BoneChat #100: Unique Venture Studio & Overland Mobile Labs for anytime anywhere surgical training.

Okay, today on Bone Chat number 100, I can't believe this is 100. We have John Allaman. It's a pleasure to welcome back John. Uh, he's founder and general partner of a venture firm called Endeavor 45, founder of Overland Mobile Labs, we'll hear about that, and an early BoneChat member. So take it away, John, the mic is all yours.

Okay, well, uh, it's good to see everybody. Um, I will throw up some slide decks. My goal, and what I'll do is I'm going to introduce, uh, let's see if I'm sharing that properly, is to— I'll introduce Matt and Natalie, and then I'll do a quick run-through on, uh, an update on Endeavor 45, kind of where we are, what world we're living in, and how things are going. And then I'll talk to you guys, uh, briefly, uh, about, uh, the Overland Mobile Lab that we created. And Natalie is the general manager, and Matt is my— is a co-founding partner. Um, so, uh, let me introduce Natalie. So Natalie Zuniga, uh, came over to help with Endeavor 45, kind of on the venture and product development side. She had a fairly significant history with Acumed in running their medical education group, which included the mobile vans that came over from Exomed. So Natalie came over and we, you know, she helped us on the other part of our business. But the idea of these mobile labs and how valuable they were to Exomed and how much I needed them when I was running Endeavor Orthopedics, and just knowing how valuable those early labs are, we just kept talking about it and kept talking about it. Matt, as a, uh, Matt Woods is a distributor in Cleveland. He's the co-founder, and Matt also, uh, and I had been talking about how this could be such a valuable resource that was really hard for us to access. So then, then all this, basically all the stars aligned. Matt and I decided we would never have done that venture. Ultimately, it took us a year and a half of due diligence. And we really— it came down to the fact that Natalie and some of the other team members are so experienced in this because it is much more nuanced and difficult than any of us had anticipated legally, logistically, and all those things. So anyway, Matt's a business partner from the past, but now a co-founder of Endeavor. Or I'm sorry, of Overland Mobile Labs. And Natalie is the general manager and the CEO of Overland Labs. And we are underway. We haven't taken delivery of the first truck. I'll show you guys that in a second. But we are— I don't know, we just put out a bid that would book the first truck for the entire year. So we might have to buy more trucks.

We'll find out.

Anyway, so I will hit you guys up on those details in a second. But let me give you guys a quick overview of Endeavor45. And, um, you guys, I think I've talked about this before, so I'll try to be fairly brief. Uh, the more— I'm actually very glad there are more and more of these types of companies are popping up, and that, that to me is a positive thing. It tells me that, uh, the need is really there. Um, the companies are just not doing even, even their own basic development. Um, the idea around Endeavor was fundamentally— I'll just leave this out here, I won't read it to you, but it's, uh, as a guy coming out of the corporate world, I couldn't get anything done in terms of innovation and delivering new products. So whether that was with Synthys or Acumed or MedArtist or whoever it was, the only time that I had any success getting products to the market was when I was working with the little startups, and it was the most fun. And so 45 is— I started when I was 45 years old, so it was kind of a nod to the older folks that you can still do something Cool. And the whole goal was somebody has to take responsibility for delivering innovation in this space for patients and for like, who else is going to do it? Everybody else is bailing on it. At least that was my experience. So we formed a company that would be very, very good at the early ideation to maybe the first, we say 500, but probably 100 or so cases, right? So we could build and deliver implants, innovations to the medical device world in a very cost-effective— meaning we're capitally efficient and we're time efficient. And that's our mission. That's what we want to do. We want to get innovation into patients. And, uh, truly the motivation of the team is I hand-selected everybody who's on the team that has this view that, you know, we, we— even though patients don't know it, we know it— they're waiting for us to be successful. They're counting on us. So that was the impetus for the company. Fundamentally, what we do is we take ideas and we can help fund, we can guide on funding. We do— we have in-house engineering. We're a 1345 ISO group. We have, I don't even— maybe 200+ years of development experience in-house. Same on the regulatory. Again, there's another funding piece typically here. And then we know my background is commercialization, marketing, product management. Starting way back when I was a SynthE sales guy. So we were able to add that commercialization and market understanding at the beginning, which is important. You guys have probably all seen products that get started like, oh, there's no market for this, there's no code for this, nobody wants this. It's cool, but nobody wants it. So we can be a bookend at the front and we can be a bookend at the back, meaning then we can also execute on some early, you know, micro-commercialization. So we basically just take ideas, whether whatever stage you're in, we reduce the risk by executing on basically this path. Um, anybody who's tried to develop a medical device on their own, or Doc— my doctor friend and my aunt who's an engineer, and we'll put all the pieces together— those gears grind. I am convinced that one of the reasons that medical device companies have such a high failure rate is not just that they're risky, and they are, but it has to do with the— people have no appreciation for what these gears are, the level of communication and teamwork that needs to take place. And then you start running into all this stuff. And it— you have now, you know, if you didn't see this coming, you've now wasted $500,000 and you're out. And so we— I would say on a— at least on a monthly basis, I'm experiencing a sad story from a surgeon founder and his cousin Bob, who was an engineer at Boeing, and they've spent $300 grand and now they want somebody else to fund it and they have to start over, right? Because none of the work was done under design controls. None of the due diligence was worked, the voice of customer, all that stuff. So anyway, my dream was to do this, build the right gears in-house. Have it be very, very streamlined. And then therefore we can be, you know, we're minimizing risk and we can use capital very efficiently and intelligently and then get to market. And we also know that the piece at the end here, which is that micro-commercialization or modest commercialization that the big companies are requiring, they won't buy, they typically will not buy IP, they will not buy an idea, they will not buy a cleared product. They want to see $1 million in sales. With the big dogs. So you've got it. You can't just run through the development and then hope that someone's gonna buy it. Again, I shouldn't say never, those things still happen, but it's not daily. It's very rare.

