Corporate VCs: What They Want, and How They Align With M&A and Business Development | LSI USA '24

Bill Little  0:04  
So my name is Bill    Little. I'm with a innovation investment company called Orchestra BioMed. And we have a unique business model wherein we look to help companies bridge that really challenging period between early proof of concepts a post AFS study where we have some promising data. And we're staring down a three or 400 patient RCT, that's going to cost us $40 million. And we're burning 1,000,005 a month for the next four years. And so, you know, we've talked to numerous companies over the last year, that all needs somewhere between 75 and $125 million to get to that, that FDA approval and an Orchestra BioMed. We work to try to bridge that gap by providing some expertise and capability and capital. In fact, I'm joined here by David Allen from Medtronic. Medtronic is our largest shareholder. We have a, an ongoing IDE study, in collaboration with Medtronic with a pacemaker algorithm that acutely and sustainably reduces systolic blood pressure. And so we're here as an organization to kind of share what we do. But I think the the stars of the show are the folks that are joining me here up on the panel and the fact that we've got really four titans of the medical device industry between intuitive and Dexcom and Boston Scientific and Medtronic. I'm really humbled to be on the stage with these folks. And I'm going to ask each one to introduce themselves and tell us a little bit about what we do before we get into the discussion. Muriel wanted to take it away.

Murielle Thinard McLane  1:42  
Thanks, Bill. So Murielle    Thinard McLane I oversee intuitive ventures so we are $250 million in assets under management funds strategic, really an ecosystem play to help company expand in the world of minimal invasive care. We invest in early stage seed to series B's are sweetspot.

Steve Pacelli  2:05  
Alright, thank you, everybody, everybody. Yeah, everybody hear me? Steve Pacelli. With Dexcom ventures I started Dexcom ventures a little over four years ago, and I was blessed with intuitive putting out a press release about three months prior to us founding Dexcom venture. So I literally just had to change the name and put the 100 million dollar fund that the board approved for us. We've been doing it you know, again, investing in earlier stage technologies. Ducks comet ms, many of you know is a very large one trick pony doing continuous glucose monitoring. We were not limited to investing in diabetes related technologies. But we're reminded constantly by our board that our investments need to somehow tie back to the to the mothership to the to the corporate parent.

Michael Ryan  2:51  
Hello, everyone. I'm Michael Ryan, Boston Scientific. I've been with BSC for coming up on 18 years, most of that time doing business development. And we're one of the most active acquirers in the med tech industry, we tend to do a good handful of acquisitions every year. I lead the BD teams for the med surg divisions, that's our endoscopy, urology and neuromodulation divisions. And then we're also one of the most active venture investors we deploy, generally somewhere north of 100 million a year into venture investments in the med tech sector. And I lead the the venture team for the corporation as well.

Dave Allen  3:29  
Hi, everyone, I'm Dave Allen binder, Medtronic about 10 years, I lead business development and strategy for medical surgical portfolio. So similarly, our industry business or surgical business, surgical robotics, as well as our acute care monitoring business. You know, we have a billion dollar minority investment portfolio as a company, obviously focused solely on med tech. And then within that billion, I'd say about 250 million of it would be direct VC investing in companies such as yourselves, and you know, we're quite active in the space, you know, bringing usually five to 10 Investment Recommendations a year, historically, obviously, the last year has been a little bit different. So happy to get in discussion here. Glad to see it looks like a pretty full house. So happy to get in the conversation.

Bill Little  4:14  
Thanks, Dave. And I'm gonna I'm gonna start with you, Dave, with the first question and, and maybe give a little bit of wind up. Personally. I about a year ago, at this meeting, I was I was sitting in the audience and I was raising money. I was part of a little startup called neovascular that we sold right around this time to shockwave medical. And during the three years that I was there, one of the things that was most difficult for me, and we had a clear sell the company goal, that was absolutely what we were trying to do. But for me, one of the biggest challenges was trying to figure out how these big strategics worked. And you know, fundamentally, how do you navigate through the system between BD and how Having a divisional champion inside, and the strategic team and the venture folks, and I think there's nobody, maybe more complex than the team at Medtronic. And so, Dave, how should the folks in the audience here navigate the simple organization like Medtronic?

