Good day, ladies and gentlemen, and welcome to the Sanara MedTech Inc. fourth quarter and full year 2021 results and business update. At this time, all participants have been placed on a listen-only mode, and we will open the floor for your questions and comments after the presentation. It is now my pleasure to turn the floor over to your host, Callon Nichols. Sir, the floor is yours.
Thank you, and good morning, everyone. I'd like to welcome you to Sanara MedTech's earnings conference call for the quarter and full year ended December 31st, 2021. We issued our earnings yesterday afternoon, and I would like to also highlight that we will post today's deck on our investor relations page. This supplemental deck, as well as a copy of the earnings release, the Form 10-K, and a transcript of this call will be available on this page. We will reference this information in our remarks today. We expect today's prepared comments from Ron Nixon, Executive Chairman, Zach Fleming, Chief Executive Officer, and Mike McNeil, Chief Financial Officer, to last approximately 15 minutes to allow time for Q&A.
Certain statements in this conference call, in our press release, and in our supplemental deck include forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. For more information about the risk and uncertainties involved in forward-looking statements and factors that could cause actual results to vary from those projected or implied by forward-looking statements, please see our most recent annual report on Form 10-K. Now I'd like to turn the call over to Ron Nixon.
Thank you, Callon, and good morning, everyone. Sanara generated $7 million in revenue and had a net loss of $3.6 million in the fourth quarter of 2021. For the full year, revenues were $24.1 million, representing a 55% increase from the prior year. Our net loss in 2021 was $8 million. Despite impacts from COVID-19 surges throughout the year, our surgical team was able to generate record sales in both the fourth quarter and the full year. Our net loss was largely driven by an increase in SG&A, higher R&D costs, and the recognition of losses on equity method accounting for our investment in Precision Healing.
Throughout the year, the surgical leadership team continued to focus on adding high-quality, experienced regional and territorial sales managers to our sales force, gaining additional hospital approvals, driving product adoption, and introducing new products. Zach will cover more of this in his remarks. In the fourth quarter, we continued to work on our rollout of our EMR, of our EMR WounDerm. We also completed the first virtual consult as part of our pilot in the home health industry segment and continued advancing the development of the WounDerm platform. Also in the fourth quarter, we made additions to the board and changes in leadership team to strengthen our teams. In December, Michael Carmena retired and stepped down from his position as Vice Chairman of the Board and Principal Executive Officer.
I'd like to take this opportunity to thank Mike for his years of service at the company and for helping to set the foundation for where we are today. The board made the decision to promote Zach Fleming to Chief Executive Officer in recognition of his leadership skills, strategic vision, and industry expertise. In December, Roz Mac and Eric Tanzberger were appointed to our board, both are value-added board members, and I'm confident that their expertise and experience will add differing perspectives as we continue to execute our strategy. Now I'd like to turn it over to Zach Fleming to discuss our results in more detail.
Thanks, Ron. Our surgical team continues to grow in terms of sales, hospital approvals, and the size of our team. In the fourth quarter, we added an additional person to our field sales team, and that brought the total to 30 individuals. Seven of these are territory sales managers or TSMs. Going forward, we will continue to increase the proportion of TSMs to regional sales managers or RSMs in our sales force. The TSMs work to further penetrate markets covered by our regional sales managers, and they generally receive a lower salary compared to the RSMs, while the RSM model will continue to be utilized to open markets, and they will establish business and grow our representative coverage. We continue to see growth in our distributor partnerships and increase both the number of teams and individuals representing our products.
At the end of Q4, CellerateRX had been sold in 471 hospitals and ASCs across 26 states. That was during the full year of 2021. We were approved to be sold in over or in approximately 1,100 facilities. As we've discussed before, we believe there are approximately 12,000 hospitals and ASCs in the United States where CellerateRX Surgical could be used. In Q4, we continued to see strong demand for and interest in our products. As Ron mentioned, our team achieved record sales for both the quarter and the year. December was also a record high sales month for the company. Throughout the year, we saw an increase in our sales across a larger geographic area as well as wider adoption within key facilities.
