facility located in Redwood City, California. In 2018, the Company expanded the lease space and extended the lease agreement through October 2023. The lease agreement provides for an escalation of rent payments each year and the Company records rent expense on a straight-line basis over the term of the lease. Rent is payable monthly. As of March 31, 2022 and
In December 31, 2021, the remaining future minimum lease payments under this lease is $3.9 million and $4.5 million, respectively.
Rent expense recognized under the lease, including additional rent charges for utilities, parking, maintenance, and real estate taxes, was $0.7 million for each of the three months ended March 31, 2022 and 2021.
As of March 31, 2022 and December 31, 2021, the Company has future commitments of $53.9 million and $54.5 million from debt repayments and office space under a non-cancelable operating lease expiring October 2023, respectively.
Future minimum annual operating lease and debt repayments are as follows (in thousands):
As of March 31, 2022Minimum Lease PaymentsDebt RepaymentsTotal
2022$1,842 $— $1,842 
20232,092 12,500 14,592 
2024— 37,500 37,500 
Total minimum payments3,934 50,000 53,934 
Less: amount representing interest/unamortized debt discount(335)254 (81)
Present value of future payments3,599 50,254 53,853 
Less: current portion(2,181)— (2,181)
Non-current portion$1,418 $50,254 $51,672 
As of December 31, 2021Minimum Lease PaymentsDebt RepaymentsTotal
2022$2,445 $— $2,445 
20232,092 12,500 14,592 
2024— 37,500 37,500 
Total minimum payments4,537 50,000 54,537 
Less: amount representing interest/unamortized debt discount(441)(437)
Present value of future payments4,096 50,004 54,100 
Less: current portion(2,105)— (2,105)
Non-current portion$1,991 $50,004 $51,995 
As of March 31, 2022 and December 31, 2021, the Company’s security deposit is in the form of, and recorded as, restricted cash.
On December 31, 2021, the Company entered into a lease for 2two existing buildings, comprising approximately 158,221 square feet of space, located in San Jose, California. The term of the lease is anticipated to commence no later than December 31,commenced in July 2022, and will continue for 122 months following the lease commencement,thereafter, with 2two five year options to extend the term of the lease. The Lease provides for annual base rent of $4.3 million for the first year, which increases on a yearly basis up to $5.5 million for the tenth year, for an aggregate of $49.2 million. In January 2022, the Company issued a standby letter of credit to the landlord in the amount of $3.0 million as the security deposit for the lease. The standby letter of credit is secured by a $3.0 million bank deposit and will be recorded as restricted cash. Under the terms of the lease, the Company will receive an allowance of up to $7.9 million from the landlord to be applied to the Company’s construction of tenant improvements following the landlord’s delivery of the 2two buildings to the Company. During the three months ended September 30, 2022, the Company recorded both an right-of-use asset and liability of $22.7 million related to the lease. Lease payments have not yet commenced for the lease. The Company intendsused 9% as its discount rate and the remaining operating lease term is 10.4 years.
Rent expense recognized under the lease, including additional rent charges for utilities, parking, maintenance, and real estate taxes, was $1.9 million and $0.5 million for the three months ended September 30, 2022 and 2021, respectively, and $3.3 million and $1.5 million for the nine months ended September 30, 2022 and 2021, respectively.
As of September 30, 2022Minimum Lease PaymentsDebt RepaymentsTotal
2022$658 $— $658 
20235,610 12,500 18,110 
20244,184 37,500 41,684 
20254,297 — 4,297 
20264,426 — 4,426 
Thereafter24,146 — 24,146 
Total minimum payments43,321 50,000 93,321 
Less: amount representing interest/unamortized debt discount(17,433)692 (16,741)
Present value of future payments$25,888 $50,692 76,580 
Less: current portion(2,473)— (2,473)
Non-current portion$23,415 $50,692 $74,107 
As of September 30, 2022 and December 31, 2021, the Company’s security deposit is in the form of, and recorded as, restricted cash.

12.    Subsequent Event
In October 2022, the Company entered into a loan and security agreement (the "CIBC Loan Agreement") with Canadian Imperial Bank of Commerce ("CIBC"). The CIBC Loan Agreement provides for a senior secured term loan facility in the aggregate principal amount of $52.0 million (the "Term Loan Facility") which was borrowed in full.
The Term Loan Facility was used to relocate its operationsrepay and terminate the Company's previous loan facility (see Note 6), transaction fees, and related expenses.
The Term Loan Facility is scheduled to mature on the fifth anniversary of the Closing Date (the "Maturity Date"). The CIBC Loan Agreement provides for interest-only payments on the Term Loan Facility for the first thirty-six months following the Closing Date (the "Initial Interest-Only Period"). The Initial Interest-Only Period will be extended to an additional twelve months if the Company achieves either (i) $200.0 million or greater in revenue in any twelve-month period or (ii) $0 or greater in EBITDA in any six-month
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period. Thereafter, amortization payments on the Term Loan Facility will be payable monthly until the Maturity Date in monthly installments equal to 20% of the then outstanding principal amount of the Term Loan Facility divided by 12 plus any accrued and unpaid interest. The Company has the option to prepay the Term Loan Facility without any prepayment charge or fee.
The loan borrowed under the Term Loan Facility bears interest at an annual rate equal to the facility in San Jose priorsecured overnight financing rate ("SOFR") (calculated based on an adjustment of .10%, .15% and .25%, respectively, for one-month, three-month or six-month term SOFR as of a specified date, subject to a floor of 1.5%) plus an applicable margin of 2.25%.
The obligations under the endCIBC Loan Agreement are secured by substantially all of the termCompany's assets, including its intellectual property and by a pledge all of the lease forCompany's equity interests in its facilityU.S. subsidiaries and 65% of the Company's equity interests in Redwood City, California.its non-U.S. subsidiaries that are directly owned by the Company. The Company is obligated to maintain in deposit accounts held at CIBC the lesser of (i) $150.0 million or (ii) all of its non-operating cash.
The Company is currently assessing the accounting impact of the CIBC Loan Agreement on its consolidated financial statements.

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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The following discussion and analysis of our financial condition and results of operations together with our financial statements and related notes included elsewhere in this report. In addition to historical financial information, the following discussion and analysis contains forward-looking statements that involve risks, uncertainties and assumptions. Our actual results and timing of selected events may differ materially from those anticipated in these forward-looking statements as a result of many factors, including those discussed in the section titled “Risk Factors” and elsewhere in this report. Please also see the section titled “Cautionary Note Regarding Forward-Looking Statements.”