Dave Allen  5:19  
Yeah, super, super simple organization, highly matrix global. I think meetings like this help. And then getting connected to the right folks, within your area of expertise is probably the most important your spoke a little bit briefly about just finding a, a kind of champion within the company is probably the most important finding that advocate who can kind of navigate the approval process we have to go through to make these types of investments is what you really need to find. And so that can be one of our operating unit presidents almost always, as well, as, you know, senior BDS leaders like myself and others that are here at the conference, those are probably your two most important touch points. And finding those kinds of real champions of the technology that can communicate it internally and help kind of drive the strategy and drive the business plan and the model and the presentations is likely the most important, kind of just disparately going through the org is usually would probably leave you frustrated. So you know, connecting with people like me, you know, much of my job is to find the right person for your technologies within the organization to get a fair fair assessment. So that's where I really spend most of my time is, it's my job to understand our company in our matrix, and then connect you to the right people within the organization to represent your business.

Bill Little  6:38  
Steve, this one's for you. So on your team, if you think about the VC folks and the strategy, folks and the business development, folks in the business unit commercial leads, if those are the four pillars, and I'm not saying they are but but at first, I guess, are those the four pillars? And what type of support? Would the folks in the audience need? From those various pillars? To get a deal done? In your shop? How does that work? And do you need them all? Do you need one? Can you just walk through? How you can make it happen? No,

Steve Pacelli  7:09  
it's a great question, I would tell you, the closer an investment would be to the core business meaning diabetes, or insulin delivery, I probably need more support from the core business, as opposed to some of the things we're looking at. You know, we're typically investing in earlier stage technologies, our typical check size is going to be somewhere between three to 5 million in any given round. So you get to a Series C round, we're not going to move the needle because you're probably looking at raising growth capital at that point. So our sweet spot is really that series seed series A Series B follow on and we reserve dry powder at any of these deals. What I've gotten myself a little over my skis a few times with the core business where, you know, we're reminded, again, we're strategic investors first financial investors second, and we, when we invest in a company or when we pitch a company, oftentimes we're pitching a company to participate in a deal. We get a little ahead of ourselves in promising clinical support, regulatory support, quality systems support, not that Dexcom in and of itself is going to do those things for the portfolio company. But we do like to be able to bring in resources to help as a strategic as a let let us help you not make the mistakes that we've made over the last No, I'm pushing 20 years at Dexcom. So let us help you let me get you to the right people. But again, the closer it gets to the core, the more support I would need really from from the corporate development group, as opposed to some of the earlier true technology development, we have a little more flexibility and freedom.

Bill Little  8:43  
Right, right. And, Muriel, how about an intuitive, you guys have obviously been wildly successful and pioneer to space. And, you know, a big chunk of this meeting happens because of what you guys have pioneered? Right? If you were in the last session, you saw that? Can you walk us through your process, with particular emphasis on how successful you guys have been about creating categories, the types of bets you have made have been category creators that may be through that lens, because I think a lot of the folks that we look at at orchestra are looking at creating entirely new ways of doing things and and there's been arguably no company more successful than intuitive and doing that. So with that wind up, let's hear the let's hear the magic miracle.

Murielle Thinard McLane  9:29  
Yeah, of course, I have the magic recipe for him and anybody afterwards come to me. No, but kidding aside, so we have been a category, innovator. And that's why now is the fun. We're looking at supporting companies that want to aspire to be category leaders. And like Steve, we're really looking at ecosystem play. And I would say the closer it is to the core, the more corporate development it is going to be to the point where we're not going to be involved Now as we're looking at the ecosystem play will be an early investors. And as a strategic, that's where we're trying to bring to bear all of that expertise. And that knowledge for our portfolio companies being in the automation in imaging in big data, in hardware in software, regulatory quality, right? So there's a lot that we can contribute to the table. And I would say the, our goal is really to foster innovation through the process. So now, unlike people, other people, I would say that we do not need a business unit sponsor. Actually, my investment committee is really composed of our CEO, a board member, and then some of our key leaders. So chief strategy officer or chief product officer, so we're really looking at the ecosystem 1015 years out and seeing how we can make it successful, more globally. That's great.

Bill Little  11:06  
Mike, when I was when I was 24 years old, I went to work for Boston Scientific and, and I used to show up at the Natick office when there when there wasn't a tech office every day and a blue blazer and a white shirt, because that's that's how you showed up at Boston Scientific in 1994. How does how does decision making work now at Boston Scientific 30 years later, that you guys have obviously become, you know, arguably one of the most successful companies in the space and, and certainly one of the top performing companies in the space, I think a lot of us are envious of the performance of your stock price and, and just the the reputation that you guys have built. And so maybe you could talk a little about decision making in what's become, you know, this this phenomenal organization that's well respected, and yet very complex.