And they want de-risked, uh, innovation.

Yes. And so, so that became— it kind of evolved in like, well, that's what we can do. And a very key component of that is being able to make sure that you're— that you have a legitimate quality management system and you can do the designs, you can move fast. And I really have found that the execution is the hard part. And so having a, you know, a very good system here that's streamlined and efficient, but still compliant to what needs to happen with the FDA, anybody who wants to acquire your company. All of those things, uh, is a very key component. I will give credit to a guy named Gordon Van Umersen, who is a Stryker executive. He said, John, if you do this, get a quality management system. I've— we've had to kill so many deals because we look and we go, they want $20 million, it's going to cost us $11 million to remediate everything because we got to start over, and it's going to be then another 5 years. So, um, we did. We, we, despite the board at the time saying, why are you wasting your money on this, we built a very robust fast but very efficient startup-style 13485 quality management system. And this is— and there's more people to add to this. So Brittany Martinez has joined us. We have a couple engineers in the holding tank. But this is really what makes the thing hum. Not necessarily me, but Mark Summers. We have Natalie, Brandon. Natalie is going to get removed from this, I think, and moved over to Overland, and there'll be some others. But the engineering team and the expertise and the having these folks in-house on a team working on projects is what is making things work. No question. The other thing, Tiger, we were talking about getting older. You quickly realize that you're not as smart as you think you are. And these groups of people are on our advisory board. They are also amazing, also hand-selected. So we have venture capital hedge fund. You know, this is Credit Suisse, people that understand financing and deal structure. We have operation guys. Bob Johnson was the CEO of Acumed for a long time under one of its most successful runs when it wasn't under Randy Hubener over here. You guys may know Bart Bachman, Vijay, Matt's on the call. These, in my opinion, are some of the guys who are the best. At taking new technology and delivering it to the market and getting over that, that hump of like, yeah, you get 3, 3, uh, early adopters, and then how do you get that to everybody else? Yeah, go ahead.

I'm a big fan of Bart and Vijay. I work with them at Ellipse. They're, uh, they're the best.

I, you know, I can't afford Vijay anymore. Like, I'm the one that hired him at Carbofix and got him interested in startup, but Vijay is— if you guys watch CurvaFix, Curvafix is a startup that is doing quite well at the OTA. They train 35% of every attendee went to their labs. I mean, it was— I've never seen anything like it. And then we've got a group of really forward-thinking surgeons. There's probably a couple more that are on here that we tap into based on the projects that we're working on. So this is a nod to knowing that I need bigger brains. We need bigger brains. We do 2 things. We do consulting. So people want a technique guide. People want remediation of their prints. People want a voice of customer study. We do all of that. The— this is, you know, we don't own any equity. We just help execute quickly and cost-effectively for groups that need work. This helps us kind of keep the lights on, but it's also, you know, it allows companies and individuals to really just say, I just need this and we do it. The other part of the business, which is more fun, I would say it's harder, is the kind of the venture side of things. And so what we do is we have a, we've developed a pretty unique way to create portfolio companies. We use a legal group out of Madison, Wisconsin, which is basically just dialed in for this. And they even said, this is really unique, but it's really, really good. But it was hard to build kind of the model, the boilerplates on how we do this. But fundamentally, we partner up with these companies. We, we don't earn, but we have equity, pretty significant equity stakes in these companies. And then we do all of that work to vest that equity, and then we're able to launch these into it could go in many different directions. It can be— there could be a co-development agreement with an OEM. So two of these, Loop Core and Axis 3, likely will be core development or co-developments with larger OEMs. Uh, Cora Innovations— and I'll give you guys a little detail on these things in a second— is likely going to be a standalone that will be an acquisition or may get folded into another, uh, company that we're working on right now. So the whole piece here is that we, we will do Endeavor45 is able to deliver that early-stage, pre-seed, seed-stage work very efficiently and very cost-effectively and getting these products to market. So then they're either able to commercialize on their own if that's what— if that's the best path, or to be acquired or licensed. And so I'll give you guys a little detail on LoopCore. LoopCore is a soft tissue suture-based company. That works in extremity medicine and maybe some other, but right now kind of extremity orthopedics. We are currently working with a few big OEMs that need some of the products that we have slated, and that will likely be a co-development agreement. Cora Innovations is a deformity correction company that is right now focused in the ped space., but will likely— the technology as we're moving forward, uh, will be, uh, patent— it's patentable and will be used in other mostly trauma, uh, um, and, uh, reconstruction procedures. Uh, so that's underway. Uh, and then Axis 3 Ortho, which is the one that's closest to my heart, that is a distal femoral fracture solution company. Again, right now it's a one-product company and we have literally the dream team of surgeon design designers dialed in. And again, it's such a big project that likely we will— we would not take that to market ourselves. We would do that in a co-development vein with one of the big strategics. And we're in those conversations right now, but from my— it's really amazing.

Axis 3 is implants and instruments, right?