Overview
We are a surgical robotics company focused on advancing patient care by developing transformative solutions in urology. We develop, manufacture and sell the AquaBeam Robotic System, an advanced, image-guided, surgical robotic system for use in minimally invasive urologic surgery, with an initial focus on treating benign prostatic hyperplasia, or BPH. BPH is the most common prostate disease and impacts approximately 40 million men in the United States. The AquaBeam Robotic System employs a single-use disposable handpiece to deliver our proprietary Aquablation therapy, which combines real-time, multi-dimensional imaging, personalized treatment planning, automated robotics and heat-free waterjet ablation for targeted and rapid removal of prostate tissue. We designed our AquaBeam Robotic System to enable consistent and reproducible BPH surgery outcomes. We believe that Aquablation therapy represents a paradigm shift in the surgical treatment of BPH by addressing compromises associated with alternative surgical interventions. We designed Aquablation therapy to deliver effective, safe and durable outcomes for males suffering from lower urinary tract symptoms, or LUTS, due to BPH that are independent of prostate size and shape or surgeon experience. We have developed a significant and growing body of clinical evidence, which includes nine clinical studies and over 100 peer-reviewed publications, supporting the benefits and clinical advantages of Aquablation therapy. As of March 31,September 30, 2022, we had an install base of 150208 AquaBeam Robotic Systems globally, including 93139 in the United States.
Our U.S. pivotal trial, the WATER study, is the only FDA pivotal study randomized against transurethral resection of prostate, or TURP, which is the historical standard of care for the surgical treatment of BPH. In this study, Aquablation therapy demonstrated superior safety and non-inferior efficacy compared to TURP across prostate sizes between 30 ml and 80 ml, and superior efficacy in a subset of patients with prostates larger than 50 ml. We have established strong relationships with key opinion leaders, or KOLs, within the urology community and collaborated with key urological societies in global markets. This support has been instrumental in facilitating broader acceptance and adoption of Aquablation therapy. As a result of our strong KOL network and our compelling clinical evidence, Aquablation therapy has been added to clinical guidelines of various professional associations, including the American Urological Association.
In the United States, we sell our products to hospitals. We are initially targeting 860 high-volume hospitals that perform, on average, more than 200 resective procedures annually and account for approximately 70% of all hospital-based resective procedures. Over time, we willexpect to gradually expand our focus to also include mid- and low-volume hospitals. These customers in turn bill various third-party payors, such as commercial payors and government agencies, for treatment payment of each patient. Effective in 2021, all local Medicare Administrative Contractors, or MACs, which represent 100% of eligible Medicare patients, issued final positive local coverage determinations to provide Medicare beneficiaries with access to Aquablation therapy in all 50 states. We also have favorable coverage decisions from several large commercial payors, including Aetna, Anthem, Cigna, Humana, Health Care Service Corporation, Independence Blue Cross Blue Shield, BlueCross – Massachusetts, Emblem Health, and CareFirst.payors. We plan to leverage these recent successes in our active discussions with all commercial payors to establish additional positive national and regional coverage policies. Outside of the United States, we have ongoing efforts in key markets to expand established coverage and improve payment which we believe will expand patient access to Aquablation therapy.
We manufacture the AquaBeam Robotic System, the handpiece, integrated scope and other accessories at our facility in Redwood City, California. This includes supporting the supply chain distribution and logistics of the
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various components. Components, sub-assemblies and services required to manufacture our products are purchased from numerous global suppliers. Each AquaBeam Robotic System is shipped to our customers with a third-party
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manufactured ultrasound system and probe. We utilize a well-known third-party logistics provider located in the United States and the Netherlands to ship our products to our customers globally.
We generated revenue of $14.2$51.2 million and incurred a net loss of $17.2$59.0 million for the threenine months ended March 31,September 30, 2022, compared to revenue of $7.2$24.3 million and a net loss of $12.8$41.5 million for the threenine months ended March 31,September 30, 2021. As of March 31,September 30, 2022, we had cash and cash equivalents of $284.3$249.2 million and an accumulated deficit of $278.7$320.5 million.
We completed our IPO in September 2021, which raised $172.4 million, net of issuance costs. Previously, our primary sources of capital have been from private placements of redeemable convertible preferred securities and debt financing agreements. As of March 31,September 30, 2022, we have raised $337.1 million from private placements of redeemable convertible preferred securities from our investors. We expect our expenses will increase for the foreseeable future, in particular as we continue to make substantial investments in sales and marketing, operations and research and development. Moreover, we expect to incur additional expenses as a result of operating as a public company, including legal, accounting, insurance, compliance with the rules and regulations of the SEC and those of any stock exchange on which our securities are traded, investor relations, and other administrative and professional services expenses. Based on our operating plan, we currently believe that our existing cash, and cash equivalents, and anticipated revenue and available debt financing arrangements will be sufficient to meet our capital requirements and fund our operations through at least the next twelve months from the issuance date of the financial statements. If these sources are insufficient to satisfy our liquidity requirements, we may seek to sell additional public equity or debt securities or obtain an additional credit facility. The sale of equity and convertible debt securities may result in dilution to our stockholders and, in the case of preferred equity securities or convertible debt, those securities could provide for rights, preferences or privileges senior to those of our common stock. Debt financing, if available, may involve covenants restricting our operations or our ability to incur additional debt. Any debt financing or additional equity that we raise may contain terms that are not favorable to us or our stockholders. Additional financing may not be available at all, or in amounts or on terms unacceptable to us. If we are unable to obtain additional financing, we may be required to delay the development, commercialization and marketing of our products.
Factors Affecting Our Performance
We believe there are several important factors that have impacted and that we expect will impact our operating performance and results of operations for the foreseeable future. While these factors may present significant opportunities for us, they also pose significant risks and challenges that we must address. See the section titled “Risk Factors” for more information. These factors include:
Grow our install base of AquaBeam Robotic Systems: As of March 31,September 30, 2022, we had an install base of 150208 AquaBeam Robotic Systems globally, including 93139 in the United States. In the United States, we are initially focused on driving adoption of Aquablation therapy among urologists that perform hospital-based resective BPH surgery. We are initially targeting 860 high-volume hospitals that we estimate perform, on average, more than 200 resective procedures annually and account for approximately 70% of all hospital-based resective procedures. To penetrate these hospitals, we willexpect to continue to increase our direct team of capital sales representatives, who are focused on driving system placement within hospitals by engaging with key surgeons and decision makers to educate them about the compelling value proposition of Aquablation therapy. As we increase our install base of AquaBeam Robotic systems we expect our revenue will increase as a result of the system sale and resulting utilization.