Michael Ryan  11:53  
Thank you for the compliment. And the question. decision making at Boston is pretty simple. So I think I have a little bit of a different answer to some of the questions that came before versus some of the other panelists, there's 40,000 People at Boston Scientific. But if you're trying to engage with Boston on a venture investment, or an acquisition, there's maybe more like 20 people that you need to worry about. So we get together with our CEO, and CFO and General Counsel every few weeks, for literally hours at a time, and go through the business cases of all the investments and acquisitions and other deals that we want to do. So it's a tight knit group of people who are proposing business cases, to a small group of decision makers very frequently, and were in constant communication, very tightly aligned. So on the venture side, we've got three full time folks on the team doing venture. And then within each of our six major business units, we've got two business development people who are just focused on that sector. So that right there is 15, folks, and whether you're earlier late, or whether you're really close to our core, or a little further out in an adjacency, it's the same group of people at Boston Scientific, that are going to work through whether or not something is a great opportunity for us. So every venture investment, winds up being sort of co sponsored, and the business case is CO written by someone from venture, and someone from the business unit BD team, they both have to love it. And the division president of that division needs to also love it. And if those three things are too we have a true we have a constructive conversation with our decision making body and we can move really quickly. So that's that's the gist of decision making. David

Bill Little  13:43  
Medtronic is it? Is it mandatory to have a business unit lead sort of co sponsor like, like Michael just outlined for Boston? Yeah,

Dave Allen  13:53  
it's not, I wouldn't say it's mandatory, but it's highly preferred. I mean, we have 16 operating units across and all focused on med tech. So the odds that the opportunity doesn't fit within one of those is exceedingly low. So similarly, you know, if you don't have that President who really truly owns the business, communicating their need for that technology, and why, you know, we can't build it ourselves and why this is the right opportunity. It does create more questions than typical. So I'd say that's ideal, but it's not absolutely mandatory.

Bill Little  14:24  
And, and so I'll ask me this to each of the panelists, is it the divisional present? First of all, if you just quick show of hands, it sounds like for the for the Medtronic and Boston folks, you pretty much

Steve Pacelli  14:33  
we only have one partition, right? We do.

Bill Little  14:37  
So for the for the other two, folks, is it essentially mandatory to have divisional business units support to do a deal? No, no, no. I

Steve Pacelli  14:46  
mean, like I said, for us, it's the closer it is to the core, the more I would want someone in either corp dev or commercial or otherwise kind of pushing it, as opposed to some of the earlier stage technology investments that we kind of do on our own

Bill Little  15:00  
And for the guys on the end. Dave, you mentioned divisional president. I mean, my experience has been a lot of times that that divisional president is often influenced by somebody that's either a deep technical expert or a commercial leader. Can you talk about who the influencers are? And if and if you're sitting in this audience trying to figure out how do I get Medtronic or Boston or Dexcom or intuitive to pull the trigger? Can you give maybe some some advice around who can influence that President? I don't think there's any divisional presidents that are at this meeting. Right? And they're typically hard to get to. But we can get to deeper people in the organizations through, you know, meetings and whatnot, maybe if you could just comment about how to make that influencing happen.

Michael Ryan  15:43  
Sure. So here at this meeting, there are four of us from Boston, it's the whole venture team, and you can come find any one of us will get you to the right, one of us. Who who speaks for venture, and like I said, we'll be closely connected to those division presidents and divisional BD leaders. I think every division president is surrounded by a management board. I think that's that's true at Medtronic, as well, you can go find any of those people, you're going to be funneled right back to the business development team. We're really the ones BD NVC who are on point for helping the division presidents to decide what they're going to champion in front of the CEO. Yeah,

Dave Allen  16:22  
echoing, and I would say business realm strategy first, and then internally, we look very quickly and closely, technically. So we'll find our technical SMEs that can kind of communicate that your technology internally and understand it. So to me, when we do initial first assessment is gonna be your business on strategy team. And then your technical scientists, depending on what the opportunity is, what we're looking at would be certainly the core three or four. And then quickly, we move into commercial opportunities, you start thinking about our marketing teams, or our key sales leaders. And usually, once you get those kind of three core folks together, you can get a pretty good idea of what the opportunity is, what risks remain, and what the final runway is, depending on the opportunity, obviously, in some cases, you'll be bringing your clinical team much sooner as well, just depending on where you are from a development perspective, Muriel,

Bill Little  17:16  
and intuitive if you had to stack up the technical folks, the clinical folks and the commercial folks to summarize, I think what what they've said, how would you prioritize influence for your team amongst those functions or other other functions that you look at, to help guide your decisions?