Yes, yes. Uh, and I think they all are. So of those ones that are down there, there's a couple right now that we're percolating with, but they haven't become a portfolio company yet, uh, are all implant and instrument systems.

Okay.

Some are very basic, they're going to be a one, one product thing. Some are more broad and they have, um, full, you know, an indication here and an indication there with the same technology. Um, anyway, so that— so, so those things are ongoing and very exciting. And, uh, I do stick to— go ahead, I heard somebody.

So how did you— it's hard to do this from scratch. How did you, uh, you must have raised around, or you have a big chunk of angel funding?

You know, I wish, I really wish, Tiger, but the reason that I look like this And I tell this in all straight— I am happy to share— my wife and I were below the poverty line in 2013. Like, we, we, we, we built it from scratch and it was really hard. Now, that being said, there's some of the way that we do it is kind of built into the kind of the proprietary trade secret way that we do it. But the funding has come in from various sources to, to, to fund these ventures. Okay. So from us, some of it from founders.

Yeah.

But keep in mind, they're all pre-seed and seed. So it's pre-early stage stuff. So it's not tens of millions.

Yeah. Hundreds of thousands to get them started.

Yeah.

Yeah.

Got it.

Yes.

And we live and breathe in that space because we think we can drive the most value there. We can get these companies to places where they are attractive. They're structured correctly. They have you know, the products have all been developed under, you know, the 1345 guidance so that when, let's say, Luke Corps, so when I'm just going to make this up. So when DePew says we need that, they look at it and they go, oh, we don't even have to remediate anything. Or, yeah, yeah. So, I can tell you it hasn't been hard, but I'm glad that we did it and some of it Honestly, it's been good luck. I, you know, it's just we— these things lined up and then we got good at them and now we're able to do them. So, coming back to the premise, I think what I've learned, maybe an update for everybody who is interested in this type of work, is the ideas are— there's a lot. I spend a lot of time saying no or maybe later, but it really has to do with that execution step and being very good at taking the idea and then actually delivering the stages of the, of the delivery. And so that's who we are. We, we, we fit in as the execution team, whatever stage things are, are at so that we can get the innovation into the house. This is one that we did that I'm really proud of. It was really the first main one. They share my name because the truth was we were lazy and I just said, hey, why don't we just, we'll just do a modification of Endeavor 45. Who cares? We'll just do it. It'll save us some money on the branding. And so Endeavor Orthopedics was— is related to Endeavor 45, and we just own— I just own a stake in that company, but they are off and running. I think they're well over 200 cases now. The clinical data is coming back significantly better. So where there's typically 20 to 50% revision on patella fractures, their, their cases are now showing 3 to 5, and that is aligning with some of the other independent clinical trials that are talking about patella fractures that don't really deal with this system particularly.

So, and the, the secret sauce is you've married, uh, mechanical fixation with soft tissue, uh, repair.

Yes, in a way it's, it's a, it's a way to deal with avulsion fractures where during the healing process, there's avulsion forces trying to pull things apart. And there's a soft tissue component that if you neutralize that or work with the soft tissue component, you get really, really good, stable fixation, and then early mobilization, which continues to be a theme through what's very important is early mobilization. And the cool thing I love, the cool thing about this is if you look at the sutures, and they're like zip ties, or like, I think the Zipknot is the trademark that they have. But they, you know, you, you put anything together, You sew it up with crack house stitches, you do all this cool stuff, and then you kind of— and it's almost like the old tightrope days where doctors like, ooh, you know, it's really fun to do, but it makes a big difference in tying these extensor mechanisms together. So in this fracture, the fact that that entire extensor mechanism, not just the bone, is fixed is very important. If you look at a lot of the solutions today, most of it deals with the bone and maybe the adherence to the soft tissue here, but it rarely does it include the quads, tendon, and patellar ligament, uh, really being dialed into the whole thing. Anyway, um, so that is Endeavor 45. Um, yeah, it's, it's, it's been— I feel like it's okay. I'm almost 54 now, and we're finally doing what I want. So that just means we're doomed.

That's Endeavor 54 now.

Endeavor— we're Endeavor 54, which I don't even— I shouldn't admit that. But, uh, so anyway, so, so one of— as we mentioned, this Overland Mobile Lab concept really sprung up. And I will say that it started kind of as a side hustle idea. It evolved into something like, this is a very needed service for these startups, for the big companies, because Natalie— our experience and Natalie's experience is to set these up in-house, unless you are a monster at J&J, it's very difficult to spend millions of dollars a year on keeping these labs running 24-hour, you know, every day of the year. Um, and the return on that can be questionable. So in Acumed's case, let's say you're training on a 10-year-old elbow platform. This might help a little, but it's not, you know, it's not going to help a lot. But when you're launching a new product or when you need to convert a big-time doctor, this is very helpful because you can show up at their house and show up at their clinic, and within an hour they're like, we love— this is amazing. So Natalie and Matt, you guys jump in where I screw this up because I really, you know, I've been very involved in the due diligence, but Natalie is running this business. We believe that, you know, obviously these training components are very important. One, patient safety, patient understanding. I don't know about you guys, I used to be in the field a lot and you'd go in and they'd be like, "Yeah, yeah, it'll be fine, we'll figure it out." You're like, "Oh God, please let me show it to you before the case." And they're kind of, you know, that never seems to be wonderful. So we believe fundamentally for everyone involved, the training is is, is not really optional. The other thing we noticed— so when I was at Endeavor Orthopedics, you know, the board was on me. We need, you know, we need cases. So how do we get cases? This was— the implant was something that you needed doctors to touch and feel and look at and use, and then the, you— the aha moment would come on. So we try to set up labs and they'd be like, well, we maybe next October, and then, oh, I'd have to take vacation time, like, so the timeline to get to those doctors that were heavy patella plate users or thinkers was unbelievable, right? So they were so busy, they had families because they were typically the— right in the pinnacle of their career. We couldn't get them anywhere. So, you know, set up in a hotel, that was never good, that never felt good. We decided not to do that anymore. And so, um, I called Exomed. That's how I got to know John Holder. I said, Hey, I want to rent your vans. And they were like, yeah, no, you cannot. I'm like, can we ride with you? We'll do a co-share. No. So long story short is I needed one as a startup CEO and I couldn't get one. And the HCP's time, one thing that I've continually thought about is it's not just convenient for the— and financially advantaged for the companies that use this service. The doctors are happier. They are— they do a cadaver lab in an hour. They don't have to go anywhere. They get to go home at night. We come to them. So it's not just the company that's happy because of the shortened timeframe. It's the— their customers are thrilled with the service.