We also formally launched two innovative extracellular matrix products, FORTIFY TRG tissue repair graft and FORTIFY FLOWABLE extracellular matrix. We saw our first sales of FORTIFY TRG tissue repair graft in Q4. FORTIFY FLOWABLE is included in a facility's medical severity diagnosis-related group payment for each unique case. For FORTIFY TRG in the hospital setting, the product is also considered part of the MS-DRG payment. However, in ambulatory surgical centers, it falls under a HCPC code or H-C-P-C code and is packaged into the facility's payment for each unique procedure performed. Turning to our comprehensive strategy, we continue to have discussions with a number of value-based and at-risk healthcare companies. In Q4, our pilot for virtual consults in the home healthcare space saw positive results, and our partner is committed to expanding the service offering from one to an additional six agencies in the Midwest in Q1 2022.
WoundDerm is now licensed in all 50 states, expanding our ability to offer wound care virtual consult services. Additionally, in Q4, we started the implementation process with Homecare Homebase, the largest EHR provider in the home health market, to integrate the WoundDerm mobile app. The Precision Healing Imager 510(k) is being prepared for submission to the FDA and is expected to be filed before the end of Q3. The submission target date was changed due to a strategic decision to file with the commercial unit design rather than the beta unit design. If we had filed using the beta design, we would have been required to file a new submission on the commercial unit as well.
The Rochal assets are now fully integrated into Sanara as Rochal Technologies, and we continue to work with the added Rochal employees on a number of products, including next generation CellerateRX and HYCOL, as well as BIASURGE, our sterile antimicrobial cleanser for the surgical market. I'll now turn it over to Mike McNeil to discuss our financial results.
Thank you, Zach. For the year end December 31st, 2021, we generated revenues of $24.1 million compared to revenue of $15.6 million in 2020, an increase of 55% over prior year. The higher revenues in 2021 were primarily due to increased sales of our surgical wound care products as we continue the execution of our strategy to expand our sales force and independent distribution network in both new and existing U.S. markets. SG&A expenses for the year ended December 31st, 2021 were $28.1 million, compared to $18.7 million in 2020.
The higher SG&A expenses in 2021 were primarily due to increased selling costs resulting from our sales force expansion and operational support, higher sales commission expense as a result of higher product sales, higher non-cash equity compensation costs, higher payroll costs related to the mid-year addition of the Rochal workforce, and higher costs associated with the launch of our WounDerm technology platform. Breaking down SG&A a little further, sales force expansion and operational support were responsible for 16% of the increase, while higher commissions related to our higher sales represented approximately 39% of the increase. Non-cash equity compensation was responsible for 9% of the increase, and costs related to WounDerm and Rochal accounted for 22%.
In addition, the costs related to travel and in-person promotional activities increased in 2021 after those activities had been canceled or postponed in 2020 as a result of the COVID-19 pandemic. These costs accounted for 8% of the increase in SG&A. As part of our continued strategy to expand our sales reach in new and existing markets, we employed 11 additional field sales managers since December 31st, 2020. For the year ended December 31st, 2021, we had a net loss of $8 million compared to net loss of $4.4 million in 2020. The increase in net loss in 2021 was due to the higher SG&A costs discussed, higher R&D expenses, and the recognition of our equity method investment in Precision Healing. Cash on hand at the end of the year was $18.7 million.
Cash used in operating activities for the full year was $4.8 million. Cash used in operating activities in the fourth quarter was $1.8 million. The large increase in the fourth quarter was partly due to our strategic year-end inventory build, which negatively impacted fourth quarter cash by approximately $500 thousand. I'll now turn it back over to Ron for a few closing comments. Ron, you may be on mute.
Thanks, Mike. As we discussed in both the fourth quarter and the full year of 2021, our team generated record sales and saw the continued adoption of CellerateRX. We continued to pursue potential partnerships for our comprehensive wound strategy while progressing on the Precision Healing Imager and new product development. That concludes our remarks, and we look forward to answering any questions you may have. Matt, we're ready to open the call for questions. Thank you.
Certainly. Ladies and gentlemen, the floor is now open for questions. If you have any questions or comments, please press star one on your phone at this time. We do ask that while posing your question, please pick up your handset if you're listening on speakerphone to provide optimum sound quality. Once again, if you have any questions or comments, please press star one on your phone. Please hold while we poll for question. Your first question is coming from Ian Cassel from MicroCapClub. Your line is live.