Murielle Thinard McLane  17:36  
So I'll start by saying first, you usually start with the venture team, and wherever you go in the organization, your will be pointed back to the Metro team. So that's where it starts. And if we believe that this is something that we're interested in, because it has, it is in a big enough market, and there's a big enough clinical need, we'll start with technical and product. Before going down to is it the right team to execute. And I want to emphasize that piece as well. And then from there, we'll go into clinical regulatory reimbursement, given where we invest commercial is probably the area that we look last in our process, frankly. So

Bill Little  18:18  
this one's for the group. So whoever feels compelled to take it? How do you consider investments or acquisitions, in technologies that you don't have an existing Salesforce for that look really appealing? And how do you how do you think through that, you know, we meet with a lot of folks that we try to figure out where does it fit best with a strategic? And a lot of times, it doesn't exist? Because you're creating a new category. And I look at, you know, a company like Edwards when they got into TAVR. And how do you go after that business? How do you create the TAVR? Model? How does How do you guys think about that, and any advice that you'd have for this group?

Steve Pacelli  19:00  
I guess I can start. You know, again, depending on how early stages, the company is right? It could be truly a technology development. We're basically using balance sheet dollars to fund r&d is the way I kind of think about it on the earlier stage deals. If it's a little bit later stage investment, in terms of the company's lifecycle, there probably is a commercial component to it. But it's probably something that we're not focused on at the core. So one example I've got a an investment in obesity platform technology that is basically built around the Dexcom sensor platform. Is it something that Dexcom as the core is interested in? Yes, but we're focused on type one and type two diabetes. Now this company is a little more progressive looking at obesity. How do we use sensors, continuous glucose sensors to help people manage their weight? We've not done any acquisitions in my four years to this point, but that would be one that you could you could envision where it could potentially become part of Dexcom The mothership, because it's a platform technology built around our core sensor technology.

Michael Ryan  20:05  
I'll take a stab at that one. So Boston will only invest in companies, if there is a division of Boston that looks at it and says, yes, in a few years when certain risks or losses are retired, we'd like to actually own that. And we only choose to buy things. If there is some kind of fit with one of those divisions. That doesn't mean it has to be the same Salesforce though. So we have an announced and pending transaction with exotics, we do not have a sacral neuromodulation. Salesforce, we will need one and value there's, but we have a urology division. And so there are other points of commercial and r&d, and GNA leverage that we can see around that business without necessarily needing to have a sales force, a drop in the back for our sales force, but there doesn't have to be some kind of fit with one of the operating units.

Dave Allen  20:59  
You know, we're very similar in that regard. I, you really need to have a believe it's a platform technology you can build around. Because if you're talking about something like that, you're probably going on a real market development journey for a long period of time that requires a lot of investment, especially when you're talking about building nowaday, or augmenting existing Salesforce is real investment over a long period of time. And so you'd really have to believe that, that technology is a platform you can build around over time. And I completely agree, you know, given the size and scale of our two respective businesses, the odds that wouldn't fit tangentially at least in one of them is pretty low, given we're focused on medtech. So I think a common in similar to how you're thinking about it,

Michael Ryan  21:44  
just to make sure that I'm not misinterpreted the there's a one plus one equals three element to this in terms of synergies synergies are that when we put these businesses together, the collection can grow faster than either one on its own. So the opportunity for having these multiple products in one organization to drive growth among all the products, incremental revenue, and the ability to pour on resources and drive the acquired product to places it maybe wasn't going to go on its own.

Murielle Thinard McLane  22:16  
We have a slightly different Yes, I know, we're slightly different in how we operate. So we have an investment in dental robotics platform, for instance. So it's really getting expanding access to dental care into your regular dentist offices. Clearly not in that space, we can help in a number of ways on the technical side, but frankly, where we spending a lot of time is educating them on how to think about selling capital equipment in a different space and how you go to market what lessons you can learn to create a new category that we've been through as well. So it's the one plus one equals three. But for us, it's not necessarily through an acquisition, it's really lesson learns from creating a unique category and being successful at it. And just taking those lessons and applying it to new innovative platforms out there.