I'll second that. Let me— my first job was called NovaLine. We had a humeral fracture system and we had to fly surgeons into the Mary in Memphis every 6 weeks. And the gating item was the surgeon's calendar and it slowed development down. So yeah, wow, we would have used this for sure.

And that was it. Little things have sprung up like development labs and getting to your design surgeons and verification validation labs. There's all kinds of things that have— we've been getting inquiries about that we think this will be helpful. And we know from the business side. Now, if you're— Natalie, plug your ears. So if you're from a bit— if you're from the med ed side, you know, you're really not supposed to mix med ed and business. But we know from the business side of things that the time for a surgeon to adopt a new technology can be greatly condensed if they have a wonderful experience in a cadaver lab. And so fundamentally, that means time to revenue is greatly increased. And again, we're not an OEM. We're not manufacturing these products. So I feel very comfortable that we can say that. And we do notice that we get a lot of attention from the sales side of the organization, right? But we make sure, you know, we do it right. We don't make commitments and promises on the sales side, but we all know that intuitively if the doctor's trained and they like it, the chances of adoption are much better. So our statement is this: we believe that surgical training is critical. It's better without travel. And we can bring this kind of white glove service right to the customers. And that makes a big difference for everybody. And the lab is almost done. And so I have a couple pictures, but they're beautiful. When I went to visit it, I was like, oh my gosh, now I know why this thing was so expensive. Because they really are. It's like a little operating room on wheels. It's got, you know, 3 training stations. It's got 2 X-ray machines. It's got you know, a high ceiling so people don't have to crouch over. They're really cool. I think it's going to have an air horn. Anyway, so this is it. And Natalie, one of the big values that Natalie is bringing to all the customers is just her one exemplary skill set on organizing, training, medical education, understanding medical education. So her service her skills come along. So if Zimmer Biomet says, we wanna do these 19 labs, they get Natalie to help them plan that and to organize it and to make sure it goes where it needs to go, when it needs to get there. It's got a driver who is basically a lab technician, but he's not a guy unlike me. He's a guy who has been in the field, in the operating room, and totally understands what we're doing. So he won't be doing the training, that will be the company representatives,, but he will be making sure that that lab is smooth and we handle everything. We handle the specimens, we handle the cleanup, we handle the gowns, like everything. So it's, you know, it's a white glove. It's the Zimmer Biomet team can come do their lab and they're out and we go on to the next one. And like I said, Matt and I, without Natalie and the team, we would have been like, yeah, we're not doing it. There's a lot to it. So, Natalie, the colors on this slide change. I think that's because I moved it over to— I think, yeah, they did. Yeah, sorry about that. So, so I think I've covered all this, but here's some things on the right that we think this will be a great fit for: product conversions, new product launches, which I think for me was always a big one, a journal club, trade shows. We can— with some trade shows, we can put this lab with— let me go back to the picture of the lab— with the Zimmer Biomet information all over it, and it can be parked on the floor. In some cases, we have to do things like remove the gasoline. There's some stuff you got to do, but it can sit on the trade show floor. Value analysis sometimes requires training of OR staff, the validation labs, design surgeons, stuff that I spend a lot of my time in, and then sales consultant training. So really, we can deliver any of those types of trainings to someone's house, a Starbucks, a clinic lab, a distributor's parking lot, wherever it needs to be. And we didn't, we actually did not believe that we were going to be the cheaper option. We didn't want to be. We didn't want people to be like, oh, this is less expensive, let's do it. We wanted people to say, oh, this is fast, it's amazing, and it's worth every dime because I can get to these 10 doctors. But when we ran the modeling, as the modeling evolved, we realized because this van can go around, we can get a lot of people trained in one geographical area in the course of a day. And so therefore the cost per doctor that's not flying doesn't need a hotel, doesn't need food, Maybe, maybe we have a taco truck that follows us. I don't know. Um, you know, does it, you know, really can get in and out, does not have leave. The cost per doctor per training goes way, way down. And so we believe we are likely significantly less expensive than the flyaway labs, modestly or lightly less expensive than a local, you know, you gotta, you do the local lab at a cadaver lab. We may not be cheaper than— I got a guy with an X-ray machine and we're going to be at the Courtyard Marriott, you know, walking around on Saran Wrap, which we don't think is a really great idea. As a guy who stays at Courtyard Marriotts, I don't— that does— that's kind of gross. But, you know, so that might be a cheaper option, but it's really not what we think is the right way to do it anyway. And then here's just some kind of some comparisons. We think we can— make it better for the customer. We can get to them when they can train. Um, we— and, and we can really ramp up the adoption curve for those new companies very quickly. So likely, you know, we probably wouldn't train on K-wires, right? Because that would take a long time to recoup your cost. But basic implants at the ASPs, even the more competitive ones that they're going for, these labs would pay for themselves very, very quickly if you target the right people.