Increase system utilization: Our revenue is significantly impacted by the utilization of our AquaBeam robotic system. Once we place a system within a hospital our objective is to establish Aquablation therapy as the surgical treatment of choice for BPH. Within each hospital we are initially focused on targeting urologists who perform medium-to-high volumes of resective procedures and converting their resective cases to Aquablation therapy. To accomplish this, we willexpect to continue expanding our team of highly trained Aquablation representatives and clinical specialists who are focused on driving system utilization within the hospital, providing education and training support and ensuring excellent user experiences. As urologists
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gain experience with Aquablation therapy we willexpect to leverage their experiences to capture more surgical volumes and establish Aquablation therapy as the surgical standard of care.
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Reimbursement and coverage decisions by third-party payors. Healthcare providers in the United States generally rely on third-party payors, principally federal Medicare, state Medicaid and private health insurance plans, to cover all or part of the cost of procedures using our AquaBeam Robotic System. The revenue we are able to generate from sales of our products depends in large part on the availability of sufficient reimbursement from such payors. Effective in 2021, all local MACs, representing 100% of eligible Medicare patients, issued final positive local coverage determinations to provide Medicare beneficiaries with access to Aquablation therapy in all 50 states. We believe that these favorable coverage decisions have been a catalyst for hospital adoption of our AquaBeam Robotic System. We believe our strong body of clinical evidence and support from key societies, supplemented by the momentum from Medicare coverage, have led to favorable coverage decisions from several large commercial payors, including Aetna, Anthem, Cigna, Humana, Health Care Service Corporation, Independence Blue Cross Blue Shield, BlueCross – Massachusetts, Emblem Health, and CareFirst.payors. We plan to leverage these recent successes in our active discussions with commercial payors to establish additional positive national and regional coverage policies. We believe that additional commercial payor coverage will contribute to increasing utilization of our system over time. Outside of the United States, we have ongoing efforts in key markets to expand established coverage and further improve patient access to Aquablation therapy.
Cost of sales. The results of our operations will depend, in part, on our ability to increase our gross margins by more effectively managing our costs to produce our AquaBeam Robotic System and single-use disposable handpieces, and to scale our manufacturing operations efficiently. We anticipate that as we expand our sales and marketing efforts and drive further sales growth, our purchasing costs on a per unit basis may decrease, and in turn improve our gross margin. As our commercial operations continue to grow, we expect to continue to realize operating leverage through increased scale efficiencies.
Investment in research and development to drive continuous improvements and innovation. We are currently developing additional and next generation technologies to support and improve Aquablation therapy to further satisfy the evolving needs of surgeons and their patients as well as to further enhance the usability and scalability of the AquaBeam Robotic System. We also plan to leverage our treatment data and software development capabilities to integrate artificial intelligence and machine learning to enable computer-assisted anatomy recognition and improved treatment planning and personalization. Our future growth is dependent on these continuous improvements which require significant resources and investment.
Impact of the COVID-19 Pandemic
The COVID-19 outbreak and the consequential economic disruptions have negatively impacted and may continue to negatively impact our operations, revenue and overall financial condition. In response to the pandemic, numerous state and local jurisdictions imposed, and others in the future may impose, “shelter-in-place” orders, quarantines, executive orders, and similar government orders and restrictions for their residents to control the spread of COVID-19. Starting in mid-March 2020, the governor of California, where our headquarters are located, issued “shelter-in-place” or “stay at home” orders restricting non-essential activities, travel, and business operations, subject to certain exceptions for necessary activities. Such orders or restrictions have resulted in our headquarters closing, slowdowns and delays, travel restrictions, and cancellation of training and other events, among other effects, thereby negatively impacting our operations. Additionally, in the United States, governmental authorities have recommended, and in certain cases required, that elective, specialty and other procedures and appointments be suspended or canceled to avoid non-essential patient exposure to medical environments and potential infection with COVID-19 and to focus limited resources and personnel capacity toward the treatment of COVID-19. 
These measures and challenges have decreased the number of BPH procedures generally, and consequently could have slowed adoption of our AquaBeam therapy and may have impacted our ability to sell our AquaBeam Robotic System. We believe the number of our systems sold has been impacted as health care organizations globally have prioritized the treatment of patients with COVID-19, and as health care organizations continue to experience consequential economic disruptions from the COVID-19 pandemic such as budget shortfalls and staffing shortages.
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Numerous procedures have been and in certain jurisdictions in which we operate are continuing to be cancelled or delayed as a result of local public health measures and hospital policies. We have also experienced disruptions, and may experience future disruptions, including: delays in sales personnel becoming fully trained and productive; difficulties and delays in physician outreach and training physicians to use our AquaBeam Robotic System; restrictions on personnel to travel; delays in follow-ups of our clinical studies; challenges with maintaining adequate supply from third-party manufacturers of components and finished goods and distribution providers; and access to physicians for training and case support.
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While many restrictions associated with COVID-19 have more recently been relaxed, the longevity and extent of the various COVID-19 pandemic remains uncertain, including due to the emergence and impact of the COVID-19 variants and continued economic disruptions. These measures and challenges may continue for the duration of the pandemic and may negatively impact our revenue growth while the pandemic continues.
Components of Our Results of Operations
Revenue
We generate our revenue primarily from the capital portion of our business, which includes sales and rentals of our AquaBeam Robotic System, and from the recurring revenue associated with sales of our single-use disposable handpieces that are used during each surgery performed with our system. Other revenue is derived primarily from service and repair and extended service contracts with our existing customers. We expect our revenue to increase in absolute dollars for the foreseeable future as we continue to focus on driving adoption of Aquablation therapy, and increased system utilization, though it may fluctuate from quarter to quarter.
The following table presents revenue by significant geographical locations for the periods indicated:
Three Months Ended March 31,Three Months Ended September 30,Nine Months Ended September 30,
20222021 2022 2021 2022 2021
United StatesUnited States88 %87 %United States92 %85 %90 %83 %
Outside the United StatesOutside the United States12 %13 %Outside the United States%15 %10 %17 %
We expect that both our U.S. and international revenue will increase in the near term as we continue to expand the install base of AquaBeam Robotic Systems and increase the units sold of our single-use disposable handpieces. We expect our increase in revenues in absolute dollars to be larger in the United States.