Bill Little  23:12  
I'm gonna ask each one of you guys this question, because you can already see the diversity of the way these businesses run. And so I feel it's unfair, just ask one that they represent each of these groups, because clearly, there are different lenses and how you guys operate. But if you think about the last few deals that each of you has done, can you talk about what the common themes are? Or what the deal makers are? That you've said, Yes, we're going to pull the trigger. And the reason we're going to pull the trigger is because of this, this and this, what is this, this and this for each one of you, and maybe I'll start with Muriel.

Murielle Thinard McLane  23:46  
The last deal we did is capstan and so it is valve with a robot in mitral. And so what made us really pulled the trigger was it was actually there's a huge clinical need very few people can get access today to prior to actually a valve just because of the limitation around the population. So there was a huge clinical need that was unaddressed It was a fantastic team. And this is an area even though we're not in cardiac at all, where we felt we could help them on the when they thinking about automation and the robotic aspect of it. So it was a combination of the unique clinical big clinical need fantastic team and where we could really add strategic value

Bill Little  24:39  
and an adjacent market. That was a new growth market for you guys too. Yeah,

Murielle Thinard McLane  24:42  
yeah, of course.

Steve Pacelli  24:43  
I think much like Mario's focused on robots. We're focused on sensors. How do we deploy sensors into adjacent markets? Right. So obesity, we're spending a lot of our time when we when we look at potential transactions, it's, you know, what are the comorbidities associated with Diabetes. So you know, blood pressure issues, kidney failure, liver disease, like all the things that you think about as, particularly in the in the Type Two Diabetes world? How can we participate as a venture organization into those categories that maybe the core business isn't focused on today, but the core business could be focused on? And at the same time, how do we deploy sensors potential into those ecosystems as we go forward?

Michael Ryan  25:26  
So I'll give an answer for venture and they'll give an answer for m&a free with purchase as you're doing. So on the venture side, we don't, we don't press release most of our investments. So I'll just say, when I look back at recent deals that we have done, the the key success factors are, as I already mentioned, there's somebody within our business units, and I can sell the hell out of that thing if it actually works. But also, there's a management team that we look at and say these people will get from point A to point B, if if it can be gotten there. And we look at their operating plan. And we think it's credible, that with the cash they're going to raise, they're really going to get to a meaningful milestone, that D risks the company and either allows for an exit or next financing. Often there's not the right management team, or often there is not a credible business plan. So those things need to be there as well as the the great gizmo. And then on the m&a side. If I look at the last three deals that Boston announced, one thing that's pretty notable about them is they were all three very material revenue generating businesses, already significant commercial businesses, two of them public companies. And I would say we do acquisitions of pre commercial products. But most of our acquisition dollars and activity goes towards companies that have been further de risked have demonstrated that there's, there's market demand, that's reimbursement. And there's already a revenue trajectory.

Dave Allen  26:57  
Yeah, I think I'll do an m&a one. I think, for us, it needs to align to a, an opera unit strategy first, and is kind of core to achieving their revenue projections and objectives over some period of time, say, five to 10 years. And when we recently announced that I'm most familiar with his company called Cosmo in Italy, but they helped invent AI assisted colonoscopy, and it's similar here is it actually started as a distribution partnership over a five year period. And as the business scaled, it was de risked, we generated more clinical evidence generated more revenue is when we finally you know, signed what we calling today, essentially a perpetual license. And so it's that kind of commercial execution that we did that gave us the confidence that it was direct enough to then make a more meaningful investment. And a lot of times our acquisitions follow similar paths, you know, we very rarely do we just wake up. And, like do an intersect, you know, these are types of companies and technologies that we've been thinking about and talking about internally for a number of years. And and only when it certain value inflection points happen, do we then ultimately decided to pull the trigger in a meaningful way? Let's say,

Bill Little  28:04  
Dave, you mentioned the concept of the perpetual license. And you know, before we walked in here, you and I were talking about how much you liked that deal. And the idea of doing things off of your own p&l, can you or others comment on where you see that heading, and just how important p&l track p&l transactions off p&l transaction using balance sheet dollars, how you think about that, and where you think that is headed in the future?