Hey, Laura Lynn's got the first comment question.

Yeah.

Hey there. Having worked for one of the big fours where we developed our own mobile lab and took it around and then mothballed it, you know, a few years later, I have a few questions. Yeah. So you're dealing with cadaveric samples, right? Yes. Yes. Okay. So, do you have a support vehicle that comes along with the lab, or how do you— are you managing all of that inside? So, we had a semi and a support vehicle and a team of people who were handling the tissue. So, how are you planning to kind of manage that?

Yeah, and I'll let Natalie add some color commentary in here, but essentially, we're doing it very similar to the way that ACUMED did it. So, we're managing all in-house. Our tissue suppliers, which Nadia will give you their acronym, uh, we have a handful of them, uh, had some very— this was all part of that due diligence. So we have alarm systems, locks, 24-hour video cameras, et cetera, et cetera, because we have to maintain monitoring when there are specimens on board. And then the specimens are couriered in and then they are couriered out. Um, and so there's, there is some heavy logistics, which we take responsibility for. We do. But Natalie, what could you add to that?

Yeah, we're working with AATB certified vendors, right? So, Matt and John have listened to me yap a lot about how important it is that we are sourcing our tissue ethically. And so, you know, you guys are obviously familiar with AATB certified vendors. It is kind of the highest standard, but with that comes some pretty strict requirements on storage. So, like John mentioned, Very tight security on these units, um, auditory alarm systems, camera systems that'll ping my cell phone or driver's cell phone if there is a breach ever. Um, and then on board our unit, we also have freezer fridge refrigeration that can hold our specimens overnight. Um, but really the intention is that these specimens are not spending very much time on our vehicle. They're coming in, they're being used promptly for their training, and then they are shipping back out to the to the tissue vendor for appropriate disposition. It's a very similar method to what I ran at ACUMED, and we had quite a bit of success with it. And these tissue companies are catching up to realizing that mobile education is kind of the way of the future. There's a lot of companies looking to go this way.

Yeah. Yeah, I congratulate you for this idea because I think it's a great idea. I think, you know, one of the challenges that we had in my tenure with this company was that, you know, the lab is only really as successful— we had some that were hugely successful because the local sales team was really on board and they did a really good job. But we had some that were also not successful for the, you know, for the contrary reason. And so I think that you guys sort of shift the responsibility. It's, you know, you're going to get paid no matter what. So I think it's brilliant. Whether you've got, you know, 100 surgeons that show up or whether you have 3 that show up, you know, I think that you guys can be really successful with this because I do think it's really needed and I think it offers an amazing service. And, you know, like I said, I think you guys will succeed, you know, even if you have a, you know, a less than stellar, perhaps, you know, site visit. And so I think, but I do think managing that and making companies really understand that you can't just roll a lab into town and, you know, expect it to be really successful. There's a lot of other stuff that has to go into it. And, you know, it sounds like you guys have the experience with, you know, coaching and consulting them to do that. So I think it's, again, I think it's a really good idea. And I think the, I wish you guys a lot of success for it because I think it's a good service.

Thank you so much. I mean, one thing that I'm like super passionate about is how do you make your education more than just one moment in time. And so by taking a lot of the pressure off of these manufacturing companies when it comes to the just the weight of the logistics and planning labs, right, that's all getting deferred to Overland. Let us handle those for you. It does kind of free them up for what's your follow-up plan, right? How are you going to make sure that that training sticks and does ultimately move the needle for your, for your company? And so we've already experienced this with some conversations with potential clients that I've shared with them. I'm like, I will be throwing a lot of questions at you when we're partnered together because I want this to be the most impactful thing that you've done for your business this year.

Cool. All right, Al's up and then Raymond.

Hey guys. So I'm sitting here listening to you and this is Transparently, this is very relevant to my world. I happen to be invested in a lab in the Philadelphia market, and they have some, you know, they have— I think we're up to 4 now in the Mid-Atlantic to, you know, Virginia area, but You know, it's, it's, I'm just gonna be full transparent. I mean, it's, it's, it's still a challenge. So I'm a distributor, you know, for a long time and doing other things. And I'm also developing and launching a new device, not an implant, but so I've got this balance where I even use in my own invested lab, there's a certain cost to that, but then moving people and getting them and coordinating HCP schedules and even the design and board, you know, evaluators is difficult. So—

Oh, yeah.