Cost of Sales and Gross Margin
Cost of sales consists primarily of material costs, direct labor and manufacturing overhead costs, warranty and service costs, and other direct costs such as shipping costs. A significant portion of our cost of sales currently consists of manufacturing overhead costs. These overhead costs include compensation for personnel, including stock-based compensation, facilities, equipment and operations supervision, quality assurance and material procurement. We expect our cost of sales to increase in absolute dollars for the foreseeable future primarily as, and to the extent, our revenue grows, or we make additional investments in our manufacturing capabilities, though it may fluctuate from period to period.
We calculate gross margin percentage as gross profit divided by revenue. Our gross margin has been and will continue to be affected by a variety of factors, primarily, product and geographic mix and the resulting average selling prices, production volumes, manufacturing costs and product yields, and to a lesser extent the implementation of cost reduction strategies. We expect our gross margin to increase over the long term as our production volume increases and as we spread the fixed portion of our manufacturing overhead costs over a larger number of units produced, thereby significantly reducing our per unit manufacturing costs, though it may fluctuate from quarter to quarter. Our gross margins can fluctuate due to geographic mix. To the extent we sell more systems and handpieces in the United States, we expect our margins will increase due to the higher average selling prices as compared to sales outside of the United States.
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Operating Expenses
Research and Development
Research and development, or R&D, expenses consist primarily of engineering, product development, regulatory affairs, consulting services, materials, depreciation and other costs associated with products and technologies being developed. These expenses include employee and non-employee compensation, including stock-based compensation, supplies, materials, quality assurance expenses, consulting, related travel expenses and facilities expenses. We expect our R&D expenses to increase in absolute dollars for the foreseeable future as we
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continue to develop, enhance and commercialize new products and technologies, though it may fluctuate from quarter to quarter. However, we expect our R&D expenses as a percentage of revenue to vary over time depending on the level and timing of initiating new product development efforts.
Selling, General and Administrative
Selling, general and administrative, or SG&A, expenses consist primarily of compensation for personnel, including stock-based compensation, related to selling, marketing, clinical affairs, professional education, finance, information technology, and human resource functions. SG&A expenses also include commissions, training, travel expenses, promotional activities, conferences, trade shows, professional services fees, audit fees, legal fees, insurance costs and general corporate expenses including allocated facilities-related expenses. Clinical expenses include clinical trial design, clinical site reimbursement, data management and travel expenses. We expect our SG&A expenses to increase in absolute dollars for the foreseeable future as we expand our commercial infrastructure and incur additional fees associated with operating as a public company, including legal, accounting, insurance, compliance with the rules and regulations of the SEC and those of any stock exchange on which our securities are traded, investor relations, and other administrative and professional services expenses, though it may fluctuate from quarter to quarter. However, over time, we expect our SG&A expenses to decrease as a percentage of revenue.
Interest and Other Income, (Expense), Net
Interest Expense
Interest expense consists primarily of interest expense from our loannote payable.
Interest and Other Income, (Expense), Net
Interest and other income, (expense), net, consists primarily of interest income from our cash and cash equivalents balances, and fair value adjustments from our redeemable convertible preferred stock warrant liabilities and our loan facility derivative liability.
In connection with our sales of redeemable convertible preferred stock, we issued warrants to purchase shares of our Series E redeemable convertible preferred stock. We classified these warrants as a liability on our balance sheets that we remeasured to fair value at each reporting date with the corresponding change in fair value being recognized in our statements of operations. Upon completion of our IPO in September 2021, the redeemable convertible preferred stock warrant liability was reclassified to additional paid-in capital in stockholders’ equity (deficit) for warrants exercised and statement of operations for warrants expired.
Additionally, in connection with the loan facility, we are obligated to pay a fee upon the earlier occurrence of a defined liquidity event, including but not limited to, a merger or sale of our assets or voting stock, or our achieving a $200 million trailing twelve months revenue target, in each case, by September 2029. The fee is calculated at the time of the liquidity event occurrence to be $1.0 million if only the first installment has been drawn, $2.0 million if the first two installments have been drawn, $2.4 million if the first three installments have been drawn, or $3.0 million if all four installments have been drawn, in each case, upon the occurrence of the liquidity event. We adjust the carrying values of the loan facility derivative liability for changes in fair value and recognize those changes in interest and other income (expense), net.
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Results of Operations
The following tables show our results of operations for the periods indicated:three and nine months ended September 30, 2022 and 2021:
Three Months Ended
March 31,
Change
20222021$%
(in thousands, except percentages)
Revenue$14,197 $7,192 $7,005 97 %
Cost of sales6,505 3,665 2,840 77 
Gross profit7,692 3,527 4,165 118 
Gross margin54 %49 %
Operating expenses:
Research and development5,011 4,522 489 11 
Selling, general and administrative18,385 10,349 8,036 78 
Total operating expenses23,396 14,871 8,525 57 
Loss from operations(15,704)(11,344)(4,360)(38)
Interest expense(1,421)(1,464)43 
Interest and other income (expense), net(60)(14)(46)(329)
Net loss$(17,185)$(12,822)$(4,363)(34)
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Three Months Ended
September 30,
Change
20222021$%
(in thousands, except percentages)
Revenue$20,349 $8,668 $11,681 135 %
Cost of sales10,118 4,428 5,690 129 
Gross profit10,231 4,240 5,991 141 
Gross margin50 %49 %
Operating expenses:
Research and development7,582 4,919 2,663 54 
Selling, general and administrative24,754 12,118 12,636 104 
Total operating expenses32,336 17,037 15,299 90 
Loss from operations(22,105)(12,797)(9,308)(73)
Interest expense(1,455)(1,469)14 
Interest and other income, net947 163 784 481 
Net loss$(22,613)$(14,103)$(8,510)(60)

Nine Months Ended
September 30,
Change
20222021$%
(in thousands, except percentages)
Revenue$51,237 $24,335 $26,902 111 %
Cost of sales24,828 12,986 11,842 91 
Gross profit26,409 11,349 15,060 133 
Gross margin52 %47 %
Operating expenses:
Research and development19,299 13,917 5,382 39 
Selling, general and administrative62,794 34,765 28,029 81 
Total operating expenses82,093 48,682 33,411 69 
Loss from operations(55,684)(37,333)(18,351)(49)
Interest expense(4,317)(4,370)53 
Interest and other income, net1,019 198 821 415 
Net loss$(58,982)$(41,505)$(17,477)(42)
Comparison of Three and Nine Months Ended March 31,September 30, 2022 and 2021
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Revenue
Three Months Ended
March 31,
ChangeThree Months Ended
September 30,
Change
20222021$%20222021$%
(in thousands, except percentages)(in thousands, except percentages)
System sales and rentalsSystem sales and rentals$8,496 $4,831 $3,665 76 %System sales and rentals$10,554 $5,519 $5,035 91 %
Handpieces and other consumablesHandpieces and other consumables5,189 2,225 2,964 133 Handpieces and other consumables8,807 2,846 5,961 209 
ServiceService512 136 376 276 Service988 303 685 226 
Total revenueTotal revenue$14,197 $7,192 $7,005 97 Total revenue$20,349 $8,668 $11,681 135 
Nine Months Ended
September 30,
Change
20222021$%
(in thousands, except percentages)
System sales and rentals$28,434 $16,092 $12,342 77 %
Handpieces and other consumables20,551 7,614 12,937 170 
Service2,252 629 1,623 258 
Total revenue$51,237 $24,335 $26,902 111 
Revenue increased $7.0$11.7 million, or 97%135%, to $14.2$20.3 million during the three months ended March 31,September 30, 2022, compared to $7.2$8.7 million during the three months ended March 31,September 30, 2021, and increased $26.9 million or 111% to $51.2 million during the nine months ended September 30, 2022, compared to $24.3 million during the nine months ended September 30, 2021. The growth in revenue was primarily attributable to an increase of $6.3$11.2 million and $25.8 million in revenues derived from the United States. The increase was due toStates for the three and nine months ended September 30, 2022, respectively, resulting from higher sales volumes of both our AquaBeam Robotic System and our single-use disposable handpieces, resultingincreases in our average selling prices on both our AquaBeam Robotic System and our single-use disposable handpieces, from the expansion of insurance coverage, and the increase in personnel in our sales and marketing organizations.commercial organization. In addition, sales of both our AquaBeam Robotic System and our single-use disposable handpieces outside of the United States increasedhad an increase by $0.6$0.4 million in sales volume.volume during the three months ended September 30, 2022, and increased by $0.8 million in sales volume during the nine months ended September 30, 2022.