Dave Allen  28:31  
Yeah, somebody there no accountants in the room, we met tronics as creative as we can be on types of financing. And so we will, anything we can do to partner with somebody to develop a technology and, and leverage their expertise, because we can't invent everything ourselves, we know that we look for those types of relationships, this one worked. It's also a public company, they have about 50 people technical talent that's highly focused in AI, in Italy. And so, you know, they're making that investment in operations in r&d, while our business makes the investment on the commercial and marketing side. So it's a very kind of symbiotic relationship in that regard. That's why we were comfortable with such a long term license in that example. And it also allows them to have the investment sort of on their on their balance sheet, if you will, or their income statement versus ours. And it's also the skill set they have that we really couldn't felt like we couldn't build in house over a, you know, meaningfully short period of time. And so sometimes we always try and find those types of opportunities where it really is a one plus one equals three scenario. We don't try and push everything into something like that. Obviously, you know, we do do scaled acquisitions as well. But you know, if there's a way to partner with a company and we're both sides benefit and are happy with that outcome, we're more than willing to do it.

Bill Little  29:53  
Michael, Steve, Muriel, any any thoughts on that and using sort of off balance sheet type activities. And yeah,

Steve Pacelli  30:03  
I mean, like I said, we've we've not been acquisitive to date it's really for for our lens or investment lens is really much more focused on where are we not spending enough dollars internally on technology development, kind of advanced technology development? So how can we use balance sheet dollars to help they're the conductor correctly, but I don't think we have very little revenue for most of my portfolio companies. And I've got probably 10 of them right now. So, yeah,

Bill Little  30:30  
more upstream. We go ahead, Michael, I

Michael Ryan  30:33  
was I was just gonna say, so we, we do a lot of development internally, we invest significantly in innovation internally, within the confines of certain operating margin improvement targets that we're trying to hit, right. So there's some constraint there. But we also throw off a ton of cash. And we as a company have chosen to deploy approximately all of our EBIT die every year into supplementing our internal innovation with external BD. So we we try to, we're not doing we're not declaring dividends. If you look back over the last several years, net, net stock repurchases, essentially zero, we really try to leverage what's available in terms of cash on our balance sheet, to drive additional innovation through our venture investments in our acquisitions.

Murielle Thinard McLane  31:20  
And I'll say again, you get one person and one company way of behaving. So on our side, we have a very large percentage of r&d, budget, internal r&d, there's a whole group focused on that. And we have our corporate development folks that are doing their own deals. And we're the off balance sheet sort of view, very long term on the ecosystem. And where we see innovation going. Like, Steve, we don't see a lot of revenues coming from our portfolio companies quite yet. There's some. But this is frankly, more of a looking at innovation on the long term.

Bill Little  31:58  
We thank you, we talked earlier about the deal makers and things that you know, the common characteristics of the investments that you guys have made, let's let's flip the coin over and talk about the the deal breakers and the things that the the folks in this room should absolutely under no circumstances ever do.

Dave Allen  32:18  
Don't run out of cash.

Steve Pacelli  32:23  
Yeah, actually, I would, I would echo that in a little bit different ways. Don't be focused on dilution, because I find founders who are hyper focused on dilution, and make mistakes and not raising enough capital, when they have the opportunity to raise capital to de risk their story, I just take the capital and things mean, I've diluted the heck out of ducks come over by close to 20 years, they're in the public markets and taking the cash when you can get it is critically important. Those

Michael Ryan  32:50  
two comments go hand in hand with with build a great syndicate. If you want to not run out of cash, you're gonna have to accept some dilution and make sure you've got a group of people around your boardroom table, who are going to be there for the next round with with the capacity to support your company.

Murielle Thinard McLane  33:08  
I'll echo everybody was, again, a slightly different angle, which is that don't yeah, be sure you have enough to get to the next milestone and some, and then it gets to the center get. But be sure you hit your next value inflection point and have some buffer. A lot of companies have really good ideas, good team, and then they run into a snag. And if you don't have the right people at the table, you're not going to be there to see that the next stage of the company. So make sure you that gets the dilution point,

Dave Allen  33:37  
you'll have a plan, but then you got to remember, there's these unknowns that are going to happen that you can't predict. And that's why it's so important that you have that extra buffer, because that unknown unknown will eventually present itself. And you're going to need that that's what you need the buffer for, like what you put down on the side of the plant. If you hit every milestone, that's great. But something's going to come up that you didn't think of. And that's when you need that extra cash and to really, you know, make it to that milestone and then you need a syndicate like you said that can understand that and partner with you through whatever pivot or change or outcome that you need to drive for that period of time. So really, especially in this environment, that's top of my mind going into any of the venture investing committee meetings or board meetings.