I pitched this as a value add even for, like, our region as, you know, is this a revenue stream we should pursue? And, you know, it got shot down because I think it's— there's cannibalization there, right? We don't wanna We don't wanna avoid— we have meeting space and didactic space and all that stuff if you wanna host regional labs. But I've in the last 3 months had to pay for surgery centers and, you know, places that are not as accommodating to the medical device world. And it's a struggle. Yeah. So, you know, depending on how you guys are rolling this out, costs and different things and how are you are comparative lead to moving people and getting them coordinated to come into a certain location that you can, you can offer, you know, a larger scale lab. This is definitely a needed solution. There's, there's no doubt. So, I mean, like I said, transparently, I would love it not to be so I could get more of a return on my dividend for my investment. But the reality is I can't sit here in front of anybody like Matt or John, any of us who've been in the distribution business and, and talk without honesty, right? I mean, this is a challenge. This is a challenge for us. And you're absolutely right that no matter how simple the product is, well, I'd really like to do a lab and I found, find myself as a founder and investor in a, you know, now a, a launching a company as I kind of get my back up. Like, really? You really need to do a frigging lab on this? Like, this is about as basic as you get. But it's what I used to tell when I was working with my buddy Jay Parvizy and his group. Like with all these, um, you know, virtual and, and, um, you know, the glasses and the, uh, yeah, yeah, you just need the lab. You need the hands-on lab. So I commend you because I think there is a space. Like, if it didn't look really bad, I'd say come to my area and start rolling around, but I think my partners would kill me. But maybe I could do it secretly where, like, Nobody knows. And if I got to go to North Jersey instead of Philadelphia, it would be, uh, it would be a service. So I don't see any— I, I don't see a single hurdle to adoption with this, with you guys. I don't see a single hurdle. I think you are truly providing a solution. Uh, and Matt, don't write my name down and go telling my partners that. They know my position. I, I, I, I said this 2 years ago, like, guys, yeah, we're— we, we got to look, but everybody shot me down, so that's fine.

Well, Al, thank you for those comments. And we, you know, our original idea, and it still kind of holds, is we, we, we, we kind of thought potentially we would be more of the kind of the Special Forces cadaver lab. So, you know, there'd be a group of, um, you know, people that were high-value targets that were worth a little bit greater investment to get to, and we could go to their homes or their clinics. And then we're finding overall our price point is less than we thought it was going to be. So we think there's going to be a broader use for it. But I think a lot of this has to do with time, time to adoption and our customers' time. Like, they have no time. And so we almost are— it's It's— we almost have— we have to go to them so they can do it, so they can get the hands-on, because we know if they do the hands-on, we win most of the time. Yeah.

Thanks, Al. All right, Raymond in his car. Thank you.

I'm sorry if I missed this, but is this already up and running and online, or is this down the road? Yes. So we're taking delivery. I'm going to have a van in my driveway in a few days, a few weeks, um, and we are likely going to place an order for a few more very quickly because of, because of how booked things are. Like, we're like, oh, we might have to start saying no, uh, not the plan. And the other question is, is this nationwide or just in certain geographies? We, as true entrepreneurs Uh, we have built it in so we, we will drive anywhere at our cost. Now, we really do hope that we will have regional, uh, groups of these so that we have a fleet and it's a lot easier to manage. But right now, the way that it's working is if, if, Ray, you said, hey, I need you in Ohio, Florida, wherever it is, we're going there. And, uh, and we've kind of built that into our, our mileage estimations, our wear and tear on the rig, and the, you know, our lab tech operations folks that we know there's going to be some driving availability, you know, that's going to be part of it. But hopefully that will smooth out the more, the bigger the fleet gets. And then one last specific question. Do you plan to have the C-arm capability? Yes, we do. The first one has two available. Okay. I presume not an O-arm. No, we can do— we, uh, it's, uh, it's the ones that we're using right now are the smaller tabletop extremity ones. We can get the small C-arms in there and we likely can get a regular one, but there's more outfitting and regulatory pieces. So that was, you know, big year and a half of all our due diligence was working with finding out what all the states require, right? And that was no joke. So, we've got that fairly well sorted. There are some states that are, you know, we're in the bureaucracy hell that that is, but we believe we've got it pretty well figured out. Thank you. There are places to make big mistakes, and we're trying not to do that. Imagine getting pulled over on the state line, and you've got body parts and radioactive stuff on your van. You better have some paperwork.

Exactly.

All right, Kyle's up. Can I ask you about Endeavor45? Yes, sir.

Okay, so can you tell me, like, what is the bare minimum that you look for to begin engagement? Is there a certain set of milestones or things before you'd want to talk to somebody that's going to maybe become one of those portfolio companies?

Uh, you know, in the very beginning we take all comers and kind of filter them out, and, and our You know, I— we're, we're transparent on how things work, and, uh, we're doing a few of those right now where we're kind of looking at everything, and then we get a non-disclosure in place. We make sure that the— we don't have any immediate conflicts of interest, right? And if we do, we, we disclose that and say we probably can't talk because we're doing a similar project. Uh, we then do kind of a, the vetting procedure. We ask lots of questions. Those questions come back to us, and then we say, oh, this is probably a good fit for a client. You know, we can, we can just drive this forward, or it comes back and we say, this is amazing, and we'd really like to be part of this, and then we can make a venture proposal. So, we're obviously more selective on the venture proposal because obviously there's a lot more risk for us there. And, and we're basically betting, we're gambling on those, on those ventures. So they have to, they have to, a series of ideas. And for us, that's typically, does this, is this, do we believe, do we, and Deborah, I believe this will make things clinically better. Do we believe it will make things economically better? And I don't mean a $10 cheaper screw. I mean, is this by improving this procedure, are, is everyone going to win, or most people in the healthcare environment going to win? Hospitals, insurance companies, then, you know, all of that. And then the last one is, does— is this going to help doctors and patients with their satisfaction, which is kind of the triple aim, right? And it's now been expanded out into like the quadrupling, you know, but we really— we start at those questions and we say, do these tick the box? And if they do, and we think we could be really, really good at delivering the technology, then we may move into a venture proposal. But I can tell you, I spent a lot of time saying no, and there, there are heartbreaking stories that happen. And it's kind of, you know, you're like, oh my gosh, that doctor put $500,000 in, and it's a cool idea and it might work, but they're going to have to put in another $300,000 just to get them where they think they are because they did all of that stuff kind of in the back room. So it's, um, I guess it's kind of, it's kind of toughened me up a little bit. I'm still polite and professional, but I do see some sad stories from time to time.