Cost of Sales and Gross Margin
Cost of sales increased $2.8$5.7 million, or 77%129%, to $6.5$10.1 million during the three months ended March 31,September 30, 2022, compared to $3.7$4.4 million during the three months ended March 31,September 30, 2021, and increased $11.8 million or 91%, to $24.8 million during the nine months ended September 30, 2022, compared to $13.0 million during the nine months ended September 30, 2021. The increase in cost of sales was primarily attributable to the growth in the number of units sold.
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Gross margin increased to 54%50% during the three months ended March 31,September 30, 2022, compared to 49% for the three months ended March 31,September 30, 2021, and increased to 52% during the nine months ended September 30, 2022 compared to 47% during the nine months ended September 30, 2021. The increase in gross margin was primarily attributable to the growth in unit sales, which allowed us to spread the fixed portion of our manufacturing overhead costs over more production units. Additionally, we realized higher average selling prices in the United States on both our AquaBeam Robotic System and our single-use disposable handpieces.
Research and Development Expenses
R&DResearch and development expenses (“R&D”) increased $0.5$2.7 million, or 11%54%, to $5.0$7.6 million during the three months ended March 31,September 30, 2022, compared to $4.5$4.9 million during the three months ended March 31,September 30, 2021, and increased $5.4 million or 39%, to $19.3 million during the nine months ended September 30, 2022, compared to $13.9 million during the nine months ended September 30, 2021. The increase in R&D expenses was primarily due
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to employee-related expenses from increased headcount of our R&D organization. These expenses support ongoing product improvements and the development of additional and next generation technologies.
Selling, General and Administrative Expenses
SG&ASelling, general, and administrative expenses (SG&A) increased $8.0$12.6 million, or 78%104%, to $18.4$24.8 million during the three months ended March 31,September 30, 2022, compared to $10.3$12.1 million during the three months ended March 31, 2021.September 30, 2021, and increased $28.0 million or 81% , to $62.8 million during the nine months ended September 30, 2022, compared to $34.8 million. The increase in SG&A expenses was primarily due to employee-related expenses of our sales and marketing organization and reimbursement and administrative organizations as we expanded our infrastructure to drive and support our growth in revenue.
Interest Expense
Interest expense was consistent during the three and nine months ended March 31,September 30, 2022 and 2021.
Interest and Other Income, (Expense), Net
Interest and other income, (expense), net, was consistentincreased both $0.8 million during the three and nine months ended March 31,September 30, 2022 and 2021.2021, respectively due to interest income earned on cash and cash equivalents.
Liquidity and Capital Resources
Overview
We completed our IPO in September 2021, which raised $172.4 million, net of issuance costs. Previously, our primary sources of capital have been from private placements of redeemable convertible preferred securities and debt financing agreements.
As of March 31,September 30, 2022, we had cash and cash equivalents of $284.3$249.2 million, an accumulated deficit of $278.7$320.5 million, and $50.0$50.7 million outstanding on our loan facility.facility (which we refinanced in October 2022 was described below). We expect our expenses will increase for the foreseeable future, in particular as we continue to make substantial investments in sales and marketing, operations and research and development. Moreover, we expect to incur additional expenses as a result of operating as a public company, including legal, accounting, insurance, compliance with the rules and regulations of the SEC and those of any stock exchange on which our securities are traded, investor relations, and other administrative and professional services expenses. Our future funding requirements will depend on many factors, including:
the degree and rate of market acceptance of our products and Aquablation therapy;
the scope and timing of investment in our sales force and expansion of our commercial organization;
the impact on our business from the ongoing and global COVID-19 pandemic and the end of the COVID-19 pandemic, or any other pandemic, epidemic or outbreak of an infectious disease;
the scope, rate of progress and cost of our current or future clinical trials and registries;
the cost of our research and development activities;
the cost and timing of additional regulatory clearances or approvals;
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the costs associated with any product recall that may occur;
the costs associated with the manufacturing of our products at increased production levels;
the costs of attaining, defending and enforcing our intellectual property rights;
whether we acquire third-party companies, products or technologies;
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the terms and timing of any other collaborative, licensing and other arrangements that we may establish;
the emergence of competing technologies or other adverse market developments; and
the rate at which we expand internationally.
Based on our operating plan, we currently believe that our existing cash, and cash equivalents, and anticipated revenue and available debt financing arrangements will be sufficient to meet our capital requirements and fund our operations through at least the next twelve months from the issuance date of the financial statements. We have based this estimate on assumptions that may prove to be wrong, and we may need to utilize additional available capital resources. If these sources are insufficient to satisfy our liquidity requirements, we may seek to sell additional public equity or debt securities or obtain an additional credit facility. The sale of equity and convertible debt securities may result in dilution to our stockholders and, in the case of preferred equity securities or convertible debt, those securities could provide for rights, preferences or privileges senior to those of our common stock. Debt financing, if available, may involve covenants restricting our operations or our ability to incur additional debt. Any debt financing or additional equity that we raise may contain terms that are not favorable to us or our stockholders. Additional financing may not be available at all, or in amounts or on terms unacceptable to us. If we are unable to obtain additional financing, we may be required to delay the development, commercialization and marketing of our products.