Bill Little  34:25  
I think for a lot of the entrepreneurs in the room, it's not a straight path, and we all go through the ups and downs and we learned painful lessons and hopefully we have enough cash that that we can survive it. It's maybe different when you've got you know multibillion dollar valuations is everybody on the stage here has. So with that as context, what's the most painful lesson you guys have each learned in your roles over the last 10 years? You know, none of us is perfect. We've all made bad investments. We've all had things where we've championed something and it hasn't gone right and with that comes Personal and professional pain. And if you're honest with yourself, and you think about okay, this is this is a real lesson that I've learned. If you're willing to share that with this group, I think there's probably a lot of wisdom there. And I'd love to hear your own lessons and things that generally come with with painful choices. We all make Uriel

Murielle Thinard McLane  35:21  
I get the I get the softball, thank you. I would say the, to your point, for me, the biggest one, so it's not we make mistakes, right? The worst is when you believe in an idea, and you don't have the right syndicate to get to the next next stage. Because there's been, you know, an unknown unknown, that's, that's coming. And no one is ready to fund to the next stage without inflection point. And then you go down in that downward cycle of recap, and the view of the companies is sort of changed in the marketplace. So I think from our standpoint, we that's where we look at, indeed, the team, the clinical needs, the technology, the product market fit, but also we'll look at who else is around the table, we tend to go after platforms, so capital intensive, and having the right syndicate to help along the way is really helpful for that.

Steve Pacelli  36:19  
I think my biggest regret dovetails on to something you just said, which is I invested in a company, from a technology perspective, in spite of my better judgment on the CEO. And it's proven to be a colossal train wreck. To be honest, we're having trouble now raising that additional round, it's not really syndicate related. It's just I bet, I bet on the wrong horse. And so you've said it before making sure you're betting on the right management team that's going to help you get to that next round that next stage that ultimate acquisition, probably or IPO is critically important. I made one big mistake there. Turns

Michael Ryan  36:56  
out you're betting on the jockey, not the horse. So for me, in any case, like we could be having any conversation right now, in any context, the answer to what's the most painful lesson is humility. I'm wrong most of the time. And you might be too I don't know, I don't know what your circumstances are, what decisions you're facing. But I think for what that means, within dealmaking at Boston Scientific, is that we try to have a very open debate where we try to embrace a little bit of healthy conflict and pressure test each other and see if our ideas actually survive contact with each other. And then when we make investments, we try to stick or acquisitions, we try to stick to things that we could do, you know, a half dozen of these, and several of them will break and it'll still be okay. So we don't do, we don't get so confident in what we're doing that we make the big bet that is going to going to take us down. So that allows us to be very risk on in our approach, both to venture investing and, and acquiring. It also means that as we go through the process, and even into the integration processes, we're trying to listen to other people. Because whatever our deal model was, we know it's very wrong. And we need to remember that it's very wrong and try to be open to finding out exactly where it's wrong. And I'd encourage the founders and the management teams to take a similar approach, and to have a plan, but have, as you said, cushion financially in the plan because it's wrong. And to be a bit measured in how you present it to explore and acknowledge the risks, talk about what you're doing around the risks, because we're going to notice, and we're going to ask questions about those things. And the pitch that is unalloyed confidence always, always makes me wonder.

Dave Allen  38:49  
We're a little short doning I'll add is just and I'll say this generally for Medtronic is the businesses that we acquire, where we just kind of dabble tend not to work, you lose the management, focus, leadership focus, you need to really execute well, business development, by definition is risk. You know, if you're batting six or 700, in your world class, in this type of activity. And so the whole organization needs to be committed to these types of investments or acquisitions that we make. And when we say, Oh, this will just be this thing that's interesting. But it's not absolutely must have for the organization for the business. They tend to not get the right, you know, tender love and care, it needs to be as successful as as possible. And those are the ones if I look back over the last 10 years that we probably would probably think differently about doing.

Bill Little  39:41  
So we're in our last 15 seconds here and I just like to wrap up by by acknowledging the the esteemed group we have here. I mean, the fact that we were able to get this group together in one room to give us in my mind what was a very sincere, thoughtful discussion to help address what a lot of the folks in this room are going drew on on behalf of myself and everybody in here thank you guys thanks for your time this is great