And got it.

Thank you.

Good question. Blake's got a question.

Yeah, I'll just, I'll just show some pictures just because they're cool. Look at those tires. That's, that was my doing.

Cool. Blake, can we hear you? Oh, I gotta allow him to talk, I think. Sorry, my fault.

Can you hear me? Yes.

Okay.

Sorry, y'all. Yeah, this is Blake. I was obviously an Arthrex distributor for most of my career. So we built our own lab.

Yes.

And it was more of a toy hauler, but we built it really from the frame up. And we had two full arthroscopy stations, because our goals were really everything we were doing was arthroscopic. And I can tell you, I like your idea of having the truck instead of pulling a trailer. That way easier. And so question, do you guys have arthroscopy capabilities for this?

We believe so. We're actually, we're running into some of this right now. We built the, you can see it's a pretty big space. Uh, when I got there, I was like, oh, that thing is a lot bigger. So, the, the, we, we built it thinking that robotics as well as arthroscopy towers might be something that we're going to go after. So we do have a, we have a tall ceiling and our next rig that we're likely going to place an order for, I suspect, is going to be built around having bigger towers and equipment on board. Again, still, still, uh, TBD. Uh, but that's, you know, we're working with a company that, uh, right now uses robotics. And so we're going to be right on the verge of being big enough for that system.

Okay. Cause yeah, I mean, when you bring arthroscopy into it, it changes everything because now you're gonna have water, you have to have suction, drain floors. Yeah. Which was, it makes it very complicated. I'm just going to give you a heads up on that.

Yeah, but yeah, yeah, you know, nothing like a wet wooden floor, right?

Well, yeah, no, we had a metal, kind of a metal floor. I mean, it worked fine, but, um, it does bring a whole new set of challenges when you're bringing in arthroscopy because you have to have suction to work the shaver. And, you know, the arthroscopy towers are very expensive and the shavers and all that stuff. So, um, well, keep us posted if you if you get those, you know, if you can do that. And then you, you're saying you can go— so if I've got a lab in Bozeman, you guys can drive this damn thing to Bozeman?

Yes, and I'm going to be the driver because I want to go to Bozeman.

I think we'll be fighting over who's going to Bozeman, actually.

Yes, yes, we would, uh, we would show up with bells on. And, um, yeah, that's the, the, the one of our, our fleet drivers. He's a, like I said, he's a lot like me, a lot of commercial experience, a lot of OR experience. Um, and he's— they're— those kind of folks are hard to find. They're kind of nomadic. They love living on the road. They love having their mountain bike ready to go, and, and they go somewhere and then they mountain bike or ski or whatever. So, um, yeah, we, yeah, we will go, we will go anywhere in the lower 48, uh, that's possible, that, that we're asked to go.

Yeah, no, that's critical, having your operator. I had a guy that worked for me that you know, he ran my warehouse, but he also ran the lab and we were able to park it inside the warehouse. So oftentimes we'd have local surgeons just come over after work and we would just, you know, fire it up inside the warehouse. So that was really nice. But having our guy was Angelo. He was just so good at just organizing everything and that was key to the success of it. But yeah, when I sold my distributorship, I sold my lab to the guy in Dallas and you know, he's got 2 or 3 of them now. So it's a good thing. You guys are on to something.

Congrats.

Yeah.

Oh, thank you. We'll see how it goes. Right now, the joke is, and it's kind of tongue-in-cheek, but maybe it's a real joke, is my wife and I don't know if Matt's had this discussion with his wife, but there might be a chance that we live in a van down by the river if this doesn't work.

So I assume you're financing all the stuff. You're like, there's You're borrowing the money. You're not like buying the assets outright.

Yeah.

Which is smart.

A little bit of both, but yes, we had two ideas. Let's go big. And then that was going to require investors and probably outside capital coming in. We then were not sure. We just didn't know. We thought the demand was going to be big, but we didn't know. So then we decided, well, let's just finance this and then use our own capital. And like I said earlier, I am not swimming in gold coins. I just love what I do. And maybe I'll be able to retire someday is the goal. But we decided, Matt and I said, okay, let's self-finance this. So if this goes wrong, it's not going to feel good. We'll survive, but it won't feel good.

Well, I'll tell you a story. I was at Wright Medical back in the 2000s. The, I don't know if it was marketing or sales, they talked the CEO Barry Bays into having a giant 18-wheeler surgical training followed by another giant 18-wheeler of specimens. And Barry Bays said, all right, I'm gonna give you like 3 months, you know, and you gotta do this many trainings. And so after 3 months they came back and I don't, they did less than they said. Barry said, shut it down. He goes, I want to see that thing in the parking lot up, you know, for sale. For sale. Exactly. And Barry shut it down so quickly. He was a great CEO. Yeah.

Well, you got to fail fast.

You got to fail fast.