Indebtedness
In September 2019, we entered into a loan facility forthat initially made up to a total of $75.0 million available in four installments. We borrowed $25.0 million in September 2019 and an additional $25.0 million in March 2020. The third installment is for $10.0 million and was originally available for draw through March 31, 2021 contingent upon our achieving $20.0 million trailing six months revenue in any month before March 31, 2021.
The remaining $15.0 million was originally available for draw through June 30, 2021 contingent upon achieving $25.0 million in trailing six months revenue. In January 2021, the third installment was amended to be available for draw through March 31, 2022 contingent upon our achieving $6.4 million trailing six months revenue prior to June 30, 2021, and the fourth installment was amended to be available for draw though June 30, 2022.2022, which is now no longer available. The facility bears an interest rate of the greater of (i) 9.37% and (ii) 7.17% plus 30-day LIBOR. The facility includes customary negative covenants that, among other things, restrict our ability to incur indebtedness or enter into certain change of control transactions. It also contains customary events of default that would result in the termination of the commitments under the facility and permit the lender to accelerate payment on outstanding borrowings. As of March 31,September 30, 2022, we were in compliance with all covenants under the facility. The initial term of the facility is 60 months with interest-only payments, with the repayment of principal being amortized over a period of: 36 months, if we fail to achieve the revenue target for the third installment, 24 months if we achieve the revenue target for the third installment but have not raised at least $50.0 million in an initial public offering, or 12 months if we achieve the revenue target for the third installment and raise at least $50.0 million in an initial public offering. Upon completion of raising over $50.0 million in our IPO in September 2021, interest-only payments was extended an additional 12 months followed by 12 months amortization of principal and interest. We pledged substantially all of our assets as collateral for the loan. Commencing with the quarter ended June 30, 2021, we are required to achieve revenue for the previous six months ended equal to 70% of the forecast for the commensurate quarterly period. Additionally, in connection with the loan facility, we are obligated to pay a fee upon the earlier occurrence of a defined liquidity event, including but not limited to, a merger or sale of our assets or voting stock, or our achieving a $200.0 million trailing twelve months revenue target, in each case, by September 2029. The fee is calculated at the time of the liquidity event occurrence to be $1.0 million if only the first installment has been drawn, $2.0 million if
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the first two installments have been drawn, $2.4 million if the first three installments have been drawn, or $3.0 million if all four installments have been drawn, in each case, upon the occurrence of the liquidity event. As of March 31,September 30, 2022, we have drawn on the first two installments. As of March 31,September 30, 2022, we had $50.0 million outstanding under the loan facility.
In October 2022, we entered into a loan and security agreement (the "CIBC Loan Agreement") with Canadian Imperial Bank of Commerce ("CIBC"). The CIBC Loan Agreement provides for a senior secured term loan facility
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in the aggregate principal amount of $52.0 million (the "Term Loan Facility") which was borrowed in full on the Closing Date.
The Term Loan Facility was used to pay off the our previous loan facility, transaction fees, and related expenses.
The Term Loan Facility is scheduled to mature on the fifth anniversary of the Closing Date (the "Maturity Date"). The CIBC Loan Agreement provides for interest-only payments on the Term Loan Facility for the first thirty-six months following the Closing Date (the "Initial Interest-Only Period"). The Initial Interest-Only Period will be extended to an additional twelve months if the we achieve either (i) $200.0 million or greater in revenue in any twelve-month period or (ii) $0 or greater in EBITDA in any six-month period. Thereafter, amortization payments on the Term Loan Facility will be payable monthly until the Maturity Date in monthly installments equal to 20% of the then outstanding principal amount of the Term Loan Facility divided by 12 plus any accrued and unpaid interest. We have the option to prepay the Term Loan Facility without any prepayment charge or fee.
The loan borrowed under the Term Loan Facility bears interest at an annual rate equal to the secured overnight financing rate ("SOFR") (calculated based on an adjustment of .10%, .15% and .25%, respectively, for one-month, three-month or six-month term SOFR as of a specified date, subject to a floor of 1.5%) plus an applicable margin of 2.25%.
The obligations under the CIBC Loan Agreement are secured by substantially all of our assets, including our intellectual property and by a pledge all of our equity interests in its U.S. subsidiaries and 65% of our equity interests in its non-U.S. subsidiaries that are directly owned by us. We are obligated to maintain in deposit accounts held at CIBC the lesser of (i) $150.0 million or (ii) all of our non-operating cash.

Cash Flows
The following table summarizes our cash flows for the periods presented:
Three Months Ended
March 31,
Nine Months Ended
September 30,
2022202120222021
(in thousands)(in thousands)
Net cash (used in) provided by:Net cash (used in) provided by:Net cash (used in) provided by:
Operating activitiesOperating activities$(18,231)$(15,198)Operating activities$(55,208)$(40,858)
Investing activitiesInvesting activities(55)(39)Investing activities(1,787)(260)
Financing activitiesFinancing activities1,291 1,225 Financing activities4,930 261,472 
Net increase in cash, cash equivalents and restricted cash$(16,995)$(14,012)
Net (decrease) increase in cash, cash equivalents and restricted cashNet (decrease) increase in cash, cash equivalents and restricted cash$(52,065)$220,354 
Net Cash Used in Operating Activities
During the threenine months ended March 31,September 30, 2022, net cash used in operating activities was $18.2$55.2 million, consisting primarily of a net loss of $17.2$59.0 million and an increase in net operating assets of $3.3$6.7 million, partially offset by non-cash charges of $2.3$10.5 million. The cash used in operations was primarily due to our net loss due to the increase in operating expenses to support our commercialization and development activities. The expansion of our commercialization resulted in an increase in accounts receivable and a decrease in accrued compensation.inventory. Non-cash charges consisted primarily of stock-based compensation and depreciation.