Hey, congratulations on an amazing year and also an amazing quarter. One of the questions I had was about Q4. I mean, you guys showed some nice acceleration in the numbers in Q4 when almost every other med tech company I track was making excuses on why they were contracting. I just thought that's obviously a sign that you guys are executing. I also wondered, was there anything abnormal about Q4, you know, sort of a one-time stocking order or anything that positively skewed kind of Q4 over and above kind of normal execution?
Thank you, Ian.
This is Zach. I'll go ahead.
Zach, go right ahead and answer that.
Sure. There was nothing unusual. I would just say that the, you know, kind of gate from COVID had opened. More surgeries were being done. Some of the backlog was, you know, of course, a lot of our surgeries are elective, and so those were starting to be done. So we had less problems, I would say, related to COVID in that fourth quarter. It was nothing unusual or large stocking order or anything of that nature.
Maybe a follow-up question to that, Zach. You know, what is like the normal cadence during the year? I know historically kind of Q3 is normally the weakest quarter because a lot of the surgeons go on vacations and things like that. Is there any other kind of seasonality among the year?
I think you nailed that. We see that the fourth quarter tends to be pretty heavy, as you can imagine, as people start to come to the end of their deductibles and have the ability to do their surgery that maybe they've been putting off, vacation time, et cetera. So that tends to be heavy. We see sometimes a lag right after the holidays. I think that's fairly typical throughout medical. As you mentioned, the summertime can be a little seasonal with vacation. I think you actually hit it right on the head.
Okay.
Ian, I would say that one of the thing that leads to our outperformance of the other equivalent med tech companies that you're tracking is the fact that with the expansion of our geographic coverage and penetration into more hospitals, we have a larger pool that we're fishing in now, and we continue to grow that pool. Consequently, it aids us in outperformance.
You know, maybe kind of on the other side of that question is, you know, obviously, COVID may had impacts in January. Do you guys see, you know, material impacts from COVID in January, or was it kinda mainly business as usual, and you were able to kind of pick up in other areas?
Zach, in 2022-
Hi there. Go ahead, Ron.
No, I was just gonna say, I think Zach will confirm this, but, our continued strategy is being executed, and we think things are much more back to normal. We're not seeing anything unusual.
Okay.
Try to echo that.
Maybe one last question, then I'll just jump back in the queue. You mentioned your WoundDerm pilot expanding from one agency to six agencies. Can you explain that a little bit more? Like, what is an agency? Is that a building? Is that a territory? Maybe, you know, kind of explain kinda what the potential of that partnership would be if it's successful.
Yeah. An agency is where the location of the home healthcare company is, but they cover up. They differ in terms of the quantity of patients that they have in that region, but they do have a, you know, it's typically 50-mile radius or less that they've got that they draw from for those patient populations.
Okay. Thank you.
Mm-hmm. Thank you, Ian.
Thank you. Once again, ladies and gentlemen, if you have any questions or comments, please press star one on your phone at this time. Please hold while we poll for questions. Your next question is coming from Scott Weis from Semco Capital. Your line is live.
Good morning, guys. Great quarter, great year. As a follow-up to Ian's question, now that we are through the first quarter, can you comment on January, February, March trends? Did you see a continuation in the strong growth you saw through the fourth quarter?
You know, Scott, we really try to avoid giving any, you know, forward-looking statements, but I think it kinda summed up what I said earlier, which is we're continuing to execute our strategy, and we're not seeing any disruptive factors that are hurting that. I would just say for us, it's business as usual.
Okay. Understood. As a follow-up, can you talk about your investor relations strategy? Do you have any intention in 2022 to participate in conferences, investor events, anything like that we can expect, 'cause I'd like to meet you sometime on the road, if possible.
Yeah. We haven't decided that yet, Scott, you know, because everything turning back to normalcy now, we're trying to figure out travel schedules. We're looking at conferences that we wanna go to, et cetera. We'll post that when we determine what our schedule's gonna be and let you know in advance.
Okay. Thank you.
Thank you, Scott.
Thank you. Once again, ladies and gentlemen, if you have any questions or comments, please press star one on your phone at this time. Please hold while we poll for questions. Your next question is coming from Ian Cassel from MicroCapClub. Your line is live.