Yeah, exactly. And we— so we see that we— you can hear that there's a lot of distributors. There's one in Florida that has something called a Labulant. Ambulance, right? And they basically bought an old ambulance and outfitted it. So we know distributors use these, and which is some success. And, and so we, but we don't really see that as a competition, right? We're kind of thinking our customers are really kind of more at the corporate level. Like, we need to train 25 of these key folks now, and we can, we can fast rope in and do that. We did look at the, you know, there's an 18-wheeler company called STI, which is probably not the greatest name for a company, but they are, they do these and they drop the 18-wheeler on the parking lot and it's good. You can get a lot of folks through there at a hospital parking lot. But where we think we are different and maybe superior in some cases is we go to a parking lot at a clinic, we do 3 folks, we then go to the doctor's house, we do that guy, we then maybe go to a dinner location and we do 4 or 5 more and then they go to dinner. And so we can, we can, we don't have that big thing that has to be in a place. We can be wherever we need to be.

What I see is you're nimble and you're democratized. So any, any— you can have two different companies use the lab in the same day, in the same, you know, MSA.

Yeah. What's cool is we, on the, on the side of the van, we had a big stainless steel plate put in so we can put, uh, we can build and have like the Zimmer magnet thrown on there. We can, you know, so they can really look and feel like a Zimmer lab. It can feel like a Endeavor Orthopedics lab. We can do— so it really does look like, you know, we're almost like, what do you call it, white labeling, or, you know, uh, labeling our van for whatever they need. And like I said, we have some folks that really already talking about leasing this for a long period of time, so we'd, we'd really make it look like their, their lab.

Cool, man. This is— you've tested the demand cheaply. That's, uh, you know, That was with prayers, Tiger.

That was with like a, uh, what's going to happen?

I mean, it's going to take off. You, you, there's no— you'll have a second and third van. You'll just have to figure out— it's all about cash flow at this point because service is going to be great.

Yeah, yeah. I, like I said, Matt and I were very like— there is like the light bulb went on, like without Natalie and our, the, the team, we, we would have, we would have backed the heck out of this because it's, it's It needs to be a white glove service with professionals that are experts at what they do. And we just got lucky and got Natalie. So Natalie cannot quit.

Y'all are stuck with me. It's all right. I'm not going anywhere.

All right.

Oh, they are. Go ahead, Matt.

No.

So yeah, just to reiterate what John said, you know, we're excited about launching this. And the early voice of customer suggests that there's certainly a demand out there, you know, for this service. And We're optimistic that we're going to be able to add some additional units in short order and start to kind of run the geography in quadrants so that we can get to these customers in a much more timely fashion than we would be, you know, shooting across the country. But we also want, you know, are going to challenge our customers to kind of, you know, challenge the status quo and how they're looking at education, right? And they often, you know, look at it as only being in these brick-and-mortar particular situations. So the way in which we can get to customers faster, we're building out some revenue stream models to show, you know, lost revenue stream that they're, you know, missing out on by way of waiting to get to their surgeons or waiting for their surgeons to get to training. So I think that's also gonna be a very important tool for us as companies start to look at, you know, going towards mobile education versus, you know, their traditional brick and mortar. So, but nonetheless, thanks so much for having us.

Yeah, you may end up changing how mobile education's done.

Yeah.

Yeah, which would be really cool.

Yeah, yeah, we— and the other thing I'll say, one thing that, uh, kind of just to geek out a little bit, is Natalie designed this rig. So we've got solar panels, we've got really powerful battery systems, we do have a generator. Like, it can work in a state park, right?

Nothing. Starlink.

Yeah, Starlink. So you can have your KOL come in and just be on the big screen TV, and, and that person can lead the— even if we're far away because it'll be Starlink.

It has running water, right? It has ultrasonic, so you can clean your equipment when you're done.

Here, two ideas. Can you have a pop-out slide to create a bigger surgery area?

Yeah, slides are definitely a thing that we looked at quite a bit in our due diligence. This unit does not have a slide. Is that something we could add? Absolutely. Slides can, can get a little funky because it's a thing that can break, and unfortunately they do break. And then John's doing a Tilty Whirl dance over there. You, you need to add like a 4-point stabilization system when you add a slide, typically just because of that weight distribution. But is it something that can be added? Yeah, absolutely.

Yeah. Interesting.

I was going to show you guys something.

Second question was, can you, if you're doing a training with a small group of surgeons, can you port that out in real time to a screen in an auditorium somewhere? I've seen that done before.

In terms of like internet sophistication, yes, absolutely. We can send that out. We would just need to dial in the camera system a little bit, right? And make sure that we have the right mounts and whatnot. There's no reason that we can't do it, especially with the power of Starlink, which is really great.

Awesome.

Yeah, yeah, yeah.

I was just going to show this, the real important stuff here. See this canopy? We can, we can throw that out and we can have, uh, you know, a fire pit and a taco stand or an espresso machine, whatever we want to do, so that there could be kind of a place to hang out a little bit if you want.

All right, well, cool. Hey, we've gone over the hour.

This is— oh shoot.

All the best. This is, uh, definitely the demand. You just got to execute. So well done. Good job.

Thank you very much for having us. Very nice to see everybody. Yeah. And, uh, Tiger, I'm sorry I can't make them all, but now you know why I'm busy.

But I try to get to— just hand everything over to Natalie and Matt.

You are 100% correct.

Appreciate it, everyone.

Thanks so much for the invitation.

Take care.

Good stuff.