During the threenine months ended March 31,September 30, 2021, net cash used in operating activities was $15.2$40.9 million, consisting primarily of a net loss of $12.8$41.5 million and an increase in net operating assets of $3.6$4.3 million, partially offset by non-cash charges of $1.2$4.9 million. The cash used in operations was primarily due to our net loss due to the increase in operating expenses to support our commercialization and development activities. The expansion of our commercialization resulted in an increase in accounts receivable, inventory and decrease in accrued compensation,prepaid expenses, partially offset by
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an increase in accounts payable. Non-cash charges consisted primarily of depreciation and stock-based compensation.
Net Cash Used in by Investing Activities
During the threenine months ended March 31,September 30, 2022, net cash used in investing activities was $0.1$1.8 million, consisting of purchases of property and equipment. During the threenine months ended March 31,September 30, 2021, net cash used in investing activities was less than $0.1$0.3 million, consisting of purchases of property and equipment.
Net Cash Provided by Financing Activities
During the threenine months ended March 31,September 30, 2022, net cash provided by financing activities was $1.3$4.9 million, consisting of proceeds from exercises of stock options. During the threenine months ended March 31,September 30, 2021, net cash provided by financing activities was $1.2$261.5 million, consisting of proceeds from issuance of Series G preferred stock, net of issuance costs and proceeds from exercises of stock options.
Contractual Commitments and Contingencies
The information included in Note 911 to the condensed consolidated financial statements included in Part I, Item 1 of this Quarterly Report on Form 10-Q is incorporated herein by reference.
Off-Balance Sheet Arrangements
We did not have during the periods presented, and we do not currently have any off-balance sheet arrangements, such as structured finance, special purpose entities or variable interest entities.
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Critical Accounting Policies and Estimates
Management’s discussion and analysis of our financial condition and results of operations is based on our financial statements, which have been prepared in accordance with U.S. generally accepted accounting principles. The preparation of these financial statements requires us to make estimates and assumptions for the reported amounts of assets, liabilities, revenue, expenses and related disclosures. Our estimates are based on our historical experience and on various other factors that we believe are reasonable under the circumstances, the results of which form the basis for making judgments about the carrying value of assets and liabilities that are not readily apparent from other sources. Actual results may differ from these estimates under different assumptions or conditions and any such differences may be material.
The significant accounting policies and estimates used in preparation of the unaudited condensed consolidated financial statements are described in our audited consolidated financial statements as of and for the year ended December 31, 2021, and the notes thereto, which are included in our Annual Report on Form 10-K dated March 22, 2022, or Annual Report, and in “Management’s Discussion and Analysis of Financial Condition and Results of Operations” included in our Annual Report. Therewith the exception of the accounting policy change described in Part I, Item I, Note 2, there have been no material changes to our significant accounting policies during the three months ended March 31,September 30, 2022.
JOBS Act Accounting Election and Smaller Reporting Company Status
We are an “emerging growth company,” as defined in the JOBS Act. Under the JOBS Act, emerging growth companies can delay adopting new or revised accounting standards issued subsequent to the enactment of the JOBS Act until such time as those standards apply to private companies. We have elected to use this extended transition period for complying with new or revised accounting standards that have different effective dates for public and private companies until the earlier of the date that we (i) are no longer an emerging growth company or (ii) affirmatively and irrevocably opt out of the extended transition period provided in the JOBS Act. As a result, our consolidated financial statements may not be comparable to companies that comply with new or revised accounting pronouncements as of public company effective dates.
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We are also a “smaller reporting company” as defined in the Exchange Act. We may continue to be a smaller reporting company even after we are no longer an emerging growth company. We may take advantage of certain of the scaled disclosures available to smaller reporting companies and will be able to take advantage of these scaled disclosures for so long as our voting and non-voting common stock held by non-affiliates is less than $250.0 million measured on the last business day of our second fiscal quarter, or our annual revenue is less than $100.0 million during the most recently completed fiscal year and our voting and non-voting common stock held by non-affiliates is less than $700.0 million measured on the last business day of our second fiscal quarter.
On the last business day of our second quarter in 2022, the aggregate market value of our shares held by non-affiliate stockholders exceeded $700 million. As a result, as of December 31, 2022, we will be considered a large accelerated filer as defined in Rule 12b-2 under the Exchange Act, and we will cease to be an emerging growth company as defined in the JOBS Act. We will no longer be exempt from the auditor attestation requirements of Section 404(b) of the Sarbanes-Oxley Act, and our independent registered public accounting firm will evaluate and report on the effectiveness of internal control over financial reporting.
Recent Accounting Pronouncements
The information included in Note 2 to the condensed consolidated financial statements included in Part I, Item 1 of this Quarterly Report on Form 10-Q is incorporated herein by reference.
Item 3. Quantitative and Qualitative Disclosures About Market Risk
Interest Rate Risk
Cash and cash equivalents of $284.3$249.2 million as of March 31,September 30, 2022, consisted of securities carried at quoted market prices with an original maturity of three months or less and therefore there is minimal risk associated with fluctuating interest rates. We do not currently use or plan to use financial derivatives in our investment portfolio.
In addition, as described above under the subsection titled “Indebtedness,” amounts outstanding under our loan facility bear interest at a floating rate equal to 7.17% plus the greater of 2.2% or 30-day LIBOR. As a result, we are exposed to risks from changes in interest rates. We do not believe that a hypothetical 100 basis point increase or decrease in interest rates or 30-day LIBOR would have had a material impact on our financial statements included elsewhere in this Quarterly Report on Form 10-Q.
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Credit Risk
We maintain our cash and cash equivalents with multiple financial institutions in the United States, and our current deposits are in excess of insured limits. We have reviewed the financial statements of these institutions and believe it has sufficient assets and liquidity to conduct its operations in the ordinary course of business with little or no credit risk to us.
Our accounts receivable primarily relate to revenue from the sale or rental of our products. No customers accounted for more than 10% of accounts receivable at September 30, 2022. One customer accounted for 11% of accounts receivable at March 31, 2022 and December 31, 2021. We believe that credit risk in our accounts receivable is mitigated by our credit evaluation process, relatively short collection terms and diversity of our customer base.
Foreign Currency Risk
A portion of our net sales and expenses are denominated in foreign currencies, most notably the Euro. Future fluctuations in the value of the U.S. Dollar may affect the price competitiveness of our products outside the United States. For direct sales outside the United States, we sell in both U.S. Dollars and local currencies, which could expose us to additional foreign currency risks, including changes in currency exchange rates. Our operating expenses in countries outside the United States, are payable in foreign currencies and therefore expose us to currency risk. We do not believe that a hypothetical 10% increase or decrease in the relative value of the U.S. dollar to other currencies would have had a material impact on our financial statements included elsewhere in this Quarterly Report on Form 10-Q.