Yeah. I had a follow-up question on Precision Healing, you know, kinda your disruptive wound diagnostic product. You know, can you talk a little bit more about how Precision Healing kinda fits into your long-term strategy? And maybe also, you know, how you intend to monetize that as part of the strategy. Is there a reimbursement code that you can tap into in the reimbursement side for diagnosing wounds? Like how should we think about that?
Yep. Very good question, Ian. I'm happy to take that. Precision Healing is an important part of our overall comprehensive strategy because as we've said on many calls before, this is an industry that has not had the diagnostic capability, and a lot is done by visual sight and experience through wound care providers. We believe that having a multispectral imager system that includes our biomarker assay will give us a distinct advantage in terms of understanding what is going on in the wound bed to then be able to develop precise treatment protocols and formularies for the wounds. We think it's a very critical component to what we're doing. The way it would be reimbursed, it's either gonna be reimbursed under a code, and there are some predicates out there that have already received a code.
Obviously, you have to have coverage for that code, meaning it's somebody's gotta pay for that. Ultimately, for us, as we've said many times, the value-based side of this business is where we believe it should go and head, and that we wanna be an integral part of bringing that solution to the table. The imaging system, which includes the biomarker assay, will be something that will be very critical for us to really understand where we are and how we need to treat in order to be able to provide lower cost treatments and better outcomes.
On Precision Healing, Ron, is that a product that you think has also the potential for you to license that out perhaps internationally to get broader adoption, you know, at the same time?
I think it has several potential opportunities. We haven't explored any of those yet because we're ready to get it into the field and get it used and, you know, beyond the extensive study that they've done on patients at University of Miami and Brigham and Women's up at Harvard. Yes, we will be exploring that for applications, and that's probably not something that we would pursue if it's out of our field, and the wound care would be in our field, and skin, it would be in our field. Outside of that, any applications that could utilize that technology would probably be under some sort of a partnership or license if we identify it.
Yeah. I saw in the 10-K you began co-promoting, I believe, starting early this year in 2022, some products with Scendia Biologics. Could you kind of explain the potential of those products?
Yeah. Zach, I'll let you take that.
Sure. Yeah, we felt like we needed to offer what the surgeon needs to make surgeries go well. We had this partner, Scendia, that's out of Orlando. They were a distributor for us initially and had done a really nice job. We started to really understand their business, and they have these complementary products that you saw. Those products we noticed in all these other surgeries that we go to, they were often being used. Now they're bone biologic-type products as well as amniotic products. We thought there's a great handhold between that and Cellerate in order to complement. Then in a real quick fashion, we were able to put together a relationship with them and grow that.
It's been able to now go into a joint venture, and I think that's gonna be a real boon for us. I do think there's some good long term with that as well. I don't know, Ron, you might have some additional comments.
No, I think you did a great job summing that up.
Okay. Maybe one other question, and, you know, either Zach or Ron, you can take this. Maybe you both have different opinions. Which product that you're working on today that isn't on market are you most excited about?
For me, probably BIASURGE, because that's something we think would fit nicely in the surgical market. Quite frankly, if it's in our portfolio for development, I'm excited about it, because it means that we see a fit to our either overall comprehensive strategy or to surgery.
Yeah, I would echo BIASURGE, but I'd also add Precision Healing. They're both very unique, one of a kind, great products, you know, potentially game changers in certain spaces. The BIASURGE is very complementary to what we already carry, again, kind of complementing the surgeon, in terms of putting things in his hands or her hands that can complement the outcomes of their surgery.
Okay. I lied. One more question. I saw this week that the largest health insurer acquired the largest in-home health provider. I was wondering, you know, if you think that's a catalyst for your business and your vision. Just some overall thoughts on that.
You know, every home healthcare company and every provider is a potential partner for us. You know, I don't think it hurts at all that you see more vertical integration of the provider and their services to extending all the way through the home, and we think the home will be a critical part of our overall strategy as well.
Thank you.
Thank you. Once again, ladies and gentlemen, if you have any questions or comments, please press star one on your phone at this time. Please hold while we poll for questions. Thank you. That concludes our Q&A session. I will now hand the conference back to Ron Nixon for closing remarks. Please go ahead.
Well, thank you everyone for joining our call this morning. We greatly appreciate having the opportunity to report our results. Thank you all for participating. Matt, thank you for hosting it.
Thank you, ladies and gentlemen. This concludes today's event. You may disconnect at this time, and have a wonderful day. Thank you for your participation.