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We do not currently maintain a program to hedge exposures to non-U.S. dollar currencies.
Effects of Inflation
Inflation generally affects us by increasing our cost of labor and research and development contract costs. We do not believe that inflation had a material effect on our financial statements included elsewhere in this Quarterly Report on Form 10-Q.
Item 4. Controls and Procedures
Evaluation of Disclosure Controls and Procedures
Our management, with the participation of our Chief Executive Officer and our Chief Financial Officer, have evaluated the effectiveness of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act) as of the end of the period covered by this Quarterly Report on Form 10-Q. Based on that evaluation, our Chief Executive Officer and our Chief Financial Officer have concluded that, as of March 31,September 30, 2022, our disclosure controls and procedures were effective at the reasonable assurance levellevel.
Limitations on Effectiveness of Disclosure Controls and Procedures
In designing and evaluating our disclosure controls and procedures, management recognizes that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives. In addition, the design of disclosure controls and procedures must reflect the fact that there are resource constraints and that management is required to apply judgment in evaluating the benefits of possible controls and procedures relative to their costs.
Changes in Internal Control over Financial Reporting
There were no changes in our internal control over financial reporting (as defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act) during the quarter ended March 31,September 30, 2022 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

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PART II
OTHER INFORMATION
Item 1. Legal Proceeding
We are not subject to any material legal proceedings.
Item 1A. Risk Factors
Our business, financial condition and operating results are affected by a number of factors, whether currently known or unknown, including risks specific to us or the healthcare industry as well as risks that affect businesses in general. In addition to the information set forth in this Quarterly Report on Form 10-Q, you should consider carefully the factors discussed in Part I, Item 1A, “Risk Factors” in our Annual Report on Form 10-K for the fiscal year ended December 31, 2021, filed with the SEC on March 22, 2022. The risks and uncertainties disclosed in such Annual Report and in this Quarterly Report could materially adversely affect our business, financial condition, cash flows or results of operations and thus our stock price. DuringExcept as provided below, during the three months ended March 31,September 30, 2022, there were no material changes to our previously disclosed risk factors. Besides risk factors disclosed in the Annual Report and this Quarterly Report, additional risks and uncertainties not currently known or we currently deem to be immaterial may also materially adversely affect our business, financial condition or results of operations.
These risk factors may be important to understanding other statements in this Quarterly Report and should be read in conjunction with the unaudited condensed consolidated financial statements and related notes in Part I, Item 1, “Financial Statements” and Part I, Item 2, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” of this Quarterly Report. Because of such risk factors, as well as other factors affecting our financial condition and operating results, past financial performance should not be considered to be a reliable indicator of future performance, and investors should not use historical trends to anticipate results or trends in future periods.
The terms of our CIBC Loan Agreement require us to meet certain operating and financial covenants and place restrictions on our operating and financial flexibility. If we raise additional capital through debt financing, the terms of any new debt could further restrict our ability to operate our business.
As of September 30, 2022, we had $50.0 million outstanding in the form of a term loan under our loan and security agreement with Oxford Finance LLC (the “Oxford Loan”), which was repaid in full and terminated in October 2022. In October 2022, we entered into a loan and security agreement (the "CIBC Loan Agreement") with Canadian Imperial Bank of Commerce ("CIBC"), which we drew down $52.0 million upon closing. The CIBC Loan Agreement is secured by substantially all of our assets, including all of the capital stock held by us, if any. The loan and security agreement contains a number of restrictive covenants, and the terms may restrict our current and future operations, particularly our ability to respond to certain changes in our business or industry, or take future actions. See the section of this Quarterly Report on Form 10-Q titled “Management’s Discussion and Analysis of Financial Condition and Results of Operations—Liquidity and Capital Resources—Indebtedness.”
The CIBC Loan Agreement contains customary representations and warranties and affirmative covenants and also contains certain restrictive covenants, including, among others, limitations on: the incurrence of additional debt, liens or other encumbrances on property, acquisitions and investments, mergers, consolidations, liquidations and dissolutions, asset sales, dividends and other payments in respect of our capital stock, prepayments of certain debt, transactions with affiliates and changes to our type of business, control of the business or business locations. The loan and security agreement also includes financial covenants that require us to, among other things, meet certain revenue targets detailed in an approved forecast. The loan and security agreement also contains customary events of default. If we fail to comply with such covenants, payments or other terms of the agreement, our lender could declare an event of default, which would give it the right, among other things, to declare all borrowings outstanding, together with accrued and unpaid interest and fees, to be immediately due and payable. In addition, our lender would have the right to proceed against the assets we provided as collateral pursuant to the loan and security agreement. If
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the debt under the loan and security agreement were accelerated, we may not have sufficient cash or be able to sell sufficient assets to repay this debt, which would harm our business and financial condition.

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
Sales of Unregistered Securities
None.
Item 3. Defaults Upon Senior Securities
None.
Item 4. Mine Safety Disclosures
Not applicable.
Item 5. Other Information
None.
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Item 6. Exhibits
The following exhibits are filed or furnished as a part of, or incorporated by reference into, this Quarterly Report on Form 10-Q.
Exhibit No.Exhibit Description
3.1
Amended and Restated Certificate of Incorporation (incorporated by reference to Exhibit 3.1 to the registrant’s Current Report on Form 8-K filed on September 21, 2021)
3.2
Amended and Restated Bylaws (incorporated by reference to Exhibit 3.2 to the registrant’s Current Report on Form 8-K filed on September 21, 2021)
31.1**
31.2**
32.1**
32.2**
101.INSInline XBRL Instance Document – the instance document does not appear in the Interactive Data file because its XBRL tags are embedded within the Inline XBRL document.
101.SCHInline XBRL Taxonomy Extension Schema Document.
101.CALInline XBRL Taxonomy Extension Calculation Linkbase Document.
101.DEFInline XBRL Taxonomy Extension Definition Linkbase Document.
101.LABInline XBRL Taxonomy Extension Label Linkbase Document.
101.PREInline XBRL Taxonomy Extension Presentation Linkbase Document.
104*Cover Page Interactive Data File (embedded within the Inline XBRL document)
__________________
*Filed herewith.
**    Furnished herewith.    


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SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, as amended, the Registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
Dated: May 6,November 4, 2022
PROCEPT BIOROBOTICS CORPORATION
(Registrant)
/s/ Reza Zadno
Reza Zadno, Ph.D.
President and Chief Executive Officer
(principal executive officer)
/s/ Kevin Waters
Kevin Waters
EVP, Chief Financial Officer
(principal financial and accounting officer)

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